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Pavel Osten. Photo by Joelle Wiggins

By Daniel Dunaief

Male mice, as it turns out, might also be from Mars, while female mice might be from Venus. Looking at specific cells in the brain of rodents, Cold Spring Harbor Laboratory Associate Professor Pavel Osten has found some noteworthy differences in their brain cells.

In the scientific journal Cell, Osten presented data that showed that in 10 out of 11 subcortical regions of the mouse brain, female mice showed greater flexibility and even more cells. These regions of the brain are responsible for reproduction, and social and parenting behaviors. “There were more cells [in these regions] in the female brain, even though the brains tended to be bigger in the males,” Osten said.

These results are part of a multiyear collaboration called the National Institutes of Health’s Brain Initiative Cell Census Network.

In the recent Cell article, Osten indicated that his analysis offered a surprising result in the number of cells of specific types in various regions of the cortex. “Those areas that have higher cognitive functions have different compositions,” he said. The ratios of cell types “vary according to the level of cognitive function.” In retrospect, Osten indicated that he saw the logic in such a cellular organization. “It makes sense that different cortical areas would have different cell type composition tuned to the specific cortical functions,” he explained.

In an email, Hongkui Zeng, the executive director of structured science at the Allen Institute for Brain Science, in Seattle, Washington, suggested that “people never looked at this issue carefully before. She added that the “sexual dimorphism was somewhat expected, but it is still interesting to see the real data.”

Pavel Osten sailing in St. Barts and St. Martin last summer. Photo from Pavel Osten

Osten used a system called qBrain to see and count inhibitory neurons in the mouse brain. Over the next five years, he and his collaborators will build an online resource database for other researchers that will have distribution maps for numerous cell types throughout the mouse brain.

Osten estimates that there could be hundreds or even a thousand cell types within the brain that are largely uncharacterized in their specialized functions. A cell type is defined by its function in terms of its morphology, including dendritic and axonal branches. These cells are also defined by their physiology, which includes spiking properties, and connectivity, which indicates which cell is talking to other cells.

The anatomy and physiology of the cells will validate these transcriptome single-cell RNAseq studies, which probe for the variability between cells based on their gene expression, which includes differences due to day-to-day variability and differences from distinct cell types.

By analyzing the location and modulatory functions of these cell types, Osten would like to determine ways human brains differ from other animal brains. “In the human, we can mainly analyze the location and distribution which includes the ratios of specific cell types and our hypothesis is that fine-tuning the ratios of neuronal cell types may be a powerful evolutionary mechanism for building more efficient circuits and possibly even for distinguishing between human and other animals,” Osten explained in an email.

Humans, he continued, don’t have the largest brains or the most neurons. At one point, spindle neurons were considered unique to humans, but other researchers have shown that great apes, elephants and cetaceans, which is a group that includes whales and dolphins, also have them.

Osten’s hypothesis is that one of the differences is that the ratios of cells of different types built a computational circuit that’s more powerful than the ones in other species.

When he studies mouse brains, Osten collects information across the entire brain. With humans, he explores one cubic centimeter. The human work is just starting in his lab and represents a collaboration with Zsófia Maglóczky from the Hungarian Academy of Sciences at the Institute of Experimental Medicine in Budapest.

Each mouse brain dataset is between 200 gigabytes and 10 terabytes, depending on the resolution Osten uses to image the brain. He can process 10 terabytes of data in about a week.

Osten uses machine learning algorithms that develop with guidance from human experts. This comes from a long-standing collaboration with Sebastian Seung, a professor of computer science at Princeton University.

He suggested that the research has a translational element as well, offering a way to study cellular and wiring elements characteristic of diseases. “We are looking at several of the models that are well established for autism.” He is also planning to write grants to find funds that supports the analysis of brains from people with schizophrenia and Alzheimer’s disease.

