Target Health Presenting on Risk-Based Monitoring
This week, in Philadelphia, Dr. Jules Mitchel will be presenting a talk at a CBI conference on Risk-based Monitoring. The topic will be on How to Leverage Risk-Based Monitoring and Direct Data Entry to Assess Quality Metrics in Real-Time. The presentation will address how a combination of risk-based monitoring and direct data entry (DDE) results in significant increases in the efficiency of clinical trial operations, and at the same time, reduces overall monitoring costs and expedites the delivery of safe and effective drugs to the market. The case study to be presented, shares the considerations and processes employed by Target Health during their implementation of a risk-based approach.
If you will be there, you will see:
1. Lessons learned from studies and items to consider
2. Results of studies that have and have not executed this risk-based monitoring with eSource methodology
How to save time and money while complying with regulations
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.
Could the Timing of When You Eat, Be Just as Important as What You Eat?
Gluttony in a detail from The Seven Deadly Sins and the Four Last Things by Hieronymus Bosch
Americans, today, would be extremely understanding and sympathetic to corpulent President William Howard Taft’s constant search for a diet that resulted in significant weight loss. In fact, compared to some early 21st Century fatties, he would actually be slimmer, by contrast. Taft might well have tried gastric by-pass surgery, or at least the easier lap-band surgery, frequently done with robotic assistance.
Most weight-loss plans center around a balance between 1) ___ intake and energy expenditure. However, new research has shed light on a new factor that is necessary to shed pounds: timing. Researchers from Brigham and Women’s Hospital (BWH), in collaboration with the University of Murcia and Tufts University, have found that it’s not simply what you eat, but also when you eat, that may help with weight-loss regulation.
The study was published on January 29, 2013 in the International Journal of Obesity.
“This is the first large-scale prospective study to demonstrate that the 2) ___ of meals predicts weight-loss effectiveness,” said Frank Scheer, PhD, MSc, director of the Medical Chronobiology Program and associate neuroscientist at BWH, assistant professor of medicine at Harvard Medical School, and senior author on this study. “Our results indicate that late eaters displayed a slower weight-loss rate and lost significantly less weight than early eaters, suggesting that the timing of large meals could be an important factor in a weight loss program.”
To evaluate the role of food timing in weight-loss effectiveness, the researchers studied 420 overweight study participants who followed a 20-week weight-loss treatment program in Spain. The participants were divided into two groups: early-eaters and late-eaters, according to the self-selected timing of the main meal, which in this Mediterranean population was lunch. During this meal, 40% of the total daily calories are consumed. Early-eaters ate lunch any time before 3 p.m. and late-eaters, after 3 p.m. They found that late-eaters lost significantly less weight than early-eaters, and displayed a much slower rate of weight-loss. Late-eaters also had a lower estimated insulin sensitivity, a risk factor for diabetes.
Researchers found that timing of the other (smaller) meals did not play a role in the success of weight loss. However, the late eaters — who lost less weight — also consumed fewer calories during breakfast and were more likely to skip breakfast altogether. These late-eaters also had a lower estimated insulin sensitivity, which is a risk factor for 3) ___. The researchers also examined other traditional factors that play a role in weight loss such as total calorie intake and expenditure, appetite hormones leptin and ghrelin, and sleep duration. Among these factors, researchers found no differences between both groups, suggesting that the timing of the meal was an important and independent factor in weight loss success.
“This study emphasizes that the timing of 4) ___ intake itself may play a significant role in weight regulation” explains Marta Garaulet, PhD, professor of Physiology at the University of Murcia Spain, and lead author of the study. “Novel therapeutic strategies should incorporate not only the caloric intake and macronutrient distribution, as it is classically done, but also the timing of food.”
