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Long-term PPI use increases serious risks. Stock photo
PPIs may increase your fracture risk

By David Dunaief, M.D.

Dr. David Dunaief

After a meal, do you sometimes have “reflux” or “heartburn?” Many of us experience these symptoms occasionally. When it happens more frequently, it could be a sign of gastroesophageal reflux disease (GERD).

Between 18.1 and 27.8 percent of U.S. adults have GERD, according to estimates; however, since many people self-treat with over-the-counter (OTC) medications, the real numbers could be higher (1).

If you take OTC proton pump inhibitors (PPIs), you could be among the uncounted. Familiar brands include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole), among others. They are also available by prescription.

PPIs are not intended for long-term use, because of their robust potential side effects. Currently, the FDA suggests that OTC PPIs should be taken for no more than a 14-day treatment once every four months. Prescription PPIs should be taken for 4 to 8 weeks (2).

Unfortunately, many take them too long or too often, and some experience reflux rebound effects when they try to discontinue PPIs without physician oversight.

Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures, increased cardiac and vascular risks, vitamin malabsorption issues and Clostridium difficile (C. diff), a bacterial infection of the gastrointestinal tract.

PPIs can also interfere with other drugs you are taking, such as Plavix (clopidogrel).

PPIs and chronic kidney disease

Two separate studies showed that there was an increase in chronic kidney disease with prolonged PPI use (3). All patients started the study with normal kidney function, assessed by measuring glomerular filtration rate (GFR). The Atherosclerosis Risk in Communities (ARIC) study showed a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a 17 percent increased risk.

The medications were used on a chronic basis for years: the first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications and a milder drug class, H2 blockers (4).

PPIs and dementia risk

A German study looked at health records from a large public insurer and found a 44 percent increased risk of dementia in those aged 75 or older who were using PPIs, compared to those who were not (5). The authors surmise that PPIs may cross the blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower, 16 percent, increased risk.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. The research was not perfect, however. Researchers did not consider high blood pressure, excessive alcohol use or family history of dementia, all of which can influence dementia occurrence.

PPIs and fracture risk

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (6). With bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip, and any-site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (7).

PPIs and vitamin absorption

In addition to calcium absorption issues, PPIs may lower absorption of magnesium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (8). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study’s results showed use of over two years increased vitamin B12 deficiency risk by 65 percent (9).

Takeaways

Before taking OTC PPIs, consult with your physician. A milder medication, such as an H2 blocker (Zantac, Pepcid), might be a better option.

Even better, start with lifestyle changes. Try to avoid eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, before you try medications (10).

If you do need medication, recognize that PPIs don’t provide immediate relief and should only be taken for a short duration to minimize their side effects.

References: 

(1) nih.gov. (2) fda.gov. (3) JAMA Intern Med. 2016;176(2). (4) JAMA Intern Med. 2016;176(2):172-174. (5) JAMA Neurol. online Feb 15, 2016. (6) Osteoporos Int. online Oct 13, 2015. (7) Am J Med. 118:778-781. (8) PLoS Med. 2014;11(9):e1001736. (9) Mayo Clinic Proceedings. 2018 Feb;93(2):240-246. (10) Am J Gastroenterol 2015; 110:393–400.

Dr. David 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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Photo from Stony Brook University Hospital

For the estimated 1.6 million Americans diagnosed with symptomatic tricuspid valve regurgitation each year, a significant advancement in treatment is now available on Long Island. With the launch of the new Transcatheter Tricuspid Valve Replacement (TTVR) Program at the Stony Brook Heart Institute (SBHI), patients at Stony Brook Medicine have access to groundbreaking, minimally invasive therapies.

The heart has four valves — aortic, mitral, pulmonary and tricuspid — that control the direction of blood flow. In tricuspid regurgitation (TR), the tricuspid valve’s flaps do not close tightly, allowing blood to leak backward in the heart. Mild cases may cause no symptoms, but others suffer from fatigue, pulsing neck veins, fluid buildup in the abdomen and legs, and irregular, sometimes dangerous, heartbeats. If left untreated, individuals with severe TR can experience heart failure, blood clots, stroke and other organ damage.

