think twice before jumping in a public pool this summer

CDC study finds fecal contamination in pools

A study of public pools done during last summer’s swim season found that feces are frequently introduced into pool water by swimmers. Through the study, released today by the Centers for Disease Control and Prevention (CDC), researchers found germs in samples of pool filter water collected from public pools.

CDC collected samples of water from pool filters from public pools and tested the samples for genetic material (for example, DNA) of multiple microbes. The study found that 58 percent of the pool filter samples tested were positive for E. coli, bacteria normally found in the human gut and feces. The E. coli is a marker for fecal contamination.

Finding a high percentage of E. coli-positive filters indicates swimmers frequently contaminate pool water when they have a fecal incident in the water or when feces rinse off of their bodies because they do not shower thoroughly before getting into the water. No samples tested positive for E. coli O157:H7, a toxin-producing E. coli strain that causes illness.

Pseudomonas aeruginosa, which can cause skin rashes and ear infections, was detected in 59 percent of samples. Finding Pseudomonas aeruginosa in the water indicates natural environmental contamination or contamination introduced by swimmers. Cryptosporidium and Giardia, germs that are spread through feces and cause diarrhea, were found in less than 2 percent of samples. The tests used in the study do not indicate whether the detected germs were alive or able to cause infections. Indoor and outdoor public pools were sampled.

The study did not address water parks, residential pools or other types of recreational water. The study does not allow CDC to make conclusions about all pools in the United States. However, it is unlikely that swimmer-introduced contamination, or swimmer hygiene practices, differ between pools in the study and those in the rest of the country.

“Swimming is an excellent way to get the physical activity needed to stay healthy,” said Michele Hlavsa, chief of CDC’s Healthy Swimming Program. “However, pool users should be aware of how to prevent infections while swimming. Remember, chlorine and other disinfectants don’t kill germs instantly. That’s why it’s important for swimmers to protect themselves by not swallowing the water they swim in and to protect others by keeping feces and germs out of the pool by taking a pre-swim shower and not swimming when ill with diarrhea.”

This study is presented in recognition of Recreational Water Illness and Injury Prevention Week, May 20–26, 2013. The goal of the prevention week is to raise awareness about healthy swimming, including ways to prevent recreational water illnesses (RWIs). Germs that cause RWIs are spread by swallowing, breathing in the mists or aerosols from, or having contact with contaminated water in swimming pools, water parks, hot tubs, interactive fountains, water play areas, lakes, rivers, or oceans. To view the report, please visit www.cdc.gov/mmwr.

CDC recommends that all swimmers take the following steps to prevent infections while swimming:

• Keep feces and other contaminants out of the water.
• Do not swim when you have diarrhea.
• Shower with soap before you start swimming.
• Take a rinse shower before you get back into the water.
• Take bathroom breaks every 60 minutes.
• Wash your hands with soap after using the toilet or changing diapers.
• Check the chlorine level and pH before getting into the water.
• Pools: Proper chlorine (1–3 mg/L or parts per million [ppm]) and pH (7.2–7.8) levels maximize germ- killing power.
• Most superstores, hardware stores, and pool-supply stores sell pool test strips.
• Do not swallow the water you swim in.

CDC recommends that parents of young children also take the following steps:Take children on bathroom breaks every 60 minutes or check diapers every 30–60 minutes.

Change diapers in the bathroom or diaper-changing area and not at poolside where germs can rinse into the water.

For more information visit CDC’s healthy swimming/recreational water page.

quinoa becoming a popular food

As more and more people embrace a diet that's high in protein, quinoa, a grain-like crop that traces its origins to the Andes, is growing in popularity. Quinoa is a complete protein, meaning it contains all of the nine amino acids that are needed to support basic bodily function in the human body.

While many health food and exercise afficionados are aware of quinoa's nutritional benefits, they might not know that quinoa traces its roots as an edible food back several thousand years to the Andean region of Ecuador, Bolivia, Colombia, and Peru. The Incas believed quinoa was sacred, but those beliefs were eventually questioned by the conquering Spaniards, who suppressed its cultivation and forced the Incas to grow wheat instead.

Quinoa's endurance is something Hispanics can be proud of, and, thanks to its nutritional value, it's also something many people might want to share with family and friends. Those who want to celebrate their Hispanic heritage with a delicious and nutritional meal might want to consider the following recipe for "Saffron Quinoa con Pollo" from Robin Asbell's "The New Whole Grains Cookbook."