National Survey Highlights Perceived Importance of Dietary Protein to Prevent Weight Gain
Atkins Diet, Zone Diet, South Beach Diet, etc., etc., etc. Chances are you have known someone who has tried a high protein diet. In fact, according to the International Food Information Council Foundation, 50% of consumers were interested in including more protein in their diets and 37% believed protein helps with weight loss. In a new study released in the June 2013 issue of the Journal of Nutrition Education and Behavior, researchers found a relatively high proportion of women who reported using the practice of ”eating more 5) ___” to prevent weight gain, which was associated with reported weight loss.
Among a national sample, researchers from the University of Minnesota surveyed 1,824 midlife women (40-60 years old) to (1) describe perceptions about protein sources and requirements, (2) identify the reported frequency of using the ”eating more protein” practice to prevent weight gain, and (3) compare reported protein intake to reported frequency of using the ”eating more protein” practice to prevent weight gain.
Most women correctly identified good protein sources, and the majority could indicate the daily percent of dietary energy recommended from protein. ”Eating more protein” to prevent weight gain was reported by 43% of women (and more than half of obese women) as a practice to prevent weight 6) ___. Reported use of this practice was related to self-reported weight loss over two years. Two factors associated with effective use of this practice included the level of protein intake and self-efficacy toward weight management.
According to Noel Aldrich, lead author, those participants’ who had reported weight loss with “eating more protein” had a protein intake that was consistent with the focus on protein suggested by the 2010 Dietary Guidelines Advisory Committee. He said, “Education regarding dietary protein requirements may enhance the use of this practice. Women may need more information regarding protein energy content and effective selection of protein sources to enhance protein intake as a weight management strategy. Given that the majority of Americans are 7) ___, identifying the most effective practices and related factors surrounding successful weight loss and prevention of weight gain are important.”
Epigenetic Biomarkers May Predict If a Specific Diet and Exercise Regimen Will Work
Would you be more likely to try a diet and exercise regimen if you knew in advance if it would actually help you lose weight? Thanks to a new report published in the June 2013 issue of The FASEB Journal, this could become a reality. In the report, scientists identify five epigenetic biomarkers in adolescents that were associated with a better weight loss at the beginning of a weight loss program. Not only could this could ultimately help predict an individual’s response to weight loss intervention, but it may offer therapeutic targets for enhancing a weight loss program’s effects.
“Successful obesity treatment during adolescence could reduce morbidity at later stages of life and lead to a better quality of 8) ___,” said Amelia Martí, Ph.D., Pharm. D., co-author of this study from the Department of Nutrition, Food Science, Physiology and Toxicology at the University of Navarra in Pamplona, Spain. “It is crucial to find new markers for obesity treatment. Here, we describe five putative epigenetic biomarkers that could help to predict the response to a weight loss intervention in obese adolescents.”
To make this discovery, Martí and colleagues first performed a global methylation assay in 24 adolescents who had the best and worst response to the EVASYON weight loss program, and then expanded the sample to include 83 more adolescents. Researchers measured an epigenetic marker, DNA methylation levels, in 9) ___ adolescents from a blood sample at baseline and again at the end of the 10-week program. Participants were then divided into two groups (high and low responders) according to the weight loss achieved. The researchers found that the baseline DNA methylation levels of five epigenetic markers were associated with better weight loss response.
This EVASYON program is a lifestyle and nutritional educational weight loss program that includes a multidisciplinary team of nutritionists, physiotherapists, psychologists and pediatricians. EVASYON was conducted in five Spanish cities: Granada, Madrid, Pamplona, Santander and Zaragoza.
“If you’ve ever wondered why some people seem to do so well on a diet and exercise plan and others fail so miserably, then now we know that the way that genes express themselves (via epigenetics) plays an important role,” said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. “This report moves us a step closer when we will be able to prescribe a weight loss program tailored to more than just the lifestyle and conditioning level of the patient, but also to his or her particular genetic and epigenetic profile.”
