I could take it personally, you know. I mean, come on! Does this happen to everyone?
Okay, so, check it out. First, I’m coming back from the airport, and I’m starving. I don’t tend to eat too much on days when I’m on a plane. I have a sensitive stomach, yeah, right, poor me, and I’m a bit, which is an understatement, of a neurotic flier. The combination doesn’t tend to make travel, food and me a harmonious trio.
Okay, so, there I am in the car, on the way home, and my wife can tell that I’m hungry. Ever the solution-finder, she suggests I order food from a local restaurant. When I call, the woman on the phone takes my order, which includes a salad with blackened chicken, and tells me I have to get there within half an hour because they’re closing.
When we arrive home, I bring in my small bag, grab the keys, and race out to the restaurant.
“Are you Dan?” she asks hopefully as I step towards the counter.
“Yes,” I say, realizing that I’ve cut the half-hour mark pretty close.
“Here’s your food,” she says, shoving the bag across the counter.
“This is everything?” I ask.
“Yes,” she says, as she rings me up and is clearly eager for me to step outside so she can lock the door and go on to the portion of her evening that doesn’t involve taking food requests, handing people food and charging them for it, all while standing near a gratuity jar that says, not so subtly, “Even the Titanic tipped.” That, I suppose, should inspire me to consider forking over a few extra dollars.
I stop at the supermarket for a few items next door, drive home and bring the bag into the dining room, where my wife opens it.
“Uh, Dan?” she says tentatively. “They forgot your salad.”
“What?” I rage, between clenched teeth in the kitchen as I unload the groceries.
“Your salad isn’t here. Did they charge you for it?”
“Yes,” I say, as I grab some slices of turkey I bought for lunch and a few salad items.
The next day, I called the restaurant to explain that my food didn’t come. The manager said he came in that morning and saw a salad with blackened chicken in the refrigerator. He says he can make a new one that day or can leave me a gift card. I opt for a new salad,
When I arrive, the same redheaded woman with a nose ring from the night before greets me.
“If it makes you feel better, I forgot much bigger parts of other people’s order,” she says, with a curious mix of sheepishness, humor and pride.
“No, how is that supposed to make me feel better?” I ask.
Still in food ordering mode, and perhaps not having learned my lesson, I ordered two breakfasts the next morning and, this time, received a single order that was a hybrid of my wife’s and mine.
That night, my wife and I went to a professional basketball game. Stunningly, the person operating the scoreboard had the wrong statistics for each player and the wrong names and uniform numbers of the players on the floor.
What’s happening? Is customer service a thing of the past? Are we better off with artificial intelligence or online systems?
I realize that the missed food could have happened with anyone at any time and that the thankless job of taking orders, preparing food and making sure people get what they order isn’t particularly exciting.
Are people not taking responsibility in their jobs? Are they proud of their mistakes? Has customer service become like our appendix, a vestigial organ in our culture?
I’m the type of consumer who would eagerly become more loyal and would recommend services when the people who work at these establishments show me they care, want my business, and can be bothered to provide the products I purchased. Companies, and their staff, should recognize that I’m likely not the only one who enjoys efficient, professional and considerate customer service.
Some day, physicists and members of the public who benefit from their discoveries may be happy that Luisella Lari had limited musical and sports talent.
Lari, who grew up in Torino, Italy, tried numerous sports and instruments, especially with her parents’ encouragement.
Luisella Lari studies continuous feature drawings of the Electron Ion Collider. Photo from BNL
After gamely trying, Lari blazed her own trail, which has led her to become Project Manager and senior scientist for the Electron Ion Collider, a one-of-a-kind nuclear physics research facility at Brookhaven National Laboratory. BNL won the rights to construct the EIC, which the lab will plan and develop over the course of the next decade, from the Department of Energy in 2020.
By using a 2.4 mile circumference particle collider, physicists will collide polarized electrons into ions with polarized protons to answer a host of questions about the nature of matter. They will gather information about the basic building blocks of nuclei and how quarks and gluons, the particles inside neutrons and protons, interact dynamically through the strong force to generate the fundamental properties of these particles, such as mass and spin.
Lari, who joined the EIC effort on October 3rd, described her role, which includes numerous meetings, calls and coordinating with multinational and multi-state teams, as a “dream job.”
“I’m so excited to be a part of a project that can help the next generation of physicists,” Lari said. “It’s my turn to participate in the construction” of the cutting edge facility. BNL is coordinating with numerous other labs nationally, including the Thomas Jefferson National Accelerator in Virginia, an internationally on the project.
Amid her numerous responsibilities, Lari will ensure that effective project management systems, cost controls and project schedules are developed, documented and implemented. Core competencies of the team she is responsible for include procurement, quality and safety.
EIC applications
The EIC has numerous potential applications across a host of fields. It could lead to energy-efficient accelerators, which could lower the cost of accelerators to make and test computer chips. The EIC could also provide energetic particles that can treat caner cells and improve the design of solar cells, batteries and catalysts. The EIC may also help develop new kinds of drugs and other medical treatments.
Lari explained that she provides a review and approval of the safety evaluations performed by experts. She suggested this suits her background as she did similar work earlier in her career.
Luisella Lari on a recent vacation to Mackinac Island.
Lari has made it a priority to hire a diversified workforce of engineers, technicians and quality and safety managers who can contribute to a project that BNL will likely start constructing in 2026 and 2027.