Saffron Quinoa con Pollo (Serves 4 to 6)

1/2 lemon

6 whole artichokes

2 tablespoons extra-virgin olive oil

1 pound boneless, skinless chicken thighs, cut into 2-inch chunks

1 teaspoon salt, divided

1 teaspoon freshly cracked black pepper, divided

1 large onion, diced (about 2 cups)

2 cloves garlic, minced

3 tablespoons tomato paste

1 medium red bell pepper, seeded and chopped

1/2 cup frozen peas or edamame, thawed

1/2 teaspoon saffron threads

1 cup quinoa, rinsed

13/4 cups chicken stock

Fill a large bowl halfway with cool water, and squeeze in a tablespoon of lemon juice. Pull off the leaves of each artichoke, and discard. Pare out the hairy choke, trim around the artichoke bottom, and peel the stem, leaving only edible flesh. Cut each in half vertically, submerge in the lemon water, and reserve.

Preheat the oven to 350 F. In a large, heavy brazier or Dutch oven, heat the olive oil over medium-high heat and drop in the chicken chunks, then season with a bit of the salt and pepper. Let cook, undisturbed, for 2 minutes before stirring, to get a good sear. Turn the chicken and cook until both sides are browned. Drain the artichoke bottoms, pat dry and add to the pot. Add the onion, garlic, tomato paste, bell pepper, peas, saffron, remaining salt and pepper, and quinoa, and stir to coat. Cook, stirring, for 2 minutes, to soften the vegetables. Add the stock and bring to a boil, covered.

Put the pot in the hot oven, and bake for 45 minutes, then check to see if the quinoa is done. If the quinoa is tender but there is still liquid in the pot, uncover and bake for another 5 minutes. TF129430

Celiac Disease: New Hope for a Pill Treatment

By Annette Pinder

About a decade ago when my daughter, Amy, was first diagnosed with celiac disease, I found that few health practitioners understood this genetic disorder that affects one out of nearly 105 children and adults.

People with celiac disease (celiacs) are unable to eat foods containing gluten found in wheat and other grains. If they do, an autoimmune reaction results in destruction of the villi in the small intestine, and produces antibodies that attack the intestine, causing damage and illness. Untreated celiacs are at risk for osteoporosis, central and peripheral nervous system disease, pancreatic disease, internal hemorrhaging, and gynecological disorders, among other maladies.

The current treatment for celiac disease is a gluten-free diet which, fortunately reverses damage to the intestinal tract. However, because gluten is a hidden ingredient in many foods and preservatives, the diet can be challenging. And consuming just one milligram of gluten has the same effect as eating 10,000 milligrams. It didn't take long to realize that the days of eating bread, cake, pizza and pasta for Amy were over.

After reading about the Center for Celiac Research, I decided to call world-renowned pediatric gastroenterologist, research scientist, and founder of the first celiac center in the United States, Alessio Fasano, M.D.. I was encouraged when Dr. Fasano predicted that in ten years a pill would make it possible for celiacs to eat gluten. Soon thereafter, Dr. Fasano discovered zonulin, a protein that modulates the permeability (or leakage) of tight junctions between the cells of the walls of the digestive tract.

Now Justin Siegel, assistant professor of chemistry and biochemistry at the University of California, has re-engineered a naturally occurring enzyme called kumamolisin-As. According to Siegel, this enzyme breaks down gluten in the stomach into much smaller protein pieces, called peptides, which are less likely to trigger the autoimmune response that results in celiac disease's symptoms. In fact, the enzyme dismantled more than 95 percent of the gluten peptide thought to cause celiac disease.

Siegel says he hopes the enzyme will someday be available in drug stores as an over-the-counter food additive, much like Beano, and Gas-X. But it could take a decade to develop, particularly if researchers choose to make it a prescription drug, requiring U.S. Food and Drug Administration approval. He says, "We did the engineering to change the genes and created the protein. Now we need to show the enzyme is non-toxic and functions as a protein people can safely consume." To learn more about celiac disease, visit the Center for Celiac Research at http://www.celiaccenter.org. To learn about ongoing clinical trials visit www.albatherapeutics.com.