Weight Loss Surgery Not Only Shrinks Waists but Also Affects Genes
Venus of Willendorf created 24,000–22,000 BCE
Gastric bypass 10) ___ can drastically reduce the body weight of obese individuals in a short timeframe. For reasons that are not entirely clear, the surgery also leads to early remission of type 2 diabetes in the vast majority of patients. Researchers report online in Cell Reports, published by Cell Press, the discovery of gene-expression alterations in individuals who underwent the surgery compared with obese individuals who did not.
“We provide evidence that in severely obese people, the levels of specific genes that control how fat is burned and stored in the body are changed to reflect poor metabolic health,” says senior author Professor Juleen Zierath, of the Karolinska Institutet, in Stockholm, Sweden. “After surgery, the levels of these genes are restored to a healthy state, which mirrors weight loss and coincides with overall improvement in 11) ___.” When the investigators probed deeper, they found that weight loss after surgery causes changes in DNA modifications that control gene expression in response to the environment. Specifically, changes in methylation, or chemical markings, on two genes that control glucose and fat metabolism (called PGC-1alpha and PDK4) correlate with obesity but are reversed after surgery-induced weight loss. The findings suggest that the environment — in this case food intake or weight loss — can affect gene expression through this mechanism.
“The novelty of our work originates with the finding that DNA methylation is altered by weight loss.” says first author Romain Barrès, of the University of Copenhagen, in Denmark. The findings may be useful for the design of new drugs that mimic this weight-loss-associated control of gene 12) ___.
ANSWERS: 1) caloric; 2) timing; 3) diabetes; 4) food; 5) protein; 6) gain; 7) overweight; 8) life; 9) obese; 10) surgery; 11) metabolism; 12) regulation
Sources: ScienceDaily.com, Wikipedia, WebMD.com, MedicineNet.com
William Howard Taft (1857-1930), Weight Conscious President
William Howard Taft, the United States’ heaviest president, used a weight-loss program that researchers have found to be startlingly contemporary.
William Howard Taft (September 15, 1857 – March 8, 1930) was the 27th President of the United States (1909-1913) and later the tenth Chief Justice of the United States (1921-1930). He is the only person to have served in both of these offices.
Before becoming President, Taft, a Republican, was appointed to serve on the Superior Court of Cincinnati in 1887. In 1890, Taft was appointed Solicitor General of the United States and in 1891 a judge on the United States Court of Appeals for the Sixth Circuit. In 1900, President William McKinley appointed Taft Governor-General of the Philippines. In 1904, President Theodore Roosevelt appointed Taft Secretary of War in an effort to groom Taft, then his close political ally, into his handpicked presidential successor. Taft assumed a prominent role in problem solving, assuming on some occasions the role of acting Secretary of State, while declining repeated offers from Roosevelt to serve on the Supreme Court.
Riding a wave of popular support for fellow Republican Roosevelt, Taft won an easy victory in his 1908 bid for the presidency. In his only term, Taft’s domestic agenda emphasized trust-busting, civil service reform, strengthening the Interstate Commerce Commission, improving the performance of the postal service, and passage of the Sixteenth Amendment. Abroad, Taft sought to further the economic development of nations in Latin America and Asia through “Dollar Diplomacy”, and showed decisiveness and restraint in response to revolution in Mexico. The task-oriented Taft was oblivious to the political ramifications of his decisions, often alienated his own key constituencies, and was overwhelmingly defeated in his bid for a second term in the presidential election of 1912. In surveys of presidential scholars, Taft is usually ranked near the middle of lists of all American Presidents.
After leaving office, Taft spent his time in academia, arbitration, and the pursuit of world peace through his self-founded League to Enforce Peace. In 1921, after the First World War, President Warren G. Harding appointed Taft Chief Justice of the United States. He served in this capacity until shortly before his death in 1930.
