Target Health eSource Programs

 

Current major eSource programs include Migraine (Phase 2; 40 centers, 800 subjects, big pharma); Autism (Phase 3; 25 centers, 300 subjects) and ADHD (Phase 3; 15 centers, 750 subjects). An NDA is planned for Q4 2015 for a completed program. The advantages are huge, including the cost-savings. A recent pre-approval inspection by FDA audited our approach to eSource, site monitoring, central monitoring and data management, and no Form FDA 483 was issued.

 

Summer Solstice, Last Light, As Seen From Stone Mountain (James Farley, Master Photographer)

 

Here is what James had to say: “After being greeted by a lightning storm, I quickly moved out to get this shot! This is the last light of the longest day of the year. The storm system can be seen to the left in the image, out on the horizon.”

 

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©James Farley Photography 2015

 

ON TARGET is the newsletter of Target Health Inc., a NYC-based, full-service, contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services to the pharmaceutical and device industries, including the paperless clinical trial.

 

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.

 

Joyce Hays, Founder and Editor in Chief of On Target

Jules Mitchel, Editor

 

QUIZ

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Grapefruit and Melanoma

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F. Perry Wilson, MD, MSCE

 

An analysis based on two large cohorts of health professionals has suggested that citrus consumption, particularly grapefruit, may be associated with an increased risk of incident cutaneous malignant melanoma. This association appeared to be independent of 1) ___ and other dietary factors but was more apparent in individuals at high risk of sunburn. These individuals included those who had a higher residential exposure to ultraviolet (UV) radiation with flux, and those who had a history of blistering sunburns in childhood or adolescence. The study was reported online in the Journal of Clinical Oncology, authored by Abrar A. Qureshi, MD, Warren Alpert Medical School, Brown University, Providence, R.I., and colleagues. The association between citrus consumption and2) ___ risk appeared to be exposure-dependent, consistent among women and men, and independent of consumption of other fruits and juices and vegetables. The association also appeared to be stronger among obese individuals and those who didn’t exercise. Supplemental vitamin C did not appear to be associated with an increased risk of melanoma, said the researchers. “These findings provide evidence for the potential photo-carcinogenic effect of psoralen-rich foods,“ said Qureshi, adding that, “further investigation is needed to con?rm our findings and [to] guide 3) ___ exposure behaviors among individuals with high citrus consumption.“

 

A link between 4) ___ intake and melanoma might have biologic plausibility, but the real take-home message of the study involves the low rate of melanoma, Perry Wilson, MD, of Yale School of Medicine, commented in the accompanying “Analysis in 150 Seconds“ video. “We’re talking seven cases per 10,000 people per year,“ said Wilson. “To prevent just one of those cases, you would need to convince roughly 2,500 people who were high-citrus eaters to stop eating citrus. Compare that with the roughly 150 people you would need to convince to wear sunscreen to prevent a case of melanoma.“

 

Psoralens, along with furocoumarins, are two naturally occurring chemicals found in citrus fruit. They interact with ultraviolet (UV) light to stimulate the proliferation of melanoma 5) ___. Strict regulations have been imposed on psoralen-containing suntan lotions and cosmetic products as a result of this, pointed out Qureshi. While the study findings are intriguing, it’s far too soon to recommend any changes to consumption of grapefruit or oranges, commented Gary Schwartz, MD, an expert spokesperson on behalf of the American Society of Clinical Oncology (ASCO). “Until conclusive data are available, we should continue to be cautious about protecting our 6) ___ from sun exposure,“ said Schwartz in a statement released by ASCO. Previous studies have suggested that fruit intake may be beneficial for the prevention of chronic diseases, such as breast cancer and type 2 diabetes. The findings from this study, however, are consistent with experimental studies that demonstrate a synergistic effect between psoralens and UV 7) ___.

 

In an accompanying editorial, Marianne Berwick, PhD, department of internal medicine, University of New Mexico, Albuquerque, N.M., noted that this study does have its strengths, including its size and prospective data collection. However, she also said that the association between citrus consumption and risk of melanoma is relatively small and even though the study fulfills some of the criteria set out by Austin Bradford Hill in 1965, it cannot be considered definitive. “There is no other study in another population that has found this relationship between grapefruit or citrus consumption and the development of melanoma and thus, there is little consistency in these findings,“ she said. Berwick pointed to two much smaller case-controlled studies of melanoma, one in Italy and the other in Hawaii. The first study found a protective effect for dietary vitamin C on melanoma incidence (HR, 0.59), and the second found no significant association between dietary 8) ___ C and the development of melanoma. Berwick emphasized that “a public over-reaction leading to avoidance of citrus products is to be avoided“ and advised physicians to counsel patients who may be at higher risk to use multiple sources of fruit and juice in their diet and to use sun protection. “There is clearly a need for replication of the study findings in a different population before modifying current dietary advice to the public,“ said Berwick.