In the hands of Stony Brook’s tricuspid valve specialists, the FDA-approved TriClip™ device offers a revolutionary treatment option. Performed under general anesthesia and guided by advanced imaging, the procedure involves placing a catheter through a vein to the heart, where the TriClip™ is precisely placed to bring valve flaps together, reducing backward blood flow. Because the procedure is minimally invasive and avoids open-heart surgery, most patients are up and walking within hours, discharged in one to two days, and back to their regular lives in about a week. Clinical trials published in The New England Journal of Medicine demonstrated that TriClip ™ placement resulted in 87% of patients experiencing a significant reduction in tricuspid regurgitation, compared to less than 5% with medication use alone.

Ahmad Alkhalil, MD, MSc, Director of the Mitral and Tricuspid Interventions at Stony Brook Heart Institute, who performed SBHI’s first TTVR procedure noted, “The tricuspid valve was formerly known as ‘the forgotten valve’ because surgical approaches were too risky and no other treatments were effective for the majority of patients. With our full range of minimally invasive therapies, including tricuspid transcatheter edge-to-edge repair (TEER) and tricuspid transcatheter valve replacement (TTVR), we are proud to be a leader in providing new options for patients on Long Island.”

“We are proud to be at the forefront of bringing new treatment options for symptomatic tricuspid regurgitation,” says Allison McLarty, MD, Interim Chief, Cardiothoracic Surgery, Stony Brook Heart Institute and Professor of Surgery, Renaissance School of Medicine at Stony Brook University. “Our skilled and dedicated physicians are continuously exploring new and innovative approaches to improve outcomes and the patient experience of people with valve disease.”

“Effective treatment begins with a precise diagnosis. Patients at Stony Brook Heart Institute benefit from a full suite of advanced imaging technologies, including 3D transthoracic and transesophageal echocardiography (TTE and TEE), cardiac MRI, CT angiography, nuclear stress testing and carotid ultrasound. These tools allow SBHI’s specialists to map each patient’s unique valve anatomy and tailor treatment to their needs,” added Smadar Kort, MD, Co-Director of the Valve Program and the Director of Non-Invasive Imaging at Stony Brook Heart Institute. “With multiple advanced imaging and procedural locations across Suffolk County, including Stony Brook, Commack and Riverhead, the Heart Institute ensures patients receive top-tier care close to home.”

“At the core of Stony Brook Heart Institute’s TTVR program is a multidisciplinary team of interventional cardiologists, cardiac surgeons, imaging specialists and advance practice practitioners who collaborate closely to ensure every patient receives seamless, compassionate care,” says Hal Skopicki, MD, PhD, Co-Director of Stony Brook Heart Institute and the Ambassador Charles A. Gargano Chair of Cardiology, Renaissance School of Medicine at Stony Brook University. “As an academic medical center actively participating in national and international clinical trials, we provide patients with access to emerging valve devices and interventions not yet widely available — offering many the opportunity to avoid open-heart surgery and benefit from the most cutting-edge, patient-centered cardiovascular care available today.”

To contact the Stony Brook Heart Institute, call 631-44HEART or visit heart.stonybrookmedicine.edu. 

About Stony Brook Heart Institute:  

Stony Brook Heart Institute is located within Stony Brook University Hospital as part of Long Island’s premier university-based medical center. The Heart Institute offers a comprehensive, multidisciplinary program for the prevention, diagnosis and treatment of cardiovascular disease. The staff includes full-time and community-based, board-certified cardiologists and cardiothoracic surgeons, as well as specially trained anesthesiologists, nurses, advanced practice practitioners, respiratory therapists, surgical technologists, perfusionists, and other support staff. Their combined expertise provides state-of-the-art interventional and surgical capabilities in 24-hour cardiac catheterization labs and surgical suites. And while the Heart Institute clinical staff offers the latest advances in medicine, its physician-scientists are also actively enhancing knowledge of the heart and blood vessels through basic biomedical studies and clinical research.