Taft is often remembered as being the most obese president. He was 6 feet 2 inches tall; his weight peaked at 335–340 pounds toward the end of his Presidency. He was definitely a weight conscious person who tried hard to win the battle of the bulge. Evidence from eyewitnesses, and from Taft himself, strongly suggests that during his presidency he had severe obstructive sleep apnea. His chief symptom was somnolence. While President, he fell asleep during conversations, and at the dinner table, and even while standing. He was also strikingly hypertensive, with a systolic blood pressure over 200.
Within a year of leaving the presidency, Taft lost approximately 80 pounds (36 kg). His somnolence problem resolved and, less obviously, his systolic blood pressure dropped 40–50 mmHg (from 210 mmHg). Undoubtedly, this weight loss extended his life. Soon after his weight loss, he had a revival of interest in the outdoors; this led him to explore Alaska. Beginning in 1920, Taft used a cane; this was a gift from Professor of Geology W. S. Foster, and was made of 250,000-year-old petrified wood.
Taft’s 1909 Inauguration
Taft retired as Chief Justice on February 3, 1930, because of ill health. Charles Evans Hughes, whom he had appointed as an Associate Justice while President, succeeded him as Chief Justice. Five weeks following his retirement, Taft died on March 8, 1930, the same date as Associate Justice Edward Terry Sanford’s unexpected death. As it was customary for members of the court to attend the funeral of deceased members, this posed a “logistical nightmare”, necessitating cross-country travel. The house at which Taft died is now the diplomatic mission of the Syrian Arab Republic to the United States. Three days following his death, on March 11, he became the first president to be buried at Arlington National Cemetery. James Earle Fraser sculpted his grave marker out of Stony Creek granite. Taft is one of two presidents buried at Arlington National Cemetery, and is one of four Chief Justices buried there. Taft was the only Chief Justice to have had a state funeral.
1921: Supreme Court Chief Justice, William Howard Taft
William Howard Taft, the only massively obese man ever to be president of the United States, struggled mightily to control his weight a century ago, worrying about his health and image, and endured humiliation from cartoonists who delighted in his corpulent figure. But new research has found that his weight-loss program was startlingly contemporary, and his difficulties keeping the pounds off would be familiar to many Americans today.
On the advice of his doctor, a famed weight-loss guru and author of popular diet books, he went on a low-fat, low-calorie diet. He avoided snacks. He kept a careful diary of what he ate and weighed himself daily. He hired a personal trainer and rode a horse for exercise. And he wrote his doctor, Nathaniel E. Yorke-Davies, with updates on his progress, often twice a week.
In a way, he was ahead of his time. Obesity became a medical issue by the middle of the 20th century, around the time the term “obesity” rather than “corpulence” came into vogue, said Abigail C. Saguy, a sociologist at the University of California, Los Angeles, who specializes in the study of obesity. Taft’s story shows that “at least in some cases, corpulence was already treated as a medical problem early in the century,” she added.
Like many dieters today, Taft, 6 feet 2 inches tall, lost weight and regained it, fluctuating from more than 350 to 255 pounds. He was 48 when he first contacted Dr. Yorke-Davies, and spent the remaining 25 years of his life corresponding with the doctor and consulting other physicians in a quest to control his weight. Taft’s struggles are also recounted by Deborah Levine, a medical historian at Providence College in Rhode Island. She discovered the extensive correspondence between Taft and the diet doctor, including Taft’s diet program, his food diary, and a log of his weight. Her findings were published Monday in The Annals of Internal Medicine.
Obesity – often said to be a product of our sedentary lifestyle and fast foods – has been a concern for over a century. Obesity experts said Taft’s experience highlights how very difficult it is for many fat people to lose substantial amounts of weight and keep it off, and how little progress has been made in finding a combination of foods that lead to permanent weight loss.
“Maybe we are looking for something that doesn’t exist,” said David B. Allison, the director of the Nutrition Obesity Research Center at the University of Alabama at Birmingham. Doctors today would most likely offer Taft weight-loss surgery – which could have a big effect on weight – or drugs, which have a small effect at best. But the diet he was advised to follow would be largely unchanged, Dr. Allison said.