If you or someone you know has celiac disease you might want to know more about local events and support groups visit www.buffaloglutenfree.org or call 432-3338.

University Community Farmers Market Now Open At UB South Campus

BUFFALO, N.Y. – The seventh season of the University Community Farmers Market will open Saturday May 18th on the University at Buffalo South (Main Street) Campus featuring a variety of new and old vendors selling fresh food and local products.

The market will be held from 8 a.m. to 1 p.m. each Saturday through October 12th on the Main Street sidewalk at Kenmore Avenue. Attendees can park for free in the Allen, Main and Bailey parking lots on the South Campus, directly behind the market across from the University Plaza.

“The University Community Farmers Market improves the quality of life in our neighborhood by providing an opportunity to buy healthy fresh produce from local farmers, to support local artisans, and to meet our neighbors in a relaxed outdoor environment,” said Gail Willsky, Market Manager and faculty in the School of Medicine and Biomedical Sciences.

Vendors will be selling fresh fruits and vegetables, artisan pasta, breakfast breads, homemade jams, jellies, and relishes, herbs, plants, flowers, and in the fall season mums, pumpkins, winter squash, ornamental corn, corn stalks, and gourds.

The Market Planning Committee needs individuals to help coordinate the market, all are welcome. Vendor applications are encouraged. For more information contact the UB Office of Community Relations at 716-829-6145 or visithttp://www.ourheights.org/farmersmarket/

Elmwood-Bidwell Farmers Market Opened May 11

Western New York’s most popular open-air market, the Elmwood-Bidwell Farmers Market, will return for the 2013 season on May 11. The market will be open from 8 a.m. to 1 p.m. Saturdays, rain or shine, through Dec. 21.

Visitors to the market will discover a few new surprises this year, including several new vendors. Joining the market for the 2013 season are Blackbird Sweets, Bieter and Sons Farm, Plato Dale Farm, T-Meadow Farm and Eveningside Vineyards. Several Western New York wineries will also continue to provide tastings on a rotating basis.

The Elmwood-Bidwell Farmers Market, a program of the Elmwood Village Association, is a producer-only market, meaning that all vendors grow or produce what they sell — no middlemen and no compromises. Patrons know they are dealing directly with the source, helping to create a diverse and healthy local economy.

The market is turning into a popular entertainment venue as well, with three musical acts booked each Saturday. Local musicians are slated to perform from 8:15 to 9:45 a.m., 9:45 to 11:15 a.m. and 11:15 a.m. to 12:45 p.m., weather permitting. Entertaining the crowds on May 11 will be singer/guitarist Paul Arata, the talented duet of Dan & Leanne, and singer/guitarist Casey Bolles. Casey recently opened for Teddy Geiger during his recent visit to Western New York!

Community groups will also be part of the farmers’ market landscape once again in 2013, with four to five nonprofits and community minded organizations scheduled to host informational tables each week. Week one will feature GObike Buffalo, Precious Paws, Yelp Buffalo and the SPCA Serving Erie County.

The market would also like to congratulate Melissa Blasz, winner of the annual Elmwood-Bidwell Farmers Market poster competition. Posters will be distributed to businesses throughout the Elmwood Village area and displayed at the market for the entire season. A limited number of posters will also be available at the Elmwood Village Association table at the market beginning May 11.

The market’s Electronic Benefit Transfer (EBT) program, which allows individuals and families receiving public assistance to purchase products from eligible market vendors, will be in place once again this season. Information is available each week at the Elmwood Village Association table during market hours.

Additionally, the market is once again partnering with the Erie-Niagara Tobacco-Free Coalition to promote a smoke-free environment at the market. The purpose of the Coalition is to reduce the risk of cancer, heart, lung and other tobacco-related diseases in Erie and Niagara counties by reducing tobacco use and reducing the exposure of all residents to secondhand smoke. For more information, please visit www.tobaccofreewny.com.

For more information on the market, please visit www.elmwoodmarket.org. Frequent updates are also available on Facebook atwww.facebook.com/ElmwoodBidwellFarmersMarket?fref=ts.