The analysis is a promising avenue of research, other scientists said. “It will be extremely interesting to compare the ratio of different cell types in various diseased brains with normal healthy brains, to see if the diseases may preferentially affect certain cell types and why and how,” Zeng explained in an email. “This could be very helpful for us to devise therapeutic means” to treat diseases.

Zeng has known Osten for about seven years. Last year, she began a collaboration using qBrain to quantify cell types.

A current resident of Williamsburg, where his reverse commute is now about 40 minutes, Osten works with a company he and Seung started called Certerra, which provides a rapid analysis of brain activity at different times. The company, located in Farmingdale, has a growing customer base and has a staff of about five people.

As for the recent work, researchers suggested it would help continue to unlock mysteries of the brain. This research is “a basic but important step toward understanding how the brain works,” Zeng added. “This paper provides a new and efficient approach that will be powerful when combined with genetic tools that can label different cell types.”

AUTUMN HARVEST Gerard Romano of Port Jefferson Station stopped by the Ward Melville Heritage Organization’s Educational & Cultural Center in Stony Brook Village last week and snapped this photo. He writes, “At the entrance were the nicest pumpkin decorations. I was drawn to the color and arrangement.”

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Halloween has always seemed like an opportunity to explore the creatively terrifying parts of our imagination. We put up ghosts, goblins, skeletons and spiderwebs around our houses; we dress our children as Dracula, Frankenstein’s monster and zombies; and we jump out from behind bushes, yelling “Boo” or “Happy Halloween.”

Maybe, instead of indulging the frightening side of life that seems present almost daily, we should take this opportunity to develop wouldn’t-it-be-nice costumes.

For starters, we could dress our kids, or ourselves if we’re in jobs that allow us to come to work in costume, as giant, dirty hands. When asked to explain ourselves, we could suggest that we’re helping hands, willing to get our hands dirty to help those in need anywhere. This includes Puerto Rico, where people are still without power and are seeking to meet basic needs such as food and water. It also could include a co-worker dealing with an illness or death in the family, or an injured neighbor who can’t get his recycling to the curb.

While we’re at it, we could dress as a door with a giant lever people could pull to knock. What are we? We could be opportunity. Every day presents an opportunity to become what we wish, whether that’s someone who can and will lose weight, or someone who sets an incredible example for our children and for other people’s children, or someone who no longer stays silent when he or she sees any type of injustice, whether that’s discrimination, harassment or bullying.

Maybe, we could send our kids out as giant ears. They could become the great listeners. We have so many aspiring great speakers who share every thought in their head, whether that’s online, in a tweet or on a TV show, scoffing, pontificating and second-guessing everyone and everything. What does a great listener do, besides absorbing the deluge of thoughts coming his or her way? That person imagines the ideas and motivation behind those words, considers the hurt or vulnerability that those ideas might convey, and thinks of ways to change negative thoughts and behavioral patterns into something positive and inspiring.

Extending the auditory idea, we could also send our kids out in togas with a bucket of fake ears. Why the togas? They could be Romans. Why the ears? Just ask Shakespeare, whose Mark Antony exhorts a crowd in Act III, scene ii of “Julius Caesar” with the opening line, “Friends, Romans, countrymen, lend me your ears.”

We could encourage children to listen and read one of the greatest and most often cited speeches from Shakespeare, helping them learn about the power of rhetoric and the passion of ideas. The older children might even suggest that they are a walking example of praeteritio, the literary technique Antony uses when he suggests he’s not going to discuss that which he shares in great detail, namely, the recently deceased Caesar’s contributions to Rome and its citizens.

For those who need something with a shriek component, we could create a costume in which someone dresses up in everyday clothing. An individual could hold a small cage or a tight box containing whatever horrifying image that person imagines in connection with a disease. He or she could suggest that the disease is contained and that this illness, which is locked in a box, is being taken for a walk. As a result, a horrifying disease is minimized and contained.

Finally, we could cover our kids in the kind of headlines we’d like to see, including “Peace breaks out all over the world,” “Children cure cancer,” “Bullying takes a day off,” “Endangered species recover from the brink of extinction” and “Leaders agree to work together.” What would we call such a costume? Fake news.