“I am a strong supporter of building a diverse workforce at levels of the organization,” she explained in an email. “I am strongly convinced that it will add value to any work environment and in particular in a scientific community.”
Applying her experience
Lari isn’t just an administrator and a project coordinator —she is also a physicist by training.
She earned a master’s degree in nuclear engineering from Politecnico di Torino University in Italy and a PhD in physics from the Swiss Federal Institute of Technology Lausanne in Switzerland.
Early in her professional career, Lari worked at Thales Alenia Space, an aerospace company in Turin, Italy, where she collaborated for the development of her master’s thesis. She worked for two years at the company, performing tasks that included testing internal fluid supply lines for one of the International Space Station’s pressurized modules that connects the United States, European and Japanese laboratories in orbit.
She enjoyed the opportunity to work for a “really interesting project” and still routinely uses the NASA system engineering handbook.
She also worked for about a dozen years as an applied physicist and planning officer at CERN, a particle physics lab, which is on the border between France and Switzerland near Geneva.
Lari also served as a project manager and scientist for the European Spallation Source, a neutron source under construction in Sweden. She coordinated ESS Accelerator Project budgets and ran data-driven safety analyses.
Recently, Lari was a senior manager at Fermi National Accelerator in Illinois, where she coordinated international partner contributions to the Proton Improvement Plan II, which upgraded the accelerator complex.
A need to know
When Lari was in middle school, the Chernobyl nuclear power plant melted down. As a school assignment, she had to explain what happened. At that point, she said she understood nothing, which motivated her to want to become a nuclear engineer.
She was “fascinated by nuclear energy.” When she worked at CERN, she had not been studied much about accelerator physics. She attended meetings where sophisticated discussions physics took place and was driven to learn the material.
“All my life, which started when I was a child, I wanted to understand the world around me,” she said. Her work in project management for scientific projects is also her passion, she said. “My mother would say to me when I was younger that I should choose my job in a way that I would do something I like, because I will spend half my life doing it.”
In addition to committing to understanding the physics and helping other scientists pursue their curiosity, Lari said she appreciates the opportunity to collaborate.
While Lari never became proficient in music or athletics, she enjoys dancing and is looking forward to attending Broadway musicals in New York.
She has hosted her parents at each of the places where she has worked, broadening their horizons.
As for her work, Lari recalls being impressed by the ability of the managers at the LHC to summarize complex work in a few pages and to make big picture decisions that affected so many other scientists. She became impressed and inspired “by the power of the project administrator approach,” she said. She also appreciates the opportunities to interact with experts in several fields, which gives her the chance to “better understand and learn.”
Like the rest of the state and country, Suffolk County is grappling with a shortage of pediatric amoxicillin, the drug most often used to treat bacterial infections such as strep throat and ear infections.
In the last few weeks, parents have gone to their local pharmacies, only to find that the liquid form of the medicine that’s suitable for their children is out of stock.
“There is a shortage,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, who estimates that the medicine isn’t available about half the time the hospital prescribes it. “We worry that it’s going to continue to happen.”
As more children are around their friends and family before and during the holidays “it’s going to get worse,” she added.
This, doctors said, is not a Long Island or even a New York state problem. It’s national.
Nachman’s granddaughter needed amoxicillin in Florida. Her daughter drove around from pharmacy to pharmacy until she found one that had the medicine.
Doctors suggested that a number of factors have contributed to the shortage. For starters, some urgent care centers and doctors around the country are prescribing amoxicillin when children have viral infections. The medicine not only isn’t helping with sore throats or other viral symptoms, but it also isn’t as available for the children who have bacterial infections.
Nachman urges parents to make sure their children have an infection for which amoxicillin or any other drug works before picking it up from the pharmacy.
“When the pediatrician does a viral test and you get a positive, you know what it is,” she said. “When they do a throat swab for strep and it’s negative, you know what it’s not.”
Nachman told parents to ask whoever is prescribing antibiotics like amoxicillin if their children really need the medicine.
“If there is a silver lining, it’s forcing clinicians to try not to over prescribe it,” said Dr. James Cavanagh, director of Pediatrics at Port Jefferson’s St. Charles Hospital.
Finally, the stock of amoxicillin is low nationally.
For parents, the effect of the shortage has ranged from the expected anxiety over a limited resource to an awareness of a new reality.
Indeed, earlier this year, parents struggled to find baby formula.
“They are accepting of it, given the climate we’ve been in with formula,” Cavanagh said. “Parents are unfortunately getting used to it.”
Other infections
With viruses like respiratory syncytial virus, the flu, and COVID-19 prevalent and increasing in communities around Long Island, children and adults are increasingly getting sick and exhibiting the kind of general symptoms that could be viral or bacterial.
Stony Brook Children’s Hospital continues to have a steady stream of patients.
“We were full before Thanksgiving, full on Thanksgiving and full after Thanksgiving,” Nachman said. “As soon as a bed opens, another child comes in.”
While strep throat is easy to diagnose, ear infections can be either viral or bacterial.
Pediatric associations offer various guidelines. For children who are 9 and over, parents can do watchful waiting, but for children who are younger, like 4 months old, parents should use antibiotics.
While childhood forms of amoxicillin are limited, adult supplies, in the form of pills and capsules, are not. Children as young as 7 years old can take pills as long as the milligrams of the pills to the kilograms of the child’s weight are appropriate for
the dosage.
