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This is the season for speeches. We’re about to enter the graduation and wedding time of year, when principals, best men, maids of honor and valedictorians stand in front of a group of people and share their thoughts during these momentous occasions.

For those about to grab the microphone, I’d like to offer my top 10 list of things not to do in a speech — in reverse order.

10. Don’t make inside jokes that no one, outside of your best friend and maybe your sibling, understands. Looking at your friend after you’ve made a joke that no one gets and pointing back and forth between this other person and you only endangers that friendship.

9. Don’t make a speech without practicing. Find someone who can be helpful and not someone who thinks you shouldn’t change anything you do, ever. That honest person might prevent you from saying, “The groom is so lucky. He gets to sleep with Karen — I always wanted to sleep with Karen. I can’t wait to hear about it.”

8. Don’t correct yourself on small details, such as, “Remember when we had that school snowball fight in second grade? No, wait it was first grade, right? No, no, it was second grade. I was right the first time.” Most people won’t care about those details. They’d rather you got it wrong than hear you go play a one person game of memory ping-pong.

7. Don’t forget to thank everyone you should thank. You can acknowledge your friends for helping you get through those tough years, the writers of your favorite movies for giving you a chance to laugh, and the woman at the supermarket for encouraging you to submit an application that got you into a summer program. Never forget to thank your parents, any relatives who are in attendance and the teachers who somehow managed to educate you despite your insistence that their subject was irrelevant.

6. Don’t imagine that alcohol makes you a better singer. It doesn’t. Besides, there’s always an enormous collection of cellphones at any wedding. You can’t erase that horrible rendition of “You’ve Lost That Loving Feeling.” Ever. Strangers will come up to you and screech at you.

5. Don’t quote someone else extensively. Winston Churchill was a tremendous speechmaker, JFK said some memorable things, too, as did Martin Luther King Jr. Audiences can read and have no desire to hear you butcher an extensive collection of words someone else delivered.

4. Don’t try to sell something. You’re there to support the graduate, the bride and groom and numerous families. This isn’t the time to suggest that people moved by your speech can pick up tissues at your store
because you sell the softest tissues in town.

3. Don’t talk about how difficult it is for you to give a speech. Chances are the audience supports you
anyway, so there is no need to tell them, over and over again. If you aren’t particularly good at public speaking, they’ll notice.

2. Don’t look down at your poorly written notes during the entire speech. If you look up once in a while, you won’t sound like you’re muttering anecdotes and advice in your sleep.

1. Don’t give a long speech. The most important part of any speech is to keep it short. Sure, you might be funny and have some words of wisdom that people will remember. And, yes, you might recall an
anecdote that sheds light on the people in your class. People want to eat dessert, go to a party, or throw their ridiculous square hats with tassels into the air for the annual picture of stupid hats in the air. A good rule of thumb for speeches: When in doubt, leave it out.

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For those of us who remember the savage Korean War (1950-53) and the various attempts at a peace treaty over the years, North Korea’s leader Kim Jong-un’s pirouette from warmonger to statesman is astonishing. All of us remember the test missiles that were fired from North Korea, some over Japan, into the sea as recently as last year.

We also remember the bellicose rhetoric about being able to reach the continental United States from North Korea with those missiles.

What happened?

First there was President Donald Trump’s equally bellicose rhetoric, some of it personally aimed at North Korea’s leader, referred to as “Little Rocket Man.” Trump was severely criticized at the time for sounding like a schoolyard bully rather than a diplomatic leader. The world watched in horror, wondering if we were on the edge of nuclear war. All the while North Korea’s ongoing tests were apparently successful. Probably the most concerned was South Korea’s new leader, Moon Jae-in.

Next came the Winter Olympics serendipitously and President Moon’s invitation to the North Koreans to participate under one flag. This too was unprecedented. Kim accepted and perhaps more tellingly sent his sister as his representative. She seems to be one family member he trusts. We all witnessed the diplomatic success at the Olympics.

In retrospect, something seems to have changed after that. Was it a new perspective for the two Koreas as a result of the games? Or did it have some connection to the subsequent visit Kim made to China in the middle of one night? I believe that was Kim’s first trip out of his country, and of course it is significant that he chose to visit Premier Xi Jinping. Was Kim invited or did he request the meeting? What advice was he given by the powerful Chinese leader, who seems to have established a rapport with Trump? What will the Chinese, with their long-term view, want to happen now?

At this point, Kim has been counseled, Moon has been galvanized and the tenor of the Korean debate begins to shift. Kim invites Trump to meet with him, and over the objections of our diplomats, Trump immediately accepts. There is no doubt that Trump is partially responsible for this shift.