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At some point along my ancestral chain, I must have been Italian. Or Chinese. How do I know? I have an unbelievable passion for pasta. That’s not a carbohydrate lust. While I have never met a carb I don’t like, I can take or leave rice or bread and the many other forms in which carbohydrates can be found. But my soul soars for pasta.

It was World Pasta Day Oct. 25, and that got me to thinking about my love affair with pasta. I suppose it started in my early childhood, as almost everything does. SpaghettiOs came in a can, and my mother occasionally served it to us as part of a meal. However, the story is not that straightforward. She felt the sauce was a bit sharp, and so she sprinkled the spaghetti with a little sugar. Now this is enough to make any self-respecting Italian restaurateur gag. Many did, as I would ask, “Can I have some sugar please?” of my waiter as I was served a bowl of steaming pasta. “Sugar? You mean Parmesan cheese?” he would ask. “No sugar, thank you, granulated sugar,” I would patiently explain. Then he would watch in fascination as I topped off my dish accordingly.

It wasn’t until I visited Italy for the first time that I understood the miracle of pasta. The secret is in the sauce, which decidedly is not improved with the addition of sugar. Somehow the pasta itself tastes different there too, the same way water does depending on where it comes from. I remember that first trip very well, as I fell in love with the beauty of the country, the kindness of the people, the richness of its art. But what I remember best is the pasta, which I will tell you that I came to eat there three times a day. And it never tasted the same way twice because all chefs proudly make their own secret sauces. The high point occurred in Amalfi, in a small restaurant on the side of a mountain overlooking the sea. We were with a tour but unscheduled for lunch, and we wandered around the town looking for a likely eatery. They are all charming, you know, but one in particular attracted us and we went in to find that the luncheon special consisted of six different kinds of pasta.

Six! I thought I had died and gone to heaven. The chef, who spoke no English and needed none, came out to explain that we should start with the mildest pasta on the huge plate, then work our way around much as an artist does with his paint palette, to the one with the strongest flavored sauce. The six pastas were each different and the experience was, as you can tell, exquisitely memorable.

Although some think pasta was invented in Italy, others believe Marco Polo brought it back from his travels to China, where he supposedly tasted it at the court of Kublai Khan. There is record of the Chinese eating noodles as early as 5000 B.C. and, in fact, the Etruscans from western Italy seem to have made pasta in 400 B.C. There are bas-relief carvings in a cave 30 miles north of Rome depicting instruments for making pasta: a rolling-out table, pastry wheel and flour bin, according to the National Pasta Association. Anyway in the 13th century, the pope set quality standards for pasta. Thomas Jefferson fell in love with a macaroni dish he tasted in Naples while serving as ambassador to France and promptly ordered crates of the pasta, along with the pasta-making machine, sent back to the United States. Indeed, he may have been the one to introduce macaroni to this country. Cortez brought tomatoes back from Mexico in 1519, but it took two centuries before the marriage with pasta was consummated.

There have been many imitation pastas, meaning not made from wheat, that have come along, but only one makes the grade with me, and I give it a shameless plug here for those who can’t or won’t eat the real thing. Manufactured by Tolerant, it is made of beans and called Organic Red Lentil Pasta.

Buon appetito!

'Back Porch Pumpkin' by Al Candia

By Irene Ruddock

Artist’s statement:  I hope that my paintings create a deeper sense of the relationship between ourselves and the splendid world in which we live, and are moving through too quickly. — Al Candia

 

Al Candia

Al Candia, a Stony Brook resident, has been interested in art since childhood. He began painting seriously while teaching English at Commack High School, continuing his studies of art at Stony Brook University. His workshops and private study included courses with many noted artists, including Joseph Reboli. Candia has become an award-winning artist exhibiting extensively in galleries all over Long Island. Chosen as Honored Artist by the Setauket Artists in 2015, Candia is October’s Artist of the Month at The Long Island Museum.

