Above, Harbor Country Day students and staff, along with two U.S. Marines, stand in front of a truck filled with Toys for Tots donations. Photo courtesy of Harbor Country Day School
On Dec. 14, United States Marines from the Sixth Communications Battalion, Alpha Company, in Farmingdale, visited Harbor Country Day School in St. James to collect thousands of toys donated to the Suffolk County Toys for Tots program. In addition to collecting donated toys from its own students, Harbor Country Day also served as a drop-off location for the surrounding community.
Harbor Country Day has contributed to the Toys for Tots drive since 1998, when former Harbor employee Mike Guido instituted the program. Now retired from the school, Guido directs the delivery of toys from various sites throughout Smithtown to Harbor Country Day and other drop-off locations. The John W. Cooke V.F.W. Post 395 of St. James, of which Guido is a member, also contributed funds, which were used to purchase toys for the drive.
“We are honored to play a part in the Suffolk County Toys for Tots program,” said John Cissel, head of school for Harbor Country Day School. “During this time of year, when our lives are exceptionally busy and hectic, we cherish the opportunity to slow down a bit and remind our students about the importance of ‘stepping outside of ourselves’ and helping others in need. The Toys for Tots program is a perfect opportunity to do that and, at the same time, to make a valuable contribution to our surrounding community.”
Members of the Laurel Hill student council prepare to wrap presents purchased for two families in need. Photo courtesy of Laurel Hill School
During the holidays this December, Laurel Hill School in East Setauket, led by its student council, partnered with an organization called Toys of Hope and The Child and Family Services of NY to adopt a family in need and help bring a little of the spirit of the holidays to them.
Families chosen for the Adopt-A-Family program are living in homeless shelters or have been referred to Toys of Hope by county social service agencies, schools, hospitals, fire departments, religious institutions and other service organizations. Members of these families often suffer from illness or disabilities that prevent them from working.
The children and families of Laurel Hill raised $2,565 in cash and gift cards and purchased two vouchers for oil deliveries for two Long Island families. On Dec. 18, 2016 the student council members, their parents and third-grade teacher Mrs. Stine met at the Setauket Walmart, Toys R Us and Costco to shop for toys, books, blankets, clothes, boots and health and beauty essentials for the families and their pets as well as cereals, soups, pasta and a complete feast for a family of five and a family of four, making their holiday a little brighter.
The Mount Sinai Harbor, above, will undergo jetty reconstruction to make navigation easier and bring back winter shellfishing. File photo by Erika Karp
The Town of Brookhaven stands stronger than ever in the midst of a major economic lag in Suffolk County as it enters the new year.
During the final Brookhaven town board meeting of last year, on Dec. 15, Supervisor Ed Romaine (R) announced several large bond resolutions, including one for $4.5 million to pay for the dredging and restoration of Lily Lake in Yaphank and another for $12.3 million to pay for the resurfacing of various town-owned roads. These bonds will help move forward the long-term capital projects within his approved budget for 2017 — to the concern of some residents in attendance unsure as to why so much money was being proposed all at once.
The projects will be made possible with the help of bonds secured by the Town of Brookhaven, which Supervisor Ed Romaine helped secure. File photo by Rachel Shapiro
But the supervisor insists that taxpayers in Brookhaven have nothing to worry about in terms of fiscal spending.
“This is no different than what we’ve done every other year,” Romaine explained in a phone interview. “Each year, we have to authorize bond resolutions, have to go to bond counsel, and then float the bond [into the bond market] because long-term assets are what you borrow for. We need the money in 2017 and we want to get a head start on that.”
In fact, he said, Brookhaven’s borrowing in terms of bonding out is down and the township pays off its bonds well before their maturity dates in most cases.
“We don’t spend money we don’t have,” Romaine said. “When we go to bond, we go to bond very cautiously, we try to pay off our bonds very quickly, and we don’t believe in taking on too much debt.”
For instance, Romaine said, Brookhaven is the only town in all of Long Island that has paid off all of its pension debt.