Dr. Levine became interested in Taft’s story when she read old newspaper articles that mentioned he was working with Dr. Yorke-Davies to lose weight. She found their letters in the Library of Congress. Dr. Yorke-Davies was known for creating strict personal diet plans for his patients. In a relationship sustained entirely by mail, he advised Taft to lose at least 60 to 80 pounds. Meals were to be eaten at certain times and meats were to be weighed. Taft was to eat a small portion of lean meat or fish at every meal, cooked vegetables at lunch and dinner (no butter), a plain salad, and stewed or baked fruit (unsweetened). He got a single glass of “unsweetened” wine at lunch. The doctor also allowed his own diet product, gluten biscuits, that were produced to his specifications in London. Taft bought them and had them shipped to the United States.
Taft tried to adhere to the program and also employed a personal trainer, known at the time as “a physical culture man.” By April 1905, six months after he first wrote to the doctor, Taft had lost 60 pounds. But even though people told him he looked good, he was “continuously hungry,” he wrote the doctor. Taft began to gain back the weight and stopped writing to the doctor, who asked Taft’s friends and family what was going on. After learning Taft had regained 19 pounds, he told Taft he needed to return to his diet program or “in another three or four years you will be almost back to your original weight.” By the time Taft was inaugurated as president in 1909, he had indeed regained all he had lost, and more, weighing 354 pounds. He became the butt of jokes, with many relishing a story that he had gotten stuck in a White House bathtub. But Taft never gave up. When he died in 1930, he weighed 280 pounds.
The tale is strikingly modern, obesity experts said. The self-monitoring – weighing himself daily, keeping a food diary – are “the fundamental tenets of changing behavior,” said Dr. Kimberly Gudzune, an obesity researcher at Johns Hopkins. “Keep yourself accountable.” In some ways Taft got the sort of medical care doctors today wish they could provide. He was in constant touch with his doctor over a period of many years. “That is really a model we try to strive for today,” Dr. Gudzune said. She sees her patients once a month, a frequency that, for most primary care doctors, “is almost unheard-of.” She and others were also struck by Taft’s persistent hunger pangs.
Dr. Jules Hirsch, an obesity researcher at Rockefeller University, said losing a substantial amount of weight and keeping it off amounts to telling the body it is starving. He saw this in his own pioneering studies decades ago. Fat people agreed to live in a hospital ward while they dieted to a normal weight. But they were ravenous and almost every one of them eventually succumbed to intense hunger and regained the weight that was so painfully lost. “One of the most important drives we have is to prevent starvation,” Dr. Hirsch said.
Sources: The New York Times, Wikipedia
Brain May Flush Out Toxins During Sleep
According to a recent study published online in Science (18 October 2013), a good night’s rest may literally clear the mind. Using mice, the study showed for the first time that the space between brain cells may increase during sleep, allowing the brain to flush out toxins that build up during waking hours. These results suggest a new role for sleep in health and disease.
For centuries, scientists and philosophers have wondered why people sleep and how it affects the brain. Only recently have scientists shown that sleep is important for storing memories. In the present study, it was serendipitously found that sleep may be also be the period when the brain cleanses itself of toxic molecules. During sleep, a plumbing system called the glymphatic system may open, letting fluid flow rapidly through the brain. The glymphatic system also helps control the flow of cerebrospinal fluid (CSF), a clear liquid surrounding the brain and spinal cord.
Initially the authors studied the system by injecting dye into the CSF of mice and watching it flow through their brains while simultaneously monitoring electrical brain activity. The dye flowed rapidly when the mice were unconscious, either asleep or anesthetized. In contrast, the dye barely flowed when the same mice were awake. According to the authors, they were surprised by how little flow there was into the brain when the mice were awake, and it suggested that the space between brain cells changed greatly between conscious and unconscious states.”