Can you elaborate on your artist’s statement?

I concentrate on the immediate world around me. I try to avoid “grand” subjects and tend to focus on the common, ordinary things that I find meaningful, but that we are sometimes too busy to notice: a farm fence in an open field, ancient beach chairs frozen in the snow, a jetty marching down into the ocean, flowers stuck in an old bucket, a small pumpkin on the steps.

How did you learn to paint?

The most important teacher is “the doing.” I can’t tell you how many acres of canvas I went through to arrive at a level where I began to consider myself as an artist.

It has been said that your paintings ‘touch the heart’ and are soulful. Why do you think that is?

Perhaps by going through life so fast, people might secretly yearn for a simpler way of life. They may enjoy slowing down a bit to “take a breath” and see the ordinary and realize it can be extraordinary.

You were an English teacher for 36 years before becoming a full-time artist. How did teaching influence your work?

For me, there is wonderful connection between fine art and literature. Writers and poets deal very much in the creation of images. An image can haunt us, fill us with joy. It is what makes a written work alive and vivid. It is what made me want to become a painter. I would see something — a broken seashell, a window in the late afternoon shadows — that would move me deeply and would be heavy with meaning. I very much wanted to celebrate that in a painting.

‘Back Porch Pumpkin’ by Al Candia

How do you find inspiration for a painting?

Robert Frost said that a poem begins with a lump in the throat. He was talking, of course, about being moved or shaken by something — an idea, an experience, an object — that needs to be expressed. That is true for me also. Recently, I came across a pumpkin on the worn steps of a back porch. I was so taken with this simple object that hardly anyone would see. I thought of the person who placed it there out of a some personal gesture. I thought it would make a touching painting that reveals some small aspect of our humanity.

What is your method?

I usually begin with a bunch of photos. I take these back to my studio and begin to work up a drawing idea for the painting. This is an important step where you design the composition, simplify, arrange the elements, and begin to think of color and light. From there, I proceed as many oil painters do by washing the canvas with a thin mixture of warm color diluted with mineral spirits. Next I begin to lay in the large shapes. Essentially I am carrying on a dialogue with the canvas, finding out what is working and what is not.

Why have you chosen oil painting over other mediums?

I think the medium choose me. It somehow fits my personality. Oil painting is slow moving and deliberate. It often will take a few days to allow the painting to dry before moving on to the next step. During these intervals the painting is percolating in my brain, trying to make the painting as good as it possibly can be. I compare it to a child with a wind up toy, winding that toy as tight as possible in order to release it to its maximum effect.

What is the biggest difficulty you encounter in the creation of a painting?

After working with a painting for a couple weeks, you can lose the sense of it, you lose perspective. You can begin to doubt yourself: did I make all the right decisions, is the color just right, did I overwork it, does it still capture what you set out to do? At this time, for me, it is important to have honest feedback from others. My wife is an important part in keeping me on track.

‘Hydrangeas in a Bucket’ by Al Candia

After all that work and effort, it must be difficult to let a painting go.

Not at all. I love the entire process of painting from the initial moment of finding a subject, to creating a design, through the struggle of execution. And hopefully someone will come along and appreciate the painting enough to buy it and hang it in their home. For me that completes the cycle, and the painting begins its life.

Beside the Visitor’s Center at The Long Island Museum in October, where can we see your work?

I will be exhibiting at the Setauket Neighborhood House in the 37th annual Setauket Artists exhibit from Oct. 22 to Nov. 20. People are always welcome to visit my studio by appointment. You can contact me by visiting my website at www.alcandia.com.

A trustee must put the interests of the trust beneficiaries before their own

By Nancy Burner, ESQ.

Nancy Burner, Esq.

If you have been named as a trustee of someone’s trust, you may be wondering what you are supposed to do. It is important that the trustee understand his or her duties and responsibilities. The most important thing to remember as a trustee is that the trust assets are not your assets. You are safeguarding them for the settlor and/or beneficiaries, who will receive them after the settlor dies.

