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Yearly Archives: 2017

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Student Giancarlos Llanos Romero will be joining the SBU team on a trip to Kenya this summer. Photo by Phoebe Fornof

By Daniel Dunaief

In a region known for the study of fossils left behind millions of years ago, a team of students from Stony Brook University’s College of Engineering and Applied Sciences is planning to travel to Kenya this summer to learn about and try to solve the challenges of today.

The university will send eight undergraduates to the Turkana Basin Institute for the engineering department’s first program in Kenya, which will run for over four weeks. In addition to classroom study, the students will seek opportunities to offer solutions to problems ranging from refrigeration, to energy production, to water purification.

The students learned about the opportunity in the spring, only a few months before they would travel to a country where the climate and standard of living for Kenyans present new challenges. “We were skeptical about how many students we would be able to get,” said Fotis Sotiropoulos, the dean of the College of Engineering and Applied Sciences, who “didn’t start marketing this” until after he took a trip to Kenya and the Turkana Basin Institute, which Stony Brook created at the direction of world-renowned anthropologist Richard Leakey.

Giancarlos Llanos Romero, who is interested in robotics and nanotechnology and is finishing his junior year, had originally planned to spend the summer seeking an internship in the Netherlands or Germany. When he learned about this opportunity, he immediately changed his focus. “I need to do this,” Romero said. “This is much more important than anything I could do in an internship.”

On first blush, the trip is anything but ideal for Romero, whose skin is sensitive to extreme heat, which he can expect to encounter in the sub-Saharan African country. He didn’t want that, however, to stop him and is planning to travel with seven other people he met for the first time last week. Romero said his immediate family, which is originally from Colombia, supported the trip.

Sotiropoulos, who is in his first year as dean, embraced the notion of connecting the engineering department with the Turkana Basin Institute. “Before I came here” said Sotiropoulos, “I felt very passionately about making sure that engineering students became familiar with the rest of the world” and that they understood global challenges, including issues like poverty and water scarcity.

Sotiropoulos met with TBI Director Lawrence Martin during one of his interviews prior to his arrival at SBU. Martin invited Sotiropoulos to visit with Richard Leakey, the founder of TBI whose family has been making scientific discoveries in Kenya for three generations.

Women and children in Kenya searching for, and drinking from, water found beneath the dry riverbed. Photo by Lynn Spinnato

This program quickly came together after those meetings. The two courses will teach students about design thinking, said Robert Kukta, the associate dean for undergraduate programs in the College of Engineering and Applied Sciences. Stony Brook would like to help students develop “the ability to think broadly about solutions and boil it down to the essence of the problem,” Kukta said. This, he said, will all occur in the context of a different culture and local resources.

Students will start their summer experience in Nairobi and then they will travel to Princeton University’s Mpala Research Centre, Martin said. “The journey through Kenyan towns opens visitors’ eyes tremendously to how different peoples’ lives are in different parts of the world,” Martin explained by email. “The goal is not so much to contribute immediately but to understand the challenges that people face, the resources available locally and then to improve their ability to think through possible solutions.”

Once students arrive at TBI, they will have an opportunity to see fossils from many time periods, including those from late Cretaceous dinosaurs. “Every visitor I have ever taken to TBI is amazed and in awe of the abundance of fossil evidence for past life on Earth,” Martin said.

A distinguished professor in the Department of Chemistry at SBU, Benjamin Hsiao, who traveled with Sotiropoulos to Kenya in the spring, is a co-founding director of Innovative Global Energy Solutions Center. Hsiao has been developing water filtration systems through IGESC, which brings together TBI with universities, industry, international governments and foundations. He is well acquainted with the challenges the first set of students will face.

“Once we bring technologies over to Kenya, [sometimes] they do not work for reasons we have not thought of,” which include dust or a broken part for which it’s difficult to find a replacement, he said. “Those failed experiments give us tremendous insight about how to design the next-generation systems which will be much more robust and sustainable and easier to operate by local people.”

