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Yearly Archives: 2016

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By Victoria Espinoza

In the Northport-East Northport school district, change is coming.

Residents approved a $161 million budget on Tuesday night with 2,568 votes in favor to 687 against, ousted an incumbent from the school board and reduced the number of board of education members from nine to seven. The district clerk’s office said the latter change will go into effect next year. Trustees Regina Pisacani, Donna McNaughton and Jennifer Thompson will all be up for re-election next year, but only one of their three seats will be open.

Shawne Albero, left, hugs Allison Noonan after results are announced. Residents voted in Noonan but not Albero. Photo by Victoria Espinoza
Shawne Albero, left, hugs Allison Noonan after results are announced. Residents voted in Noonan but not Albero. Photo by Victoria Espinoza

Northport’s budget stayed within the 0.55 percent tax levy cap, and a separate proposition for $2 million in capital improvements, which was approved with 2,848 to 390 votes, will include many athletic facility upgrades for the coming year, including a new gym ceiling and field repairs.

Board President Andrew Rapiejko did not support the reduction in board members.

“It was not a board-supported proposition,” he said. “I think nine members is more representation. It’s a very large district and if you look at even right now, we just have one board member who’s from East Northport out of nine people.”

Armand D’Accordo, a member of the United Taxpayers of Northport-East Northport, the group that introduced the idea for a smaller board, said he was pleased with the results.

“Clearly the nine-person board was not getting the job done,” he said. “Now we have an opportunity to break up the majority of incumbents that have been on the board for too long and get more independent and objective members. Most importantly, fewer members will provide more effective governance over the district and improve academic outcomes.”

Rapiejko and Trustee Lori McCue were both voted in for another term with 1,984 votes and 1,560 votes, respectively.

“I’m very grateful for the people who came out and supported me,” McCue said. She looks forward to finishing an energy performance contract with the district that aims to make it more energy-efficient.

Northport resident Allison Noonan came in first for the night, with 2,039 votes, and said she felt grateful and humbled by the results, and is excited to add a fresh voice and a fresh perspective to the board.

Incumbent Julia Binger came in fourth 1,543 votes and Shawne Albero collected 1,410 votes, so both fell shy in their bids for the board.

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Comsewogue's Dave Heller slides home safely. Photo by Bill Landon

By Bill Landon

Comsewogue's Jordan Lisco makes the tag against a Miller Place player at first base. Photo by Bill Landon
Comsewogue’s Jordan Lisco makes the tag against a Miller Place player at first base. Photo by Bill Landon

Miller Place struggled to keep pace with Comsewogue’s baseball team, as the Warrior bats did the talking in their Class A opening-round playoffs Tuesday afternoon. The Panthers tied the game, 1-1, early on, but 13-5 Comsewogue showed why it’s the League VI champion, as the team wore down Miller Place’s defense and put its opponent away 8-2.

“They’re a tough team, but we came out and played great,” Comsewogue catcher Justin Virga said. “We hit the ball well, played great defense behind our pitcher and we pulled out a win. Today was a hard-fought game.”

Comsewogue wasted no time. Jake Sardinia drew a walk that moved teammate John Braun over to second base, as Jordan Lisco stepped into the batters’ box. Lisco drilled a ground ball through the gap that brought Braun home for the early lead.

“Today we hit the ball, played defense and that’s all you can do,” Lisco said. “We hit the ball with runners on base, which is something we’ve struggled with.”

The Panthers answered back in the top of the second when Cole Francis, on a passed ball at the plate, advanced to third base. Teammate Kevin Kelleher layed down a perfect bunt that plated Francis to tie the game.

Comsewogue's Dave Heller slides home safely. Photo by Bill Landon
Comsewogue’s Dave Heller slides home safely. Photo by Bill Landon

Comsewogue bats cracked in the bottom of the inning, and Bryan Hurley drove the ball through the gap, sending David Heller, the go-ahead run, to second. With Joseph Ciancarelli at the plate, a passed ball moved both base runners into scoring position. Ciancarelli chopped an infield dribbler and Heller came sliding home, eluding the tag, for the 2-1 advantage. With Hurley on third, Ciancarelli stole second and Braun smacked the ball deep through the infield, bringing Hurley home for a 3-1 lead with one out in the bottom of the third. Then, Ciancarelli found his way home on a sacrifice fly for a three-run lead.