“We have reserve funds for when the town landfill is closed, [as well as] a snow reserve fund of up to $2 million on top of the $6 million budgeted for snow in case we get a really heavy year,” he said.
While most every municipality in Suffolk County struggles with tremendous debt, Brookhaven has been prosperous. Standard and Poor’s Financial Services assigned its AAA credit rating to the town, the highest designation issued by the New York City-based agency. The AAA rating means Brookhaven has been recognized as having strong capacity to meet financial commitments.
It was its top-tier credit rating that allowed Brookhaven to acquire so much money for capital projects and low interest rates.
“When we go to bond, we go to bond very cautiously, we try to pay off our bonds very quickly, and we don’t believe in taking on too much debt.”
—Ed Romaine
“Where a lot of Suffolk County has been downgraded, we’re the largest town in Suffolk County and we’re getting upgraded to the highest level possible, and I think that speaks to the supervisor’s leadership and fiscal discipline,” Department of Waste Management Commissioner Matt Miner said. “We’re close to reducing [more than] $30 million in pipeline debt … and on the operating budget, he’s been very disciplined in how to spend taxpayer money, and we’re complying with the New York State property tax cap. We’re one of the few municipalities to do so.”
As for the planned projects described in the bond resolutions, Romaine said the ones most important and expensive for the North Shore will be revitalizing Lily Lake to get rid of invasive weeds and restore it back as a recreational haven, reconstructing the jetties in Mount Sinai Harbor to make boat navigation easier and help bring back shellfishing in the winter and continuing to work with the highway department to improve and pave roads.
Other resolutions included the issuance of $2.5 million to pay the cost of various original improvements to the town landfill, including, but not limited to, gas management, odor control and leachate control improvements and $600,000 to pay the cost of acquisition and installation of various equipment for use at town facilities.
A six-year-old James meets Hillary Clinton in 2008. Photo from Anne Shybunko-Moore
On Friday, Jan. 20, about 900,000 people are expected to be gathered on the National Mall in Washington, D.C. to witness Donald Trump being sworn in as the nation’s 45th president.
Among the crowd of thousands will be selected future leaders from schools across the country, including James Moore, a sophomore at Ward Melville High School, who will represent Long Island in a five-day program surrounding the historic event.
The Presidential Inauguration Leadership Summit, held between Jan. 18 and 22, gives students like James the opportunity to take part in a series of workshops, seminar discussions and presentations that coincide with the inauguration, listen to world-renowned speakers — some of this year’s honored guests include General Colin Powell, the youngest-ever Nobel Laureate Malala Yousafzai via video satellite, renowned filmmaker Spike Lee, former governor of Maryland Martin O’Malley (D) and Fox News commentator Tucker Carlson — and gain a perspective on local, national and global issues facing their generation.
Ward Melville High School student James Moore will attend the Presidential Inauguration in Washington, D.C. Jan. 20. Photo from Anne Shybunko-Moore
James was invited to participate in the exclusive experience as an alumnus of the Junior National Young Leaders Conference, which he was chosen to join by his elementary school teacher when he was entering seventh grade.
He served on the student council and Junior Honor Society while at Gelinas Junior High in East Setauket, received Triple C Award upon graduating sixth grade for demonstrating outstanding “Courage, Character, and Commitment throughout the school,” has volunteered at Island Harvest packaging food for the homeless and received the New York State Scholar-Athlete Team Award in 2015 as a varsity-level track runner who maintained a GPA of 90 percent or better during the season.
Additionally, James volunteers at Setauket Presbyterian Church by helping to teach Sunday school.
“Being part of history is a big part of why I wanted to go,” James said in an interview. “I’m looking forward to hearing the other side of politics, how people are seeing things from around the country, and just getting to be with people who are similar to me … it’s cool to be able to think and be part of this [moment] together.”
He said the 2016 presidential election was “surprising” and “interesting to watch.”
“I remember waking up after the election was over going ‘wow, that happened?’” he said. “[But] I’m not upset with it and I’m not going to go out and complain about it but it threw me off.”