To test this hypothesis, the authors inserted electrodes into the brain to directly measure the space between brain cells. They found that the space inside the brains increased by 60% when the mice were asleep or anesthetized.
Certain brain cells, called glia, control flow through the glymphatic system by shrinking or swelling. Noradrenaline is an arousing hormone that is also known to control cell volume. Similar to using anesthesia, treating awake mice with drugs that block noradrenaline induced unconsciousness and increased brain fluid flow and the space between cells, further supporting the link between the glymphatic system and consciousness.
Previous studies suggest that toxic molecules involved in neurodegenerative disorders accumulate in the space between brain cells. In this study, the researchers tested whether the glymphatic system controls this by injecting mice with labeled beta-amyloid, a protein associated with Alzheimer’s disease, and measuring how long it lasted in their brains when they were asleep or awake. Beta-amyloid disappeared faster in mice brains when the mice were asleep, suggesting sleep normally clears toxic molecules from the brain.
NINDS is the nation’s leading funder of research on the brain and nervous system and its mission is to reduce the burden of neurological disease – a burden borne by every age group, by every segment of society, by people all over the world.
Tanning Gene Linked to Increased Risk of Testicular Cancer
The p53 stimulates skin tanning when ultraviolet light activates it in the skin. It then must bind a specific sequence of DNA located in a gene called the KIT ligand oncogene (KITLG), which stimulates melanocyte production, causing the skin to tan.
According to an article published online in the journal Cell (10 October 2013), the p53 gene has been linked to higher risk for testicular cancer in white men. Nearly 80% of white men carry a variant form of this gene, which increased risk of testicular cancer up to threefold in the study.
To conduct the analysis, a data mining expedition was performed to sieve through many different data sets. The team selected possible leads from the intersection of more than 20,000 p53 binding sites in the human genome, 10 million inherited genetic variations genotyped in the 1000 Genomes Project, and 62,000 genetic variations associated with human cancers identified in genome-wide association studies (GWAS). These data sets were gathered through joint efforts of thousands of researchers from around the world.
According to the authors, in the end, one variant in the p53 pathway was strongly associated with testicular cancer, but also, surprisingly, displayed a positive benefit that is probably related to tanning that has occurred as humans evolved.
White males with a single nucleotide variation in KITLG, called the G allele, have the highest odds of having testicular cancer. In fact, the twofold to threefold increased risk is one of the highest and most significant among all cancer GWAS conducted within the past few years. The high frequency of this allele in light skin individuals may explain why testicular cancer is so much more frequent in people of European descent than those of African descent.”
According to the authors, although the G allele increases testicular cancer risk, it may explain why testicular tumors are often easily cured with chemotherapy. The reason is that most other tumors have a mutant p53, but in these testicular cell tumors, the p53 is functioning properly, and the drugs used for testicular cancer appear to work in concert with p53’s tumor suppression function to kill the cancer cells.
TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area
FDA Approves Opsumit to Treat Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) is a chronic, progressive and debilitating disease that can lead to death or the need for lung transplantation. In PAH, high blood pressure that occurs in the arteries that connect the heart to the lungs which causes the right side of the heart to work harder than normal. Sequelae of PAH include limitations on exercise ability and shortness of breath.
The FDA has approved Opsumit (macitentan), a new drug to treat adults with PAH. Opsumit belongs to a class of drugs called endothelin receptor blockers, which act to relax the pulmonary arteries, decreasing blood pressure in the lungs.
Opsumit’s safety and effectiveness were established in a long-term clinical trial where 742 participants were randomly assigned to take Opsumit or placebo. The average treatment duration was about two years. In the study, Opsumit was effective in delaying disease progression, a finding that included a decline in exercise ability, worsening symptoms of PAH or need for additional PAH medication.
