Risk-Based Monitoring Videos From Applied Clinical Trials Are Going Viral


Target Health is pleased to share the video clips below which were recorded at the year’s DIA meeting and produced as part of the Applied Clinical Trials Risk-Based Network. Please share.


Target Health will again be presenting and sponsoring the CBINET Conference on “Risk-Based Monitoring in Clinical Studies, being held in Philadelphia on October 24 and 25. This meeting for sure will be a very productive experience for all.


Video Clips


Video 1

What are your views on risk-based monitoring?


Video 2

What is different now about risk-based monitoring vs. what companies may have been doing more innovatively about monitoring in the past?



YouTube Posting


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website.

Sleep and Phases of the Moon


Human sleep patterns may be influenced by phases of the moon. Current Biology/Cajochen et al.


Moon Matters

If you’re having trouble falling asleep, and tossing and turning all night, it might be because there’s a full moon. Check the August 2013 Calendar for phases of the moon, dates, to see when you 1) ___ well and when you don’t. The baleful influence of the moon on your sleep cycle may be more than just folklore, according to a new paper in Current Biology. Scientists from the University of Basel in Switzerland took a close look at data from a previous sleep study of 33 volunteers and found that there was a clear shift at the time of the 2) ___ moon: The subjects’ brain activity dropped by about 30 percent, they took an average of five minutes longer to fall asleep, and slept for about 20 minutes less than normal. The influence of the moon happened even though the study took place in a laboratory.


“The lunar cycle seems to influence 3) ___ sleep, even when one does not ‘see’ the moon and is not aware of the actual moon phase,” author Christian Cajochen, of the Psychiatric Hospital of the University of Basel, said in a statement. Interestingly enough, Cajochen and his colleagues didn’t originally set out to examine the tug of the moon on the human sleep cycle. The data for this latest study was originally gathered for a study on circadian rhythms in sleep — so neither the technicians nor the volunteers, nor really anyone originally involved in the study, had any idea that the scientists would be analyzing the data with respect to 4) ___ cycles. “We just thought of it after a drink in a local bar one evening at full moon, years after the study was completed,” the authors wrote (really).


Since there’s no way the moon exerts a gravitational force significant enough to affect the human body, the researchers think the rhythm they observed is another kind of internal clock. Some other animals have been known to cycle with the moon, an ability that could help them anticipate the movements of 5) ___ tides. A 1995 paper in the Journal of Biological rhythms found that Galapagos marine iguanas with internal clocks most closely synched to the moon tend to have a better survival rate, possibly because they know just the right time to go foraging for algae in the intertidal zone.


“Lunar rhythms are not as evident as circadian 6) ___ and are thus not easy to document — but they exist,” the authors wrote. “Their role is mysterious, and there are probably large individual differences that underlie the contradictory evidence for their existence — some people may be exquisitely sensitive to moon phase.”


SOURCE: Cajochen et al. “Evidence that the Lunar Cycle Influences Human Sleep.” Current Biology published online 25 July 2013.



More Health Info About Sleep


The duration of sleep alone or in combination with physical 7) ___activity, a healthy diet, limited alcohol intake, and no smoking significantly reduced the risk of heart disease. Even achieving sufficient sleep duration of at least 7 hours per night without any of the four traditional lifestyle factors had a positive impact on risk reduction of CVD (23%) and fatal CVD (43%).


The duration of sleep alone or in combination with four traditional healthy lifestyle factors significantly reduced the risk of heart disease. Those who adhered to sufficient physical activity, a healthy diet, limited alcohol intake, and no smoking had a 57% reduced risk of a composite of cardiovascular disease (CVD) and a 67% reduced risk of fatal CVD compared with those who adhered to none or one lifestyle factor, according to W.M. Monique Verschuren, PhD, of the National Institute for Public Health and the Environment in Bilthoven, the Netherlands, and colleagues. When a good night’s sleep (more than 8) ___hours) was added to those traditional factors, the risk of CVD and of fatal CVD decreased even further — 65% and 83%, respectively, researchers wrote in the July edition of the European Journal of Preventive Cardiology.


However, even achieving sufficient sleep duration without any of the four traditional lifestyle factors had a positive impact on risk reduction — 22% reduced risk of CVD and 43% reduction in fatal CVD. Also, not smoking alone carried significant weight, conferring a 43% reduced risk of CVD and of fatal CVD. Thus, nonsmoking and sufficient sleep duration were both strongly and similarly inversely associated with fatal 9) ___. The composite CVD comprised fatal CVD, nonfatal myocardial infarction (MI), and stroke. “If all participants adhered to all five healthy lifestyle factors, 36% of composite CVD and 57% of fatal CVD could theoretically be prevented or postponed,” the authors wrote. “The public health impact of sufficient sleep duration, in addition to the traditional healthy lifestyle factors, could be substantial.” Verschuren and colleagues noted that only two studies have thus far included sleep 10) ___ as a lifestyle factor.