Nachman said Stony Brook Children’s Hospital has been doing a lot more calling to pharmacies near where patients live to ensure they have amoxicillin.
“That takes extra time,” she said. Those efforts could mean that families may have to wait longer in the emergency room.
The amoxicillin shortage can be worse for families that don’t have cars.
“How are they getting their prescriptions filled?” Nachman asked. “This is just one more worry.”
Alternatives
Area doctors and pharmacists suggested that there are alternatives to the pediatric form of amoxicillin. Children who are old enough and meet weight requirements can take a pill.
Alternatively, with careful medical guidance, parents can open up the right dose for capsules and mix it with applesauce or some other foods, according to the American Association of Pediatrics.
Doctors can also prescribe other broad spectrum antibiotics, such as augmentin and omnicef.
Using these other antibiotics, however, increases the risk of developing antibiotic resistant infections later.
“The next infection may be harder to treat,” Cavanagh said.
These other antibiotics also may eliminate some of the good bacteria in the gut,
causing diarrhea.
As doctors have increasingly prescribed some of these other medicines, pharmacies have seen the supply of alternatives decrease as well.
“Everyone follows the same algorithm” in prescribing medicine, which means the demand for other prescriptions is increasing, Cavanagh added.
Immune boost
Doctors said children can enhance their overall health and immune systems with healthy eating and sleeping habits and by making sure they are up to date with available preventive measures.
“Get vaccinated,” Cavanagh said. He also urged good hand washing routines.
Cavanagh added that children exposed to cigarette smoke in a house are also at a higher risk of ear infection. As for what constitutes enough sleep for a child, doctors recommend between eight and nine hours per night. That, doctors said, is tough to get for children who sleep with a cell phone near their beds.
As we round out the second week of December, I’d like to offer some suggestions for a 2022 time capsule.
— A Ukrainian flag. Ukraine, with help from Americans and many other nations, has fended off Russia’s ongoing military assault. The question for 2023 will be whether they can continue to defend the country amid a potential decline in international support.
— A waterlogged dollar. With inflation at decades-high levels, the dollar isn’t buying as much as it had been.
— Florida man makes announcement. I would include a copy of the New York Post front page the day after former president Donald Trump, to no one’s surprise, announced he would be running for president in 2024. A previous ardent supporter of the former president, the Post may be leading the charge in another political direction to find a new standard bearer for the GOP.
— A red dot. Certainly, the Republicans taking over the majority in the house will have important consequences, with numerous investigations and a divided government on the horizon, but Republicans didn’t win as many national elections as anticipated.
— A miniature replica of the Supreme Court, with the words Dobbs vs. Jackson Women’s Health Organization in front of it. The Supreme Court case, which reversed the Roe v. Wade decision, removed the federal right to an abortion, enabling states to pass new laws and contributing, in part, to smaller midterm wins for Republicans.
On the much smaller personal front:
— Throat lozenges. I got COVID-19 for the first time this year and my throat was so painful for a week that I couldn’t talk. The lozenges didn’t work, but they would highlight numerous efforts to reduce pain from a virus that was worse than any flu I’ve ever had.
— The number 62. This, yet again, wasn’t the year the New York Yankees won the World Series. Nope, they didn’t even get there, yet again falling, this time without winning a single game, to the Houston Astros. It was, however, a wonderful chase for the American League home run record by Aaron Judge, who just signed a $360 million extension with the Yankees.
— Wedding bells and a tiny nerf football. For the first time in years, my wife and I attended two family weddings this year. We loved the chance to dance, catch up with relatives, eat great food, and run across a college baseball field with a $7 nerf football we purchased from the hotel lobby store.
— A miniature swamp boat. On one of the more memorable trips to New Orleans to visit our son, my wife and I saw numerous alligators and heard memorable Louisiana tales from Reggie Domangue, whose anecdotes and personal style became the model for the firefly in the Disney movie “The Princess and the Frog.”
— A shark tooth. During the summer, Long Islanders worried about local sharks, who bit several area swimmers. The apex predator, which is always in the area, likely had higher numbers amid a recovery in the numbers of their prey, which are menhaden, also known as bunker fish and, despite the prevalence of the music from the movie “Jaws,” does not include humans.
— A Good Steer napkin. My favorite restaurant from my childhood closed after 65 years, leaving behind an onion ring void and shuttering the backdrop to numerous happy family outings. If I had a way to retire expressions the way baseball teams retire numbers, I would retire the words “Burger Supreme” on a food version of Monument Park.
— A giant question mark. Scientists throughout Long Island (and the world )constantly ask important questions. Some researchers will invent technology we may use all day long, like cell phones. Others may make discoveries that lead to life-saving drugs. Let’s celebrate great questions.
Egypt’s coral reefs, shown here in a recent photo of the Red Sea in Egypt, remain one of the few pristine reef systems worldwide. Photo by Maoz Fine
By Daniel Dunaief
While global warming threatens most of the warm water reefs of the world, the reefs off the coast of Egypt and nearby countries are capable of surviving, and even thriving, in warmer waters.
That, however, does not mean these reefs, which live in the Northern Red Sea and the Gulf of Aqaba and are along the coastline of Egypt, Israel, Jordan and Saudi Arabia, are safe.