While he said he’s excited about learning more about the political process, and hearing Yousafzai’s speak in particular, the 15-year-old from Setauket is no stranger to interacting with major politicians and voicing his thoughts on social, environmental and community issues in public forums.
In fact, as the son of two presidents of major defense and trade manufacturing companies on Long Island whose event guest lists frequently include Hillary and Bill Clinton, James has been politically engaged practically since birth.
“He’s met Bill and Hillary a few times, Congressman Steve Israel, Congressman Tim Bishop; he’s met these folks and he’s very confident and comfortable in speaking with people in leadership roles,” his mother, GSE Dynamics President Anne Shybunko-Moore, said. “James has grown up in a very aware environment … because of what I do, we’re always watching the news and talking about the issues.”
“I remember waking up after the election was over going ‘wow, that happened?’”
— James Moore
James even participated in Hillary Clinton’s campaign last February and is interested in an internship position at Assemblyman Steve Englebright’s (D-Setauket) office.
His mother said her son has a “sincere realness” that makes him a natural leader.
“He’s always been very thoughtful,” she said. “He’ll see a situation and be like ‘what can I do to help or change that?’ That’s just who he is.”
James’ father, Manufacturing Consortium of Long Island President Jamie Moore, said he hopes his son gets a “fire lit” and obtains an understanding of what he can do with his life from his experience in Washington.
“I see so many of these kids just kind of floating through, and playing Pokemon Go or whatever, and there are so many opportunities they could be doing to increase their knowledge, help out other people, help other communities and this is one of those things that will hopefully help open his eyes and give him some ideas,” he said. “We try to craft that by giving him enough experiences to get out there and try new things.”
While in D.C., James said he’ll be following his program itinerary by day and studying for his school midterms by night.
Dear Readers, Welcome to our newest column in Arts & Lifestyles! Long Island is home to many wonderful and talented artists. Each month we will feature a local artist who will share his or her favorite paintings as well as their own personal story.
’Art is not what I do, art is who I am.’ — Renee Caine‘In the Moment’
Holbrook resident Reneé Caine has shown her work around Long Island for the past 20 years, most notably with the Huntington Arts Council, East Hampton Guild, Catherine Lorillard Art Club and the Watermill Museum. For the past eight years, she has exhibited with the Setauket Artists at the Setauket Neighborhood House and is a member of LIMarts. Currently, Caine is Artist of the Month at the LIMarts latest exhibit at The Long Island Museum’s Visitors Center titled Inspired By …, which is on view through Jan. 29.
What is your background in art?
I have drawn, painted or created some form of art my entire life. I received my bachelor’s of fine arts from Dowling College with a major in art education and a master’s of arts liberal studies with an emphasis in art from Stony Brook University. I have explored all types of medium including watercolor, gouache, oil, acrylic, chalk, oil pastel, pottery, clay sculpture, printmaking, soap stone carving and bronze casting.
I taught art to grades K-12 in several districts with the last 18 years of my career teaching in the Three Village school district. When I taught, I let my students know that I was a working artist and they loved to see my work. It is rewarding to see students show up at my exhibits! I have even been critiqued by a few of them using the skills I taught them!
‘Peconic River’
Who influenced you to become an artist?
My grandmother was a respected watercolorist in St. Paul, Minnesota, so I think some of my talent is genetic. For years, I followed in her footsteps painting in watercolor, but now I am painting in oils.
What is your motivation?
Picasso once said his art “was like a visual diary.” That is exactly how I feel about my work. My paintings are a reflection of where I’ve been and what I’ve seen that has caught my eye or spoken to me. When I paint, I want to draw the viewer into my “Ah” moment. I am showing the viewer what caught my eye: color, light, shadow, contrast and textures in everything around us.
How would you describe your art?
I am a realist. My work is representational. I want the viewer to experience what I felt when I saw “It.” Although realistic, I still use “artistic license” to make changes. I do not try to improve on mother nature, but at times try to clean up man’s debris. My paintings are calm, restful and peaceful and I invite the viewer to step into my world to escape for a while. However, there are times that I wish to experiment with contemporary genres such as “Hello,” which won an award at a LIMarts exhibit titled I’ve Got the Music in Me.