Acacia Leakey, who grew up in Kenya and is Richard Leakey’s grandniece, recently completed her senior design project as an undergraduate at Stony Brook. Her work is intended to help farmers extend the life of their tomato plants when they bring them to market.

About 32 percent of the tomatoes go to waste from the extreme heat. Acacia and her team developed a vegetable cooler that employs solar panels to reduce the temperature from 32 degrees Celsius to 15 degrees Celsius, which should extend the life of the tomatoes. Her classmates were “surprisingly supportive” of her work, she said, as some of them hadn’t considered applying their skills in a developing country.

Leakey, who will train for her master’s degree at Stony Brook this fall, will continue to provide insights into Madagascar, another developing African nation where the university has an internationally acclaimed research center. This summer, she will produce a video that will record information from villages near Centre ValBio in Madagascar, which she will bring back to Stony Brook in the hopes of encouraging others to use that information to create their own design projects next year.

As for Romero, who is raising money for the trip through a GoFundMe page, he is prepared to discover opportunities amid the challenges of his upcoming trip and is eager “to be able to actually help a community and say I left a mark.”

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COUNTRY LIVING Gerard Romano of Port Jefferson Station took this photo of a Farmall tractor on May 2 using a Nikon D3300 and a 11-20 mm lens. The tractor, which was produced between 1932 and 1939, sits on the front yard of the historic Sylvester Randall home, circa 1853, in Miller Place.

Send your Photo of the Week to [email protected].

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Rocky Point mother Robin Siefert is upset nothing was done after her 9-year-old daughter found a note on her desk containing several expletives (which have been removed from the photo), a swastika and Adolf Hitler’s name. Photo from Robin Siefert

Not long after Rocky Point mother Robin Siefert spoke to the school board about an anti-Semitic note left on her 9-year-old daughter’s desk March 23 at Joseph A. Edgar Intermediate School, U.S. Rep. Lee Zeldin (R-Shirley) picked up the phone.

Zeldin, one of two Jewish Republicans in Congress, has 10-year-old twin daughters and reached out to Siefert as soon as he got wind of her situation, saying, “It hit very close to home.”

Rocky Point mother Robin Siefert is upset nothing was done after her 9-year-old daughter found a note on her desk containing hate speech. Photo by Kevin Redding

“I wanted to see if there was anything I could do to assist,” Zeldin, a regular at the school’s annual Veterans Day assembly, said after his call with Siefert. “I could tell I was talking to a very loving mother passionately advocating for her daughter, and trying to be strong through a challenge that negatively impacted a young, innocent child.”

He said he felt it was important the issue be combated aggressively at its source, saying someone who draws a swastika may be inclined to do it again, or more, in the future.

“There can’t really be a tolerance for it, or it’s only going to grow,” he said.

Siefert, who will be meeting with the board again in executive session May 16, said of Zeldin’s call, “It was just very nice to know my congressman cared about the situation … I have a lot of gratitude. I still can’t believe this happened to my child, but [she’s] starting to get a little better.”

The note in question, written by a classmate of Siefert’s daughter, included three obscenities, a swastika and Adolf Hitler’s name.

Siefert argued during a board meeting April 19 that not enough was done at the administrative level to comfort her daughter, inform the parents of the incident or find the student responsible for the note.

According to Rocky Point school district superintendent, Michael Ring, a thorough investigation has been conducted since the March 23 incident occurred, and there’s been transparency between school and parents.

“The police were contacted by the district regarding the matter and information provided thereon,” Ring wrote in an email. “Parents of all students in the class were contacted by the teacher at the time of the incident. Counselors have gone into the classroom to speak about tolerance, acceptance and respect. None of this was done in response to Mrs. Siefert speaking at the [board of education] meeting. All of this was put into place after and as a result of the incident, which the school and district took very seriously.”

Conversely, Siefert said, “This is all because I went in front of the board and said what I said. All these things happened after I spoke.”

Ring noted the school has continued to employ all its existing and ongoing character education and anti-bullying initiatives, including Six Pillars of Character and Social Skills/Friendship Groups and Caring Connections.