Karine Kleinhaus
Indeed, several factors including unsustainable tourism, sewage discharge, coastal development, and desalination discharge threaten the survival of reefs that bring in more money than the Great Pyramids.
Recently, Karine Kleinhaus, Associate Professor at the School of Marine and Atmospheric Sciences at Stony Brook University, published a letter in the prestigious journal Science that suggested it’s time to conserve the Egyptian reefs, which constitute about 2 percent of the country’s gross domestic product.
Along with co-author Ellen Pikitch, Endowed Professor of Ocean Conservation Science at SOMAS, whe urged an expanded and fortified marine protected network. As of now, the MPAs only protect about 4 percent of Egypts’s waters.
Kleinhaus, who is President of the Red Sea Reef Foundation which supports scientific research on the reefs, also urged more effective fisheries management and enforcement and an investment in sustainable tourism practices and infrastructure that mitigates land-based pollution, such as waste-water treatment infrastructure and garbage disposal mechanisms.
Science published the letter just days before the 27th Conference of the Parties to the UN Framework Convention on Climate Change (COP27), which was held in Sharm el-Sheikh, Egypt.
During the COP27 conference, the United States Agency for International Development (USAID) committed up to $15 million to scale reef-positive blue economic growth and conservation finance in the Red Sea in partnership with the Global Fund for Coral Reefs.
Kleinhaus called the investment a “great start” in protecting a “valuable global treasure. It’s great that the US recognizes the value of this place and that the US is working to contribute to preserve it.”
Other work ahead
Kleinhaus added that considerable works lies ahead to protect one of the few reefs capable of surviving climate change. “We can’t turn the clock back right this minute on warming the oceans, [but] we can stop the conditions that are happening along the Red Sea reef,” she said.
Kleinhaus suggested that all the threats to the reefs are significant. Tourists who are not educated about the fragility of the nature they’ve come to see have damaged the reef. Scuba divers, meanwhile, smash into the reefs with their tanks or drag their regulators and other gauges over the reefs, killing or injuring them.
Kleinhaus with a grouper in Eilat.
During Covid travel restrictions, Kleinhaus heard that some parts of the reef, which would have otherwise been damaged by visitors, recovered. Raw sewage and general pollution reaching the reefs also threatens marine life, as is over fishing.
Other reefs, such as the Great Barrier Reef in Australia, have sustained damage from global warming. Kleinhaus described those reefs as a “warning that things are going to change.”
Transplanting parts of the Red Sea reef into other parts of the world to enhance temperature resilience is unlikely to work, Kleinhaus said. These reefs include a diverse ecosystem that supports it, including algae, bacteria, invertebrates and fish.
“We don’t have the scientific knowhow to transplant entire ecosystems at this time,” said Kleinhaus
Evolution of resistance
Kleinhaus explained that heat resistance in the Red Sea reefs developed through natural selection of the coral animals.
During the last Ice Age, the Red Sea got cut off from the Indian Ocean, which meant the temperature climbed and the sea didn’t have any rivers emptying into it. When the Ice Age ended, waters rose into the Red Sea that carried coral from the Indian ocean. The coral that survived had to be tolerant of heat and salt.
“That is the working hypothesis as to why the corals in the northern Red Sea are resilient,” Kleinhaus explained in an email. “They were selected to tolerate hotter water than where they live now.” She called this resilience a “lucky break” for the reefs.
Unusual path
Kleinhaus, who grew up in Westchester, New York, followed an unusual path into marine research.
After attended medical school in Israel at Tel Aviv Medical School, she practiced briefly as an obstetrician in New York. From there, she was the divisional vice president for North America for an Israeli biotechnology company.
Egypt’s coral reefs, shown here in a recent photo of the Red Sea in Egypt, remain one of the few pristine reef systems worldwide. Photo by Maoz Fine
Kleinhaus was reading about the effect of heatwaves and global warming on coral reefs. Upset that they were dying, she decided to make a career change and earned her master’s degree in Marine Conservation and Policy at Stony Brook’s School of Marine and Atmospheric Sciences.
The common thread in her career is that she was working on cell therapy using cells from the placenta, which is an extension of her obstetrics career. Nowadays, she studies reproduction in corals.
Like humans, corals have the hormones estrogen, progesterone and testosterone. Unlike humans, reefs are hermaphrodites and can switch back and forth between genders. Kleinhaus is exploring the relationship between hormones and the stages of reproduction in coral.
Numerous species of coral spawn once a year within 20 minutes of each other. Their reproduction is tied to the moon cycle. Kleinhaus has collected over two and a half years of data and plans to publish those results in a scientific journal.
She started diving in 1993 and said she enjoys seeing the colors, the shapes, the fish, turtle, octopuses, dolphin and barracuda. Invertebrates and sponges also contribute to the “overwhelming and glorious” experience of visiting reefs.
Down the road, she’d like to collect information from the COP27 conference and write a follow-up piece that would include more deep research about policies and conditions of the reef.
The point of the letter was to “highlight that this has to be protected and it’s a serious interest to everybody in Egypt.”
As we reach the beginning of December, we are only a month away from the inevitable promises to shed unwanted pounds.
Today, however, only a few days after our journeys to visit friends and families for Thanksgiving, I’d like to urge you to consider shedding unwanted baggage.