“They came fired up on their home field, so they weren’t just going to give it to us,” Miller Place head coach Rick Caputo said. “Honestly, I’m disappointed in the way my guys played. I think we missed a lot of opportunities, I think we played our worst game of the year and we saved it for the first round of the playoffs.”

Miller Place threatened in the top of the third inning when Matt Paghidas and Tyler Schrimpf advanced to second and third, respectively, on another passed ball. Schrimpf crossed home plate to make it a two-run game, but that was all the team could muster.

The Panthers pressured again in the top of the fifth with base runners at the corners, but the runner on first stretched his lead a little too far, and Comsewogue picked him off on an infield pop-up that was caught, to retire the side.

Mike Stiles fires a pitch from the mound for Comsewogue. Photo by Bill Landon
Mike Stiles fires a pitch from the mound for Comsewogue. Photo by Bill Landon
Thomas Bell hurls a pitch from the mound for Miller Place. Photo by Bill Landon
Thomas Bell hurls a pitch from the mound for Miller Place. Photo by Bill Landon

With runners on first and third, the Warriors looked to put the game away in the bottom of the sixth inning when Ciancarelli chopped an infield heater to bring Hurley home for a 5-2 lead.

Miller Place made a pitching change as Christian McPartland relieved Thomas Bell on the mound the rest of the way.

“My control wasn’t there all game — my curveball started working later in the game, but they’re a great hitting team and they were putting the ball in play and making things happen,” Bell said.

It was a busy sixth inning for the Warriors, and they weren’t finished yet. Mike Stiles proved he was as deadly at the plate as he was from the mound, and ripped a fastball deep into the outfield, bringing Ciancarelli and Sardinia home with a stand-up double to break the game open, 7-2.

“I knew they were a good hitting team, so I had to get ahead, mix up my pitches and it worked out in the end,” Stiles said. “We hit the ball pretty well, we played pretty good defense — it was a little sloppy in the beginning, but I knew the team had my back.”

Justin Virga smacks the ball for Comsewogue. Photo by Bill Landon
Justin Virga smacks the ball for Comsewogue. Photo by Bill Landon

Lisco brought Stiles home with a deep sacrifice fly for a six-run lead.

With gas left in the tank, Stiles made short work of the Panthers in the final inning, retiring the side in order for the victory.

“We swung the bats well today, so I was pleased with how we hit the ball and as the game went on, we protected our lead,” Comsewogue head coach Mike Bonura said. “I wasn’t happy with our defense — we booted the ball around early in the game, which is uncharacteristic for us, because we’ve been throwing the ball and fielding the ball well all year. Mike [Stiles] did a great job for us. We play again tomorrow, so we have to go right at them, same recipe — come out and play solid baseball and don’t make it too difficult.”

No. 2 Comsewogue expected another strong pitching performance when Braun took the mound against No. 6 Mount Sinai Wednesday, but results were not available at press time.

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File photo

Suffolk County Police, in conjunction with state and local police on Long Island, conducted a month-long focused enforcement effort specifically targeting distracted driving between April 1 and April 30.

During the focused enforcement effort, Suffolk County police officers issued more than 930 citations for distracted driving violations, yielding a 117 percent increase compared to the same time period in 2015.

Suffolk County police officers responded to 3,320 crashes in April 2016, an 11.75 percent decrease for the same time period of 2015.

New York State Police Troop L issued 810 citations during the initiative, including 470 cell phone tickets, 314 texting tickets and 26 Move Over Law tickets.

The initiative specifically targeted motorists who were driving while distracted by texting or talking on mobile devices due to the strong correlation between these violations and motor vehicle crashes. Drivers who did not abide by New York’s Move Over Law were also cited.

This law protects law enforcement officers, emergency workers, tow and service vehicle operators and other maintenance workers stopped along roadways while performing their duties.

The initiative, which was funded by the governor’s Traffic Safety Committee, was carried out across the state.

The additional police resources were funded through a $450,000 grant allocated to state police specifically for year-round distracted driving enforcement.