He said as recent as May 9, officers in the Suffolk County Police Department conducted an anti-bullying presentation to all grades at Joseph A. Edgar.

U.S. Rep. Lee Zeldin reached out to a Rocky Point mom over an anti-Semitic note her daughter received. File photo

“I’m glad they’re being proactive now,” said Siefert, who claims she, not the school, was the one who filed a police report after the incident. “But I’d be much happier if the kid who did this to my daughter was put in counseling and punished appropriately.”

Zeldin agreed. According to his staff, the district’s efforts to find the student responsible were outlined, but ultimately the district, as well as police, believe “there is not enough evidence to take action.”

It will, however, “continue to follow proper protocol and work with the family on this case.”

“In alignment with our anti-harassment and code of conduct policies, proven instances of bullying are treated extremely seriously and age-appropriate discipline is put in place in response to such incidents,” Ring wrote. “This is a continuing investigation.”

On April 24, Linda Towlen, principal at Joseph A. Edgar, sent a letter to parents of students in a fifth-grade class informing them of an April 21 incident where small swastikas were found on a bathroom sign-out sheet.

According to the letter, “a thorough investigation has been undertaken to determine the source of these unacceptable symbols” and “as is our protocol … the Suffolk County Police were notified and a report filed.”

After this most recent incident, the school implemented the Second Step program in the classroom that deals with bullying and teasing.

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On the eve of this year’s Mother’s Day, I have a question to ask you. Do you ever think of your parents as people? Sounds like an odd question, but I mean thinking about them in terms of the times they live through, their private satisfactions, their fears and phobias, the experiences that mold them and so forth. We know the facts they choose to tell us about their lives but not their deepest thoughts and feelings.

We can’t ever really know them, even though we grow up in their home. Most of us consider them as loving to us, making our lives comfortable, caring for us when we are sick, instructing us how to behave, making our favorite birthday dinners. But there is more to their existence than their interactions with us.

I sat down to try and picture myself in their shoes.

I know that my father met my mother when he accompanied his older brother to the home of his brother’s fiancée for the first time. There, coming down the stairs in a red dress, was the sister of the fiancée, my mother. To hear my father tell it, he was struck instantly and forever by Cupid’s arrow. Although he was only 15, the sight of her took his breath away. So we know what my father was feeling, but how about her? Did she catch sight of him and feel the same overpowering love at first sight? Was she coming downstairs merely out of curiosity to meet her older sister’s intended, then to slip away for the afternoon with her friends? Did she have nervous or polite conversation with my father? What did they talk about? By the time she was 15 and he was 17, he had persuaded her to get married during her lunch hour in Manhattan’s City Hall. They prevailed upon two men in a nearby barbershop to be their witnesses and to swear that they were both of age. They then returned to work and to their separate homes that night.

My father was triumphant, I know, because he told us so, for now he had the love of his life as his own. Did he have any idea what that meant? You know, the stuff about making a home, supporting and caring for a wife? And my mother, my always and eminently practical mother? How had he convinced her to do this without telling her parents, her brothers and sisters, especially her older sister with whom she was dearly close? Hard as it is for me to picture, she must have been wildly in love.

Theirs was a youthful marriage that worked. They were seldom apart, only during the workday, and they eagerly reunited in the evenings. I could sense the quickening of her breath as we heard his key in the front door. And they began their nightly nonstop conversations as he entered the apartment. My sister and I fell asleep each night to the hum of their voices coming from the kitchen.

My dad was born in 1904, my mother in 1906, so they had both lived through World War I. My dad was lucky to be too young for the draft, but how did he feel seeing his older brothers marching off to war? And my mother? Was she worried about the fate of her older brother? I never asked them.

My parents decided everything together. My mother was more assertive about her opinions, but if my father didn’t agree she would back off. And while he seldom disagreed with her, when he did he was not reticent to let her know. They lived through the Great Depression, but I don’t know if they worried about money or job security. Were they afraid? There was no unemployment or health insurance then. Did they have nightmares about standing on breadlines? I never asked.