As a trustee, you stand in a “fiduciary” role with respect to the beneficiaries of the trust. As a fiduciary, you will be held to a very high standard. The trustee must read the trust document carefully, upon acting initially and when any questions arise. The trust is the road map and the trustee must follow its directions in administering the trust. A trustee should be aware that failing to abide by the terms of the trust document and mismanaging the assets can have serious financial repercussions for the trustee personally such as forfeiture of commissions and surcharge.

This very issue came up in the recent Suffolk County Surrogate’s Court case of Accounting Proceeding the Schweiger Family 2013 Irrevocable Trust decided on Sept. 7, 2017.

The subject trust stated that during the lifetime of the settlor, the trustees in their sole discretion may pay the net income to or for the benefit of the settlor’s beneficiaries or accumulate such income. With respect to principal, the trustees were given the discretion to pay so much of the principal to or for the benefit of the settlor’s beneficiaries. The trust did not require equal principal distributions and same may be made to any or all of the settlor’s beneficiaries.

Distributions made to any beneficiaries during the settlor’s lifetime shall be considered as advancements in determining the beneficiary’s respective share, unless waived by the remaining nonrecipient beneficiaries in writing. The trustees had no authority to pay principal to the settlor.

Despite the language in the trust document, the trustees made distributions to themselves and to individuals that were not beneficiaries, namely the settlor, their children/grandchildren and the spouse of one of the trustees.

In addition, the trustees indicated in their accounting that several of the distributions that were made to themselves as “per settlor’s request.”

After a review of the facts and the language of the trust document, the court held that even if the distributions to the trustees were at the settlor’s suggestion, those distributions were either impermissible gifts of trust assets by the settlor or distributions that the trustees should have assessed against their respective shares as advancements.

With respect to commissions, the court held that intentionally making distributions to individuals who were not beneficiaries of the trust is, in and of itself, a basis to deny commissions. Further, with respect to their self-dealing, either the trustees were in fact aware of the language regarding offsetting advance distributions and chose to disregard it or they were grossly negligent in their failure to seek professional advice to assist them in understanding the duties and responsibilities associated with being trustees. In the end, the trustees were surcharged approximately $230,000 for their self-dealing and failure to abide by the terms of the trust document.

The take away from all of this is that a trustee must follow the terms of the trust instrument and put the interests of the trust beneficiaries before their own. If this is not done the trustee is at risk of personal liability for any breach of duty in the form of denial of commissions or surcharge.

In addition, if you are the trustee of a Medicaid-qualifying irrevocable trust and fail to abide by the terms of the trust, not only do you run the risk of denial of commissions or surcharge, but you can also nullify any protections that the trust provides to the assets held by the trust. This would make all of the assets in the trust be considered an available resource when determining Medicaid eligibility for the settlor and could result in a denial of Medicaid benefits.

With a trustee’s personal liability at stake, it is advisable to retain an attorney to provide advice regarding the trustee’s fiduciary duties and obligations in administering a trust.

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

By our silence, we affirm the destructive behaviors and destructive rhetoric that have become a cancer among us.

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

Once again our nation is in shock after the worse gun violence massacre in American history: 58 innocent people killed and more than 500 people severely wounded and/or injured during a Las Vegas concert.

At the time of this horrific attack, the nation was in the midst of recovering from three catastrophic hurricanes that left major areas of our country, Puerto Rico and the U.S. Virgin Islands overwhelmed and powerless.

Each tragic circumstance brought out the best in our American spirit. Countless heroes risking their lives to save others; the spirit of selflessness and compassion has been inspirational. If only those in elected office learned from the power of their example!

These past few months the public discourse across the country has bordered on disgraceful. The demeaning rhetoric is fueling the heat and violence that is erupting across our nation.

The recent debate around the actions of many NFL football players regarding the appropriate posture during our national anthem has sparked a national conversation that all Americans should be attentive to. No matter what your politics, the conversation it has provoked around racism, police violence and hatred is vital. We need to discuss these issues with passion, commitment and open hearts but grounded in a profound respect for one another.