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St. Charles Hospital, 200 Belle Terre Rd. Port Jefferson presents Walk Safe with a Doc, a free community walk led by Dr. Brett Silverman, Physical Medicine & Rehabilitation Specialist, on Wednesday, June 25 at noon.

Dr. Silverman will discuss the importance of walking for overall health and injury prevention and pedestrian safety experts from NYCTS will provide tips for walking safely, before leading the group on a brief 1.5 mile walk.

Walkers are to meet at the hospital’s flagpole outside main entrance. To register, call 631-963-4167.

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Deer ticks aka blacklegged ticks typically carry Lyme disease.METRO photo
The effects of Lyme disease can be debilitating

By David Dunaief, M.D.

Dr. David Dunaief

Warm weather is imminent and, if you’re like me, you’re looking forward to enjoying more time outside this summer.  

Summer’s arrival also means that tick season is in full swing, although “season” is becoming a misnomer when we refer to ticks. A June 16th New York Times article shared some of the challenges of changing tick behavior and the expansion of tick types and overlapping tick-borne diseases we’re now seeing in the Northeast (1).

The most common of these is Lyme disease, which is typically carried by deer ticks, also known as blacklegged ticks. Deer ticks can be as small as the period at the end of this sentence. The CDC site is a great resource for tick images and typical regions (2).

If a tick bites you, you should remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick; doing so may spread infectious disease (3). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommends not removing a tick with oil (4).

When you remove a tick within 36 to 48 hours, your risk of infection is low. However, you can take a prophylactic dose of the antibiotic doxycycline within 72 hours of tick removal if you are not experiencing a bulls-eye rash — a red outer ring and red spot in the center (5). This can significantly lower your risk of developing Lyme disease, although doxycycline does sometimes cause nausea.

Know Lyme symptoms

The three stages of Lyme disease are: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue, muscle pain and joint pain, headache, neck stiffness, swollen glands, and fever (6).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory issues. Late disseminated disease can cause Lyme arthritis, heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (4).

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death (7). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, clinicians should suspect Lyme carditis.

Check for ticks 

The CDC suggests wearing protective clothing, using insect repellent with at least 20 percent DEET and treating your yard. Always check your skin and hair for ticks after spending time outside. Also, remember to check your pets; even if treated, they can carry ticks into the house.

Check for Lyme infection

Lyme disease often can be diagnosed within the clinical setting or with a blood test. However, testing immediately after being bitten by a tick is not useful. It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (6). These antibodies sometimes will remain elevated even after successful antibiotics treatment.

Remember that a single tick can transfer more than one disease, so you might need testing for other common tick-borne diseases, as well.

Monitor for post-Lyme effects

There is an ongoing debate about whether “chronic Lyme” disease exists. In one analysis of several prospective studies, researchers recognize that there are prolonged neurologic symptoms in a subset population that may be debilitating even after Lyme disease treatment (8). These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment. They note, however, that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes.

The lingering effects of Lyme can debilitate you and might be a result of systemic inflammation (9). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

Prevention is key to helping stem Lyme and other tick-borne diseases. Become diligent about performing tick checks any time you’ve been outside. If you do find a tick, contact your physician immediately about prophylactic treatment.

References: 

(1) “The Tick Situation is Getting Worse. Here’s How to Protect Yourself.” New York Times. 16 June 2025. online. (2) https://www.cdc.gov/ticks/about/where-ticks-live.html. (3) Pediatrics. 1985;75(6):997. (4) nlm.nih.gov. (5) Clin Infect Dis. 2008;47(2):188. (6) uptodate.com. (7) MMWR. 2014;63(43):982-983. (8) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (9) J Infect Dis. 2009;199(9:1379-1388).

Dr. David 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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Photo courtesy of Long Island Museum

The Long Island Museum, 1200 Route 25A, Stony Brook will host the 9th Annual Arts & Alzheimer’s Conference on Thursday, June 26 from 9:30 a.m. to 3 p.m. 

