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Green beans mature in about two months. Photo by Ellen Barcel

Now that it’s August, you’ve been enjoying your garden’s produce. Some varieties of tomatoes have already ripened. The fresh corn has been delicious. You’ve had beans and salads fresh from the garden. But, it’s time to start thinking about your second harvest of quick growing and cool weather veggies.

The average first frost on Long Island is the end of October (central North Shore and North Fork) to early November (North Shore of western Suffolk and Nassau counties). These, of course, are averages. I remember a December when I still had geraniums blooming while I was putting out my Christmas wreath. And, there have been early Octobers with frost, times when I’ve rushed to get my houseplants, which were summering outside, back into the house.

Radishes mature in under a month. Photo by Ellen Barcel
Radishes mature in under a month. Photo by Ellen Barcel

First, look at the packages of seeds and see how long it is from planting to maturity. For something like green beans, depending on variety it can be anywhere from 50 to 60 days. So, knowing that the end of October is just about the last of the growing season, count backward. You need to plant the last of your green beans, again depending on variety, by the beginning of September. That will give you the two full months you need for plant maturity. Start now, and plant another row each week, finishing up the beginning of September. Lettuce is another quick growing crop. Leaf lettuce is a cool weather crop and matures in 40 to 50 days. So, the last sowing of lettuce needs to be mid-September. Head lettuce takes longer — 70 to 90 days, so chances are it won’t have time to mature.

Some varieties of cucumbers will mature in 60 days, while others take longer.

Summer squash will mature in about 60 days and radishes under a month. You can plant your radishes up to the end of September and still have a harvest before frost.

Green onions (scallions) will be ready to be picked in 50 to 60 days. Again, plant up until the beginning of September. Okra will mature in 50 to 60 days. Corn will mature, depending on variety, in 65 days and beets in 55 to 70 days. Kohlrabi will mature in 50 to 60 days.

Green tomatoes, if large enough in autumn come frost, may ripen in the house. Photo by Ellen Barcel
Green tomatoes, if large enough in autumn come frost, may ripen in the house. Photo by Ellen Barcel

Tomatoes are interesting in that the plants you put down in spring will continue to set fruit into fall, as long as the weather doesn’t get too cold. This means that you may have a lot of green tomatoes at the first frost. If they are large and with a tinge of orange, try to ripen them indoors. Some people swear by the brown paper bag method. Or, consider either making fried green tomatoes or pickled tomatoes. This latter treatment is more reliable. I’ve had some tomatoes I’ve tried to ripen just go to mush, especially if they were very small.

Remember that the above, and any dates listed on seed packages, are for optimal conditions. A sudden cold spell can delay plant maturity. Second crops can be less reliable than planting in spring, but, all you’ve invested is the cost of a few packages of seed. If it’s very dry, remember to water well. Use fertilizer, especially for very heavy feeders like tomatoes. Good luck and enjoy your second harvest!

Ellen Barcel is a freelance writer and master gardener. Send your gardening questions to [email protected]. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

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Lemon Tea Bread

Lemon Tea Bread

Lemony herbs and lemon juice give this bread its flavor.

YIELD: Makes one loaf

INGREDIENTS:

3/4 cup milk

1 tablespoon finely chopped lemon balm

1 tablespoon finely chopped lemon thyme, and/or 1 tablespoon finely chopped lemon verbena

2 cups all-purpose flour

1 1/2 teaspoons baking powder

1/4 teaspoon salt

6 tablespoons butter or margarine, at room temperature

1 cup sugar

2 eggs

1 1/2 tablespoons grated lemon zest

Juice of two lemons

Confectioners’ sugar

DIRECTIONS: Preheat oven to 325 F. Butter a 9- by 5-inch 3-inch-deep pan. Heat milk gently with herbs, set aside and let cool. Mix the flour, baking powder and salt together in a bowl. In another bowl, cream butter and sugar until light and fluffy. Add the eggs, one at a time, beating well after each. Add the lemon zest. Gently fold in flour alternately with the herbed milk, until the batter is blended. Put the batter into the prepared pan. Bake for about 50 minutes or until a toothpick inserted in the center comes out dry. Remove from pan onto wire rack that is set over waxed paper. Pour lemon glaze (juice of two lemons and 2/3 cup confectioners’ sugar) over the still-hot bread. Garnish with some freshly grated zest.