I do know that by 1939 they started their first business with all the life savings they had managed to scrape together. Then came Pearl Harbor and World War II. Once again my father was saved, being just beyond draft age. Did they feel threatened by the attack and the war? What were their thoughts and feelings? How did they cope with the stress? I came along then, but at no time in their lives did I think to ask.

Now, of course, it is too late.

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Image from Reboli Center

Fresh on the heels of a successful paint night, the Reboli Center for Art and History, 64 Main St., Stony Brook Village will present a Wreath Workshop on Monday, May 15 from 6:30 to 8:30 p.m. A beautiful wreath in your décor is something special, but a beautiful wreath made by you is even better! During this two-hour class, you’ll get to make a Pinterest-worthy wreath with the guidance of Diana from Everlastings by Diana using dried flowers and herbs. You’ll be encouraged to explore your own style within the demonstrated framework. All materials are provided and, of course, you’ll take your creation home with you! Refreshments will be served. Attendance is limited. The workshop fee is $45. To register, please call 631-751-7707.

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The front cover of the 2015 Red Light Safety Program Report.
The front cover of the 2015 Red Light Safety Program Report.

By Victoria Espinoza

The results are in for the 2015 Red Light Safety Program Annual Report — the most recent report to date — but there are still questions to be asked. The report, released in April, showed in 2015 a total of $31 million in gross revenue was collected from the program for citations issued from the start of the program in 2010 but paid in 2015 — a drop of some $1.9 million from the previous year.

However, an entire section is missing on accident data, which in years past indicated how many accidents occurred from right angles, rear ends, accidents that involved injury, what intersections they occurred at and more.

“It’s a disgrace,” Suffolk County Legislator Rob Trotta (R-Fort Salonga) said in a phone interview. “They say it’s coming — but they won’t even tell us who prepares the report.”

Trotta is not the only person to raise this concern.

Personal injury lawyer David Raimondo, based in Lake Grove, agreed not knowing what company prepares the report is a red flag. He has worked on several injury lawsuits having to do with red light camera intersections and has filed a Freedom of Information Law request to discover what company creates the current annual reports on the program. Just last month he called for a federal investigation into the program.

Suffolk County Legislator Rob Trotta goes over legislation to suspend the camera program. Photo by Phil Corso

“We don’t know who makes the report, they [Suffolk County government] claim the data used is correct, but I’m challenging that right now because I don’t think their data is accurate,” he said.

The county executive’s office did not respond to requests for comment. Every annual report has the Suffolk County seal on the cover as well as the seal of the county’s office of Traffic and Parking Violations Agency. All services in maintaining, operating and managing the red light cameras are done by Xerox, a corporation that entered into a contract with Suffolk County. Xerox provides a monthly invoice to the county for contractual requirements, and according to the study was paid $9.4 million that year. But it’s still unclear which entity condenses the raw data and creates the annual reports.

Raimondo also took issue with an article from the Insurance Institute for Highway Safety referenced in the 2015 report. “Red light cameras installed at intersections reduced the number of fatalities due to crashes at these intersections … there was a steep increase in fatalities at intersections that removed red light cameras,” the report stated.

The article also included data from 57 cities throughout the country between 1992 and 2014, comparing trends in fatal crash rates in those cities with trends in 33 cities that never had cameras.

The lawyer called the article “propaganda,” and said he has worked with many scientists and engineer experts who confirm red light camera programs do not reduce fatalities.

Another problem with the Suffolk County study, Raimondo said, is it does not include data on accidents involving bicyclists or pedestrians.

“Every single intersection with a camera and a crosswalk needs a report,” he said.

Red light cameras are placed in two types of intersections: New York State intersections, where a state road meets a state, county or town road; and non-state intersections, where a county road meets a county or town road. According to the report, intersections are chosen based on where the cameras would yield the highest safety result, but Raimondo doesn’t buy that.