The conference will provide insight, and inspiration, into how the arts can enrich the lives of those with memory loss. The full-day program will feature presentations, activities and performances from local and national experts on how the arts can help increase engagement, and will help attendees discover the vast and enriching opportunities available for individuals living with Alzheimer’s disease and other forms of memory loss.

“Art and music can play such an important role in engaging and helping those with memory loss, providing a wonderful outlet for self-expression, as well as helping to stimulate positive memories, reduce anxiety and improve mood and social interaction,” said Beth Chiarelli, Assistant Director of Education at LIM, which also offers a series of In the Moment programs designed for those living with memory loss and their care partners.

The event is offered at no cost due to generous anonymous funding, and a complimentary lunch will be provided for all attendees. “We are so pleased to be able to offer this conference to the community, and help raise awareness of how the arts can enhance the quality of life for so many people with memory loss in our community,” said Chiarelli.

Space is limited and pre-registration is required by calling 631-751-0066, ext 211, or emailing [email protected].

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METRO photo
Taking calcium may only help if you’re deficient

By David M. Dunaief, M.D.

Dr. David Dunaief

We should all be concerned about osteoporosis risk. According to the Bone Health & Osteoporosis Foundation, 50 percent of women and 25 percent of men will break at least one bone due to osteoporosis (1). Hip fractures are especially concerning, because they increase mortality risk dramatically. More than 50 percent of hip fracture survivors are no longer able to live independently (2).

Do we need to consume more dairy?

Studies suggest that milk and other dairy products may not be as beneficial as we have been raised to believe.

Studies have shown milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (3).

In a 2020 meta-analysis of several past studies, researchers concluded that increased consumption of milk and other dairy products did not lower osteoporosis and hip fracture risks (4).

Generally, studies suggest that dairy may cause additional health problems. The results of a large, 20-year, observational study involving men and women in Sweden showed that milk may be harmful (5). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. 

Dosage also mattered. For every one glass of milk consumed, there was a 15 percent increased risk of death for women. There was a much smaller, but significant, three percent per glass increased risk of death in men. For both women and men, researchers found biomarkers in the urine that indicated higher levels of oxidative stress and inflammation.

Remember: these are only associations, not decisive conclusions. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation.

Interestingly, the USDA recommends that, from the age of 9 through adulthood, we consume about three cups of dairy per day (6).

Should we take calcium supplements?

We know calcium is a required element for strong bones, but do supplements really prevent osteoporosis and subsequent fractures? While the data are mixed, it suggests supplements may not be the answer for those who are not calcium deficient.

In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food daily (7).

The researchers did not differentiate among the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In four clinical trials, the researchers saw an increase in hip fractures among those who took calcium supplements. A weakness of this large study is that vitamin D baseline levels, exercise and phosphate levels were not considered in the analysis.

Does vitamin D supplementation reduce risk?

Finally, though the data are not always consistent for vitamin D, it appears it may be valuable when it comes to fracture prevention. In a meta-analysis involving 11 randomized controlled trials, vitamin D supplementation resulted in fewer fractures (8). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, those who were aged 65 and over experienced a 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures. However, vitamin D in lower levels did not significantly reduce fracture risk.

Where does that leave us?

Our knowledge of dietary approaches is continually evolving. Dairy’s role may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there was no significant benefit. However, the patients in these trials were not necessarily deficient in calcium nor vitamin D.

To prevent fracture, older patients may need at least 800 IUs of vitamin D supplementation per day.

Remember that treatment and prevention approaches should be individualized, and deficiencies in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References: 

(1) www.bonehealthandosteoporosis.org. (2) EndocrinePractice. 2020 May;26(supp 1):1-46. (3) JAMA Pediatr. 2014;168(1):54-60. (4) Crit Rev Food Sci Nutr. 2020;60(10):1722-1737. (5) BMJ 2014;349:g6015. (6) health.gov. (7) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (8) N Engl J Med. 2012 Aug. 2;367(5):481.