So many of the events that have erupted since January have underscored that there are many serious social issues that as a nation we must confront. They go beyond the scope of our differences around health care and tax reform.

Our criminal justice system is in dire need of reform. The way we treat drug addicts who commit nonviolent crimes is scandalous and needs to be addressed. The growing incidences of discrimination based on race, religion and sexual orientation need to take center stage as part of the national agenda.

The social indifference that has become so infectious is counterproductive. By our silence, we affirm the destructive behaviors and destructive rhetoric that have become a cancer among us.

We need to be more proactive on every level. Our students need to be a part of these important conversations. The average citizen needs to become more involved in our political process and understand that his/her voice does matter and does make an important difference.

The people’s voice needs to be heard. Those who have been elected must be held accountable to the people who elected them — not to a specific political party.

These are challenging times; however, we are all part of the challenge. We must lead by example. Our churches, synagogues and mosques must address the social issues and become a part of the national conversation. Our clerical leadership must urge their congregants to take a more active role in the political landscape of our communities.

As Mahatma Gandhi once said, “Be the change that you wish to see in the world!” Hope must be the anthem of our souls.

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

Foods high in Vitamin D include egg yolks, beef, shiitake mushrooms, cheese, milk and cold-water fatty fish like salmon, above.
In most geographic locations, sun exposure will not correct vitamin D deficiencies

By David Dunaief, M.D.

Dr. David Dunaief

Vitamin D is one the most widely publicized and important supplements. We get vitamin D from the sun, food and supplements. With our days rapidly shortening here in the Northeast, I thought it would be worthwhile to explore what we know about vitamin D supplementation.

Vitamin D has been thought of as an elixir for life, but is it really? There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of the treatment paradigm. However, many questions remain. As more data come along, their meaning for vitamin D becomes murkier. For instance, is the sun the best source of vitamin D?

At the 70th annual American Academy of Dermatology meeting, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, spoke about how, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, such as salmon, sardines and tuna.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular and autoimmune diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. The Institute of Medicine recommends more than 20 ng/dl, and The Endocrine Society recommends at least 30 ng/dl. More experts and data lean toward the latter number.

Skin cancer

Vitamin D did not decrease nonmelanoma skin cancers (NMSCs), such as squamous cell and basal cell carcinoma. It may actually increase them, according to one study done at a single center by an HMO (1). The results may be confounded, or blurred, by UV radiation from the sun, so vitamin D is not necessarily the culprit. Most of the surfaces where skin cancer was found were sun exposed, but not all of them.

The good news is that, for postmenopausal women who have already had an NMSC bout, vitamin D plus calcium appears to reduce its recurrence, according to the Women’s Health Initiative study (2). In this high-risk population, the combination of supplements reduced risk by 57 percent. However, unlike the previous study, vitamin D did not increase the incidence of NMSC in the general population. NMSC occurs more frequently than breast, prostate, lung and colorectal cancers combined (3).

Cardiovascular mixed results

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (4).

However, a small randomized controlled trial (RCT), the gold standard of studies, calls the cardioprotective effects of vitamin D into question (5). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points. However, these results do make you think.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/dl, compared to those below this level, in the Study of Osteoporotic Fractures (6).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/dl in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (7). The difference between the groups was statistically important, but clinically small: 9 percent reduction with vitamin D plus calcium and 7 percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures (8). It does not seem to reduce fractures and increases the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention.

Need for clinical trials

We need clinical trials to determine the effectiveness of vitamin D in many chronic diseases, since it may have beneficial effects in preventing or helping to treat them (9). Right now, there is a lack of large randomized clinical trials. Most are observational, which provides associations, but not links. The VITAL study is a large RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer. It is a five-year trial, and the results should be available in 2018.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it may play an integral role with many disorders.