“It’s an insult to the residents.” — Rob Trotta

“They’re putting them in areas with the highest volume of people who don’t want to go to court and can afford to pay the ticket,” he said. “They’re targeting middle class people. It’s a real racketeering operation, it’s enterprise corruption.”

Trotta echoed the sentiment.

“It’s a sham,” he said. “It’s the equivalent of a 63 percent tax increase on resident’s general fund tax, except this way the Suffolk County executive can say he didn’t raise it — but in actuality he did and it’s absurd. He [Steve Bellone (D)] thinks the people of Suffolk County are idiots. It’s an insult to the residents.”

According to the report released last month analyzing the 2015 data, 352,472 red light camera fines were paid in 2015, including payments immediately after first notice of a ticket and court-related fines. This has led to more than $17.6 million in gross fine revenues for the year ($19 million in 2014 on 380,809 fines paid). These fines and fees are deposited directly into a Suffolk County comptroller’s account, according to the report.

Some areas across Suffolk County saw more red light camera incidents recorded and tickets issued in 2015, but others stayed at a steady rate or saw a decrease.

The study details how many incidents a red light camera intersection tracks in a certain year, as well as how many tickets are issued from those incidents.

In 2015 in Huntington Station on Oakwood Road, a huge 73,217 red light camera incidents were noted, with 3,741 tickets issued, compared to 9,773 incidents noted and 602 tickets issued in 2014. Lake Grove had 86,343 incidents with 4,636 tickets issued in 2014, and the next year that number jumped to 106,145 incidents yet saw a drop in tickets to 4,435. In East Setauket on Route 347, more than 1,000 incidents were recorded than the prior year at 37,594, however 45 fewer tickets were issued at 1,838. On Miller Place Road, 117,016 incidents were recorded in 2014, with 7,055 tickets issued, and in 2015 there was a drop in incidents tracked at 113,915, with 6,088 tickets issued.

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What keeps us young? Well, certainly eating healthy foods, exercising and sleeping are all on that list.

But there’s something else that works, too. If you can, try hanging out with a group of younger people at a party, even if the music is loud and incomprehensible.

At a recent party, I wasn’t sure what my daughter was saying, as I watched her sing every word with her eyes wide open and her hands fluttering at her sides like a butterfly’s wings.

It’s as if both of my children have sped up the needle so fast on their speech that I suspect that what’s coming out of their mouths probably started out as distinct words at some point. I’m hoping that the message they are repeating isn’t something offensive or objectionable, like, “Environmental regulation is bad, so let’s put the fox in charge of the hens at the Environmental Protection Agency. Go fox, Go fox, Go fox.” No, wait, this isn’t about politics.

A room full of children at the party, held by a family friend, made me think a bright scientist may one day figure out how to harness that energy, store it and release it at just the right time, either when someone needed to warm a house or a heart.

The next generation seems to follow a simple formula: Why walk when you can run, skip or flip, why talk when you can shout and why stay on the ground when you can challenge gravity to hold you down?

I recognize that loud parties filled with perplexing music may not be everyone’s cup of tea. The decibel level may damage hearing aids, destabilize pacemakers, or rattle fillings or dentures.

You don’t need to attend a kids party, especially if you weren’t invited to one, to share the exuberance of youth. Have you stopped your car on the way back along familiar routes to watch a T-ball baseball game, to listen to a chorus singing music you might know, or to watch a marching band trying to master John Philip Sousa while figuring out what yard line they’re supposed to be on when they reach the high notes?

All that energy begets energy. I’ve heard people talk about how their children keep them young. Imagine multiplying that, even for a day or a few hours, by however many kids are celebrating the moment in a way that doesn’t get bogged down in blinking Blackberries, a pending deadline or a need to disappear into the immobile ether of the television.

And if you’re fortunate enough, you can engage with some of the next generation in questions they raise about the world. Many of us think we are pretty knowledgeable. That may be the case, until a child asks us a question we can’t answer. Of course, we could rush to the internet to find an answer we might soon forget, or we could try to inch our way to an answer or even revisit a question we hadn’t pondered in years.