Dr. David 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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Photo from Stony Brook University Hospital

Stony Brook University Hospital (SBUH) has been named one of the Top 25 Hospitals in the country for its work pursuing environmental excellence. Based on a rigorous scoring system, this award honors success and performance in a range of sustainability programs including leadership, waste, chemicals, greening the operating room, food, sustainable procurement, energy, water, climate, transportation, and green building. As Practice Greenhealth’s highest honor for the Partner for Change application, this award recognizes the best of the best in health care environmental sustainability.

Additionally, SBUH’s multi-disciplinary efforts on reducing its environmental footprint in various impact areas have resulted in earning the recognition of Circles of Excellence in Chemicals, Sustainable Procurement, Energy, and Green Building. The Circles of Excellence Awards honor the 10 highest-performing hospitals in each area of sustainability impact.

“Our sustainability successes come from many passionate employees working to make our hospital a leader in providing world class healthcare, while ensuring our resources are used efficiently to minimize our impact on the environment,” said Carol Gomes, MS, FACHE, CPHQ, Chief Executive Officer, Stony Brook University Hospital. “I’m incredibly proud of the Stony Brook Medicine faculty and staff for their continued dedication and hard work in advancing environmental excellence within healthcare.”

Some of the Hospital’s successes over the last year include:

  • Significant reductions in our use of the anesthetic desflurane
  • Significant reductions in regulated medical waste generation
  • Expansion of our reprocessing and sustainable purchasing programs
  • Reduction in total waste per patient day
  • Expansion of the impact of our Food Farmacy program and our Stony Brook Heights micro-farm that distributes food to food-insecure community members
  • Elimination of the central nitrous oxide system at Ambulatory Surgery Center
  • Several physical plant and capital projects that reduce our energy use, including the very visible Curtain Wall project and less visible infrastructure projects.

Practice Greenhealth is the leading sustainable health care organization, delivering environmental solutions to more than 1,700 hospitals and health systems in the United States and Canada.

To learn more about Stony Brook Medicine’s sustainability efforts, visit stonybrookmedicine.edu/sustainability.

 

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With the Medical Aid in Dying Act having passed both houses of the New York State Legislature, Cona Elder Law will host a free webinar titled “End-of-Life Conversations: Tools for Dignity, Clarity, and Comfort” on Wednesday, June 18 at 9 a.m.

The webinar will be hosted by Jennifer B. Cona, founder and managing partner of Cona Elder Law and Melissa Negrin-Wiener, Esq., Senior Partner, Cona Elder Law.

The Medical Aid in Dying Act (S.138/A.136) would allow mentally competent, terminally ill adults with six months or less to live to request life-ending medication. The bill passed the New York State Assembly and Senate and now awaits signature by Governor Hochul. If signed, New York would become the 12th state to legalize medical aid in dying.

While the legislation has generated both support and criticism, it has also sparked a vital conversation about how individuals and families approach end-of-life decisions.

“This is a critical topic for our clients and their loved ones,” said Jennifer B. Cona, founder and managing partner of Cona Elder Law. “We have daily conversations regarding living with dignity, safeguarding choice of care and living arrangements, end-of-life care, and ensuring wishes are followed, both as to healthcare as well as asset distribution. This law is another tool in the toolbox for ensuring dignity, control, and a life worth living defined by one’s own terms.”

The webinar will provide:

  • Guidance on initiating end-of-life care conversations
  • Legal tools such as health care proxies and living wills
  • Strategies for aligning personal values with medical decisions
  • What the community needs to know about the new law
  • A forum for questions about the current legal landscape

The event is free and open to the public. Registration is available here.

About Cona Elder Law

Cona Elder Law concentrates in the areas of elder law, estate planning, estate administration and litigation, and health care law. Cona Elder Law takes a holistic approach to elder law, providing support and resources for older adults and caregivers, and maintains long-term, partnering relationships with clients to provide the best solutions for multiple generations.