Lavender Olive Oil Cake with Honeyed Ricotta

The lavender honey gives this cake a fresh, slightly floral aroma, but you can try using different types of honey in this recipe to subtly vary the flavor.

YIELD: 8 to 10 servings

INGREDIENTS:

Pillsbury Baking Spray with Flour

1 3/4 cups Pillsbury BEST All Purpose Flour

1 1/2 teaspoons baking powder

1/2 teaspoon kosher salt

1 cup sugar

1 tablespoon finely grated orange peel

1 tablespoon culinary lavender, crushed, plus additional 1 to 2 tablespoons for garnish

1/4 teaspoon freshly ground black pepper

2/3 cup plain yogurt

3 large eggs

2/3 cup Crisco Pure Olive Oil

1 teaspoon vanilla extract

3/4 cup heavy cream

3 tablespoons honey

3/4 cup ricotta cheese, at room temperature

DIRECTIONS: Heat oven to 350 F. Spray a 9- by 5-inch loaf pan generously with baking spray; set aside. Combine flour, baking powder and salt in a small bowl. Whisk together sugar, orange peel, lavender and pepper in a large mixing bowl until evenly distributed. Add yogurt, eggs and olive oil; continue whisking until smooth. Whisk in vanilla. Add flour mixture and gently whisk in until just combined. Scrape batter into prepared pan. Bake 55 minutes or until a toothpick inserted in center comes out clean. Cool in pan 5 minutes; remove from pan and cool completely. Whip cream with an electric mixer until soft peaks form. Add honey and continue to whip until stiff. Add ricotta, a dollop at a time, and beat until fluffy. Slice cake. Top slices with honeyed ricotta cheese and sprinkle with lavender.

 

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No Bake Peanut Butter Bars

Here are some delicious quick desserts when you just have a craving for something sweet.

No Bake Peanut Butter Bars

YIELD: 16 bars

INGREDIENTS:

1/2 cup salted butter, melted

1 cup graham cracker crumbs (about 8 full sheets)

1 cup powdered sugar

3/4 cup and 2 tablespoons creamy peanut butter (not natural style)

1 cup semi-sweet chocolate chips

DIRECTIONS: Line a 8-by-8 or 9-by-9 square baking pan with aluminum foil. Set aside. In a medium bowl, mix the melted butter, graham cracker crumbs, and powdered sugar together until combined. Stir in 3/4 cup of peanut butter. Spread into prepared baking pan. In a small bowl, microwave 2 tablespoons of peanut butter with the chocolate chips until melted. Stir until smooth. Spread over peanut butter layer. Chill until completely firm, at least 3 hours. Allow to sit at room temperature for 10 minutes before cutting. Bars stay fresh for 5 to 7 days stored in the refrigerator. Serve chilled. (Setting them out for a few hours at room temperature for serving is OK.) Bars can be frozen up to 2 months. Thaw overnight in the refrigerator.

Two Minute Apple Tart
Two Minute Apple Tart

Two-Minute Apple Tart

YIELD: Serves 8

INGREDIENTS:

1 refrigerated ready-to-use pie crust

1 pound apples, cored and sliced

2 tablespoons cold butter

1/4 cup granulated sugar

1 teaspoon cinnamon

DIRECTIONS:

Heat oven to 425 F. Remove pie crust from refrigerator and warm to room temperature, about 15 to 20 minutes. Unroll crust and place it on large baking sheet. Arrange sliced apples on crust, leaving about two inches of space around edge. Chop cold butter into small bits and scatter over apples. Mix sugar and cinnamon together and sprinkle over apples. Fold two-inch section of open pie crust over apples — this will not cover apples, but contain them inside crust. Bake 20 to 25 minutes until crust is golden brown and apples are just soft.

Easy Plum Tart
Easy Plum Tart

Easy Plum Tart

YIELD: Serves 10

INGREDIENTS:

¾ cup canned almond pastry filling

1 refrigerated premade pie crust

4 medium plums, sliced

DIRECTIONS: Spread canned almond pastry filling on pie crust (rolled out to 12 inches on parchment-paper-lined cookie sheet), leaving 2-inch border; top with plums, fold in edges, and bake at 400 F for 30 to 35 minutes or until crust is golden and filling is bubbling.