I’m sure teachers feel the same kinds of highs and lows that appear in so many other jobs. They have to discuss the Magna Carta year after year, or explain how the change in Y over the change in X represents the slope of a line.

But, then, every once in a while, a student may ask a new question that brings the material to life and gives the teacher an opportunity to learn from the student. The best answers inevitably lead to the next best questions.

Energy, insight, curiosity and joy don’t exist solely in the world of youth, but they are often easier to spot among a group of children whose joie de vivre lifts off at a party.

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Rella speaks out against standardized testing in 2015. File photo

According to an organization that has been accrediting school districts for 125 years, Comsewogue is one of the best in the world. The district earned accreditation by the Middle States Association of Colleges and Schools Commissions on Elementary and Secondary Schools, a worldwide leader in accreditation and continuous school improvement.

The lengthy and rigorous process is a self-study that is then evaluated by volunteers from association-member schools during an approximately two-year period. With the distinction, Comsewogue became the only full district of public schools on Long Island recognized by the commission.

The certificate Comsewogue received from the Middle States Association. Photo from Joe Rella

“After spending a few days here, I was reminded of a country music song by Eddie Arnold that went something like this: ‘Welcome to my world, won’t you come on in,’” Pat Impreveduto, chair of the Middle States Validation team for Comsewogue’s application, said in a letter to the district breaking the good news. “The team has heard and observed evidence that this is a commonplace in your district. It is evident that staff collaboratively works hard to set this as the expected and not the exception.”

To receive accreditation the district had to conduct self-evaluation in categories like aptitude for growth and improvement; mission, beliefs and profile of graduates; student performance data; district leadership, governance and organization; educational programs and resources; student services and student life; maintenance and operations; school district improvement planning and many more. After evidence of self-evaluation of all the categories was submitted, the commission’s volunteer team had no recommendations for ways to improve Comsewogue’s application, meaning they were well on their way to earning accreditation. About 2,700 schools worldwide have been granted Middle States accreditation.

“It validates things we’re doing,” Superintendent Joe Rella said in an interview. Rella, who has been in the district for 23 years, said he first had the idea to pursue the accreditation about 10 years ago, and added receiving the prestigious honor as a culmination of those efforts ranks at the top of his list of proudest accomplishments in education. Rella likened himself to a baseball manager who often gets credit for “home runs other people hit,” meaning receiving the distinction would not be possible without the other dedicated professionals working in the district. About 200 volunteers worked on the application. “It lifts up our community,” he said. “It’s going to be good for property values. It’s going to be good for just the sense of the community that they’re getting a good value for their dollar.”

Rella added the value of receiving the affirmation that the district is as high quality and special as they always believed they were is invaluable and extremely gratifying. Accreditation is granted on a seven-year basis, so the district now has a long-term plan for continued self-evaluation and improvement to ensure they have their application approved again in 2024.

“We’re not a wealthy district — our community can kind of feel used and abused,” Rella said. “We want to get [word of the accreditation] to the realtors, because the realtors are still in the mindset that we’re the ugly stepchild. Maybe not — maybe we just got a little better looking.”

The district plans to invite members from Middle States, elected officials and other members of the community to celebrate the achievement sometime in mid-June.

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Hypertension risk factors include poor diet, lack of exercise, age and depression.
Complications are highest during sleeping hours

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension (high blood pressure) deserves a substantial amount of attention. There are currently about 76 million people with high blood pressure in the U.S. Put another way, one in three adults have this disorder (1). If that isn’t scary enough, the Centers for Disease Control and Prevention reports that the number of people dying from complications of hypertension increased by 23 percent from 2000 to 2013 (2).

And talk about scary, it turns out that fear of the boogie man should take a back seat to high blood pressure during nighttime sleeping hours. This is when the probability of complications, such as cardiovascular events and mortality, may have their highest incidence.

Unfortunately, as adults, it does not matter what age or what sex you are; we are all at increased risk of complications from high blood pressure, even isolated systolic (top number) blood pressure, which means without having the diastolic (bottom number) elevated as well. Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (3). At least some of the risk factors are probably familiar to you. These include being significantly overweight and obese (BMI >27.5 kg/m²), smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (4).