 

The study assessed data from 63,810 women in the Nurses’ Health Study (1984 to 2010) and 41,622 men in the Health Professionals Follow-Up Study (1986 to 2010) over a period of 24 to 26 years. Every 2 to 4 years during the follow-up, diet was assessed and incident melanoma cases identified through self-report. These were then confirmed by pathologic records. In all, 1,840 incident melanomas were documented. After adjustment for other risk factors, including smoking status and alcohol and caffeine intake, the pooled multivariable hazard ratios for melanoma were:

 

1) 1.00 for overall citrus consumption <twice per week

2) 1.10 for two to four times per week

3) 1.26 for ?ve to six times per week

4) 1.27 for once to 1.5 times per day

5) 1.36 for greater than or equal to 1.6 times per day (P trend <0.001)

 

The pooled multivariable hazard ratio for melanoma comparing the extreme consumption categories of grapefruit (greater than or equal to three times per week versus never) was 1.41; P trend <0.001). Among individual citrus products, grapefruit showed the most apparent association with risk of melanoma. This may be explained by its higher levels of psoralens and furocoumarins when compared with 9) ___, said Qureshi. The pooled multivariable hazard ratio for melanoma comparing the extreme consumption categories of grapefruit (greater than or equal to three times per week versus never) was 1.41; P trend 0.001). Berwick also pointed to a number of other factors that “limit enthusiasm for this study.“ The lack of representativeness of the general population is the most important, said Berwick. And in their report, the investigators also noted that both cohorts were comprised of white, educated U.S. health professionals. “Future studies are needed to confirm this association in populations of other ethnicities,“ they said. According to Berwick, there was a major inconsistency in the study protocol based on the fact that it compared different forms of dietary citrus: juice versus whole fruit. With grapefruit, for instance, the whole fruit but not the juice was used to assess risk. With oranges, however, it was the opposite. The juice but not the whole fruit was used to assess risk. In addition, a high-risk group of those with a history of non-melanoma was excluded from the study, even though they are at a twofold increased risk for developing melanoma, said Berwick. “An artificial bias may have been introduced by eliminating a group who were at significant risk of developing melanoma and who might not have the same risk associated with citrus consumption.“ Finally, continuous UV exposure rather than intermittent UV exposure (weekends, holidays) was associated with melanoma in this study. This, said Berwick, “… is at odds with the current literature; continuous exposure does not demonstrate an increased 10) ___ for developing melanoma.“ This study was supported in part by National Cancer Institute Grants No. UM1 CA186107, P01 CA87969, UM1 CA167552, and R01 CA137365. Source: MedPageToday.com

 

ANSWERS: 1) age; 2) melanoma; 3) sun; 4) citrus; 5) cells; 6) skin; 7) radiation; 8) vitamin; 9) oranges; 10) risk

 

John Hunter MD, 1728-1793, First Melanoma Operation

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Painted by John Jackson, 1813, after Sir Joshua Reynolds, 1786

 

John Hunter FRS (1728-1793) was a Scottish surgeon, one of the most distinguished scientists and surgeons of his day. He was an early advocate of careful observation and scientific method in medicine. He was a teacher of, friend of, and collaborator with, Edward Jenner, the inventor of the smallpox vaccine. His wife, Anne Hunter (nee Home), was a minor poet, some of whose poems were set to music by Joseph Haydn. Hunter learned anatomy by assisting his elder brother William with dissections in William’s anatomy school in London, starting in 1748, and quickly became expert in anatomy. He spent some years as an Army surgeon, worked with the dentist James Spence conducting tooth transplants, and in 1764 set up his own anatomy school in London. He built up a collection of living animals whose skeletons and other organs he prepared as anatomical specimens, eventually amassing nearly 14,000 preparations demonstrating the anatomy of humans and other vertebrates.

Hunter became a Fellow of the Royal Society in1767. The Hunterian Society of London was named in his honor, and the Hunterian Museum at the Royal College of Surgeons preserves his name and his collection of anatomical specimens.

 

Hunter was born at Long Calderwood, now part of East Kilbride, Lanarkshire, Scotland, the youngest of ten children. The date of his birth is uncertain; Robert Chamber’s “Book of Days“ (1868) gives an alternative birth date of 14 July, and Hunter is recorded as always celebrating his birthday on this date rather than 13 July as shown in the parish register of the town of his birth. Three of Hunter’s siblings (one of whom had also been named John) died of illness before he was born. An elder brother was William Hunter, the anatomist. As a youth, John showed little talent, and helped his brother-in-law as a cabinet-maker. When nearly 21 he visited William in London, where his brother had become an admired teacher of anatomy. John started as his assistant in dissections (1748), and was soon running the practical classes on his own.