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North Shore Jewish Center. File photo

By Rabbi Aaron Benson

One of the truly special aspects of Jewish life is the interconnectedness of the Jewish world. This trait comes to the fore on a holiday like Yom Ha-Atzma’ut, Israel’s Independence Day, which was celebrated on the Jewish calendar this year on May 12. Jews from around the world join together in remembering those who have died in bringing into being and defending Israel, praying for peace and security in Israel and the Middle East and celebrating the true miracle that is not just the return of the Jews to their historic homeland but also all the many accomplishments of Israel in the 68 years since it was founded.

Rabbi Michael Schudrich has Long Island roots and visited from Poland to share his experiences at the North Shore Jewish Center. Photo from Rabbi Aaron Benson
Rabbi Michael Schudrich has Long Island roots and visited from Poland to share his experiences at the North Shore Jewish Center. Photo from Rabbi Aaron Benson

The North Shore Jewish Center celebrated the special place Israel has for our community by joining the leader of another Jewish community, that of Poland, whose chief rabbi, Rabbi Michael Schudrich, was visiting Long Island last week. A native of Patchogue, Rabbi Schudrich graduated from Stony Brook University, where he was being honored during his visit. The chief rabbi has a unique attachment to NSJC, as he was a religious school teacher at our synagogue back when he was a student.

He shared with us about the situation of the Jewish community in Poland. It certainly has its challenges. The Jewish community was nearly destroyed during the Holocaust, losing 90 percent of its numbers. Communism brought about more years of persecution. But since the 1990s, there have been some signs of growth and stability. Young Polish Jews today, for example, travel to Israel as part of the Birthright program, something young American Jews do, too. Rabbi Schudrich explained how a strong connection to Israel for his community is one of the achievements of Poland’s Jews.

Learning about the rebirth of Jewish life in Poland was a hopeful story for our congregants to hear. And to learn that our co-religionists in Poland feel a deep commitment to Israel just as we do, too (our synagogue is planning a trip to Israel for this fall), brought home a deeper meaning to the holiday.

For it reminded us that no matter where Jews may live all around the world, a love for Israel inspires us all. That made our Yom Ha-Atzma’ut particularly memorable this year.

The author is the rabbi at the North Shore Jewish Center in Port Jefferson Station.

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Superintendent Diana Todaro and Assistant Superintendent Francesco Ianni were both delighted the budget passed. File photo

Tuesday night was a success for school districts in the Huntington area, with all budgets approved, including Harborfields’ cap-piercing $82.8 million budget.

Throughout budget season, Assistant Superintendent for Administration and Human Resources Franceso Ianni had presented the board with several options for the 2016-17 budget. Some stayed within the 0.37 percent state–mandated tax levy cap, but did not offer programs the community had been asking for, like full-day kindergarten. Others included such programs but went above and beyond the cap. After much debate, the board adopted a nearly $83 million budget with a cap-busting 1.52 percent increase to the tax levy.

Among the costs in the budget are $600,000 for full-day kindergarten, $70,000 for a BOCES cultural arts program, $52,000 for a third-grade orchestra program and $120,000 for an additional special education teacher and two teaching assistants.

Harborfields residents have been vocal about wanting full-day kindergarten on the budget and one group, Fair Start: Harborfields Residents for Full-Day Kindergarten, traveled to Albany to seek help from state legislators on making it possible.

Rachael Risinger, a member of Fair Start, said she and the organization are elated to see a budget pass with full-day kindergarten on the menu.

“We are extremely thankful the Harborfields community came together to pass this year’s school budget,” she said in an email. “Kindergarten orientation was this week and we’ve heard from so many parents how excited their young kids are to go to full-day kindergarten starting in September. Now they will have the same fair start as every kindergarten student on Long Island.”

The district needed a 60 percent supermajority to override the cap in its budget, and with 2,099 votes in favor and 1,017 votes against, the supermajority was achieved.

Superintendent Diana Todaro said she is pleased with the outcome.

“It’s a budget that supports and meets the needs of all of our children, from kindergarten through the high school,” she said. “We just want to thank our community, parents, staff members and especially the board of education who supported us throughout this entire process.”

Ianni, who will be taking over for Todaro in 2017 as superintendent, said he is excited to work with the programs in this budget next year. “I’m very exited and pleased for the students and the community, [for] all the programs that we’re going to have,” he said. “I’m really excited [to go] into the new school year as the new superintendent in January, [with] these kinds of programs in place.”