Metaphorically, we all lug unwanted baggage with us — remembering the spot where a girlfriend or boyfriend broke up with us; the moment we decided to substitute the wrong player in a game we were coaching; and the time our teacher gave someone else partial credit for the same answer on which we received no credit.
Some of that baggage is constructive, giving us the tools and the memory to learn from our mistakes and to have a perspective on the things that happen to us.
We might, for example, learn to cope with losses on the athletic field more gracefully when recalling how we felt the time we shouted at a coach, an umpire or an opposing player. Days, weeks, or years later, we might realize that we have the tools and the distance to understand the moment better and to develop a grace we might not have possessed when we were younger.
Extending the baggage metaphor, it seems that the more we carry with us everywhere, the harder it is to move forward. Baggage, like those unwanted pounds that make it harder to hike up a hill or to climb stairs, keeps us in place, preventing us from improving and moving forward.
Shedding pounds, which isn’t so easy itself, has a prescribed collection of patterns, often involving an attention to the foods we might mindlessly eat and a dedication to exercise.
But how do we get rid of the emotional baggage that gets in our way? What do we do to move forward when the burdens around us weigh us down?
For starters, we might learn to forgive people for whatever they did that annoys or puts us down. Forgiveness isn’t easy, of course. We sometimes hold onto those slights as if they are a part of our identity, becoming a doctor to show our biology teacher who didn’t believe in us that we are capable and competent or developing into a trained athlete after a neighbor insulted us.
Holding onto those insults gives other people unnecessary power over us. We can and should set and achieve our goals because of what we want and not because we continue to overcome limits other people tried to set for us.
We also might feel weighed down by our own self-doubt. As I’ve told my children, their peers and many of their teammates, we shouldn’t help our competitors beat us. Believing the best about ourselves is difficult.
We also don’t, and won’t, always win. It’s easier to carry the memories of the times we failed a test or when we didn’t reach the top of the mountain on a hike. Carrying those setbacks around with us for anything other than motivation to try again or to go further than we did before makes it harder to succeed.
Now is the time to set down that baggage, to walk, jog or even run forward, unencumbered by everything that might make us doubt ourselves and our abilities and that might make it harder to achieve our goals. While all that baggage might feel familiar in our hands, it also digs into our palms, twists our fingers and slows our feet.
Even before we resolve to eat better, to exercise, to lose weight and to look our best, let’s check or even cast aside our emotional and psychological luggage. Maybe dropping that baggage in the last month of the year will make achieving and keeping our New Year’s resolutions that much easier.
From left to right, physician assistants Michelle Rosa and Katherine Malloy, Dr. David Fiorella and Dr. Jason Mathew visit Joseph Annunziata in his hospital bed. Photo from Stony Brook Medicine
By Daniel Dunaief
Joseph “Bob” Annunziata, a resident of Kings Park, wants you not to be like him.
An army veteran, Annunziata urges residents and, in particular, other veterans, to pay attention to their medical needs and to take action when they find out they have a problem.
A self-described “tough guy” who grew up in Bay Ridge, Brooklyn, Annunziata put off medical care for a partially blocked left carotid artery and it caused a medical crisis.
“My brother and sister vets, if you got a pain or the doctor tells you to do something, do it,” he said. “It almost cost me my life. I don’t want that to happen to anyone else.”
Joseph Annunziata at his 80th birthday party
Annunziata, 80, was driving to the supermarket on Veterans Day when his right hand became limp and he was slurring his speech. Knowing he was in trouble, he turned the car around and drove 10 minutes to the Northport VA Medical Center.
The doctors evaluated him and rushed him to Stony Brook University Hospital, which is well equipped to handle stroke-related emergencies and is the only hospital in the state named one of America’s 100 Best Hospitals for Stroke Care for eight years in a row.
Several doctors evaluated Annunziata, including by Dr. David Fiorella, Director of the Stony Brook Cerebrovascular Center and Co-Director of the Stony Brook Cerebrovascular and Comprehensive Stroke Center, and Jason Mathew, stroke neurologist.
“We identified that there was a severe blockage in the left side of his brain,” said Dr. Mathew. “If blood flow is not returned to this area, the patient is at risk for a larger area of stroke.”
Indeed, a larger stroke could have caused right side paralysis and could have robbed Annunziata of his ability to speak or worse.
Performing emergency surgery could protect endangered brain cells, but also presented some risk. If not removed carefully and completely, the clot in the carotid artery could travel into the brain or the stroke could expand over time due to a lack of sufficient blood flow to the left side of the brain.
Time pressure
Stony Brook doctors discussed the particulars of the case together and explained the situation to Annunziata, who could understand what they were describing and respond despite symptoms that threatened to deteriorate.
The hospital, which does between 200 and 250 interventional stroke treatments per year and handles many more strokes than that annually, has a group of health care specialists who can provide accessible information to patients who are not experts in the field and who need to make an informed decision under time pressure.
Stony Brook has become adept at “conveying this complex information in a time-sensitive way,” Dr. Fiorella said. In those cases for which surgery is the best option, each minute that the doctors don’t open up a blood vessel reduces the benefits and increases the risk of longer-term damage.
Stony Brook sees about one to two of these kinds of cases per month. As a whole, the hospital, which is a large referral center, sees numerous complex and unusual cerebrovascular cases of all types, Dr. Fiorella said.
Annunziata and the doctors decided to have the emergency surgery.