The two Korean leaders then enter into a diplomatic choreography with lots of positive dialogue that plays well for the people of both Koreas, and the rest of the world for that matter, who want peace. In war, it is humankind that suffers terribly, and the people can only hope and pray for their leaders to keep the peace.

So what does North Korea want, as far as we can tell? Certainly Kim wants to stay in power as the No. 1 priority. So far his most visible achievement is his development of nuclear missiles. He also professes to want an improved economy. In fact, he was surprisingly forthright about the woeful condition of his roads and infrastructure in talking with Moon. When North Koreans went to the Olympics, they were apparently impressed by the South’s trains — and probably everything else that attests to a good economy.

The South wants to eliminate the threat of nuclear war and confrontation. And perhaps it wishes to invest in the economic recovery of the North, where there will be money to be made. The Chinese would like to see the United States leave the Korean Peninsula. I would be keenly interested in what else China expert Henry Kissinger thinks the Chinese want. Undoubtedly the South would also like to see us go if peace is
somehow assured. There are some 30,000 American troops still stationed in South Korea.

And what would we like? We would first like the removal of nuclear weapons from North Korea and finally a formal peace treaty ending the 65-year conflict.

Those goals have seemed irreconcilable until now but perhaps what we will get is a prolonged peace.

Where is the Invisible Hand of China in the Current Korean Dance?

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Accumulating evidence supports an association between depression and inflammation. Stock photo
C-reactive protein is an important biomarker

By David Dunaief, M.D.

Dr. David Dunaief

Many of us have inflammation in our bodies, inflammation that is a potential underlying cause for a great number of diseases. Can we demonstrate the level of inflammation by measuring it? The answer is yes.

One of the most widely studied biomarkers for inflammation is high-sensitivity C-reactive protein (hsCRP), also referred to as CRP. High sensitivity means that we can measure levels as low as 0.3 mg/L more accurately.

What is the significance of the different levels? In heart disease, individuals who have levels lower than 1.0 mg/L are in the optimal range for low risk of inflammation. Levels of 1 to 3 mg/L represent the average risk range, and greater than 3.0 mg/L is a higher risk profile. Above 10.0 mg/L is less specific to heart disease, although still related, but more likely associated with other causes, such as infection and autoimmune diseases (1, 2). This biomarker is derived from the liver.

CRP is not specific to heart disease, nor is it definitive for risk of the disease. However, the upside is that it may be helpful with risk stratification, which helps us understand where we sit on a heart disease risk spectrum and with progression in other diseases, such as age-related macular degeneration, diabetic retinopathy, depression and autoimmune diseases. Let’s look at the evidence.

Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in patients over the age of 65 (3). Therefore, it is very important to help define risk stratification for this disease. In a prospective study, results showed that hsCRP levels were inversely associated with the risk of developing AMD. The group with an hsCRP greater than 3.0 mg/L had a 50 percent increased risk of developing overall AMD compared to the optimal group with hsCRP lower than 1.0 mg/L. But even more interestingly, the risk of developing neovascular, or wet, AMD increased to 89 percent in this high-risk group.

The significance of wet AMD is that it is one type of advanced-stage AMD that results in blindness. This study involved five studies where the researchers thawed baseline blood samples from middle-aged participants who had hsCRP levels measured. There were more than 2,000 participants with a follow-up as long as 20 years. According to the study’s authors, annual eye exams and lifestyle modifications, including supplements, may be able to stem this risk by reducing hsCRP.

These results reinforce those of a previous prospective study that showed that elevated hsCRP increased the risk of AMD threefold (4). This study utilized data from the Women’s Health Study, which involved over 27,000 participants. Like the study mentioned above, this one also defrosted blood samples from baseline and looked at follow-up incidence of developing AMD in initially healthy women.

The highest group had hsCRP levels over 5.2 mg/L. Additionally, when analyzing   similar cutoffs for high- and low-level hsCRP, as the above trial used, those with hsCRP over 3.0 had an 82 percent increased risk of AMD compared to those with an hsCRP of lower than 1.0 mg/L.

Diabetic retinopathy — a complication of diabetes

We know that diabetes affects approximately 10 percent of the U.S. population and is continuing to rise at a rapid rate. One of the complications of diabetes affects the retina (back of the eye) and is called diabetic retinopathy. This is a leading cause of vision loss (5). One of the reasons for the vision loss is macular edema, or swelling, usually due to rupture of tiny blood vessels below the macula, a portion of the back of the eye responsible for central vision.

The Diabetes Control and Complications Trial (DCCT), a prospective study involving over 1,400 Type 1 diabetes patients, showed an 83 percent increased risk of developing clinically significant macular edema in the group with the highest hsCRP levels compared to those with the lowest (6). Although these results were with Type 1 diabetes, patients with Type 2 diabetes are at equal risk of diabetic retinopathy if glucose levels, or sugars, are not well controlled.