Incumbent Hansen Lee and newcomer Colleen Wolcott were also voted in as school board members for the upcoming year, with 1,569 and 1,301 votes, respectively.

“I am extremely excited about the passing of this historic budget, and how the community came together for all of our kids,” Lee said. “[And] I am excited about my second term and [am] looking forward to more exciting things to come at Harborfields.”

Wolcott said she is eager to get started.

“I’m very excited to serve my community more than I have already been doing,” she said. “It is my honor. I’m excited to have a voice on the board of education and to work collaboratively with the district to make it better than it already is.”

Challengers Chris Kelly (1,001 votes), Marge Acosta (992 votes) and Joseph Savaglio (571 votes) fell short in their own bids.

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Does it annoy you too when the pitchman in the commercial urges negotiating with your credit card company, with the advertiser’s help of course, to pay less than you owe? It’s the same message when it comes to “settling” with the IRS. “You don’t have to pay all that you owe,” encourages the adman’s voice. “Call us and we’ll reduce your amount to a third without bankruptcy.”

What about us poor schnooks who paid every last penny of what we owed? Were we incredibly stupid when we could have gotten off with far less cost? Maybe it’s only the rich who pay everything they owe, but I know that’s not true. Men and women will work two and three jobs to be able to meet their expenses, especially those incurred for their children. They must not know that all they had to do was run up the bills — the higher, the better — then declare that they couldn’t afford them, and they would get a reduction of their debt.

What has happened to honor? Maybe it is just those of us of a certain age who still carry these old-fashioned ideas in our heads. “Pay as you go” was my parents’ adage. The idea of a credit card puzzled them. If you couldn’t afford to buy a car when you wanted one, then wait until you had the money and you could buy it. Delayed gratification was admired. They were even dubious about a mortgage, although that became the American way after World War II.

But the thought of not honoring one’s debts was anathema. In essence you gave your word when you accepted credit, and “your word was your bond.” People who walked away from their debts expected to go to prison, certainly not to call a “negotiator” who would beat down your creditor into accepting less — or nothing at all.

Donald Trump raised the possibility of our nation reducing its national debt by bargaining with our creditors, an unwelcome but nonetheless real technique in business. These creditors of American debt would include other nations, as well as widows and orphans who buy U.S. government bonds because they believe in our creditworthiness — our honor to repay. People who cannot repay, while they no longer are imprisoned in a jail, are imprisoned by their actions. They are never trusted to the same extent again, and if they have to borrow in the future they pay a significantly higher rate of interest on the borrowed money, if they can get a loan at all.

The same holds for nations. Those countries whose economies crashed have had to pay exorbitant interest on their bonds to entice new capital, and their people have been impoverished in the long run, leading to disastrous social unrest. History is rife with such examples.

So what is a person, whose intentions at the time of borrowing were honorable but whose circumstances have dramatically changed through no fault of his or her own, to do with that debt? Borrowers may lose their jobs; they or a family member may get sick and require ruinous financial support; insurance on property or health may be insufficient or nonexistent — and so forth. As the expression goes, “life happens.”

Most commonly, the terms of repayment can be changed. A longer time in which to repay the borrowed money can be arranged, allowing the borrower a chance to recover from whatever the disaster. This lowers the monthly rate of repayment although it does increase the total cost of the debt. But it does preserve creditworthiness — and reputation. That solution only works, however, if there are good prospects down the line and a willingness on the part of the debtors to assume responsibility for their actions. In circumstances where there is no hope for recovery, then bankruptcy is the only choice.

But the idea of those who know how to play the system bouncing from one loan to the next with little consequence is unacceptable and makes fools of us all. And those who make a business out of helping such individuals run off with other people’s money are worse yet.

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I can’t see anything up close with my glasses on and I can’t see anything at a distance with my glasses off. I know, I know, welcome to getting old. Well, I’d like to give that aging process a big fat Bronx cheer.

But, wait, technology can come to the rescue. No, I’m not talking about laser surgery and I’m not looking for a special blended form of bifocal, trifocal or whatever. No, you see, technology makes it possible for me to use my state-of-the-art smartphone without needing to see it.

“Siri, send a text message to my wife,” I can say.