 

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Stony Brook University Hospital. File photo

By L. Reuven Pasternak, MD

How can you be sure you’ll get safe, quality care when you go to a hospital? You can consult any of the numerous rating systems created by the government, insurance companies, medical associations, registries, health care report cards, national magazines and patient evaluation websites. However, because there are no common guidelines for rating attributes like hospital quality or safety, it’s difficult to make apples-to-apples comparisons. The same hospital can be rated at the top by one agency and at the bottom by another.

When you’re searching for information, rely only on results from reputable, unbiased sources. And make sure the information is up-to-date. A ranking or a report card based on data that’s more than a year old may no longer be accurate.

With no single source of reliable, relatable information to evaluate health care providers, how can you uncover the facts you need?

Ask your primary care physician for a referral. Your doctor is very familiar with the quality of care that hospitals and specialists in your area provide. Talk to family and friends who’ve had firsthand experience. Ask nurses and doctors if they would send their relatives to that hospital or specialist.

Hospital and state health department websites provide statistics about procedures, results, specialists and facility certifications. Some hospitals also post information about the specialists who work there. If you’re having heart or orthopedic surgery, for example, get specifics about those procedures. Find out how often the surgeon and surgical team have done the procedure and what the nurse-to-patient ratio is, as well as the rate of readmissions and infections, in addition to other indicators of safety and quality.

And, find out what the hospital is doing to improve. Hospitals should always be looking to raise the bar, to pursue excellence. With our Patient Safety First program and other quality and safety initiatives, Stony Brook University Hospital has instituted rigorous systems to identify and prevent potential issues rather than react to them.

To enhance the patient experience, we have made and continue to make many improvements. For example, we’ve created “quiet times,” which involve shutting lights during specified times during the day, and we will also be offering noise reduction aids in the near future. To make the rooms more comfortable, we’re improving furnishings and creating a clutter-free environment. And, beyond the walls of our hospital, we’re taking steps to coordinate care among more than 500 countywide organizations to support health care providers and patients in achieving individual health goals.

Finally, don’t wait until an emergency happens to learn about health care facilities in your area. There is a lot of useful information available to help people make good choices, but it’s best accessed before you need it. At Stony Brook University Hospital, we want to answer all your questions — simply call our Department of Patient Advocacy at 631-444-2880 or visit www.stonybrookmedicine.edu.

Our goal is to exceed your expectations every time you turn to Stony Brook for your care — by delivering high quality, safe and compassionate care that supports your well-being every step of the way.

L. Reuven Pasternak, MD, is the CEO at Stony Brook University Hospital and vice president for health systems at Stony Brook Medicine

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By Bob Lipinski

‘Drink wine in winter for cold, and in summer for heat.’

— Henry G. Bohn 1796–1884, British publisher, ‘Handbook of Proverbs,’ 1855

For centuries wines have been bottled in glass containers (bottles) and enjoyed by millions of drinkers, novices and connoisseurs alike.

Over the past few decades, wineries have sought alternative containers for consumers to enjoy their red, white and rosé (blush) wines. Some of the ideas are: aluminum cans similar to a six-pack of beer, aluminum bottles, single servings of wine in a plastic glass, plastic wine bottles, bottles made from cardboard (plastic lined), Tetra Pak cartons (they house tomato sauce), AstraPouch (Capri Sun) ceramic bottles (Lancer’s Rosé) and yes even in a paint can!

By far, the best alternative package for wine is the “bag-in-the-box” or BiB for short. BiB packaging refers to a food-grade, plastic bag hidden inside a cardboard box fitted with a tap for serving and a handle for transport. The BiB was invented by U.S. chemist William R. Scholle in 1955 for the safe transportation and dispensing of battery acid. In 1965, the idea was patented and became the Wine Box thanks to Thomas Angove (1918–2010), a winemaker from Renmark, South Australia.

BiB comes in various sizes, including 1.5-liter (2 bottles), but the 3-, 4-, and 5-liter containers are the most common. It easily fits inside the refrigerator and is ideal for dispensing a single or multiple glasses of wine. BiB is ideal for the outdoor locations where glass may not be appropriate or accepted — swimming pools, outdoor concerts, picnics, barbecues, sporting events, parks and beaches.