Both studies mirrored the current study by showing an independent association of sleep with CVD risk and a reduced risk of CVD when sleep duration was included with traditional lifestyle factors. However, neither study separated out the protective benefit of sleep from the other healthy lifestyle benefits. The investigators therefore decided to examine whether sufficient sleep duration further reduces risk of CVD on top of the traditional lifestyle factors. Participant data came from the Monitoring Project on Risk Factors for Chronic Diseases (MORGEN), a prospective cohort study from 1993 to 1997. Follow-up was a mean of 12 years. The study comprised 6,672 men and 7,967 women, with a mean age of 42 and 41, respectively. A total of 12% of both men and women reported having all five healthy lifestyle factors at baseline, while 6%, reported having zero or one factor. Rounding out the middle were 33% of both men and women who adhered to three lifestyle factors, and 32% and 29% of men and women, respectively, adhering to four factors. In an analysis that adjusted for age, gender, educational level, and with and without mutual adjustments, nonsmoking was “strongly inversely” associated with composite CVD (hazard ratio 0.57), as were sleep duration (HR 0.78) and limited alcohol consumption (HR 0.79). In terms of fatal CVD in the adjusted analysis, only nonsmoking (0.61) and sufficient sleep duration (0.57) were significant factors in reducing death. As an explanation for the results, the investigators noted that short sleep duration has been associated with a higher incidence of overweight, obesity, and hypertension, along with higher levels of blood pressure, total cholesterol, hemoglobin A, and triglycerides, effects which are “consistent with the hypothesis that short sleep duration is directly associated with CVD 11) ___.”

The importance of sufficient sleep “should now be mentioned as an additional way to reduce the risk of cardiovascular 12) ___,” Verschuren said in a statement. “It is always important to confirm results, but the evidence is certainly growing that sleep should be added to our list of CVD risk factors.” An earlier study from this group of researchers found that those who slept less than 7 hours and got up each morning not fully rested had a 63% higher risk of CVD than those sleeping sufficiently — (Sleep 2011; 34: 1487-1489).


A limitation of the current study includes the inability to know how or if depressive symptoms, sleep apnea, or psychological stress impacted the risk of CVD. Also, the potential for CVD to be misclassified “may have attenuated” the results.


The Monitoring Project on Risk Factors for Chronic Diseases (MORGEN study) is supported by the Ministry of Health, Welfare and Sport for the Netherlands and the National Institute for Public Health and the Environment. Verschuren MWM, et al “Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study” Eur J Prev Cardiol2013; DOI: 10.1177/2047487313493057.


ANSWERS: 1) sleep; 2) full; 3) human; 4) lunar; 5) ocean; 6) rhythms; 7) activity; 8) seven; 9) CVD; 10) duration; 11) risk; 12) disease

Sleep and Sleep Therapy

Sleep that knits up the raveled sleeve of care,
The death of each day’s life, sore labor’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast. Macbeth, Act 2, Scene 2


Sleeping and dreaming always have been a fundamental part of human existence. Most early writing on these subjects was almost entirely speculation. During the twentieth century, however, scientific observation and experimentation abounded. This article emphasizes the evolution of the key concepts and research findings that characterize sleep research and sleep medicine, crucial discoveries and developments in the formative years of the field, and those principles and practices that have stood the test of time.


History of deep sleep therapy (“First do no harm”)


Deep sleep therapy (DST), also called prolonged sleep treatment or continuous narcosis, is a psychiatric treatment based on the use of psychiatric drugs to render patients unconscious for a period of days or weeks. Induction of sleep for psychiatric purposes was first tried by Scottish psychiatrist Neil Macleod at the turn of the 20th century. He used bromide sleep in a few psychiatric patients, one of whom died. His method was adopted by some other physicians but soon abandoned, perhaps because it was considered too toxic or reckless. In 1915, Giuseppe Epifanio tried barbiturate-induced sleep therapy in a psychiatric clinic in Italy, but his reports made little impact. Deep sleep therapy was popularized in the 1920s by Swiss psychiatrist Jakob Klaesi, (1883 – 1980) using a combination of two barbiturates marketed as Somnifen by pharmaceutical company Roche. Klaesi’s method became widely known and was used in some mental hospitals in the 1930s and 1940s. It was adopted and promoted by some leading psychiatrists in the 1950s and 1960s, such as William Sargant (1907 – 1988, whose work is seldom cited in modern psychiatric texts) in the UK and by Donald Ewen Cameron, (1901 –1967), who was a 20th-century Scottish-born psychiatrist involved in the United States Central Intelligence Agency’s (CIA) MKULTRA mind control program, which CIA head Sidney Gottlieb ultimately dismissed as “useless.”