Dr. Fiorella used a balloon guiding catheter, which is a long tube with a working inner lumen that has a soft balloon on the outside of it that is designed to temporarily block flow. He deploys these occlusion balloons in most all stroke cases.
The particular way he used it in these complete carotid occlusions is unique. The balloon guiding catheter makes interventional stroke procedures more efficient, safer, and the outcomes better, according to data for thrombectomy, Dr. Fiorella said.
The occlusion balloon enabled Dr. Fiorella to control blow flow the entire time, which makes the procedure safer. The surgery took under an hour and involved a small incision in Annunziata’s right wrist.
Joseph Annunziata with his girlfriend Rosemarie Madrose
After the surgery, Annunziata was able to speak to doctors and call Rosemarie Madrose, his girlfriend of five and a half years. “He came out talking,” said Madrose. “I could understand him. I was relieved.” Four days after the emergency operation, Annunziata, who also received post operative care from Dr. Yuehjien Gu, Neurocritical Care Unit Director, left the hospital and returned to his home, where he spent the next morning preparing a welcome meal of a scrambled egg and two slices of toast.
The doctors attribute Annunziata’s quick recovery to a host of factors. Getting himself to the hospital as soon as symptoms started saved precious minutes, Dr. Fiorella said, as “time is brain.” He also advised against driving for people having stroke-like symptoms, which can include slurred speech, numbness, weakening of the arm or leg and loss of vision in one eye.
Dr. Fiorella urged people to call for help or to get a ride in an ambulance. Stony Brook has two mobile stroke unit ambulances, which are equipped with technology to assess patients while en route, saving time and alerting doctors in the hospital to patients who might need immediate attention and intervention.
These mobile units, which are available from 8 a.m. to 8 p.m., have helped reduce death and disability for stroke and have cut down the length of stays in the hospital.
People or family and friends who are observing someone who might be having a stroke can call 911 and indicate that the patient is having stroke-like symptoms. The emergency operator will alert the mobile stroke unit of a possible case if the unit is available and the patient is in range.
Helping a veteran
The doctors involved in Annunziata’s care were well aware of the fact that they were treating a veteran on Veterans Day.
“Oftentimes, we think about how we can give back more than just a thank you” to people like Annunziata, who “risked his life and helped his country the way he could,” said Dr. Mathew. “I’m helping him the way I can help.”
Dr. Fiorella added that he thought it was “wonderful” to “help someone who’s given so much to our country on Veterans Day.”
Army origin
Annunziata explained that he wound up in the Army through a circuitous route.“We watched all the war movies” when he was young and wanted to join the Marines, he said.
When he went to enlist in 1962, he was told there was a two and a half year wait. He and his young friends got the same reception at the Air Force, Navy and the Army. As they were leaving the Army building on Whitehall Street, he and his friends ran into a sergeant with numerous medals on his uniform. The sergeant urged them to go back up the hallway and enter the first door on the right and indicate that they wanted to expedite the draft. About a week later, Annunziata was drafted and got a 15 cent token in the mail for a train trip to Wall Street.
After basic training at Fort Dix, he was stationed in Greenland, where Annunziata operated a radar at the top of a mountain for two years. He participated in drills in which he had to catch American planes flying overhead.
Fortunately, he said, even during the height of the Cold War and just months after the Cuban Missile Crisis, Annunziata never spotted a Russian threat, even though the base was just 20 minutes from Russian air space.
Having gone through emergency surgery that likely saved his life, Annunziata urges residents to pay attention to any medical needs on their radar.
Dr. Fiorella was amazed at how quickly Annunziata expressed concern for his fellow veterans during his recovery.
“One of the first things he talked about was, ‘How can I use what happened to me to help other vets?’” Dr. Fiorella said.
Annunziata’s girlfriend Madrose, who is grateful that the procedure saved his life, said he “didn’t listen to me. He knew he had to do this. I kept saying, ‘When are you going to do it?’ He said, ‘I will, I will, I will.’ He learned the hard way.” She added that they both know he is “extremely lucky.”
Now, we can really get down to some important, democracy building and unifying investigations. Undoubtedly, these investigations will get to the bottom of some important political questions that people absolutely want answered.
Hunter Biden is and will be a prime target. How can he not be? If you look at some of the pictures of him that newspapers have found, he looks guilty, and that should be more than enough. Besides, who doesn’t like a few insightful, incisive and critical First Family questions?
Once they finish — assuming they can get it done in two years — with the important questions, I have ideas for investigations that I’d like to lob in as well. They range from the obvious, to the quirky to the frivolous, but, I figured I might as well make my suggestions now.
I’m going to write it here because you know it’s inevitable. Hillary Clinton. She might be a private citizen now, and she might have run for office six years ago, but she’s got to be responsible for something. Maybe she knocked the nose off the sphinx. Or maybe she tilted the Tower of Pisa. Come on, she’s got to have done something wrong.
I’d like to know why my email fills with stuff I talk about, but don’t type into my computer. Is someone listening? My wife and I might discuss a trip to Bora Bora and then, the next morning, I find an invitation to visit. Is someone listening all the time?