Depression

Depression is a very difficult disease to control and is a tremendous cause of disability. If we can minimize the risk of complications and hospitalizations, this is probably the most effective approach.

Well, it turns out that inflammation is associated with depression. Specifically, in a prospective observational trial, rising levels of CRP had a linear relationship with increased risk of hospitalization due to psychological distress and depression (7).

In other words, compared to levels of less than 1 mg/L, those who were 1 to 3 mg/L, 3 to 10 mg/L and greater than 10 mg/L had increased risk from 30 to 84 to 127 percent, respectively. This study involved over 70,000 patients.

What can be done to reduce inflammation?

This is the key question, since we now know that hsCRP is associated with systemic inflammation. In the Nurses’ Health Study, a very large, prospective observational study, the Dietary Approaches to Stop Hypertension (DASH) diet decreased the risk of both heart disease and stroke, which is impressive. The DASH diet also decreases the levels of hsCRP significantly, which was associated with a decrease in clinically meaningful end  points of stroke and heart disease (8).

The DASH diet is nutrient dense with an emphasis on fruits, vegetables, nuts, seeds, legumes and whole grains and a de-emphasis on processed foods, red meats, sodium and sweet beverages.

Conclusion

As the evidence shows with multiple diseases, hsCRP is a very valuable nonspecific biomarker for inflammation in the body.

To stem the effects of inflammation, reducing hsCRP through lifestyle modifications and drug therapy may be a productive way of reducing risk, slowing progression and even potentially reversing some disease processes.

The DASH diet is a very powerful approach to achieving optimal levels of hsCRP without incurring potential side effects. This is a call to arms to have your levels measured, especially if you are at high risk or have chronic diseases such as heart disease, diabetes, depression and autoimmune diseases. HsCRP is a simple blood test with easy-to-obtain results.

References:

(1) uptodate.com. (2) Diabetes Technol Ther. 2006;8(1):28-36. (3) Prog Retin Eye Res. 2007 Nov;26(6):649-673. (4) Arch Ophthalmol. 2007;125(3):300-305. (5) Am J Ophthalmol. 2003;136(1):122-135. (6) JAMA Ophthalmol. 2013 Feb 7;131:1-8. (7) JAMA Psychiatry. 2013;70(2):176-184. (8) Arch Intern Med. 2008;168(7):713-720.

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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By Eric Rashba, M.D.

Dr. Eric Rashba

Atrial fibrillation, or AFib, is generally considered to be reaching epidemic numbers, especially among people over age 60. This condition, which is characterized by an erratic, irregular heartbeat, can cause problems ranging from unpleasant symptoms to serious problems like heart failure or stroke.

At the Stony Brook Heart Rhythm Center, our physicians and entire team of heart rhythm experts are constantly working to help people with AFib live better and longer. These are some of the important new state-of-the-art therapies:

Reducing stroke risk for people with atrial fibrillation

People with AFib have a 5 to 7 percent increased risk of having a stroke compared to people without AFib. To help prevent strokes, blood thinners such as warfarin or direct oral anticoagulants (DOACs) are prescribed. Most people do well with medication, but some experience bleeding problems or have other reasons why blood thinners aren’t the best option. 

At the Heart Rhythm Center, our specialists are treating appropriate patients with an implantable heart device, called Watchman™, to offer lifelong protection against stroke. For people who have AFib that’s not caused by a heart valve problem, the device provides an alternative to the lifelong use of blood thinners by blocking blood clots from leaving the heart and possibly causing a stroke. 

Miniaturized pacemaker for people with bradycardia

Bradycardia, also called slow heart rate, is when the heart beats at 60 times a minute or less. Not everyone with a slow heart rate needs a pacemaker — the presence of symptoms and the type of rhythm disorder are key. At our Heart Rhythm Center, for people whose slow heart rate can be treated with a pacemaker in just one of the four heart chambers, we use a pacemaker that is 93 percent smaller than traditional pacemakers, called Micra™. It is the world’s smallest pacemaker available and it offers some big benefits to the patient. 

Conventional, bulkier pacemakers are visible under the skin and have a lead wire that is threaded from the pacemaker into the heart. Our team implants the Micra pacemaker in the electrophysiology lab where the device is placed aboard a catheter (a thin, flexible tube) and moved up to the heart through the femoral vein in the leg. The device lasts for about a decade, and because it is so small, another one can be added to the same heart chamber years down the road when needed. The patient can also be safely scanned using certain types of full-body MRI.  