Cameron has been heavily criticized in medical circles for his administration without patient consent of disproportionately-intense electroshock therapy and experimental drugs, including LSD, which caused some patients to become permanently comatose. Sargant wrote in his standard textbook An introduction to physical methods of treatment in psychiatry:


“Many patients unable to tolerate a long course of ECT, can do so when anxiety is relieved by narcosis. What is so valuable is that they generally have no memory about the actual length of the treatment or the numbers of ECT used. After 3 or 4 treatments they may ask for ECT to be discontinued because of an increasing dread of further treatments. Combining sleep with ECT avoids this. All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs and ECT [which] together generally induce considerable memory loss for the period under narcosis. As a rule the patient does not know how long he has been asleep, or what treatment, even including ECT, he has been given. Under sleep, one can now give many kinds of physical treatment, necessary, but often not easily tolerated. We may be seeing here a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anesthesia in surgery”.


Australian Chelmsford scandal


Deep sleep therapy was also practiced (in combination with electroconvulsive therapy and other therapies) by Harry Bailey between 1962 and 1979 in Sydney, at the Chelmsford Private Hospital. As practiced by Bailey, deep sleep therapy involved long periods of barbiturate-induced unconsciousness. DST was prescribed for various conditions ranging from schizophrenia and depression to obesity, PMS and addiction. Twenty-six patients died at Chelmsford Private Hospital during the 1960s and 1970s. After the failure of the agencies of medical and criminal investigation to tackle complaints about Chelmsford, a series of articles in the early 1980s in the Sydney Morning Herald and television coverage on 60 Minutes exposed the abuses at the hospital including 24 deaths from the treatment. This forced the authorities to take action, and a Royal Commission was appointed. The Citizens Commission on Human Rights, a psychiatric reform group established by the Church of Scientology, was an advocate for victims and received documents from the hospital copied by a nurse “Rosa”.


In 1978 Sydney psychiatrist Brian Boettcher had convened a meeting of doctors working at Chelmsford and found there was little support for deep sleep therapy (Harry Bailey did not attend). However the treatment continued to be used into the following year. Legal action on behalf of former patients was and is still being pursued in New South Wales. In her book First Half, Toni Lamond described what it was like when she was admitted there in 1970. She had an addiction to prescription drugs and a friend told her about Dr Bailey who duly became her psychiatrist. “I was given a semi private room. On the way to it I saw several beds along the corridors with sleeping patients. The patient in the other bed in my room was also asleep. I thought nothing of it at the time. Although it was mid-morning, the stillness was eerie for a hospital that looked to be full to overflowing. I was given a handful of pills to take and the next thing I remember was Dr Bailey standing by the bed asking how I felt. I told him I’d had a good night’s sleep. He laughed and informed me it was ten days’ later and what’s more he had taken some weight off me. I was checked out of the hospital and this time noticed the other patients were still asleep or being taken to the bathroom while out on their feet.”


The New South Wales government recently admitted that three people over the last three years had been kept continuously unconscious for 48 hours whilst undergoing ECT.


More sleep therapy info


There are approximately 84 different sleep disorders. Listed below are some of the most common disorders with links to more information about them.



Sleep Research Timeline


The following timeline describes some of the important milestones in the history of sleep research:


Year Event
c. 350 BCE – Aristotle viewed sleep as, “an inhibition of sense perception” for “conservation.”


1729 – Jean Jacques d’Ortous deMairan, French Astronomer, experimented with plants and biological rhythms. He is thought to be the first to experiment with biological rhythms.


1846 – Dr. Edward Binns published “The Anatomy of Sleep.”