‘Parisian Door, Number 4,’
Do you have any early memories of your art?
My first painting I ever sold was a nine by twelve oil pastel of a horse grazing in a field. I was in ninth grade when the secretary in the office wanted to buy it. She paid me $20 saying, “You will sell many of your paintings in your life, but you will always remember the first one you sold.” She was right as that experience was a wonderful incentive and affirmation for a child.
Do you have a favorite painting?
I remember the day I was in the Metropolitan Museum of Art and saw Johannes Vermeer’s “Young Woman with a Water Jug” painted in 1632. Having seen it only in textbooks, I was surprised by how small it was. Although small, I found it was powerful. Vermeer’s use of light so astounded me that it remains my favorite painting to this day.
Where is your favorite place to paint?
I am quite sure that Giverny, France, is now and will remain the most motivating place I’ve ever been. While walking through Monet’s home and gardens, I felt almost transformed to another time. As I was processing all the beauty surrounding me, I felt the enormous energy there.
What is your process when painting?
When something inspires me I take many photographs of the subject from different angles and with different lighting; then I visualize the composition in my head. It is not unusual for me to think about a painting for a couple of months before I paint it.
What is your vision for your future in art?
I feel my talent is God-given, therefore, it is my wish to develop it to the fullest. I want each painting to be an improvement over the last one. With each painting I learn something new. Growth is my quest! Keep growing, keep learning is my motto! Since I retired, I am devoting myself to my art full time and immersing myself into the art community. In the new year, I am especially looking forward to working with Neil Watson by becoming a member of the steering committee for LIMarts.
What are your other interests?
Outside of my devotion to my husband, daughter, son and three adorable grandsons, I’m an avid gardener. My property is my living sculpture. I have color from early April to late November. I have nooks, crannies and brick walkways I designed and put in myself. My vegetable garden feeds my family all summer and growing an abundance of cucumbers supplies us with pickles that we enjoy all winter. When I’m not gardening, I can be found painting in my garden! I will continue to grow as art is not what I do, art is who I am.
From left, Debbie Reynolds, Donald O’Connor and Gene Kelly in a scene from ‘Singin’ in the Rain. Courtesy Warner Bros. Home Entertainment Inc.
What a glorious feeling!
In celebration of its 65th anniversary, Fathom Events, Turner Classic Movies and Warner Bros. Entertainment will bring “Singin’ in the Rain” back to nearly 700 select cinemas nationwide on Wednesday, Jan. 18 at 2 p.m. and again at 7 p.m. as part of its TCM Big Screen Classics series. Running time is 2 hours.
The event, which gives audiences a chance to see Debbie Reynolds in her breakout role and Gene Kelly at the pinnacle of his career, also includes exclusive commentary from Turner Classic Movies host Ben Mankiewicz, who will give insight into this classic film. Starring Reynolds, Kelly, Donald O’Connor, Jean Hagen, Cyd Charisse and Rita Moreno, the 1952 classic is still as fresh and delightful as the day it was released.
Musician Don Lockwood (Kelly) rises to stardom during Hollywood’s silent-movie era — paired with the beautiful, jealous and dumb Lina Lamont (Jean Hagen). When Lockwood becomes attracted to young studio singer Kathy Selden (Reynolds), Lamont has her fired. But with the introduction of talking pictures, audiences laugh when they hear Lamont speak for the first time — and the studio uses Selden to dub her voice.
“Sixty-five years ago, no one dreamed that we would still be watching ‘Singin’ in the Rain’ in 2017,” said Gene Kelly’s widow, film historian Patricia Ward Kelly. “Gene would be very proud.” “Singin’ in the Rain,” set in the days of Hollywood’s transition from silent films to “talkies,” continues to this day to provide pure cinematic entertainment. Written by legendary musical “book” writers Betty Comden and Adolph Green, “Singin’ in the Rain” was helmed by renowned directors Gene Kelly and Stanley Donen. The film was nominated for two Academy Awards and is the No. 1 musical on the American Film Institute’s (AFI) list of the “25 Greatest Movie Musicals” (2007) and No. 5 on AFI’s “100 Years, 100 Movies” list (2007).