Roswell Park Researchers Receive More Than $3.3 Million in Grant Support for Cancer Research Efforts

BUFFALO, NY — Roswell Park Cancer Institute (RPCI) is proud to announce that several faculty members have received grant funding totaling more than $3.3 million from federal agencies and other sources. These monies will fund important research that helps to further our understanding of cancer, develop new ways to treat it and improve patients’ quality of life. These recent grant recipients are:

Yuesheng Zhang, MD, PhD, Professor of Oncology in the Department of Chemoprevention, received a five-year, $1.7 million grant award from the National Institutes of Health (NIH) to study the molecular basis for why men have a risk for bladder cancer that’s four times higher than women’s risk. The research will also assess intervention strategies.

John Blessing, MD, PhD, Executive Director of the Gynecology Oncology Group (GOG) Statistical and Data Center, received a one-year subcontract award of $300,552 from the GOG and the National Cancer Institute (NCI) for a long-term follow-up study of patients at high genetic risk for breast and ovarian cancer.

Kenneth Gross, PhD, Chairman of the Department of Molecular and Cellular Biology, Dominic Smiraglia, PhD, Associate Professor of Oncology in the Department of Cancer Genetics, and Norma Nowak, PhD, Associate Professor of Oncology in the Department of Cancer Genetics, received a two-year, $290,839 grant from the NCI to identify genetic mutations and other abnormalities that lead to the genesis and spread of pancreatic islet-cell cancer. Dr. Smiraglia also received a two-year, $165,000 grant from the American Institute for Cancer Research to explore how dietary folate interventions ¾ depletion and supplementation ¾ affect progression to recurrent prostate cancer.

Santosh Patnaik, MD, PhD, Assistant Professor in the Department of Thoracic Surgery, received a two-year year grant of $241,931 from the NCI as co-principal investigator with a collaborator from Memorial Sloan Kettering Cancer Center to develop microRNA methods to predict prognosis in early-stage lung cancer.

Michael Higgins, PhD, Associate Professor of Oncology in the Department of Molecular and Cellular Biology, received a two-year subcontract award of $209,235, from the United States Department of Defense and the University of Nebraska Medical Center to determine whether abnormal expression of a specific gene, called the BORIS gene, contributes to cancer formation in the ovary.

Vijay Jayaprakash, MBBS, PhD, Assistant Professor in the Department of Dentistry & Maxillofacial Prosthetics, received a two-year grant of $206,066 from Merck Sharp & Dohme Corp. to evaluate the prevalence of human papillomavirus (HPV) 16 and 18 in oral precancerous lesions and study whether persistent HPV infection is related to the progression to invasive cancer.

Robert Plunkett, MD, Associate Professor of Neurosurgery, received a two-year subcontract amount of $146,716 from Buffalo BioLabs LLC and the NCI for work on his project to test a novel anticancer agent, which uses a pathway found in many cancers, against glioblastoma multiforme, the most aggressive type of primary brain tumor.

Katerina Gurova, MD, PhD, Assistant Professor in the Department of Cell Stress Biology, received a one-year grant of $125,000 from the NCI to test novel anticancer compounds called curaxins against pancreatic cancer.

Elizabeth Repasky, PhD, Professor in the Department of Immunology, received a six-month grant of $23,767 from Cleveland BioLabs Inc. to evaluate the effect of a new anticancer agent from the curaxins family in combination with the FDA-approved drug Tarceva against non-small-cell lung cancer.

Nathalie Zeitouni, MD, Chief of Dermatologic Surgery, received a one-year grant for $7,641 from the American Society for Dermatologic Surgery for a project that aims to confirm that non-invasive imaging can accurately measure the depth and thickness of skin tumors.

Skin Cancers of the Feet Are Often Painless

The Centers for Disease Control have declared May as “Skin Cancer Awareness Month” and the New York State Podiatric Medical Association (NYSPMA), which represents more than 1,200 foot specialists across the Empire State, is urging New Yorkers to pay special attention to the skin on both the top and bottom of their feet. While harmful sunrays may be the primary cause of skin cancers on parts of the body that receive sun exposure, skin cancers of the feet are more often related to viruses. Doctors of Podiatric Medicine (DPMs) are foot specialists, trained to recognize and treat conditions that present on the skin of the foot. 

Skin on the feet, especially on the bottom, is often overlooked during routine medical exams. According to Dr. Gary Stones, NYSPMA’s President and a practicing podiatrist, skin cancers of the feet have several features in common. “Most are painless, but often there’s a history of recurrent cracking, itching, bleeding or ulceration,” he cautions. “These cancers often go undiagnosed until another issue presents itself near the affected site,” added Stones. 