To which the automatic voice activation feature will reply, “What is your wife’s name?” And then, when I don’t reply in time, the voice will say, “I’m not sure what you said there.”

But assuming Siri and I can get on the same page about the desired recipient of my intended message, I can start talking into the phone and she will take dictation. No need for an administrative assistant like Mrs. Wiggins, courtesy of Carol Burnett, to take a memo.

Except that, like Mrs. Wiggins, there are some potential comedic kinks in the system. For one thing, whenever I start a text or email with the word Hi, Siri only seems to hear the letter “I.” My texts start out with “I Dr. Smith.” It’s a poor start to have a missing letter at the beginning of a text or email that I can’t check because I can’t see well with my glasses on and I can’t take my glasses off in that moment.

While Siri gets most of the words right, sometimes she struggles with grammar and words that are pronounced alike — such as to, too and two. Or what I mumble. I admit that I don’t always speak clearly. In fact, when I say, “This is Dan,” people sometimes hear, “This is Stan,” because I don’t pause long enough before saying my name.

I was discussing this problem with a friend of mine, who spends a considerable number of hours in the car each week, traveling from one job to another. He said he dictates emails and text messages on his phone constantly to make use of his travel time.

“Hey, be careful when you’re dictating, particularly when you’re driving,” he cautioned.

“Why?” I asked.

“Well, you know that thing picks up everything you say, right?”

“Yeah?” I asked, tilting my head to the side and waiting for a punch line.

“The other day I was driving and I sent an email that went something like this:

“Dear Mr. Jones, I got your response to my invoice and … oh, so you thought cutting me off in my lane was a good idea? And you didn’t even use your blinker. Where’d you get your license? … I was wondering if we might discuss the additional cost of gas which, as you know, is … that’s how I would drive if I had a death wish, too … climbing. Anyway, I’m happy to discuss by phone or at a … thanks for sharing your music with us. That’s what we all want to hear when we’re at a traffic light, your music. Isn’t that how we got some dictators to surrender, by playing that kind of music outside their presidential estates? … meeting. OK, so give me a call when you have a chance.”

While he said that was a slight exaggeration, he realized something was amiss when someone wrote back, “OK, next time I’ll use my blinker.”

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A model shows off one of Nan Guzzetta’s beautiful costumes during The Port Jefferson Conservancy’s Fashion Show on May 15. Photo by Michael Tessler
A model shows off one of Nan Guzzetta’s beautiful costumes during The Port Jefferson Conservancy’s Fashion Show on May 15. Photo by Michael Tessler
A model shows off one of Nan Guzzetta’s beautiful costumes during The Port Jefferson Conservancy’s Fashion Show on May 15. Photo by Michael Tessler
A model shows off one of Nan Guzzetta’s beautiful costumes during The Port Jefferson Conservancy’s Fashion Show on May 15. Photo by Margot Garant
Models show off two of Nan Guzzetta’s beautiful costumes during The Port Jefferson Conservancy’s Fashion Show on May 15. Photo by Margot Garant
Photo by Lis Calendrino

By Michael Tessler

History came to life this past weekend as the Port Jefferson Harbor Education and Arts Conservancy hosted an exquisite “Downton Abbey”-themed fashion show, complete with high tea, light snacks and beautiful costumes provided by Port Jefferson’s very own Nan Guzzetta.

This special event was the brainchild of former Port Jefferson mayor and Conservancy chairwoman, Jeanne Garant. This longtime local leader has a great record of bringing to life history in fun community-oriented ways. Having helped found the village’s beloved Charles Dickens Festival, it’s no surprise she’d dream up such a unique fundraiser.

Organized by Conservancy President Lisa Perry, her fellow board members and many volunteers, this event was one attendees won’t forget.

Nan Guzzetta, who provided the costumes for the event, is a true treasure in our community. Her passion for history, attention to detail and her ability to bring to life any bygone era is an extraordinary talent. Every piece of clothing she selects is so perfectly prepared, adorned with accessories that embellish without distracting, every ornate decoration on a hat so cleverly placed, every shoe properly fit and polished. She is a master of her art form, and what a splendid art it was to spectate.