Once opened, BiB can easily last several weeks before a replacement is needed. In years past, the quality of some offerings was low-end, appealing to the “jug drinkers.” However, the past few years has seen not only the quality dramatically improve but also the offerings. You can purchase cabernet sauvignon, merlot, Shiraz, Riesling and many others.

Two of my recent favorite brands are Archer Roose and Bota Box:

Archer Roose Sauvignon Blanc (3-liters) Central Valley, Chile: Aroma of stone fruit and kiwi is followed by a crisp, clean flavor of tropical fruit, and lemon, with hints of tartness.

Archer Roose Carmenère (3-liter) Maipo, Chile: Full bouquet and flavor of spicy plums, black raspberries, cherries and black pepper. Medium-bodied with subtle flavors of mint, herbs and dark chocolate.

Archer Roose Cabernet Sauvignon (3-liter) Maipo, Chile: Deeply colored with a bouquet and taste of black currants, blackberries and cherries. Medium-bodied with flavors of chocolate-cherry and spices.

Bota Box Chardonnay (3-liter) California: Bouquet and flavor of baked bread, pineapple and apples. Off-dry with just the right amount of citrus to keep it interesting.

Bota Box 2014 Sauvignon Blanc (3-liter) California: Aroma and flavor of melon, mint and orange blossoms. Light-bodied with plenty of flavor.

Bota Box 2014 Night Hawk Black (3-liter) California: Ruby-colored with a luscious bouquet and off-dry taste of blackberries, cherries and jam.

Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Vodka, Gin, Rum & Tequila” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com or [email protected].

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Where you choose to learn and intern can have a significant effect on your success. Photo from Ryan DeVito

Ryan DeVito

The adage “location, location, location” should be applied beyond the real estate market. Where you choose to learn and intern can have a significant effect on your success. Like it or not, urban environments trump sleepy suburbia every time.

I’m not a sociologist, but it’s hard not to notice certain trends in my peer groups. Those who attended college in urban areas seem to have found post-graduate employment more easily. Their networks tend to be large and diverse, too. On the other hand, those who ventured out into the hinterlands for college seem to have had decidedly less luck when it came to immediate post-graduate employment.

What’s the difference-maker for urban students? It boils down to a few key elements.

First, urban environments multiply the network effect. Students attending urban colleges have more opportunity to network with diverse audiences who, in turn, refer those students to their own networks. This is a big deal when it comes to landing an internship or job. Having someone recognize your name —  or, better yet, offer a personal recommendation — goes a long way in the hiring process.

Second, so-called hybrid professors are more likely to reside and teach in urban areas. These are the professors who have vast experience outside of academia. They are the movers and shakers who, for one reason or another, choose to impart their wisdom on a new generation of students.

Third, colleges and companies are connected to their cities. Urban colleges often encourage their students to engage with their city community, whether it be through service or some other outlet. Companies that are invested in the socioeconomic development of their community tend to prefer to hire those who are already a part of that community. Therefore, someone studying at New York University is likely going to have a much easier time landing a position in New York than would someone studying at Indiana University, a cultural world away.

There’s a reason why New York University spent enormous amounts of money to build housing for students in the village. Prior to the late 1980s, NYU had a reputation as a commuter school in the shadow of Columbia University and Fordham University. Giving students the opportunity to live in the city and become a part of its social fabric quickly changed the university’s reputation in the region.

Now, there are always those rising stars who are able to transcend geographic factors. Going to college in the middle of nowhere isn’t a success-killer. Far from it. Some of the most renowned colleges in the world, including Cornell University and Dartmouth College, feature isolated locations.

Location matters. As you plot you future, consider how an urban environment could help you take your education and career to the next level. Urban environments are professional accelerators. Still, it’s up to you to make the most of that grand opportunity.

Ryan DeVito is a Miller Place native who started a college advising company to help Long Island students reach their potential. Learn more at www.TheModernGraduate.com

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Summertime provides an opportunity to slow down, renew our energy and get ready for the intensity of the fall. These summer days encourage us to relax and enjoy those beautiful summer breezes and those sunny days.