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Photo from SCWA

The Suffolk County Water Authority announced on June 10 that all treated water it supplies to customers is in full compliance with the federal drinking water standards for PFOA and PFOS—six years ahead of the 2031 compliance deadline set by the U.S. Environmental Protection Agency (EPA).

The EPA finalized a new enforceable standard of 4 parts per trillion (PPT) for both PFOA and PFOS in April 2024. SCWA’s testing this past April confirmed that no treated water in its system contained PFOA or PFOS above that level. This achievement comes despite the widespread presence of PFAS in Long Island’s aquifer.

“Given the extent of PFAS detections across Long Island and the size of our system, this is a historic achievement,” said SCWA Chairman Charles Lefkowitz. “This result shows that with the right investment and urgency, we can stay ahead of emerging threats to public health.”

PFAS, or per- and polyfluoroalkyl substances, are a class of synthetic chemicals that have been widely used for decades in products such as non-stick cookware, stain-resistant fabrics, food packaging and firefighting foams. These substances do not break down easily and have leached into groundwater in many areas, including Long Island. Long-term exposure to certain PFAS compounds—particularly PFOA and PFOS—has been linked to health effects including developmental issues, hormone disruption and certain cancers.

To meet the new federal standards well ahead of schedule, SCWA installed 17 granular activated carbon (GAC) treatment systems for PFAS in the past year alone. GAC filters remove PFAS by adsorbing the contaminants onto specially prepared carbon. Water is passed through these large vessels, and the PFAS compounds adhere to the carbon, allowing clean water to continue through the system. Testing by SCWA shows that GAC removes PFAS compounds to non-detectable levels.

“This didn’t happen overnight,” said SCWA Chief Executive Officer Jeff Szabo. “We’ve been working for years to build a treatment program that protects our customers and anticipates regulatory changes. The fact that we’re already in compliance—years ahead of the federal deadline—speaks to the expertise of our team.”

 SCWA continues to test regularly and will immediately remove any well from service if it detects PFOA or PFOS above 4 PPT if that well does not already have treatment in place. SCWA’s long-term goal is to supply water without any detectable levels of PFAS compounds, and additional treatment systems are planned for installation.

“This is about protecting public health,” said Suffolk County Executive Ed Romaine (R). “I want to thank the Suffolk County Water Authority for acting early and doing what’s necessary to provide residents with some of the cleanest drinking water in the country. Their leadership and investment in treatment technology are making a real difference.”

“Ensuring public safety and preserving our water quality are two of the highest priorities for me and my legislative colleagues. The leadership of the Suffolk County Water Authority has again shown its commitment to protecting the public, and in this case has exceeded expectations set by the federal government in achieving safer, even zero levels, of PFAS compounds in our water,” said Presiding Office Kevin J. McCaffrey.

“Clean drinking water is essential to public health, and PFAS contamination is a serious threat that demands action,” said Adrienne Esposito, Executive Director of Citizens Campaign for the Environment. “Meeting the federal standards well ahead of schedule is a positive step forward in safeguarding Suffolk’s residents.”

SCWA’s accelerated timeline has been supported in part by $16 million in grant funding awarded by New York State. These funds have helped offset the significant cost of installing advanced PFAS treatment systems, allowing SCWA to move faster while minimizing the financial impact on customers. By leveraging state support and working efficiently, SCWA has been able to continue delivering high-quality water at some of the lowest rates in New York.

“This is one of the largest groundwater systems in the country—and one of the most complex,” Lefkowitz added. “We’ve proven that even in a region with serious PFAS challenges, we can deliver water that meets the highest health standards.”

SCWA is an independent public-benefit corporation operating under the authority of the Public Authorities Law of the State of New York. Serving approximately 1.2 million Suffolk County residents, the Authority operates without taxing power on a not-for-profit basis.