Models from all across the country joined to be a part of this spectacular presentation of Edwardian era clothing. Each outfit appeared to outdo the next, so beautifully capturing not just the style but the stories of the early 20th century. Styling of suffragettes, elaborate evening gowns, feathered flappers and everything in-between showed what an exciting time it was to be alive. From the Titanic to the twenties, it was a beautiful demonstration and a roaring good time!

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Above, from left, Lorna Role, Li Jiang and David Talmage, members of a Stony Brook University research team that has developed a method to control memory in mice. Photo from Stony Brook University

Not all memories are created equal. Some moments, like the time we first hold our child tower in the memory landscape over the moments we clip our toenails.

Focused on how we hold onto some of these more important memories, Lorna Role, SUNY distinguished professor and chair of the Department of Neurobiology and Behavior who is also a professor at the Neurosciences Institute at Stony Brook Medicine, used an animal model to test the way a neurotransmitter she’s studied for years, called acetylcholine, might affect memories of a recent, fear-inducing event.

Collaborating with several other scientists, including her husband David Talmage, a professor of pharmacological sciences at Stony Brook University, Role found that stimulating the axons of nerves in the amygdala region of the brain to release acetylcholine during a traumatic event affected the mouse’s behavior for a longer period of time.

On the other hand, reducing acetylcholine in that region during a traumatic event reduced the response. They recently published their work in the journal Neuron.

This research may have applications for conditions such as post traumatic stress disorder. In PTSD, memories of a traumatic event may be significant and painful enough to reduce the quality of life.

To be sure, Role recognizes that there’s a long way to go between what she’s discovered and any potential human therapy. “There are a lot of steps between the basic science set of observations and the applications,” she said. “I don’t have an answer for how it will be done.”

Still, she hopes this type of information could lead to an approach to treating PTSD with nonpharmacological therapies. It also might provide a better target for drug therapies. The results are also consistent with prior work suggesting that cigarette smoking can worsen PTSD. Nicotine is a drug form of acetylcholine.

Role targeted the release of acetylcholine by the cholinergic neurons. Along with Talmage and several other collaborators, Role used the relatively new molecular biology technique of optogenetics. With light, they can activate a select class of neurons without affecting other neurons nearby.

The group went to the axons, which extend far from the cell body, and activated them. “We wanted to go into a particular region associated with a kind of memory and activate the cholinergic terminals,” said Role. They were only releasing acetylcholine in the amygdala.

The group played a tone at the same time the mouse had an unpleasant experience. If the animal had a higher level of acetylcholine for a brief time during that experience, the mouse continued to react in fear in response to the tone even when the sound didn’t occur at the same time as something unpleasant.

“It made the memory essentially indelible. It was much harder to eradicate the memory,” Role said.

When the animal’s acetylcholine levels were lower during the combination of a negative event and the tone, the animal didn’t exhibit fear in response to the sound. “We didn’t expect we could block the recollection of this pairing” of the tone and the unpleasant experience, she said.

One of the next experiments will involve exploring how to decrease the effect of these traumatic experiences after they’ve already occurred.

Talmage, who has a shared lab with Role, said the idea for this set of experiments originated during a meeting in Chicago. The concept was a compelling idea, but “everybody has ideas. It’s what you do with having a crazy idea” that matters. He credits Role with “putting together the team that’s willing to take a risk” to do work that may not pan out as they had hoped. He suggested she spearheaded the research “exceedingly well.”

Role’s broader research interest is in slowing down or reversing memory loss. She is aware of the difficulties families endure when a member has a cognitive decline where that person can’t recognize a loved one.

“It is my hope that not only will we be able to use some of these techniques to strengthen memories that have been diminished, but also to strengthen positive emotionally salient memories,” she said.

Role can envision increasing acetylcholine in these key areas that are important for memory recollection. Cognitive declines can affect the quality of life for people with diseases including Alzheimer’s and Parkinson’s.

Memories that are critical to Role include moments with her daughters, Lindsay Standeven, who is a psychiatrist and resident at Johns Hopkins, and Masha Role, who is receiving her training as a clinical psychologist.

Role and Talmage, whose descendants include the founding families in Southampton and Bridgehampton and members of the Setauket spy ring during the American Revolution, live in Port Jefferson.