Participating movie theaters in our neck of the woods include AMC Loews Stony Brook 17, 2196 Nesconset Highway, Stony Brook; Farmingdale Multiplex Cinemas, 1001 Broadhollow Road, Farmingdale; and Island 16 Cinema de Lux, 185 Morris Ave., Holtsville.
Future “TCM Big Screen Classics” films for 2017 will include “Some Like It Hot,” “The Godfather,” “The Graduate,” “Guess Who’s Coming to Dinner,” “An Affair to Remember,” “All About Eve,” “The Princess Bride,” “Smokey and the Bandit,” “Fast Times at Ridgemont High,” “E.T. The Extra-Terrestrial,” “North by Northwest,” “Bonnie and Clyde” and Casablanca.” For more information, visiti www.fathomevents.com.
For many, the question of how to best care for our aging loved ones becomes a reality sooner than we think. Most people, when given the option, would prefer to age in place, remain in their homes for as long as possible receiving the care services they need in a familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid, makes that an affordable and therefore viable option.
Oftentimes we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most cases, that is not the case. Although an applicant for Community Medicaid must meet the necessary income and assets levels, it is important to note that there is no “look back” for Community Medicaid. What this means is that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period, allowing families to mitigate the cost of caring for their loved ones at home.
An individual who is applying for Medicaid Home Care may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource so long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also an exempt resource. The primary residence is an exempt asset during the lifetime of the Medicaid recipient; however, if the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away.
With respect to income, a single applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, if the applicant has income that exceeds that $845 threshold, a pooled income trust can be established to preserve the applicant’s excess income and direct it to a fund where it can be used to pay his or her household bills.
These pooled trusts are created by not-for-profit agencies and are a terrific way for persons to take advantage of the many services available through Medicaid Home Care while still preserving their income for use in meeting their monthly expenses.
Functionally, the way that these trusts work is that the applicant sends a check to the fund monthly for that amount that exceeds the allowable limit. Together with the check, the applicant submits household bills equal to the amount sent to the trust fund. The trust deducts a small monthly fee for servicing these payments and then, on behalf of the applicant, pays those household bills.
As you can see, this process allows the applicant to continue relying on his monthly income to pay his bills and, at the same time, reduce his countable income amount to the amount that is permitted under the Medicaid rules. An individual who is looking for coverage for the cost of a home health aide must be able to show that they require assistance with their activities of daily living. Some examples of activities of daily living include dressing, bathing, toileting, ambulating and feeding. In fact, where the need is established, the Medicaid program can provide care for up to 24 hours per day, seven days per week.
The Community-Based Medicaid Program is an invaluable program for many seniors who wish to age in place but are unable to do so without some level of assistance.
Nancy Burner, Esq. practiceselder law and estate planning from her East Setauket office.
THE SAILOR Gerard Romano of Port Jefferson Station captured this image of the sailor statue at the Mary Bayles Waterfront Park before the North Shore’s first snowfall this year using a Nikon D3100 with a Nikon 10.5 mm fish eye lens. Danfords Hotel & Marina appears in the background. According to the Port Jefferson Historical Society’s website, the statue, which gazes out over the waters of Port Jefferson Harbor, was dedicated to the park in 1984, ‘‘In recognition of the shipbuilders who from the late 1700s launched over 400 vessels to answer the call of country, commerce, whaling and pleasure.”
I’m sure we all can agree that type 2 diabetes is an epidemic that needs to be discussed again. Again, because this disease is just not going away. There are a number of different drug classes to treat diabetes, and these classes keep on growing in number and diversity; each has its merits and drawbacks. Since there are so many drugs and drug classes, you will need a scorecard to keep track.
When we talk about this disease, the first thing that comes to mind is glucose levels, or sugar, which is what defines having diabetes. However, we are going to look beyond the sugars to the nonglycemic effects.