Caton records the brain’s electrical activity of animals in England.
1877 The problem of narcolepsy is first described in the medical literature.
1880 Gelineau describes a group of patients in France with a problem he names “narcolepsy.”
1902 Loewenfeld coins the term “cataplexy” to describe the onset of muscle weakness that often affects people with narcolepsy.
1929 Berger discovers and reports the “electroencephalogram (EEG) of man” in Germany.
1937 Loomis documents the EEG patterns of what is now called non-rapid eye movement (NREM) sleep.
1945 Ekbom describes restless legs syndrome in Sweden.
1953 Kleitman and Aserinsky at the University of Chicago describe the rapid eye movement (REM) stage of sleep and propose a correlation with dreaming.
1956 Burwell and colleagues publish a description of the obesity hypoventilation (Pickwickian) syndrome, laying the groundwork for the discovery of obstructive sleep apnea.
1957 Dement and Kleitman describe the repeating stages of the human sleep cycle.
1960 Vogel recognizes that REM sleep in narcoleptics begins near sleep onset rather than one to two hours later.
1963 Wurtman and colleagues report that melatonin synthesis in the pineal gland is under the inhibitory control of light.
1965 Oswald and Priest use the sleep laboratory to evaluate sleeping pills.
1966 Gastaut and colleagues in France, and Jung and Kuhlo in Germany discover obstructive sleep apnea (OSA).
1968 Rechtschaffen and Kales publish a scoring manual that allows for the universal, objective comparison of human sleep stage data.
1972 Studies pinpoint the suprachiasmatic nuclei (SCN) as the site of the biologic clock.
1973 First report of a narcoleptic dog.
1974 Holland gives the name “polysomnography” to the overnight sleep study.
1976 Carskadon established sleep latency as an objective measurement of sleepiness.
1981 Sullivan and colleagues use continuous positive airway pressure (CPAP) to treat OSA.
1986 Schenck, Mahowald and colleagues publish the first formal description of REM sleep behavior disorder (RBD).
1989 Rechtschaffen and colleagues find that total sleep deprivation results in the death of all rats within two to three weeks.
1991 Johns develops Epworth Sleepiness Scale to diagnose sleep disorders.
1999 Studies show that hypocretin mutations cause narcolepsy in mice and dogs.
2000 Mignot and colleagues at Stanford discover that human narcolepsy also is associated with hypocretin deficiency.
2001 Ptacek et al discover 1st human gene involved in circadian rhythms.
2003 Stickgold and colleagues publish evidence of sleep’s effect on memory and learning process.
2007 American Academy of Sleep Medicine reclassifies stages of non-REM sleep into 3 categories.
2008 Young and colleagues find high mortality risk for untreated sleep-disordered breathing.
2010 Redline et al associate obstructive sleep apnea with increased stroke risk for men.


Sources: Shepard JW, Buysse DJ, Chesson AL, et al. History of the development of sleep medicine in the United States. J Clin Sleep Med. 2005;1:61-82. 

Mignot E. History of narcolepsy. A hundred years of narcolepsy research. Arch Ital Biol. 2001 Apr;139(3):207-20.

Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2005.

Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation


The rabies virus causes a fatal encephalitis and can be transmitted through tissue or organ transplantation. In February 2013, a kidney recipient with no reported exposures to potentially rabid animals died from rabies 18 months after transplantation. As a result, a study published in the Journal of the American Medical Association (2013;310:398-407) was performed to investigate whether organ transplantation was the source of rabies virus exposure in the kidney recipient, and to evaluate for and prevent rabies in other transplant recipients from the same donor.


For the investigation, organ donor and all transplant recipient medical records were reviewed. Laboratory tests to detect rabies virus-specific binding antibodies, rabies virus neutralizing antibodies, and rabies virus antigens were conducted on available specimens, including serum, cerebrospinal fluid, and tissues from the donor and the recipients. Viral ribonucleic acid was extracted from tissues and amplified for nucleoprotein gene sequencing for phylogenetic comparisons. The main outcome measures were to determine whether the donor died from undiagnosed rabies and whether other organ recipients developed rabies.


Results showed that in retrospect, the donor’s clinical presentation (which began with vomiting and upper extremity paresthesia and progressed to fever, seizures, dysphagia, autonomic dysfunction, and brain death) was consistent with rabies. Rabies virus antigen was detected in archived autopsy brain tissue collected from the donor. The rabies viruses infecting the donor and the deceased kidney recipient were consistent with the raccoon rabies virus variant and were more than 99.9% identical across the entire N gene (1349/1350 nucleotides), thus confirming organ transplantation as the route of transmission. The 3 other organ recipients remained asymptomatic, with rabies virus neutralizing antibodies detected in their serum after completion of postexposure prophylaxis (range, 0.3-40.8 IU/mL).


According to the authors, unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors and a standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered. In addition, risks and benefits for recipients of organs from these donors should be evaluated.

The State of U.S. Health, 1990-2010


According to an article published online in the Journal of the American Medical Association (10 July 2013) a study was performed to measure the burden of diseases, injuries, and leading risk factors in the U.S. from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organization for Economic Co-operation and Development (OECD) countries.