Zero-radiation ablation

Ablation is a procedure that uses cauterization to burn or scar the electric pathways that trigger the arrhythmia or abnormal heart rhythm. During a conventional ablation procedure, real-time X-ray, called fluoroscopy, is used and it delivers the equivalent radiation of up to 830 chest X-rays. At Stony Brook, my colleague, Dr. Roger Fan routinely performs complex ablations for AFib without any fluoroscopy at all. This important advance eliminates radiation exposure to the patient, with the same excellent results as conventional ablation. Zero-radiation ablation is such an important advance for the overall health of the patient, since excessive radiation can lead to medical problems over the long term. 

Questions about your heart’s rhythm? Call Dr. Rashba at 631-444-3575 or call 631-444-3278. Interested in learning more about your heart health? Take the free heart health online risk assessment at www.stonybrookmedicine.edu/hearthealth.

Dr. Eric Rashba is the director of the Heart Rhythm Center at the Stony Brook University Heart Institute.

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in Greek mythology, he Caucasian Eagle was tasked by Zeus to torture Prometheus every day.

By Elof Axel Carlson

Elof Axel Carlson

Science is a way of knowing. In today’s world it is based on reason, experimentation, technology and a belief that the natural world can be explained without invoking the supernatural as an explanation. Components of this definition of science have been around ever since humans formed communities and left traces of their daily lives in caves, burial sites and waste disposal sites.  

But in oral lore and written accounts more than 2,000 years ago, three supernatural explanations were used to explain how science arose. In Genesis, we are told the story of Adam and Eve and how Eve was tempted to eat of one of two forbidden trees in the Garden of Eden. Eve and Adam ate of the fruit from the tree of knowledge. For this disobedience Adam and Eve were cursed with a life cycle ending in death as well as pain and a struggle to survive.  

We owe to Greek mythology two different ways knowledge came to humans. Prometheus felt sorry that humans were helpless victims of difficult environments and he gave them a tool, fire, to warm themselves and make their own tools and form a civilization. For this, Prometheus was punished and chained to a rock by Zeus and had an eagle devour his liver every day only to have it regenerate at night.    

The other Greek myth involves Pandora who was given guardianship of a closed box containing the environments of the future. Her curiosity got the best of her and she opened it, shutting in hope and releasing all the ills of the world — disease, hunger, war, failure and madness.   

Note that the biblical version uses material reward (appetite or self-indulgence) as the motivation for disobedience. Adam and Eve and all of humanity to come are punished for their act. Note that Prometheus, not mankind, is punished for giving a tool to humanity. Note that Pandora’s curiosity is blamed for the ills of society.  

These three mythic views of how knowledge came to humanity reveal a tension between the world seen by those invoking the supernatural and the views of those who innovate, who explore their curiosity about the world and who show how to apply knowledge to advance human happiness and desire for improvement of their circumstances.  

The tension between religion and science is not a winner takes all choice with either one side or the other being correct, historically or in practice. Scientists can betray the ideal of science through fraud, conflict of interest or indifference to real or possible bad outcomes of their work. Religious or not, humans frequently rationalize their behavior.  

It is the Prometheus version of the gift of fire to make tools and apply science to human welfare that most scientists would favor. Science is seen as a way of describing the world and changing harmful environments into safe ones. It is a tool that leads to new knowledge and experiments and endless applications.   

In Pandora’s universe curiosity is not seen as beneficial. It is seen as a dangerous behavior leading to the release of the evils of this world. What kept us safe before Pandora was some supernatural box in which those evils were contained. Pandora, like Eve, could not resist satisfying her curiosity. But unlike Adam and Eve, she was not looking for a material benefit symbolized by forbidden fruit.  

Note the role of compassion in the motivation of Prometheus. Note the lustful anticipation in Eve’s gullible acceptance of the snake’s guile and to the sexual nature of knowledge reflected by Adam and Eve making clothes as their first act after eating the fruit. Note the lack of forethought to unintended consequences in Pandora’s opening the box.  

While all generations of humanity have faced similar hardships of finding food, building shelters, raising a family and finding meaning in their lives, different generations have interpreted knowledge and its applications in many ways. But all three ancient views of the acquisition of knowledge share a belief, regardless of its origins or its occasional shortcomings, in the importance of knowledge and technology in order to live a better life.    

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University

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By Lisa Scott

At the end of March Gov. Cuomo (D) and the New York State Assembly and Senate agreed to a $168 billion budget that tried to please constituencies in an election year while ignoring reforms that are desperately needed. Budget negotiations were conducted behind closed doors among the governor and three top legislative leaders, out of sight of even other lawmakers. It was clear that the policy issues such as gun control or bail reform would not be addressed until (possibly) after the budget’s April 1 deadline, in favor of financial considerations. 