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, there are nonpharmacological approaches that have benefits. These include lifestyle modifications with diet, exercise and potentially supplements. An item on the game show “Jeopardy” read: “You can treat it with diet and lifestyle changes as well as drugs: HBP.” The corresponding answer was, “What is high blood pressure?” We made the big time!

Risk factors matter, but not equally

In a study, results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (5). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²) at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk. Interestingly, weekly binge drinking at 1.87 times increased risk was equivalent to being overweight. This study was observational and involved 2,763 participants. The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension (systolic between 140 and 159 mmHg and/or diastolic between 90 and 99 mmHg).

High blood pressure doesn’t discriminate

One of the most feared complications of hypertension is cardiovascular disease, because it can result in death. In a study, isolated systolic hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (6). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, which is not the best, it was very large and had a 31-year duration.

Nightmares that may be real

Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), the results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (7).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration. Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).

There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (8). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (9). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

Dietary tidbits

Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (10). This is not bad, especially since the patients were prehypertensive, not hypertensive, at baseline, with a mean systolic blood pressure of 138 mmHg.

This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase a substance called nitric oxide, which helps blood vessels relax, reducing blood pressure.

The results of another study showed that girls who consumed higher levels of potassium-rich foods had a significant reduction in both systolic and diastolic blood pressure (11). The highest group consumed at least 2,400 mg of potassium daily, whereas the lowest group consumed less than 1,800 mg. The girls were 9 and 10 years old and were followed for a 10-year duration. Though the absolute change was not large, the baseline blood pressure was already optimal for both groups, so it is impressive to see a significant change.

In conclusion, nighttime can be scary for high blood pressure and its cardiovascular complications, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

References: (1) Health Stat Report 2011. (2) CDC.gov. (3) Diabetes Care 2011;34 Suppl 2:S308-312. (4) uptodate.com. (5) BMC Fam Pract 2015;16(26). (6) J Am Coll Cardiol 2015;65(4):327-335. (7) J Am Coll Cardiol 2015;65(4):327-335. (8) Eur Heart J 2015;35(46):3304-3312. (9) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (10) J Acad Nutr Diet 2015;115(3):369-377. (11) JAMA Pediatr online April 27, 2015.

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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The second attempt passes House, will head to Senate for further scrutiny

U.S. Rep. Tom Suozzi and U.S. Rep. Lee Zeldin weigh in on the AHCA, which passed the house last week. File photos

The battle to repeal and replace the Affordable Care Act, commonly referred to as Obamacare, was left in the hands of the House of Representatives for a vote last week, and two representatives for the North Shore had differing opinions on the bill. The American Health Care Act passed in the House by a slim 217 to 213 margin, though before it becomes law it must also pass the Senate and ultimately be signed by President Donald Trump (R).

U.S. Rep. Lee Zeldin (R-Shirley) for New York’s 1st Congressional District was among those in favor of the bill, fulfilling a campaign promise of his own and the vast majority of Republican lawmakers across the country since Obamacare was enacted in 2010.

“Almost everyone agrees that our current system is deeply flawed,” Zeldin said in a statement. “The American Health Care Act provides relief from billions of dollars of crushing taxes and mandates enacted under the ACA. Additionally, the bill repeals the individual and employer mandates, taxes on prescription and over-the-counter medications, health insurance premiums and medical devices.”

“The revised version of the AHCA passed by the House is not sound health reform. … Access to insurance is meaningless if premiums are unaffordable and the coverage is not comprehensive.”

— Kevin Dahill

Zeldin also sought to dispel “outright lies” being perpetrated on social media and elsewhere about the new bill, the first incarnation of which he was slow to support unless important amendments were added, he said in March. One thing he specified as a misconception is the idea that people with pre-existing conditions might lose coverage, or that millions will be left uninsured.

“The bill protects people with pre-existing conditions, and gives states greater flexibility to lower premiums and stabilize the insurance market,” he said.