Jose Altuve. The Houston Astros star second baseman, whom baseball fans in other stadiums, particularly Yankee Stadium, love to hate, still seems to be operating under a cloud of suspicion. Did he cheat? Did he have a tattoo that he didn’t want anyone to see when his teammates seemed poised to tear off his jersey many years ago against the Yankees? Is it safe for purist baseball fans to root for him again? Will he be eligible for the Hall of Fame someday?
Open Water. Did you see the movie? It was incredibly popular. I don’t want to spoil it for you, but, well, I’m going to do it anyway. These two people suffer through endless torment and fear after their boat leaves them behind while they are scuba diving. It’s not a feel good movie. Injured, cold and miserable, they try to fight off sharks — guess who wins that one? Afterward, I overheard someone say, “seriously? I watched those people for two hours for that?”
Jan. 6th. There’s likely to be a committee investigating the committee investigating the riots. Fine. But wouldn’t it throw Democrats, Republicans and conspiracy theorists for a loop if another committee then investigated the committee that investigated the original committee? It’d be like seeing images several times in a combination of mirrors.
Tom Brady. Okay, I know he’s not having his usual spectacular world-beating season, but the guy is 45 and strong, muscular, athletic 20-year-olds are putting everything they have into throwing him to the ground. How is he still functioning? He’s not playing golf. Did someone replace him with a robot? Has he discovered some magical diet or fountain of youth that makes it possible to compete at such a high level when he’s at such an advanced age? I throw a ball with my son, and it takes me a week for my arm to recover. The world needs to hear his secrets.
Socks. I’m not particular about my socks. White ones that go above my ankle are fine. Most of the time, I buy socks that look like the ones I already own, which makes matching them pretty easy. And yet, somehow, I wind up with an odd sock more often than not. Where is that missing sock? Is someone stealing socks from dryers?
Asparagus. I kind of like the taste, but I’d prefer that my pee didn’t smell later. Can’t someone do something about it? It’s the only vegetable that has that effect. Let’s figure out a better-smelling asparagus.
Daniel Knopf and Josephine Aller. Photo by John Griffin/Stony Brook University
By Daniel Dunaief
The ocean often serves as an enormous reflecting pool, showing a virtual image of migrating and water birds soaring on the wind, planes carrying people across continents, and clouds in multiple layers sporting various shades of white to grey.
Those clouds have more in common with the ocean below than just their reflection. In fact, some of the ice nucleating particles that help form the clouds come directly from the phytoplankton in the water below.
Daniel Knopf, Professor of Atmospheric Chemistry at Stony Brook University, and Josephine Aller, microbial oceanographer in the School of Marine and Atmospheric Sciences at Stony Brook University, have been teaming up to study the effect of sea spray aerosols on cloud formation in the ocean for 15 years.
Recently, the duo published a paper in the journal Science Advances, in which they simulated sea spray aerosols in laboratory tanks to reflect ocean conditions. They found that organic compounds released by marine microorganisms become ice nucleating particles.
“We performed ice formation experiments in our lab using particles generated from our tanks to determine under which conditions (of temperature and relative humidity) they form ice,” Knopf explained in an email.
During specific temperature and relative humidity conditions, these sea spray aerosols, which are released when bubbles at the surface containing the materials burst or when wind carries them from the ocean into the air, initiate ice crystal formation.
Previous studies revealed that the water contains organic material from biological activity, but the researchers could not identify the specific type of nuclei.
“The current study closes this gap and identifies polysaccharides and proteinaceous matter” as the ice nucleating particles, Knopf explained.
Through work in the lab, Knopf and Aller showed that the particles produce ice crystals through two different pathways under typical atmospheric conditions. Ice can form either by water vapor onto the aerosolized particles or from liquid aerosol droplets.
From x-rays to climate models
Aller and Knopf explored the composition of individual particles using x-ray microscopy technology at the synchrotron light source at the Lawrence Berkeley National Laboratory in California.
After digitally marking particles, the researchers transferred the particles to the x-ray microscope to determine their shape and composition.
“This allowed us to unambiguously examine the ice nucleating SSA particles and compare their organic signature with reference spectra of organic/ biogenic matter,” Knopf wrote.
Aller added that the research provides a clear picture of the conditions necessary for freezing.
“This study not only identifies the ice nucleating agent, but also provides the first holistic parameterization to predict freezing from SSA particles,” she said in a statement. “This new parameterization includes immersion freezing, as the INP is engulfed in a liquid, usually water, and the deposition ice nucleation where ice forms on the INP without any visual water.”
The parameterization can be applied in cloud-resolving and climate models to determine the climatic impact of ice crystal containing clouds, Aller added.
This type of modeling can help with climate models of the polar regions, which is heating at a rate faster than other parts of the world.
At this point, Knopf said the Stony Brook researchers have collaborated with scientists at NASA GISS who work on climate models to improve the understanding of mixed-phase clouds.
“We will make use of the newly developed ice formation parameterization in cloud-resolving models and compare the results to observations,” Knopf wrote. “Those results, ultimately, will be useful to improve climate models.”
Competition in the clouds
As for any surprises, Knopf added that it is “astonishing how biological activity in surface waters can be related to cloud formation in the atmosphere.” Additionally, he was amazed that the organic matter that nucleated the ice was similar independent of the water source.
Spectroscopically, the ice showed the same features, which allowed the researchers to combine the various data sets.
This means that different parts of the ocean do not need local freezing parameterization, which makes modeling the impact of oceans on cloud formation easier.