The governor had drafted initial budget proposals that touched on many progressive reforms, yet the negotiations showed that a Republican-led NYS Senate was able to fight hard against any new taxes and fees, and defer inclusion of social policies, while the NYS Assembly had pushed for a large spending increase in its initial budget proposal. The financial 900-lb gorilla in the room was the impact of the new federal tax plan whose cap on SALT (state and local tax deductions) would fall the hardest on New York’s middle class homeowners and taxpayers. The governor called the tax plan “an arrow aimed at the economic heart of the State of New York.” 

The budget also included $26.7 billion in school funding, which will prove useful to incumbent Senate and Assembly members as they campaign for re-election this November.

The League of Women Voters, along with other good government groups, has lobbied long and hard in two areas that were ignored in the final budget: election reform and campaign finance and ethics reforms. Although including the funding for reforms in the budget is the likeliest way to ensure their adoption, it is still possible for the NYS Senate and Assembly to pass bills on these reform areas stipulating their adoption and funding in the following fiscal year (if funding is actually needed). The NYS Senate and Assembly only meet until June 20, so the time for lobbying and constituent pressure is of the essence.  

Election law reforms advocated by the NYS League of Women Voters

Early voting

The league supports enacting early voting in New York State. Currently 37 states allow for some form of early voting. Early voting should be implemented in a manner that will allow equivalent access to the polls for all voters.

 Voter registration

The league supports Election Day registration, on the same day, as a proven method of increasing voter participation. The league also will support reducing the voter registration deadline to 10 days before an election. The league supports pre-registration of 16- and 17-year-olds.

Ballot design

The league supports improvements to ballot design that would make a clear delineation between offices with a bold vertical bar and a fine line between the candidates, a larger font with an absolute minimum size and fill-in circles in black instead of gray.

Automatic voter registration 

Currently 10 states and the District of Columbia have automatic voter registration (AVR). The league supports an opt-in AVR system that would not require voters to duplicate information. The league supports all state agencies participating in an AVR program.

No-excuse absentee

The league supports a constitutional amendment to allow for no-excuse absentee voting. Currently 27 states and the District of Columbia allow for no-excuse absentee voting.

Single June primary

The league supports legislation that would create a single combined congressional and state June primary date and would bring New York State into compliance with the Military Overseas Voter Empowerment (MOVE) Act. 

Electronic poll books

The league strongly supports replacing printed poll books with electronic poll books to eliminate time and resources spent producing paper poll books and updating voter information and to speed up processing voters at the polls on Election Day. 

Campaign finance and ethics reforms advocated by the NYS League of Women Voters

Ban ‘pay to play’

Strict “pay to play” restrictions on state vendors. The U.S. attorney’s charges that $800 million in state contracts were rigged to benefit campaign contributors to the governor underscores the need to strictly limit contributions from those seeking state contracts.

Close ‘LLC loophole’

Ban unlimited campaign contributions via limited liability companies. LLCs have been at the heart of some of Albany’s largest scandals. 

Strict limits on outside income

Real limits on the outside income for legislators and the executive branch. Moonlighting by top legislative leaders and top members of the executive branch has triggered indictments by federal prosecutors.

Create a database of deals

A “database of deals” will list all state economic development benefits, including grants, loans or tax abatements awarded to a particular business or organization. The database of deals will also include the cost to taxpayers of each job created, and create a uniform definition of what a “job” is across subsidy programs including full time, part time, permanent and contract jobs.

Many good government groups like the league continue to lobby our elected officials in Albany until the end of the session in late June. Please review the above list of reforms, choose one or two, and call or write your NY State senator, Assembly member and Cuomo to express your opinion and priorities. To find the legislators who represent you, enter your street address and ZIP code in the LWV of New York State website link: https://salsa.wiredforchange.com/o/5950/c/8551/getLocal4.jsp.

Lisa Scott is president of the League of Women Voters of Suffolk County, a nonprofit, nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org, email [email protected] or call 631-862-6860.

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Balsamic Marinated Chicken

By Barbara Beltrami

As often as we may observe or comment that someone is no spring chicken and well seasoned, there are some spring chickens of the farm variety that are young and tender and just waiting to be seasoned. It won’t be long now before we put away our slow cookers and pull out that barbecue, polish it up and start grilling. And nothing takes to the grill like chicken, especially if it’s marinated in or simply coated with a savory seasoning, sauce or rub. 

Whether it’s chicken parts such as thighs or drumsticks, boneless chicken breasts, pounded thin into paillards or left thick and sliced, a cut-up broiler/fryer or a roasting chicken, special seasonings take that bird from plain and ordinary to gourmet glamorous. Apply the seasonings ahead of time, cover and refrigerate, and when it’s barbecue time or meal time, all you need to do is grill that lovely bird. 