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Distinguished Professor Arie Kaufman demonstrating two applications in the FlexiCAVE. On the left is a protein volume (inner pivot ~10 degrees, outer pivot ~30 degrees), and on the right side is Submerse application – visualization for extreme weather flooding in urban environments (on a flat FlexiCAVE section). Photo from SBU

Technology Can Be Used in Multiple Areas Including Healthcare, Climate Change, Managing Natural Disasters, Architecture, Urban Planning and Drug Design

Stony Brook University’s Center for Visual Computing has completed construction of the FlexiCAVE—the world’s largest flexible, dynamically reconfigurable high-resolution stereo display facility. Housed on the first floor of the New Computer Science (NCS) building, the FlexiCAVE comprises 40 tiled, high-pixel-density monitors capable of rendering about 83 million pixels, all while physically transforming its shape to support a wide range of scientific and data-driven applications, improving  immersive visualization technology.

“We envisioned a display that would adapt to the data—not the other way around,” said Arie Kaufman, distinguished professor of Computer Science and the principal investigator behind the project. “With FlexiCAVE, we’re enabling researchers to literally shape their workspace to the needs of their analysis.”

Innovative Interaction and Applications

Unlike traditional static visualization walls or even curved displays, the FlexiCAVE is built on a modular architecture with rotatable display columns. The system can seamlessly transition between flat, L-shaped, U-shaped, or semi-circular configurations in real time. These transitions are not only cosmetic.  They directly influence the visualization, the user experience and the type of data interaction enabled.

A custom-built rendering engine powers the design that synchronizes stereo views and dynamically updates visualizations as users physically adjust the screen layout. The team calls this new interaction paradigm —PIVoT, which is an acronym for  Physical Interaction to Virtual Transformation.

“It’s more than a screen. It’s a physical and tangible interface for virtual exploration where users are immersed in the data, and the layout of the FlexiCAVE anchors their sense of whereness, helping them stay oriented as they navigate complex visual spaces,” noted Principal Research Scientist Dr. Saeed Boorboor, co-author of the recently submitted VIS 2025 paper which details the system.

Real-World Applications

Immersive virtual colonoscopy showing on the FlexiCAVE, where radiologists navigate inside the patient’s colon model to locate and analyze polyps (all pivot angles are ~40 degrees). Photo from SBU

The team has already demonstrated real-world applications in many areas including healthcare. For example, virtual colonoscopy shifts the layout from a flat 2D overview of the patient’s colon to a curved immersive 3D endoluminal view (see Figure 2). In medical imaging visualization, radiologists can tangibly move the FlexiCAVE displays to virtually “slice” through brain MRI or abdominal CT scans.

And in situations like in  urban flood simulations, emergency planners can  orient and navigate flooding scenarios spatially by reconfiguring the display (see Figure 1).

In addition, researchers are using FlexiCAVE to experiment with multivariate data visualization, dynamically switching between scatter plots and parallel coordinate plots by physically bending screen segments. This hands-on interaction transforms the way users explore complex datasets. In an early user study, participants preferred the flexibility of the system and reported improved spatial perception over traditional static layouts. Other areas that can be enhanced  include architecture, urban planning, geospatial data, biological systems, drug design, and many others.

Why Now?

As datasets continue to grow in both size and complexity—ranging from volumetric brain scans to climate models—there is a pressing need for immersive tools that allow researchers to explore data from multiple angles and scales. The FlexiCAVE, part of a  growing trend in large high-resolution tiled displays,takes a bold step forward by combining stereoscopy, dynamic curvature, and tangible interaction into one unified system.

With backing from the New York State and Federal agencies, the FlexiCAVE’s development represents years of engineering insight, including customized aluminum framing, inclinometer-equipped hinges, and powerful GPU clusters capable of real-time image updates in a noise-canceling cabinet.

Looking Ahead

While the current version requires manual adjustment of the display columns—a design challenge acknowledged by the team—future updates may introduce motorized column rotation for ease of use. The research group is also exploring new applications in collaborative analytics and adaptable visualization workflows.

“We hope FlexiCAVE becomes a blueprint for the next generation of immersive environments—not only here at Stony Brook, but also globally,” said Professor Kaufman.

 

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