Checking for warning signs is something anyone can do, paying particular attention to changes such as non-healing sores, bumps that crack and bleed, nodules with rolled edges or scaly areas. Examining the bottom of the foot is critical. 

Basal cell cancers may appear as pearly white bumps or oozy patches that can get crusty like other open sores. On the foot, basal cell cancers often look like non-cancerous skin tumors or benign ulcers. 

Squamous cell carcinoma is the most common type of skin cancer of the foot. They usually are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer can begin as a small scaly bump, which may appear inflamed. There can be cracking or bleeding. Sometimes it begins as a hard projecting, callous-like lesion. While painless, this type of skin cancer may be itchy. It can resemble a plantar wart, a fungal infection, eczema, an ulcer or other common dermatological conditions. 

Skin cancers on the lower extremity may have a different appearance that those arising on the rest of the body. So to test, the podiatrist will perform a skin biopsy. This is a simple procedure in which a small sample of the skin is obtained and sent to a lab where a skin pathologist examines the tissue in greater detail. If it turns out the lesion is skin cancer, the podiatrist will recommend the best course of treatment. 

Each year, approximately 2 million Americans are diagnosed with non-melanoma skin cancers. Early detection and treatment are the goals of NYSPMA’s observance of Skin Cancer Awareness Month. To find a doctor-member of the New York State Podiatric Medical Association in your community, visit NYSPMA.org and click on the “find a podiatrist” button or call Toll-free at 866-996-4400.

Kids Run celebrates 25 years at Delaware Park

BUFFALO, N.Y. (May 16, 2013) – Register as a team for this year’s 25th Annual Independent Health Foundation’s Kids Run at 9 a.m., Saturday, June 1, at the Zoofari Courtyard at Delaware Park.

The free event, which is presented by Wegmans, includes a mini-dash for kid’s ages 2 to 5 and a 1.8 mile run/walk for all ages. In addition to registering as a team, participants can create custom shirts and purchase custom road signs to cheer on team/ runner.

Trophies are awarded to the winning boys and girls and each participant receives a medal at the finish line, while supplies last. After the race, all participants can enjoy the Buffalo Zoo with $2 admission per person.

“Twenty-five years after Kids Run started at Delaware Park, it’s become a fantastic tradition for many Western New York families,” said Carrie Meyer, executive director, Independent Health Foundation. “We hope our Kids Run participants see the value of engaging in healthy activities, especially at an early age, and continue exercising as a family year round.”

To register online or download an entry form, please visit www.independenthealth.com/kidsrun. Entry forms are also available at all area Wegmans stores. Completed registration forms should be postmarked or submitted online by May 22 in order to receive official race numbers. Walk-up registration is welcome and open from 9 to 9:30 a.m. at the event.

For more information on how you, your family, organization or school can participate in Kids Run, call the Foundation at 635-4959. Kids Run is presented by Wegmans and sponsored by Independent Health Foundation, Channel 7 and GoGo squeeZ.

Established in 1992, the Independent Health Foundation works to improve the health and well being of Western New York residents through awareness, prevention and education programs focused on community health priorities. For more information on the Foundation’s activities, visit www.independenthealth.com.

Stop the Aging Process: Peel Back the Clock on Your Skin

by Annette Pinder

Face it! Men and women today are living longer, remaining in the work force for more years, and they are doing what they can to maintain a more youthful appearance. For many, chemical peels just might be a great solution.

According to the Mayo Clinic, chemical peels can improve the appearance of your skin, help skin pigmentation disorders, acne-scarring, age-related wrinkles, melasma (darkening of the skin as a result of skin damage, and help sun damage sustained to the face, neck, chest, arms and legs.

Dr. Hratch Karamanoukian, of Williamsville explains, "Skin cells give your skin color by making a substance called melanin. When these cells become damaged or unhealthy, it affects melanin production. Some pigmentation disorders affect just patches of skin. Others affect your entire body. For example, pregnancy and sun exposure can result in skin darkening. If your body makes too little melanin, your skin gets lighter. Some conditions cause patches of light skin, often as a result of infections, blisters and burns.