Balsamic Marinated Chicken

Balsamic Marinated Chicken

 

YIELD: Makes 4 servings.

INGREDIENTS: 

¼ cup extra virgin olive oil

¼ cup balsamic vinegar

½ cup white wine

1 shallot, finely chopped  

3 to 4 garlic cloves peeled and sliced

1 tablespoon each fresh thyme and oregano leaves, or 1 teaspoon dried

Salt and freshly ground pepper, to taste

4 boneless, skinless chicken breasts 

DIRECTIONS: 

In a small bowl, whisk together the first seven ingredients. Remove fat from chicken, rinse and pat dry. Place everything in a 1-gallon resealable plastic bag. Seal tightly and tilt to be sure all chicken pieces are coated; refrigerate at least 2 hours, preferably more, up to 8 hours. When ready to cook, oil grill rack, then preheat grill to medium high. Grill chicken, turning once and basting frequently with marinade until brown on the outside and clear juices run on the inside, 5 to 10 minutes per side depending on thickness. Discard any unused marinade. Remove from grill, slice across grain and serve hot, cold or at room temperature with grilled veggies and wild rice.

Rosemary, Garlic and Mustard Marinated Chicken Thighs

Rosemary, Garlic and Mustard Marinated Chicken Thighs

YIELD: Makes 4 servings.

INGREDIENTS: 

¼ cup olive oil

1 tablespoon prepared mustard

1 tablespoon chopped fresh rosemary leaves or 1 teaspoon dried

4 garlic cloves, peeled and chopped

Salt and freshly ground pepper, to taste

4 to 8 chicken thighs, depending on size

DIRECTIONS: 

In a small bowl, whisk together the oil, mustard, rosemary, garlic and salt and pepper. Remove fat and skin (if desired) from chicken thighs. Place chicken in a shallow nonreactive baking dish. With a pastry brush or rubber spatula, coat the chicken on both sides with the prepared mixture; cover tightly and refrigerate 2 to 4 hours until ready to cook. Prepare and preheat grill to medium high. Grill thighs 8 to 10 minutes per side. Check for doneness, remove from grill and serve hot, warm or cold with fresh corn on the cob, ratatouille and sweet potato fries.

Chicken in Curry-Yogurt Marinade

Chicken in Curry-Yogurt Marinade

YIELD: Makes 4 to 6 servings.

INGREDIENTS:

3/4 cup plain Greek yogurt

¼ cup olive oil

2 tablespoons curry powder

2 tablespoons freshly squeezed lime juice

½ teaspoon ground cayenne pepper

Salt to taste

1 broiler-fryer, cut up

DIRECTIONS: 

In a small bowl, whisk together the yogurt, oil, curry powder, lime juice, cayenne and salt. Lay chicken parts in a shallow dish and slather marinade over them. Place chicken and any remaining marinade in a resealable gallon bag and refrigerate 4 to 8 hours. 

When ready to cook, prepare and preheat grill to medium high. Place chicken parts over direct heat, meaty sides down. Grill until outsides are a light brown (about 10 minutes), then turn the pieces and grill another 5 minutes. Remove chicken to indirect heat, close grill lid and grill 30 to 40 minutes, until cooked through. Let sit for 10 minutes. Serve hot, warm or cold with tomato, olive and onion salad, rice and sautéed spinach.

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SOME SPRINGTIME GREEN

Joe Kelly (www.joekayaker.com) captured this photo of a great egret in breeding colors and plumage at Frank Melville Memorial Park in Setauket on April 18. He writes, ‘You really can’t see much of the plumage in this shot but just look at the green in its face. Even the Hulk would be impressed with that color! Frank Melville Park is a good place to catch these guys in action. Come down to the park and take a stroll. It’s a beautiful place.’

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

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'Fulfillment'

Artist statement:  ‘My process melds classic photography with digital energy,                                               creating a medium I call interpretive photography’ — Mac Titmus

By Irene Ruddock

Mac Titmus

Mac Titmus is a photographer whose work melds classic photography with evolving digital art. He graduated from Adelphi University with a bachelor’s in English and a master’s in education/psychology. After a career in education, he retired to pursue his lifelong passion for photography. Titmus has won dozens of awards with his work appearing on magazine covers as well as being a distinguished judge. He is a leader in the art world and is currently vice-president of the North Shore Art Guild. He resides in Coram with his wife Mary, whom he calls his “best friend.”  

You describe your photography as ‘interpretative photography.’ Can you elaborate on that?  