References: (1) Arch Dermatol. 2011;147(12):1379-1384. (2) J Clin Oncol. 2011 Aug 1;29(22):3078-3084. (3) CA Cancer J Clin. 2009;59(4):225-249. (4) Circulation. 2008 Jan 29;117(4):503-511. (5) PLoS One. 2012;7(5):e36617. (6) J Women’s Health (Larchmt). 2012 Jun 25. (7) J Clin Endocrinol Metabol. online May 17, 2012. (8) AHRQ Publication No. 12-05163-EF-2. (9) Endocr Rev. 2012 Jun;33(3):456-492.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For more information, visit www.medicalcompassmd.com.

From left, Gary Gerard, lead interventional/cardiac catheterization technologist, Stony Brook Southampton Hospital; Dr. Travis Bench, director, Cardiac Catheterization Lab, Stony Brook Southampton Hospital; Helen VanDenessen, nurse manager, Imaging, Stony Brook Southampton Hospital; and Dr. Dhaval Patel, cardiologist, Stony Brook Medicine. Photo from SBU

By Javed Butler, MD

Dr. Javed Butler

Stony Brook Medicine has opened the new Cardiac Catheterization (Cath) Laboratory at Stony Brook Southampton Hospital to improve access to lifesaving heart care for residents of the East End of Long Island.

The lab provides emergency and elective treatments delivered by Stony Brook University Heart Institute specialists, for easier, faster access to the highest standards of cardiac care. The standard of care for a person experiencing a heart attack is that the blocked artery should be opened within 90 minutes of contact with medical care. That procedure can only be done in a cardiac catheterization lab by highly trained personnel.

For the rapidly increasing population of the East End, the nearest cath lab was previously located at Stony Brook University Hospital, up to 70 miles and a 60- to 90-minute drive. Even transportation by ambulance or helicopter could result in a life-threatening delay.

The new cath lab, led by interventional cardiologist Dr. Travis Bench, is currently the only facility in the East End capable of providing clinically complex care to critically ill heart patients. Bench and his partner, Dr. Dhaval Patel, have East End cardiology practices in Southampton and Center Moriches.

The lab will save lives by providing more immediate intervention for serious heart events such as myocardial infarctions (heart attacks). A delay in restoring blood flow through an artery increases the likelihood for significant damage to the heart. By allowing physicians to open a blocked artery in Southampton, without having to first transport a patient to Stony Brook, damage to the heart can be minimized and total heart failure may be prevented.

At the Southampton cath lab, doctors will be able to perform percutaneous coronary intervention (PCI), a nonsurgical procedure in which a physician inserts catheters through the skin to reach affected structures. The PCI treatments at Stony Brook Southampton Hospital include emergency and elective procedures.

The Southampton lab is staffed every day, around the clock, by Stony Brook Heart Institute’s interventional cardiologists with the most up-to-date knowledge and skills to diagnose and treat patients with heart disease.

For patients who need emergency catheterization, Stony Brook’s “Code H” protocol has produced an average “door-to-perfusion” time of 56 minutes, almost 45 minutes below the New York State regulated treatment guidelines. That is the level of care we strive for at Stony Brook Southampton Hospital. The systems and processes are in place and we look forward to taking care of our patients out east with that same dedication to quality and excellence.

To view a video and learn more about the Cath Lab at Stony Brook Southampton Hospital, visit www.heart.stonybrookmedicine.edu.

Dr. Javed Butler is the co-director of the Heart Institute and chief of the Division of Cardiology at Stony Brook Medicine.

Japanese maple seedlings in a woodland setting have the best fall colors. Photo by Kyrnan Harvey

By Kyrnan Harvey

“It’s fall, right?” my 7-year-old just asked. And I was like, “Um, yeah?” Notwithstanding a few weeks of unseasonably balmy, if not muggy, days, it is October and the first noticeable autumnal tints are seen in the American dogwoods that grow along the margins of the Laurel Ridge-Setauket Woods Nature Preserve on Belle Mead Road.