While sea spray aerosols can and do act as ice nucleating particles, the Stony Brook scientists added that other airborne particles also contribute to the formation of clouds. A heterogeneous mix of particles creates a competition among them for activation. Dust and certain fly ash serve as more efficient ice nucleating particles compared to sea spray aerosols.
During periods when sufficient water vapor is in the area, the sea spray aerosols can also be activated. When these organic particles do not become a part of clouds, they form supercooled droplets or float around as interstitial aerosols and get transported to other areas, Knopf explained.
As for the impact of global warming, Knopf suggested that such increases may first change the microorganisms’ activity and breakdown of chemical species in the ocean surface waters. “How this impacts the source of sea spray aerosols and ice nucleating particles, we do not know that yet,” he said.
The particular species of planktonic communities may change, as differences in nutrient levels could select for cyanobacteria over the normal mix of algal groups. That could cause a change in the exudates produced.
Locally, Knopf and Aller are working with Chris Gobler, Professor in the School of Marine and Atmospheric Sciences at Stony Brook, in Lake Agawam in Southampton, which is prone to harmful algal blooms. The Stony Brook scientists are working to understand if the toxins produced by these algae are becoming airborne in sufficient mass.
“It may imply a health-related issue when aerosolized and one is close to the source,” Knopf explained. “There won’t be toxic clouds due to dilution and aerosol mass constraints.”
Knopf and Aller hope to continue to develop these models by combining their lab work with field data.
“This is an ongoing process,” Knopf said. “The more data we acquire, the more accurate the parameterization should become.”
From left, CSHL President and CEO Bruce Stillman, CSHL Board of Trustees Chair Marilyn Simons, and 2022 Double Helix Medal recipients Albert Bourla and Jennifer A. Doudna. Photo by Sean Zanni / Patrick McMullan Company
By Daniel Dunaief
One of them helped tap into a process bacteria use to fight off viruses to develop a gene editing technique that has the potential to fight diseases and improve agriculture. The other oversaw the development of a vaccine at a record-breaking pace to combat Covid-19.
Cold Spring Harbor Laboratory honored both of them at its 17th annual Double Helix Medal Dinner at the American Museum of Natural History in NYC on Nov. 9.
The lab celebrated Dr. Jennifer Doudna, who won a Nobel Prize in Chemistry in 2020 for her co-discovery of the CRISPR-Cas9 gene editing system and Pfizer Chairman and CEO Dr. Albert Bourla, who helped spearhead the development of an RNA-based vaccine.
The black-tie optional award dinner, hosted by television journalist Lesley Stahl, raised a record $5.8 million for research at the famed lab.
“We are giving hope to people, hope for science — and that’s something that gives us a lot of pride,” Dr. Bourla said in a statement.
Dr. Doudna, who is Professor of Biochemistry, Biophysics and Structural Biology at the University of California at Berkeley, was encouraged by the transformative nature of gene editing.
“When I think about new therapeutics that are only possible using CRISPR technology, I’m thinking about ways that we can not just treat a genetic disorder chronically, but can provide a one-and-done cure,” she said in a statement.
The awards dinner has raised over $50 million since its inception. Pfizer underwrote the entire event last week.
Attendees included previous award winners Drs. Marilyn and James Simons, who founded Renaissance Technologies, actress Susan Lucci, who starred on All My Children for 41 years, Representative Tom Suozzi (D-NY3) and his wife Helene, David Boies, Chairman and Managing Partner of the law firm Boies, Schiller Flexner, and Jeanne Moutoussamy-Ashe, photographer and widow of tennis legend Arthur Ashe, among other business and philanthropic luminaries.
Cold Spring Harbor Laboratory will incorporate the funds raised through the dinner into its operating budget, which supports integrated research and education in fields including neuroscience, artificial intelligence, quantitative biology, plant biology, cancer, and neurodegenerative diseases like Alzheimer’s.
The funding from the dinner helps CSHL scientists engage in high-risk, high-reward research that can lead to important discoveries, CSHL said in a statement.
“Rather than relying entirely on the grant system, [scientists] are given the freedom to further explore the future implications of their work,” CSHL added.
Philanthropy also helps CSHL expand its Meetings & Courses program. The operating budget supports community engagement and environmental stewardship on Long Island.
Senior leadership at the lab chooses the honorees each year.
This year’s dinner surpassed the $5 million raised last year, which honored baseball Hall-of-Farmer Reggie Jackson, as well as Leonard Schleifer and George Yancopoulos, the founders of Regeneron, the pharmaceutical company that provided life-saving antibody treatment for Covid-19.
Other previous honorees included actor Michael J. Fox, basketball great Kareem Abdul-Jabbar, actor and science educator Alan Alda, and newscasters Tom Brokaw and Katie Couric.
The chairs of the Double Helix medal dinner included Jamie Nicholls and O. Francis Biondi, Barbara Amonson and Vincent Della Pietra, Drs. Pamela Hurst-Della Pietra and Stephen Della Pietra, Mr. and Mrs. John Desmarais, Elizabeth McCaul and Francis Ingrassia, Mr. and Mrs. Jeffrey Kelter, Dr. and Mrs. Tomislav Kundic, Mr. and Mrs. Robert Lindsay, Ivana Stolnik-Lourie and Dr. Robert Lourie, Dr. and Mrs. Howard Morgan, and Marilyn and James Simons.
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