What do I mean by this? There seems to be a renaissance occurring where there is a focus in drug trials on the treatment of diabetes complications rather than just the lowering of sugars. Some of the complications that we will investigate include cardiovascular disease and nonalcoholic fatty liver disease (NAFLD). Several drugs may reduce the risk of cardiovascular disease (CVD) mortality. Diabetes patients who have cardiovascular disease are more likely to die about 12 years prematurely (1). However, new research suggests that relatively new diabetes drugs reduce the risk of CVD mortality. These include empagliflozin (Jardiance), a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and liraglutide, a glucagon-like peptide-1 (GLP1) receptor agonist. There is also a third, older drug that has shown CVD risk benefit, metformin. Though these drugs are not without their caveats. Liraglutide has also been shown to potentially reduce the risk of nonalcoholic fatty liver disease.
In fact, the American College of Physicians has recently updated its recommendations on the treatment of type 2 diabetes with oral medications (2). The first line continues to be metformin, the tried and true. The favored second-line drugs to add to metformin may be the SGLT2 cotransporter inhibitors, such as empagliflozin, or DPP-4 inhibitors, such as sitagliptin. The sulfonylureas class, such as glimepiride, and thiazolidinediones class, such as pioglitazone, are also consider second line but not as favorable. GLP1 receptor agonists, such as liraglutide, are not on the list, since they are injectable medications. There are always downsides to drug therapy, and diabetes drugs are no exception. Drawbacks include expense with newer drugs, as well as adverse side effects with all of these drugs, new and old. Though empagliflozin has been shown to reduce CVD mortality, others in the same class have been shown to increase the risk of acute kidney failure.
Before I go any further, I want to state that lifestyle modifications including a plant-based diet and exercise are likely the most powerful tools we have in treating, preventing and reversing diabetes. So, I am not a proponent of diabetes drugs. But, there are many patients who could and do benefit from drug therapy. Lifestyle modifications should always be a significant component whether on drugs or not. Recently, plant-based diets were ranked highly for treating and preventing diabetes in U.S. News and World Report, with the DASH (dietary approach to stop hypertension) diet ranked number one and the Mediterranean diet number two (3), although rankings are not the be-all and end-all. Let’s look at the evidence.
New diabetes drugs may reduce cardiovascular mortality.
Drug benefit on cardiovascular disease
As I mentioned, there are two new drugs, empagliflozin and liraglutide, and one older drug, metformin, that have shown potentially beneficial effects on the macrovascular portion of diabetes treatment and prevention — cardiovascular disease. For the longest time, most diabetes drug trials were focused only on reducing sugars, not on clinical end points.
Empagliflozin
In a the EMPA-REG OUTCOME trial, a randomized, double-blind, placebo-controlled trial, results showed that empagliflozin reduces the risk of cardiovascular mortality (heart attack or stroke) by a relative 38 percent compared to placebo in patients with type 2 diabetes and cardiovascular disease (4). There was also a 32 percent reduction in all-cause mortality compared to the placebo group. Two different doses of empagliflozin were used with similar results, 10 mg and 25 mg once a day. There were 7,020 patients with a duration of 3.1 years. Most of those in the placebo arm were on statin (cholesterol) drugs, ACE inhibitors (blood pressure medication) and aspirin.
The FDA approved this drug for the prevention of heart attacks and strokes in diabetes patients with known cardiovascular disease (5). However, the FDA advisory board only narrowly recommended the drug for this label (6). The label change is based on one trial, and the mechanism for CVD mortality reduction is unclear. However, there are several pitfalls to this study. Empagliflozin was compared to placebo, rather than the usual standard of care, and these patients had cardiovascular disease, which means that we don’t know if the benefit actually holds true in those without CVD. Interestingly, the placebo group’s HbA1C was 8.2 percent at the trial’s end, while the treatment group was reduced to 7.8 percent, neither of which is considered controlling the sugar levels. The treatment group saw a 0.5 percent reduction in HbA1C, which is not overwhelming.