One procedure available now available in Buffalo is called the Obagi Blue Peel, and no, you don't turn blue, at least not permanently. Obagi Blue makes it possible to replace layers of dead skin cells that exfoliate. These dead skin cells are replaced with healthier cells, resulting in clearer, more transluscent and tighter skin. There is also no increased risk of hyperpigmentation (skin darkening) as a result of the procedure. In fact, the lighter the color of your skin, the less likely is hyperpigmentation to occur with any type of aesthetic skin intervention.

Patients typically drive themselves both to and from the doctor's office. Following the procedure, which lasts about 30 minutes, the peel is washed off and a special soothing cream is applied to moisturize the skin. A very light blue (smurfy) skin hue lasts about 12 hours. However, some patients are able to go out to dinner the same evening.

According to Dr. Hratch Karamanoukian, who is a big proponent of this highly effective procedure, the peeling process actually begins on the third day after a patient returns home, and ends within seven to ten days. Patients say the experience is highly tolerable. The extent of discomfort is typically a mild burning sensation that lasts several minutes, that is helped with fanning. Ibuprofen taken 30 minutes prior to the peel also helps to minimize pain. Although rare, patients who are extremely anxious may be required to take xanax or valium one hour before the treatment.

Dr. Karamanoukian says, "A physician administered medical peel is safe and effective, but cautions that following a chemical peel, skin is temporarily more sensitive to the sun, so it is important to wear sunscreen daily that protects against the sun's UVA and UVB rays. To find out if you're a candidate for the Obagi Blue Peel procedure and schedule a consultation with Dr. Karamanoukian, call 716-568-2139 or visit www.AdvanceYourBeauty.com.

Potential New Treatment for Type 1 Diabetes

UB Research Team Testing New Drug as Additional Treatment to Insulin
in Type 1 Diabetes

By Nitesh Kuhadiya, MD, MPH

Since the landmark discovery of insulin by Banting & Best in 1921, advances in the treatment of type 1 diabetes have centered mainly on preparations of insulin with different rates of absorption from the subcutaneous tissue (region beneath the skin). These modifications led to a variety of insulin preparations. Some have prolonged bioavailability like Lantus, Levemir, or NPH. Others have more rapid absorption than human insulin. These include Novolog, Humalog and others. Both types facilitate diabetes management. Use of insulin pumps and continuous glucose monitoring systems contribute further to management of blood sugars.

With consistent efforts, some patients are able to maintain their HbA1c (A1c) (an estimate of the average blood sugar in last 3 months) at the goal of 7% or under. However, adequate blood sugar control in patients with type 1 diabetes still continues to be a major challenge. Even in patients with an A1c of less than 7%, blood sugars are erratic and have wide oscillations. This leads to frustration for the patient and the treating physician! Thus, novel means are still being sought to improve blood sugar control in patients with type 1 diabetes.

In 2011, research conducted at SUNY Buffalo showed for the first time that a once-a-day injection of a drug containing a glucagon-like peptide-1 analog called Liraglutide (Victoza)) in addition to insulin resulted in the reduction of average fasting and weekly blood sugars. Further, there was a reduction in blood sugar oscillations. Use of Victoza was also associated with a decrease in insulin requirements. There was no change in the frequency of low blood sugars, but A1c levels decreased by 0.5%. The fall in HbA1c occurred in spite of fact that the baseline A1c was 6.5%, implying that these patients were already well controlled. Additionally, there was a weight loss of almost 10 pounds over a period of 24 weeks.


With the use of Victoza our SUNY Buffalo team has also demonstrated similar benefits in poorly
controlled and obese patients. These patients had Type 1 diabetes and an average weight of 212 pounds. This is extremely relevant, since most patients with type 1 diabetes are not well controlled, and over 50% of patients with type 1 diabetes in the United States are obese.

Our results have been exciting, but we still need to do further research. The Endocrinology Division of the University at Buffalo is conducting studies to assess the effects of Victoza (Liraglutide) in patients with type 1 diabetes. If you are interested in participating in this clinical trial please visit our website at www.ubdiabetes. com or call 716-626-7998 for more information.


ABOUT THE AUTHOR: Nitesh Kuhadiya is an endocrinology fellow in the Division of Endocrinology and Metabolism, University at Buffalo. Dr. Kuhadiya is a member of the research team of Dr. paresh Dandona that is conducting four randomized placebo controlled trials on the effect of Liraglutide in Type 1 diabetes.