The study used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the U.S. and to compare U.S. health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages.


Results showed that U.S. life expectancy for both genders combined, increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the U.S. population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the U.S. rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th.


According to the authors, from 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the U.S. health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area


Safety of Imported Food


In order to implement the bipartisan Food Safety Modernization Act (FSMA) signed by President Obama, the FDA issued two proposed rules aimed at helping to ensure that imported food meets the same safety standards as food produced in the U.S. These proposals are part of the FSMA approach to modernizing the food safety system for the 21st century. FSMA focuses on preventing food safety problems, rather than relying primarily on responding to problems after the fact. Under the proposed rules, importers would be accountable for verifying that their foreign suppliers are implementing modern, prevention-oriented food safety practices, and achieving the same level of food safety as domestic growers and processors. The FDA is also proposing rules to strengthen the quality, objectivity, and transparency of foreign food safety audits on which many food companies and importers currently rely to help manage the safety of their global food supply chains.


The new measures respond to the challenges of food safety in today’s global food system. Imported food comes into the U.S. from about 150 different countries and accounts for about 15% of the U.S. food supply, including about 50% of the fresh fruits and 20% of the fresh vegetables consumed by Americans.


Under the proposed regulations for Foreign Supplier Verification Programs (FSVP), U.S. importers would, for the first time, have a clearly defined responsibility to verify that their suppliers produce food to meet U.S. food safety requirements. In general, importers would be required to have a plan for imported food, including identifying hazards associated with each food that are reasonably likely to occur. Importers would be required to conduct activities that provide adequate assurances that these identified hazards are being adequately controlled.


FSMA also directs the FDA to establish a program for the Accreditation of Third-Party Auditors for imported food. Under this proposed rule, the FDA would recognize accreditation bodies based on certain criteria such as competency and impartiality. The accreditation bodies, which could be foreign government agencies or private companies, would in turn accredit third-party auditors to audit and issue certifications for foreign food facilities and food, under certain circumstances.


Importers will not generally be required to obtain certifications, but certifications may be used by the FDA to determine whether to admit certain imported food that poses a safety risk into the United States. The FSVP proposed rule and the third-party accreditation proposed rule are available for public comment for the next 120 days. The two proposed rules will help the FDA create an integrated import oversight system that works efficiently to improve food safety and protect the public health. These proposals work in concert with the proposed rules released in January 2013, for produce safety and preventive controls in facilities that produce human food. Those proposed rules are currently open for comment until September 16, 2013, but the FDA intends to grant a 60-day final extension of the comment period to allow commenters an opportunity to consider the interrelationships between the January proposals and the two proposals being announced today.


For more information:

1. FDA Food Safety Modernization Act (FSMA)

2. Fact Sheet: Foreign Supplier Verification Programs for Importers of Food for Humans and Animals

3. Fact Sheet: Proposed Rule on Accreditation of Third-Party Auditors

4. Consumer Update

Chicken-Radish Salad with Frisee & Green Grapes




4 cups bite-size, cooked chicken
2 stalks fresh celery, chopped well
1/2 sweet onion, chopped
1 garlic clove, juiced
1 or 2 radishes, cut in half, then sliced thin
1 cup green grapes, cut in half
1/2 of a fresh endive, leaves cut on the diagonal
1 cup Frisee
3 Tablespoons low-fat Kraft mayo


Combine above ingredients, then add the mayo and toss.


This recipe is so quick and easy, that it’s amazing how delicious it is. The secret is the right blend of fabulous, very fresh ingredients. For me, what makes it so quick, is that, for the cooked chicken (if I don’t have any left-overs) I simply buy a rotisserie chicken at Dean and Deluca (this is a spacious NYC high-end type deli) and use all the while meat, and if not enough of that, then the dark meat. We had this last night, with some left-over Spinach/Strawberry/Feta Salad, which we love in the summer, (from several weeks ago in the newsletter) and some Balsamic Cauliflower. BTW, I was raised on Hellman’s mayo, so that only years later, when I took a big step away from what I was used to, I discovered (just a personal preference) that Kraft mayo tasted better. I’m not invested in, or a spokesperson for, Kraft products at all, I’m just suggesting that you might like it better too. Even the Kraft no-fat and low-fat mayo has more flavor.


Getting back to our menu: you might also like to nibble on warm pita bread, dipped in your best extra virgin olive oil. We ended our summer repast with a fresh blueberry dessert, topped with a big dollop of no-fat Cool Whip. Your favorite icy white wine would go well with all of the above.


Beautiful fresh radishes for the chicken salad