We all need time to renew and refresh our energy. However, we still must be vigilant when it comes to parenting our children and attentive to what is happening in our world. Too often during the summer parents relax their rules and give their teenage children a little slack. The challenge is to find the balance. Too often during this time, parents turn a blind eye to serious social circumstances. Underage teenage drinking escalates. There are more parties to attend, more opportunities to socialize at the beach, on the boat, at the park and going to concerts, just to name a few.

Too many parents see teenage drinking as a rite of American passage. Unfortunately, my experiences document that more and more teenagers are under the influence of alcohol when they first try illegal drugs like heroin.

Heroin use within our community is escalating daily. Young people of privilege even have this drug delivered to their home. Parents need to be more vigilant. The local clergy have indicated that in their respective congregations they are burying at least one young person a month who has died because of a heroin overdose — that is tragic!

If we are going to turn the tide on this devastating health crisis, we need to form a coalition of concerned persons who are willing to demand change from our insurance companies and from our government leaders. We need more detox and long-term treatment beds today — not tomorrow, not next year, today! Enough with the political lip service to this serious life issue.

This summer we’re getting a real education in American civics. It is a very disturbing lesson! Both major parties have formally nominated their candidate for president of the United States. The money that is being wasted on negative campaigning is shameful. Attacking the character and integrity of each party’s candidate is a real distraction from the real issues that we as a nation must confront.

Our political landscape is wrought with land mines that do nothing but distract us from what is important and blur the real truth. This political season has been embarrassing. It seems to be more fixated on divisiveness than unity. We are a nation blessed with diversity; we need to work harder at building bridges instead of walls between us.

Both candidates should commit themselves to a language of respect, inclusiveness, human rights, social justice and equality for all Americans. Yes, this election needs to address our racial divide. It needs to address discrimination based on sexual orientation and socioeconomics, loss of respect for law enforcement, our broken and inhumane immigration system, our deteriorating schools, the cost of college education, our position on the world stage, international terrorism and the renewed violence in our nation.

Whoever we elect as president of the United States in November must bring us together as one nation founded on freedom and respect for all citizens no matter what our human circumstance. He or she must give voice to every American!

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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By Nancy Burner, Esq.

Consider this scenario: An individual executes a will in 1995. The will leaves all of his personal property (household furnishings and other personal effects), to his friend who is also the named executor. The rest of his estate he leaves to his two sisters. When he died in 2012, his two sisters had predeceased him. There were no other individuals named as beneficiaries of the will.

The executor brought a petition requesting that the court construe the decedent’s will so that she would inherit the entire estate as the only living beneficiary in the will. The executor stated that the decedent intended to change his will to name her as the sole beneficiary, but he died before he signed the new will. There was also an unwitnessed handwritten will that left his entire estate to the executor.

The court held that the testator’s intent to give his residuary estate to his two sisters was unambiguous. Having failed to anticipate, at the time that the will was executed, that his two sisters would predecease him, the court was not allowed to find that the decedent intended a gift of the residuary estate to his friend, the executor.

The court held that there were limitations on its ability to rewrite the decedent’s will to accomplish the outcome sought by the executor. Since the executor was only named as the beneficiary of personal effects, she could not inherit the rest of his estate. This is because the sisters predeceased him and they had no children, the will failed to name a contingent beneficiary.

The result was that the individuals who would have inherited had he died without a will would inherit. In the case at hand he had a distant cousin (to whom he never intended to leave anything) who was entitled to inherit all of his residuary estate. If the decedent had no other known relatives, his residuary estate would have escheated to New York State at the conclusion of the administration of the estate.

What it is important to realize here is how crucial it is to review and update your estate planning documents regularly. This is especially true after experiencing a significant life event such as a birth, death, marriage and/or divorce. You want your documents to reflect your intentions as they are today, not as they were 20 or 30 years ago.

If you are an unmarried person, with no children, living parents or siblings and your only relatives are aunts, uncles and/or cousins with whom you do not have close relationships, you especially want to make sure you have estate planning documents in place to avoid intestacy and having these relatives inherit by default. With these family circumstances, you also want to consider avoiding probate all together with a revocable or irrevocable trust.