You needn’t be a gardener — nor ferry up to New England — to enjoy the weeks of glorious colors in the maples and the oaks in random woods and suburban roads: the yellow Norway maple, the red-orange of sugar and red maples, the russet-reds of the oaks.

There are many kinds of shrubs too, of course, that present fall color. These typically color up best in sunnier locations, but the native spicebush (Lindera benzoin), ubiquitous in our woods because the deer leave them alone, are beginning to yellow even in heavy shade. Last Saturday I was driving on Mt. Grey and West Meadow roads in Old Field, where homes are nestled into our native oak woods. Naturalized in the understory are the native mountain laurel, Kalmia latifolia, and planted rhododendrons that had grown massive before the deer population exploded.

If you live under a high canopy of oak trees, but want some great fall color, Japanese maples are a superb understory tree: They prefer some shade and will color up well despite it. Japanese maples are not limited to the popular weeping lacy trees. They are primarily Acer palmatum, but they also refer to Acer japonicum and Acer shirasawanum.

Japanese maple seedlings flourish in a woodland setting. Photo by Kyrnan Harvey

The grafted cut-leaf Japanese maple is justifiably popular but not inexpensive. These are propagated vegetatively, i.e., not by seed; they are called cultivated varieties (cultivars, in the trade), meaning they have specific genes; and they are identical to one another in leaf shape, size and color and also in rate of growth and habit, by which is meant the shape of the crown, whether pyramidal, weeping or columnar.

The spectacular cut-leaf Japanese maple (Acer palmatum var. dissectum), red-leafed or green, is better used singly, as a specimen. Mature tress will get to be 15 feet in diameter, so do not make the common mistake of planting it too close to your driveway or front path or up close to your house. It is always a shame to have to restrict with pruning the natural form of these.

If you have the opportunity to plant a grove of Japanese maples, maybe for screening or to start a woodland garden, then the most expedient way would be to find a source of random Acer palmatum seedlings. Young trees, cheap. Don’t overly favor the showy red-leaved ones; select if you can a mix of green and red. In Joe’s garden, a client, there were three or four mature Japanese maples. We had many dozens of seedlings, offspring from the mother trees, growing out of the compost of years of leaf-blowing.

Many years ago Joe and I potted up a few of the younger ones, from 3 to 7 years old, and on a sunny Saturday morning in late October loaded them into the 8-foot bed of my ’68 Chevy. We parked on 5th Avenue in Park Slope in Brooklyn and presented a sidewalk sale. They were gorgeous in their variety of fall reds, oranges and even yellows. Fifteen years later and there are many dozens more seedlings, I just can’t bring myself to pull them up and throw them in the compost pile.

True, the deer will nip them as long as they can reach the branches. It is worth the effort to spritz a little deer repellent, especially in April, May, and June, for the first couple years until the branches are up and out of their reach. There is a blight on them, a soil-borne fungus called Verticillium wilt, that causes branches to die. Cut them back to the trunk. Sometimes the whole tree dies. If you have a dozen or more trees, as I recommend, and they are seeding themselves around, then it’s easy-come-easy-go. You don’t have to mourn the loss of a tree if there are many more healthy ones about.

It’s okay to start with unnamed seedlings of Acer palmatum. They are always gorgeous, leafing out in spring with their iconic leaves, or changing color in fall, they are never out of scale in the garden and comport well with companion shrubs and perennials. You could order a dozen and supplement them with a few choice named cultivars that you gradually collect at the garden center or through mail-order sources; or you could start right off with the choice varieties.

It would be preferable to have some of these splendid cultivars because some of their offspring seedlings will carry their desirable traits. Japanese maples are prolific self-sowers, so you might want to plant two or three of the great, well-known varieties: Invest in a few large trees, sourced at a nursery. Have them planted in locations that establish the structure and articulate the paths of a new woodland garden, underplant them with perennials and start looking out for seedlings next year!

Kyrnan Harvey is a horticulturist and garden designer residing in East Setauket. For more information, visit www.boskygarden.com.