Critics of the bill have noted it was not subject to scrutiny by the Congressional Budget Office prior to the vote, and in the first version that nearly reached a vote in March, the CBO suggested about 24 million people were in danger of losing their coverage.

An amendment to the bill the second time around introduced by U.S. Rep. Fred Upton (R-Michigan), would establish funds for a “high risk” pool, which would be used to provide coverage for people with pre-existing conditions.

“The high-risk pool plan is an attempt to cover up for another provision in the bill, via an amendment by New Jersey Rep. Tom MacArthur (R), that would allow states to easily waive protections for Americans with pre-existing conditions in the individual market if they experienced a gap in coverage,” according to the Center for American Progress, a nonpartisan policy institute.

U.S. Rep. Tom Suozzi (D-Glen Cove), of New York’s 3rd Congressional District, was among those critics. He voted against the bill.

“I’m disappointed that House Republicans chose not to work with Democrats to create a common-sense bill,” Suozzi said in a statement. He also called on the Senate to disregard the legislation and focus on working toward a bipartisan solution.

“It will result in skyrocketing premiums, higher out-of-pocket costs, a discriminatory age tax and will steal from Medicare,” he said. “And all of this was done without an updated Congressional Budget Office score to determine how much the new amendment to the bill will cost taxpayers.”

Suozzi also addressed what it might mean for New Yorkers.

“For New Yorkers, this legislation leaves 2.7 million people without proper access to health insurance,” he said. “$4.7 billion will be cut from our state’s Medicaid budget, putting seven million people who rely on Medicaid services and other important programs at risk. This is a bad bill for New Yorkers, plain and simple.”

The bill establishes limits on federal funding for state Medicaid programs beginning in 2020. States that exceed the cap would be subjected to reduced federal funding in the following fiscal year, according to the summary of the bill.

The most notable changes in the new health care plan compared to the existing one include an elimination of the individual mandate, which required all Americans to purchase health insurance or be subject to a fine — a sticking point for many Republicans on Obamacare; a cut of federal Medicaid funding for Planned Parenthood for one year; adjusting tax credits based on age instead of income; and shifting Medicaid expansion set forth by Obamacare to the discretion of states instead of the federal government, among many others.

According to a map on the website of the Kaiser Family Foundation, a nonprofit organization established to deliver health policy analysis to the public, issuing tax credits based on age instead of income will result in some lower income Americans paying more for coverage.

“Generally, people who are older, lower income or live in high-premium areas receive less financial assistance under the AHCA,” analysis of the bill by the foundation said. “Additionally, older people would have higher starting premiums under the AHCA and would therefore pay higher premiums. Because younger people with higher incomes and living in lower-cost areas would receive more financial assistance and would have lower starting premiums on average, they would pay lower premiums on average.”

Kevin Dahill, president and CEO of Suburban Hospital Alliance of New York State, an organization that represents the advocacy interests of Long Island health systems including St. Catherine of Siena in Smithtown, and John T. Mather Memorial and St. Charles hospitals in Port Jefferson, issued a statement regarding the House bill.

“The revised version of the AHCA passed by the House is not sound health reform,” he said. “About 70 percent of Medicaid spending in our state covers care for the elderly and disabled, including children. These people will still need care. And even more disheartening is the amendment to cut $2.3 billion in Medicaid funding by shifting the cost burden from the counties to the state. This amendment was advanced by [Republican] New York  Congressmen [John] Faso and [Chris] Collins and it leaves a huge hole in New York’s budget. … Access to insurance is meaningless if premiums are unaffordable and the coverage is not comprehensive.”

Dr. Gerard Brogan Jr., executive director at Huntington Hospital, said he would put the ACA and AHCA in the same category as flawed legislation during a phone interview. He also reiterated Dahill’s concerns that the changes put a large number of people at risk of losing their access to adequate care because of changes to Medicaid.

“There are portions that are either not derived from sound assumptions or won’t accomplish what are the issue that we need to deal with,” he said.

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