If you have missing relatives, the nominated executor would have the burden of finding your aunts, uncles and/or cousins wherever they may be located to obtain their consent to the probate of your will. This can be expensive in both time and money. If these relatives cannot be found, the court will require a citation to be issued to these unknown relatives and a guardian ad litem will be appointed to investigate the execution of the will on their behalf. This is another layer of added expense and delay to the probate process, and a good reason to avoid it.

Whether you have a will or a trust, you want to be sure to review and update it regularly to make sure that your designated beneficiaries are still living. In a situation such as the scenario above, you also want to pay special attention to your contingent beneficiaries. The contingent beneficiaries take precedence if a primary beneficiary has predeceased. If you are unsure about naming contingent beneficiaries at the time you execute your will or trust, you may want to consider choosing a charity or allowing your executor/trustee to choose a charity for a cause you care about as a contingent beneficiary. This way, no matter what happens, your estate does not escheat to New York State.

The takeaway from the scenario above is how crucial it is to regularly review and update your estate planning documents. You want to be sure that whoever you want to inherit at your death, actually inherits your property.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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Erik Muller. Photo by Yizhi Meng

By Daniel Dunaief

Diamonds may not only be a girl’s best friend, they may also be important for doctors, particularly those using radiation to treat cancer patients.

Erik Muller, a principal investigator and adjunct professor in the Department of Materials Science and Chemical Engineering at Stony Brook University, recently demonstrated that a particular type of synthetic diamond can measure the flux, position and timing of radiation beams used in cancer therapies. His research seeks to adapt diamond detectors for use with an emerging type of therapy using high-energy protons and carbon ions. “There currently does not exist a technology which can precisely measure the flux, position and timing of these proton and carbon ion beams used in radiotherapy,” Muller explained.

The diamonds Muller and his team use are more pure than any natural diamond. They contain fewer than five parts per billion of nitrogen and less boron or other impurities. They are clear with no color. Nitrogen gives diamonds a yellow or brown color and acts as a charge trap, making natural diamond unsuitable for radiation detectors.

As an SBU postdoctoral researcher, Muller joined an effort at Brookhaven National Laboratory to investigate the use of diamond as an electron source. During that study, researchers found that diamond was a valuable X-ray detector. The success of that work led to the Department of Energy funding work to develop sensors for radiotherapy.

Diamonds can provide information that enable scientists to measure in real time the development of the beam.

Once diamond growers send the product to his lab, Muller and his team screen for a defect that can lead to unwanted hot spots in the detector response to X-rays. When Muller’s lab receives the diamonds, they look like small square pieces of glass. These diamonds are bread sliced into two to three pieces that are about half the thickness of a human hair.

Partners at the Center for Functional Nanomaterials at BNL prepare, characterize, etch and pattern the diamonds in the cleanroom. The Instrumentation Division at BNL provided custom electronics, circuit design, wire bonding and assembly. “The development of the detectors, particularly the pixellated diamond X-ray detector, would not be possible without the talent and expertise” in the Instrumentation Division, Muller explained.

Muller also lauded the contribution of the Stony Brook University students who worked on the diamond effort, including Mengjia Gaowei, Tianyi Zhou, Mengnan Zou and Wenxiang Ding. In preparing a proposal for the Department of Energy to improve beam diagnostics for particle therapy, Muller met Samuel Ryu, chair of the Department of Radiation Oncology and deputy director for clinical affairs at Stony Brook University’s Cancer Center. Ryu “expressed a strong interest in using these detectors for X-ray beam therapy and we have been pursuing that as well,” Muller said.

Ryu said the existing conventional detector, which measures radiation dosage, is “limited in some sense.” He likened the radiation detector to a thermometer. If a thermometer indicates that it’s 90 degrees, it may be 91 degrees, but the thermometer may not read the temperature with enough precision to indicate the exact temperature. Similarly, the diamond detector “will improve” the precision of the radiation dose measurement. The gap in the detection of the radiation dose has been like that for more than 100 years, Ryu said.

Ryu said the addition of the diamond to the detector should be commercialized and that he and Muller are “really trying to find out how we can use these detectors in the clinic.” Ryu said he doesn’t know the time frame for when this might become available in a radiation delivery system, but he would “like to see it as soon as possible.” Ryu and his staff meet regularly with Muller and his team to analyze the data and discuss how to proceed. He described Muller as “very open-minded” and indicated that it is a “very good collaboration.”