Similar to other members of its drug class, Opsumit carries a Boxed Warning alerting patients and health care professionals that the drug should not be used in pregnant women because it can harm the developing fetus. Female patients can receive the drug only through the Opsumit Risk Evaluation and Mitigation Strategy (REMS) Program. This restricted-distribution program requires prescribers to be certified by enrolling in the program; all female patients to be enrolled in the program and comply with applicable pregnancy testing and contraception requirements before initiating treatment; and pharmacies to be certified and to dispense Opsumit only to patients who are authorized to receive it.
Common side effects observed in those treated with Opsumit include low red blood cell count (anemia), common cold-like symptoms (nasopharyngitis), sore throat, bronchitis, headache, flu and urinary tract infection.
Opsumit is marketed by San Francisco-based Actelion Pharmaceuticals US, Inc.
Easy Shrimp Salad, Appetizer, Dip or Spread
Shrimp pureed as a dip, as filling, or wonderful spread on toast or crackers
One 8-ounce container tofutti (soybean cream cheese)
Pinch black pepper, (grind to your taste)
Pinch salt (optional)
2 garlic cloves, juiced
1 teaspoon lemon zest
1 Tablespoon sherry (optional)
1/2 cup extra virgin olive oil (best olive oil)
1 teaspoon agar
2 Tablespoons chopped onion
1.5 to 2 lbs. shrimp, shelled, deveined, and cooked
Parsley, chopped for garnish only
Add all ingredients except shrimp to a large food processor. Process until well mixed. Drop in shrimp and process until either pureed or chopped to desired consistency. This recipe can be pureed to the consistency of butter or left with chunky pieces of shrimp. Garnish with a few little flakes of chopped parsley. Serve on crackers as an appetizer or on baguettes or on circles of cucumber, or fill pieces of celery (from celery hearts) with the shrimp butter. You could also make pumpernickel circles with a cookie cutter, and top with this dip.
Or consider filling tomatoes with the shrimp salad. This past Tuesday we had the dip, with small quarter pieces of toast, as an appetizer. Delicious!
As the photo below shows, this past Wednesday, I bought 2 large ugli tomatoes (or 2 large beefsteak tomatoes). Wash the tomatoes well, and then scoop out the insides of the tomatoes and fill them with the shrimp mixture (save the tomato for marinara sauce or soup). Make a salad plate for each shrimp/tomato and serve them on one lettuce leaf (romaine lettuce), along with quartered Italian bread, which I toasted, (in oven) with one quick swipe of a pastry brush dipped in our best extra virgin oil. Chop fresh parsley for garnish. We each had one tomato filled, as a beginning salad course.
Today, Friday, I bought these 4 peppers, just because I loved the colors, and thought they might make another nice salad presentation for tonight. Below, are these same peppers, filled with the shrimp salad, for another salad course. I simply washed them well, sliced the tops off, scooped out the insides, and stuck them in a preheated 400 degree oven, for about 5 to 10 minutes, just to get the skins a little softer. Keep your eye on the oven and check the peppers after 5 minutes to be sure they don’t burn. And, btw, even if they did burn a little, this might be just fine. Some people like peppers well done.
I removed the peppers from the oven, let them cool for 30+ minutes, then stuffed them with the shrimp salad. If you wanted smaller servings, do the following: just before putting in oven, cut each pepper in half. Roast for 30+ minutes, remove, cool and fill each pepper section with the shrimp salad. Arrange each section on a plate with a lettuce leaf and crackers. Garnish with chopped parsley.
We will probably share one pepper, because I also made a chicken-with-grapes-and- cashews dish. We’ll have a chilled New York State (North Fork) sauvignon blanc, that we discovered last night (Thursday) at “Rouge Tomate” 10 East 60th Street, last night with our friend and colleague, from Europe.
Have a wonderful weekend and until the next ON TARGET newsletter. Hope you enjoy doing this quick and easy shrimp recipe.
A bottle of sparkling Prosecco, to have as an aperitivo.