“Interpretative photography” is a medium that pushes photography in an exciting new direction: one that defies rules and ignores the limitations of in-camera photography. It takes advantage of and explores the evolving techniques of the digital medium. The result is a fluid art form that merges proven old-school photography with the revolution of new-age photography.

What motivated you to begin to expand from the traditional view of photography to the more interpretive digital work?

When the desktop computer became available, I found I had a natural programing ability and quickly merged the two. Digital photography allows me to create what I once spent hours trying to produce in the darkroom. 

‘Think Pink’

What methods do you use?  

My methods are really the same as most two-dimensional artists, the only difference is substance. Digital art is created on transparent canvas layers on a computer rather than paper or canvas. The tools and the artistic instincts are the same: the use of pens, brushes, canvas, color, motion, balance and light. 

You have said that you combine motion and color with energy, which makes for an exciting experience for the viewer. Why is this combination important to your art? 

 I naturally see emotions as color and use it as a language expressing passion, fear, anger, joy or sadness. This reveals itself as shades from vibrant to subdued in my photographs. 

What is the single most important thing about your photography that makes it stand out among others?  

Without a doubt it would be my strong use of color to express emotion. I use colors as both harmony and conflict, hoping to bring out unaware emotions in people. 

‘On the Street’

You have so many incredible awards. Is there one that stands out as a favorite accomplishment?  

Every award is a wonderful validation, but without a doubt, my first-place award in the Wounded Warriors Benefit at Hutchins Gallery was a highlight. Not only was it an honor to be asked to participate, but it was also the first time my photography was recognized with a first-place award in the category of art, not photography.  

Who has been your strongest artistic influence?    

Having a literary background, I find my strongest influences are the images painted in imagination by the literary works of Emerson, Whitman, Thoreau, Cummings, Beckett and Bach. However, my primary visual art inspirations have always been the works of Jackson Pollock, Salvador Dali and Claude Monet.

Your art is now on scarves and articles of clothing.  How did that start?  

People have been telling me for years that my designs would make beautiful scarves, but the problem has been finding a manufacturer that would produce them for a reasonable price. I finally found a manufacturer that reproduces my work on material as I created it. Every scarf is a reflection of me and is unique for its design and vibrancy. In addition to scarves I’ve been experimenting with a line of kimono wraps and yoga leggings. All of my “Wearable ART” can be purchased through Sidewalk Alley Art in Mount Sinai. 

‘Shadow World’

How did you become director for Artists United in the Fight for Cancer?’

Breast cancer is very personal to those that have survived it or lost a friend or family member, as I have. My hope was that by bringing artists together we could be a force to make people more aware of the importance of early detection. We initiated a yearly event for Mather Hospital and the Village of Port Jefferson called Paint Port Pink. I also organized a benefit for the Fortunato Breast Health Center at Mather Hospital as well as an art benefit titled, Through the Eyes of a Child. This benefit raised $20,000 for the art therapy program at Stony Brook University.

Do you feel that photography doesn’t get the respect in the art world that it should? If so, do you know the reason why?  

Absolutely, especially digital photography because its legitimacy as a fine art is often questioned. Many galleries are still hesitant to include digital artists, although they admit its appeal and potential audience. They hesitate embracing it as they are uncertain they can adequately explain its process. The result leaves digital artists floundering for a position in the art community.

Do you have any exhibits coming up?  

Currently I have a solo show at the Clovis Point Winery in Jamesport through April 23 with an artist reception on Saturday, April 21 from 2 to 4 p.m. During the months of April, May and June I’m exhibiting several pieces in joint shows at The Alex Ferrone Gallery in Cutchogue, The Long Island Museum in Stony Brook (LIMarts) and at Expressions Gallery in the Stony Brook Holiday Inn Express. If you can’t attend those exhibits you may see my work online at www.karynmannixcontempary.com of East Hampton or through my website, www.augustusmac.com.

This article was updated on May 3.

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Annie Laurie W. Shroyer and Thomas Bilfinger

By Daniel Dunaief

Convenience can come at a cost, even in medicine. When it comes to a heart procedure called cardiac artery bypass surgery, that cost could make a difference in the outcome for the patient.

Annie Laurie W. Shroyer, vice chair for research and professor in the Department of Surgery at Stony Brook University School of Medicine, and Thomas Bilfinger, a professor of surgery in the Division of Cardiothoracic Surgery at SBU, found that the mortality and major morbidity rates were lower for patients of surgeons performing procedures at a single center compared to those performing procedures at more than one center. 

Among physicians who operated at two or more hospitals, these surgeons performed better at their home hospital than at a secondary center.