To continue with her research and serve as the chairman of her department, Role wakes up at 4 in the morning and is most productive between 4 a.m. and 9 a.m. She recognizes that collaborating with her doesn’t involve producing numerous papers with incremental results. She’s looking for a broad understanding of what she has discovered before publishing the results and said she discusses the results all the time, because the more feedback she can get, the better.

“Everything I’ve published has been a labor of love over a long time course,” Role said. Her collaborators recognize her need to put all the pieces together before publishing. “I’ve been at this neuroscience research for more than 35 years. I prefer to work to publish as complete a story as possible.”

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Heart disease is the most common chronic disease in America. When we refer to heart disease, it is an umbrella term; heart attacks are one component. Fortunately, the incidence of heart attacks has decreased over the last several decades, as have deaths from heart attacks. However, there are still 720,000 heart attacks every year, and more than two-thirds are first heart attacks (1).

How can we further improve these statistics and save more lives? We can do this by increasing awareness and education about heart attacks. It is a multifaceted approach: recognizing the symptoms and knowing what to do if you think you’re having a heart attack.

If you think someone is having a heart attack, call 911 as quickly as possible and have the patient chew an adult aspirin (325 mg) or four baby aspirins. Note that the Food and Drug Administration does not recommend aspirin for primary prevention of a heart attack. Please note that the use of aspirin in this case is for treatment of a potential heart attack, not prevention. It is also very important to know the risk factors and how to potentially modify them.

Heart attack symptoms

The main symptom is chest pain, which most people don’t have trouble recognizing. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal, area. Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). One problem is that less than one-third of people know these other major symptoms (2). About 10 percent of patients present with atypical symptoms — without chest pain — according to one study (3).

It is not only difficult for the patient but also for the medical community, especially the emergency room, to determine who is having a heart attack. Fortunately, approximately 80 to 85 percent of chest pain sufferers are not having a heart attack but more likely having indigestion, reflux or other non-life-threatening ailments.

There has been a raging debate about whether men and women have different symptoms when it comes to heart attacks. Several studies speak to this topic.

Let’s look at the evidence.

Men vs. women

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish prospective (forward-looking) study, after having a heart attack, a significantly greater number of women died in hospital or near-term when compared to men. The women received reperfusion therapy, artery opening treatment that consisted of medications or invasive procedures less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram; they both had what we call ST elevations. This was a study involving approximately 54,000 heart attack patients, with one-third of them being women.

One theory about why women are treated less aggressively when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Women’s symptoms may include pain in the lower portion of the chest or upper portion of the abdomen and may be significantly less severe pain that could radiate or spread to the arms. But, is this true? Not according to several recent studies.

In one observational study, results showed that, though there were some subtle differences in chest pain, on the whole, when men and women presented with this main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: The duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The study included approximately 2,500 patients, all of whom had chest pain. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. This was a conspicuous weakness of an otherwise mostly solid study, since age and previous heart attack history are important factors.

Therefore, I thought it apt to present another observational study with a younger population, where there was no significant difference in age; the median age of both men and women was 49. In this GENESIS-PRAXY study, results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings (non-ST elevations), significantly more were women than men. Those who did not have chest pain symptoms may have had some of the following symptoms: back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache.

If the patients did not have chest pain, regardless of sex, the symptoms were, unfortunately, diffuse and nonspecific. The researchers were looking at acute coronary syndrome, which encompasses heart attacks. In this case, independent risk factors for disease not related to chest pain included both tachycardia (rapid heart rate) and being female. The authors concluded that there need to be better ways to calibrate non-chest pain symptoms.

Some studies imply that as much as 35 percent of patients do not present with chest pain as their primary complaint (7).

Let’s summarize

So what have we learned about heart attack symptoms? The simplest lessons are that most patients have chest pain, and that both men and women have similar types of chest pain. However, this is where the simplicity stops and the complexity begins. The percentage of patients who present without chest pain seems to vary significantly depending on the study — ranging from less than 10 percent to 35 percent.

Therefore, it is even hard to quantify the number of non-chest pain heart attacks. This is why it is even more important to be aware of the symptoms. Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. When it comes to heart attacks, suspicion should be based on the same symptoms for both sexes. Therefore, know the symptoms, for it may be your life or a loved one’s that depends on it.

References:

(1) Circulation. 2014;128. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

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 or consult your personal physician.

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