In terms of adverse reactions, empagliflozin increases the risk of urinary tract infections and diabetic ketoacidosis, since sugar is excreted through the urine. In fact, the FDA warned that two drugs from the same class as empagliflozin increase the risk of acute renal failure. These are canagliflozin (Invokana) and dapagliflozin (Farxiga) (5).
Liraglutide
In the LEADER trial, a randomized controlled trial, results showed that liraglutide 1.8 mg subcutaneous injection daily decreased the risk of CVD mortality by a significant 22 percent compared to placebo plus standard care after 3 years (7). This is the highest tolerated dose. This trial involved over 9,000 type 2 diabetes patients at high risk for CVD. Liraglutide also showed a 2.3-kg (5-lb) weight reduction and 0.4 percent HbA1C drop compared to placebo by the 3-year mark. The duration of trial was 3.5 to 5 years. The most significant side effects were gastrointestinal and increased heart rate. In another study, results showed that liraglutide reduced the liver fat in 57 NAFLD patients who were not adequately controlled on metformin, insulin or sulfonylureas (8). After six months, the liver fat in these patients decreased by 33 percent. The patients also lost almost 8 lb of weight and reduced HbA1C by 1.6 percent from 9.8 to 7.3.
Metformin
In a retrospective (backward-looking) study of over 250,000 diabetes patients, there was a greater than 40 percent reduction in cardiovascular events or mortality with metformin compared to sulfonylureas (9). However, a retrospective study is not the most reliable.
Triglyceride-lowering drug reduces CVD
Fenofibrate, which had been shown not to be of benefit, may actually help reduce CVD in a specific group of diabetes patients. In a recent analysis of the ACCORDION trial, a subset of data suggests that diabetes patients with triglycerides >204 mg/dL and HDL <34 mg/dL, when treated with fenofibrate in addition to statins, saw a 27 percent significant reduction in cardiovascular events (10). This was an observational study that requires confirmation with a randomized controlled trial. Thus, there may be a use, though a narrow one, for fenofibrate.
It is potentially exciting that drugs may reduce cardiovascular mortality in diabetes patients. If you do chose one or more of these drug therapies after discussing it with your physician, remember these drugs are in addition to continuing to work on diet and on exercise — the cornerstone of therapy.
References: (1) JAMA. 2015;314(1):52-60. (2) Ann Intern Med. online Jan. 3, 2017. (3) usnews.com. (4) N Engl J Med 2015; 373:2117-2128. (5) FDA.gov. (6) Medscape.com. (7) N Engl J Med 2016; 375:311-322. (8) J Clin Endocrinol Metab. Online Oct. 12, 2016. (9) Ann Intern Med. 2012 Nov. 6;157(9):601-610. (10) JAMA Cardiology online Dec. 28, 2016.
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.
Born in Berlin just before World War II, Eckard Wimmer has dedicated himself in the last 20 years to producing something that would benefit humankind. A distinguished professor in molecular genetics and microbiology at Stony Brook University, Wimmer is hoping to produce vaccines to prevent the spread of viruses ranging from influenza, to Zika, to dengue fever, each of which can have significant health consequences for people around the world.
Using the latest technology, Wimmer, Steffen Mueller and J. Robert Coleman started a company called Codagenix in Melville. They aim to use software to alter the genes of viruses to make vaccines. “The technology we developed is unique,” said Wimmer, who serves as senior scientific advisor and co-founder of the new company.
Mueller is the president and chief science officer and Coleman is the chief operating officer. Both worked for years in Wimmer’s lab. Despite the potential to create vaccines that could treat people around the world facing the prospect of debilitating illnesses, Wimmer and his collaborators weren’t able to attract a pharmaceutical company willing to invest in a new technology that, he estimates, will take millions of dollars to figure out its value.“Nobody with a lot of money may want to take the risk, so we overcame that barrier right now,” he said.
Eckard Wimmer in his lab. Photo by Naif Mohammed Almojarthi
Codagenix has $6.2 million in funding. The National Institutes of Health initially contributed $600,000. The company scored an additional $1.4 million from NIH. It also raised $4.2 million from venture capital, which includes $4 million from TopSpin and $100,000 from Accelerate Long Island and a similar amount from the Center for Biotechnology at Stony Brook University.