They’ve published their findings in the Annals of Thoracic Surgery. The Society of Thoracic Surgeons identified the article as the Continuing Medical Education article for the month. The article will provide a much more in-depth learning experience to a subgroup of the journal’s subscribers who seek Continuing Medical Education credits. This, Shroyer explained, will make it more likely that cardiac surgeons will read it thoroughly and discuss it.

“We believe that, based on the results, particularly complex coronary artery bypass grafting (CABG) procedures may have a better outcome at bigger institutions,” Bilfinger explained in an email. Mortality for these procedures overall in the United States is low and the analysis is about differences of a few tenths of a percent, which becomes statistically significant due to the low number.

The central issue, Bilfinger said, is whether “the mother ship does better or worse than the satellite. Decision making about centralizing versus a de-centralized approach seems to be less driven by outcomes and rather by business decisions in many circumstances. The study adds some subjective data to this discussion.”

Using a measure called observed-to-expected mortality ratios based on the health of the patient and risks of the procedure, the ratio for multicenter surgeons was higher for the satellite facilities compared to their home facilities. The ratios were 1.17 for surgeons operating at satellite facilities versus 1.01 for multicenter surgeons performing the procedure at their home hospital.

The volume of surgeries is a complicated issue, Bilfinger cautioned. “There are very well-performing smaller volume places throughout the country,” he explained in an email. “It involves dedication to the procedures from admission to discharge.”

Assuming the surgeon is just as effective in different hospitals, which is “open to discussion,” any observed difference could be attributable to the system, Bilfinger explained. Measuring the effectiveness of the participants in the process, including nurses, anesthesiologists and orderlies, is a question for ongoing research, he continued.

Joseph Carey, a cardiovascular and thoracic surgeon in Torrance, California, conducted a study based on information from California about a decade ago. In an email, Carey suggested that “you pay a price in quality working in unfamiliar conditions and I believe hospital managers do not want their surgeons traveling about.” He added that this paper “is an important reminder” of this.

Carey added that hospital systems and the makeup of the “heart team” may also be important to the outcome of a surgery.

Future research, which Shroyer plans to conduct, will evaluate other factors, such as patient risk, processes and structures of care, that impact cardiac surgical outcomes.

Other researchers could extend this study, which compares the quality of care for surgeons who work at single sites and multisites, to other areas of medical care, enabling hospital networks, insurance companies and patients to make informed risk-based decisions prior to approving difficult procedures.

The challenge, however, with similar studies for other conditions, is in finding national information. “This is the best documented group of procedures there is in the country,” Bilfinger said. For a procedure like back surgery, it might be difficult to come up with a comparable study, although Bilfinger said he “suspects strongly that this is a very similar relationship.”

Shroyer and Bilfinger will extend their work to another cardiothoracic operation. They have submitted a proposal to the Society of Thoracic Surgeons to start a parallel project to look at the difference in risk-adjusted outcomes for mitral valve procedures that compare single-center versus multicenter surgeons. The diversity of procedures may need to be considered in comparing single and multicenter surgeons.

Bilfinger said he recognizes that some doctors and hospital networks may find these conclusions disconcerting. It may give them pause in the internal discussion about value added by new satellites in any system, he explained. “This is worth a public debate. This is one of these aspects of modern health care that the consumer is not aware of.” The average consumer may not put too much emphasis on this, although the sophisticated consumer on Long Island may change or make decisions based on this type of information, he said.

Shroyer and Bilfinger, who have worked on the same floor at the Health Sciences Center since Shroyer arrived from Colorado in 2007, decided to collaborate on this project after a discussion during lunch. The duo were eating at SBU’s Simons Center Café when they were discussing the differences in outcomes for single and multicenter surgical procedures. They submitted a request to access the National Adult Cardiac Surgery Database in 2014 to the Society of Thoracic Surgeons.

For patients who are going to have a cardiac surgical procedure, Shroyer recommends that people choose their surgeon and surgery center “wisely.” She recommends researching the surgeons and their corresponding center’s bypass specific outcomes. She highlights two publicly available resources, which are Adult Cardiac Surgery Database Public Reporting|STS Public Reporting Online and Doctor Ratings — Consumer Reports.

Shroyer cautions that these ratings are somewhat outdated, so she suggests patients ask their surgeons directly about their more recent outcomes. She would also recommend contacting patients.

After conducting this study, Shroyer believes it would likely help patients if they searched for doctors who only perform bypass procedures at a single hospital. She also believes it is important for patients to consider surgeon-specific and center-specific risk-adjusted outcomes.

Ultimately, she said, the decision about a surgeon and a site for surgery is an important one that patients should make based on the likelihood of the best outcome.

“Patients should research their cardiac surgeon-hospital decision even more carefully than if they were buying a new home or a new car,” she explained in an email. “Their future health lies in their cardiac surgeon’s hands.”

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