One of the challenges in taking this diamond discovery to the next step is to ensure that the software is robust and that it has enough redundancies to turn the beam off amid any contradictory readings. Before diamonds can become a part of these carbon or ion beam treatments, researchers need to demonstrate that the radiation itself won’t damage the diamond. While Muller doesn’t expect this to happen, he said he has to prove its viability.

In the bigger picture, Muller said he and the members of his lab spend considerable time understanding the physics of radiation sensing devices in high-radiation environments. “Diamond is a very promising material in this field for continued development and is our current focus,” he suggested. “In general, I am interested in any technique and material where we can understand how the structure affects the device function.”

Residents of South Setauket, Muller lives with his wife Yizhi Meng, an assistant professor in the Department of Materials Science and Chemical Engineering at Stony Brook, and their daughter, who is in primary school. Meng, who is a graduate of Ward Melville High School, develops drug delivery materials for breast cancer and osteosarcoma, a type of bone cancer. The couple met when they were graduate students at Cornell University. They shared an interest in photography. Meng uses Nikon cameras, while Muller prefers Canon. “There’s a funny rivalry between us,” Meng said.

As for his work, Muller is optimistic that it will have an application in radiation delivery. He believes he can address the engineering challenges and is “planning to continue the commercialization of these devices.” Meng is excited by the progress Muller has been making. Muller is “working with some really great people,” she said. “It’s really exciting.”

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Exercise is important in reducing the risk of fractures. Stock photo

By David Dunaief, MD

Osteoporosis is a complex disease. For one thing, it progresses with no symptoms, until the more severe stage of fractures that cause potential disability and increase mortality. For another, the only symptoms are from the treatment with medications, better known as side effects. Third, lifestyle modifications and supplements, while important, require adherence to a regimen.

I am not a big advocate of medication, as I am sure you have gathered from my previous articles; however, medication does have its place. There are studies that show benefit from the two main classes for osteoporosis, bisphosphonates such as alendronate (Fosamax, though it is now generic) and the newer class that involves monoclonal antibodies such as denosumab (Prolia). And, of course, I am a big advocate of lifestyle modifications including diet, exercise, smoking cessation and even some supplements. The side effects of these modifications are better health outcomes for chronic diseases and disorders in general. What I can’t advocate for, as a physician sworn to help people, is the new emerging cohort that I refer to as the “do-nothing group.”

Recently, a New York Times article on June 1, 2016, entitled, “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis,” reported that prescriptions for medications to treat the disease have fallen by more than 50 percent from 2008 to 2012 because of the fear of the side effect profile that include rare instances of atypical fractures and jawbone necrosis (1).

In the article, one doctor mentions that patients prefer diet and exercise, but that it does not work. Well, he may be partially correct. Diet and exercise may not work if they’re not implemented. However, if people actually make lifestyle modifications, there could be substantial benefit. Just to give up on the medications for osteoporosis or to refuse to take them is not going to improve your chances or reduce your risk of getting fractures in the spine, hip, wrist or other locations. In other words, the “do-nothing” approach won’t help and may significantly increase your risk of fracture and other complications, such as death.

At the top of the list of risk factors for osteoporosis is nontraumatic fractures — in other words, breaking of bone with low-impact events. In this case, once you have had a fracture, the probability of having a recurrent or subsequent fracture increases more than three times in the first year, according to a recent Icelandic study (2). Lest you think that you are in the clear after a year since your first fracture: After 10 years, the risk of subsequent fracture still remains high, with a twofold increased risk.

Osteoporosis involves bone loss. We typically measure this through the bone mineral density (BMD) biomarker using a DXA scan. However, another component is bone quality. Sarcopenia, or loss of lean muscle mass, may play a role in bone quality. There are vitamins, such as vitamin K2, that can have beneficial effects on bone based on bone quality as well. No, this is not the same as the more well-known vitamin K1 used in clotting, which may also have a smaller benefit in preserving bone.

Let’s look at the evidence.