Stony Brook University recently entered an exclusive licensing agreement with Codagenix to commercialize this viral vaccine platform. Codagenix is scheduled to begin phase I trials on a vaccine for seasonal influenza this year.
The key to this technology came from a SBU collaboration that included Wimmer, Bruce Futcher in the Department of Molecular Genetics & Microbiology and Steven Skiena in the Department of Computer Science. The team figured out a way to use gene manipulation and computer algorithms to alter the genes in a virus. The change weakens the virus, giving the attack dog elements of the immune system a strong scent to seek out and destroy any real viruses in the event of exposure.
Wimmer explained that the process starts with a thorough analysis of a virus’s genes. Once scientists determine the genetic code, they can introduce hundreds or even thousands of changes in the nucleic acids that make up the sequence. A computer helps select the areas to alter, which is a rapid process and, in a computer model, can take only one afternoon. From there, the researchers conduct experiments in tissue culture cells and then move on to experiment on animals, typically mice. This can take six months, which is a short time compared to the classical way, Wimmer said.
At this point, Codagenix has a collaboration with the Universidad de Puerto Rico at the Caribbean Primate Research Center to treat dengue and Zika virus in primates. To be sure, some promising vaccines in the past have been taken off the market because of unexpected side effects or even because they have become ineffective after the virus in the vaccine undergoes mutations that return it to its pathogenic state. Wimmer believes this is unlikely because he is introducing 1,000 changes within a vaccine candidate, which is much higher than other vaccines. In 2000, for example, it was discovered that the polio vaccines involve only five to 50 mutations and that these viruses had a propensity to revert, which was rare, to the type that could cause polio.
Colleagues suggested that this technique was promising. “This approach, given that numerous mutations are involved, has the advantage of both attenuation and genetic stability of the attenuated phenotype,” Charles Rice, the Maurice R. and Corrine P. Greenberg professor in virology at Rockefeller University explained in an email.
While Wimmer is changing the genome, he is not altering the structure of the proteins the attenuated virus produces, which is exactly the same as the virus. This gives the immune system a target it can recognize and destroy that is specific to the virus. Wimmer and his associates are monitoring the effect of the vaccines on mosquitoes that carry and transmit them to humans. “It’s not that we worry about the mosquito getting sick,” he said. “We have to worry whether the mosquito can propagate this virus better than before.” Preliminary results show that this is not the case, he said.
Wimmer said there are many safety precautions the company is taking, including ensuring that the vaccine candidate is safe to administer to humans. Wimmer moved from Berlin to Saxony after his father died when Wimmer was 3. He earned an undergraduate degree in chemistry in 1956 at the University of Rockstock. When he was working on his second postdoctoral fellowship at the University of British Columbia in Vancouver, he heard a talk on viruses, which brought him into the field.
A resident of Old Field, Wimmer lives with his wife Astrid, a retired English professor at Stony Brook. The couple’s daughter Susanne lives in New Hampshire and has three children, while their son Thomas lives in Portland, Oregon, and has one child. “We’re very happy Long Islanders,” said Wimmer, who likes to be near the ocean and Manhattan.
Through a career spanning over 50 years, Wimmer has won numerous awards and distinctions. He demonstrated the chemical structure of the polio genome and worked on polio pathogenesis and human receptor for polio. He also published the first cell-free creation of a virus.
“This was an amazing result that enabled a number of important mechanistic studies on poliovirus replication,” Rice explained. Wimmer has “always been fearless and innovative, with great enthusiasm for virology and discovery.”
With this new effort, Wimmer feels he will continue in his quest to contributing to humanity.
The event, which gives audiences a chance to see Debbie Reynolds in her breakout role and Gene Kelly at the pinnacle of his career, also includes exclusive commentary from Turner Classic Movies host Ben Mankiewicz, who will give insight into this classic film. Starring Reynolds, Kelly, Donald O’Connor, Jean Hagen, Cyd Charisse and Rita Moreno, the 1952 classic is still as fresh and delightful as the day it was released.
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