Avoiding sacropenia

Sarcopenia is a fancy word for a depressing phenomenon that occurs as we age and become more and more sedentary; it is the loss of lean skeletal muscle mass at the rate of 3 to 8 percent each consecutive decade after 30 and also loss of strength (3). It may have significant effects on about one-third of those over age 60 and half of those over 80. Unless, of course, you are physically active on a regular basis. In the Study for Osteoporotic Fractures in Men, results show that sarcopenia plus osteoporosis, taken together, increases the risk of fracture more than three times in older men (4).

The researchers assessed muscle wasting by using the European Working Group on Sarcopenia in Older Patients (EWGSOP), which takes into account weakness (grip strength <20 kg for men), slowness (walking=0.8 m/s) and low lean muscle mass (< 20 percent). This involved over 5,000 men with a mean age of about 74. The group with sarcopenia had significantly lower grip strength and was less physically active. In another study, those who were healthy 65-year-old adults who had sarcopenia or low lean muscle mass were at a greater than two times risk of experiencing a low-trauma fracture within three years (5). This was according to the EWGSOP1 cutoff criteria for sarcopenia.

Preventing sarcopenia

Well, beyond the obvious of physical activity and formal exercise, there is a medication that has potentially shown positive results. This is the bisphosphonate alendronate (Fosamax). In a study, results showed that alendronate increased muscle mass significantly over a one-year period (6). In the appendicular (locomotive) skeletal muscle, there was a 2.5 times increase in muscle mass, while in lower limb muscle mass there was a greater than four times increase. This was a retrospective (backward-looking), case-control study involving about 400 participants. While these results are encouraging, we need a prospective (forward-looking), randomized controlled trial. For those who don’t want to or can’t for some reason exercise, then medication may help with muscle mass.

Exercise! Exercise! Exercise!

In a meta-analysis (a group of 10 trials), results showed there was a significant 51 percent reduction in the risk of overall fracture in postmenopausal women who exercised (7). This study involve over 1,400 participants. Does exercise intensity matter? Fortunately, the answer is no. If you like jogging or running, that’s great, but walking was also beneficial. This is important, since you want to do the type of activity that is more enjoyable to you, especially since the benefit of exercise dissipates when you stop doing it regularly (8).

The importance of K2

In a recent study, vitamin K2 was shown to reduce the risk of hip fracture by 60 percent, vertebral fracture by 77 percent and nonvertebral fractures by a whopping 81 percent (9). According to the authors, this benefit may be derived from bone strength (BMC, or bone mineral content) rather than from bone mineral density (BMD). There were 325 postmenopausal women in this study. It was a randomized controlled trial with one group receiving vitamin K2 (MK-4, menatetrenone) supplementation of 45 mg/day and the other a placebo group.

Don’t forget fruits and vegetables

In the Singapore Chinese Health Study, a prospective population-based study, results showed that there was a 34 percent reduction in the risk of hip fracture in the highest quintile of vegetable-fruit-soy (VFS) intake, compared to the lowest quintile (10). This study involved over 63,000 men, premenopausal and postmenopausal women with an age range from 45 to 74 years old. The results showed a dose-dependent curve, meaning the more VFS, the higher the reduction in hip fracture risk. Interestingly, there was no difference in risk of fracture when meat in the form of meat dim-sum was used instead of plant-based protein. The researchers concluded that an Asian plant-based diet may help reduce the risk of hip fracture. I’m not saying to take medications for osteoporosis, but you need to do something — either medications, lifestyle modifications, supplements or all three — especially if you have a history of low-trauma fractures, because your risks of disability, complications and death increase significantly with subsequent fractures. But, do not be part of the growing “do-nothing” group.

References:

(1) J Bone Miner Res. 2015;30(12):2179-2187. (2) World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases 2016. Abstract 0C35. (3) Curr Opin Clin Nutr Metab Care. 2009; 12(1):86–90. (4) American Society of Bone and Mineral Research 2013. Abstract 1026. (5) Age Ageing.2010;39:412-423. (6) Osteoporos Sarcopenia. 2015;1(1):53-58. (7) Osteoporos Int. 2013;24(7):1937. (8) Ann Intern Med. 1988;108(6):824. (9) Osteoporos Int. 2007;18(7):963-972. (10) J Nutr. 2014;144(4):511-518.

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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