 

It has recently been alleged that Hunter’s brother William, and his brother’s former tutor William Smellie, were responsible for the deaths of many women whose corpses were used for their studies on pregnancy. John is alleged to have been connected to these deaths, since at the time he was acting as William’s assistant. Historians, who have studied life in Georgian London agree that the number of gravid women who died in London during the years of Hunter’s and Smellie’s work was not particularly high for that locality and time. At that time, there was a prevalence of pre-eclampsia, a common condition affecting ten percent of all pregnancies and one easily treated today, but for which there was no treatment in Hunter’s time. This could explain a mortality rate that seems high in the 21st-century. In The Anatomy of the Gravid Uterus Exhibited in Figures, published in 1774, Hunter provides case histories for at least four of the subjects illustrated.

 

Hunter studied under William Cheselden at Chelsea Hospital and Percival Pott at St. Bartholomew’s Hospital. Hunter also studied with Marie Marguerite Biheron, a famous anatomist and wax modeler, teaching in London. Some of the illustrations in his text were probably hers. After qualifying he became Assistant Surgeon (house surgeon) at St George’s Hospital (1756) and Surgeon (1768). Hunter was commissioned as an Army surgeon in 1760 and was staff surgeon on expedition to the French island of Belle Ile in 1761, then served in 1762 with the British Army in the expedition to Portugal. Contrary to prevailing medical opinion at the time, Hunter was against the practice of ?dilation’ of gunshot wounds. This practice involved the surgeon deliberately expanding a wound with the aim of making the gunpowder easier to remove. Although sound in theory, in the unsanitary conditions of the time it increased the chance of infection, and Hunter’s practice was not to perform dilation ‘except when preparatory to something else’ such as the removal of bone fragments. Hunter left the Army in 1763, and spent at least five years working in partnership with James Spence, a well-known London dentist. Although not the first person to conduct tooth transplants between living people, he did advance the state of knowledge in this area by realizing that the chances of a successful tooth transplant would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Although donated teeth never properly bonded with the recipients’ gums, one of Hunter’s patients stated that he had three which lasted for six years, a remarkable period at the time.

 

Hunter set up his own anatomy school in London in 1764 and started in private surgical practice. In 1765, Hunter bought a house near the Earl’s Court district in London. The house had large grounds which were used to house a collection of animals including ‘zebra, Asiatic buffaloes and mountain goats’, as well as jackals. In the house itself, Hunter boiled down the skeletons of some of these animals as part of research on animal anatomy. A newspaper article reported that many animals there were ‘supposed to be hostile to each other but in this new paradise, the greatest friendship prevails’, and this image may have been the inspiration for the Doctor Doolittle literary character. Hunter was elected as Fellow of the Royal Society in 1767. At this time he was considered the leading authority on venereal diseases, and believed that gonorrhea and syphilis were caused by a single pathogen.

 

Living in an age when physicians frequently experimented on themselves, he was the subject of an oft-repeated legend claiming that he had inoculated himself with gonorrhea, using a needle that was unknowingly contaminated with syphilis. When he contracted both syphilis and gonorrhea, he claimed it proved his erroneous theory that they were the same underlying venereal disease. The experiment, reported in Hunter’s A Treatise on the Venereal Diseases (part 6 section 2, 1786), does not indicate self-experimentation; this experiment was most likely performed on a third party. Hunter championed treatment of gonorrhea and syphilis with mercury and cauterization. Because of Hunter’s reputation, knowledge concerning the true nature of gonorrhea and syphilis was set back, and it was not until 51 years later that his theory was proved to be wrong, by the French physician Philippe Ricord. In 1768 Hunter was appointed as surgeon to St George’s Hospital. Later he became a member of the Company of Surgeons. In 1776 he was appointed surgeon to King George III. In 1783 Hunter moved to a large house in Leicester Square, where today there stands a statue to him. The space allowed him to arrange his collection of nearly 14,000 preparations of over 500 species of plants and animals into a teaching museum. The same year, he acquired the skeleton of the 2.31m (7’7“) Irish giant Charles Byrne against Byrne’s clear deathbed wishes – he had asked to be buried at sea. Hunter bribed a member of the funeral party (possibly for ?500) and filled the coffin with rocks at an overnight stop, then subsequently published a scientific description of the anatomy and skeleton. The skeleton today, with much of Hunter’s surviving collection, is in the Hunterian Museum at the Royal College of Surgeons in London.

 

John Hunter is reported to be the first to operate on metastatic melanoma in 1787. Although not knowing precisely what it was, he described it as a “cancerous fungous excrescence“. The excised tumor was preserved in the Hunterian Museum of the Royal College of Surgeons of England. It was not until 1968 that microscopic examination of the specimen revealed it to be an example of metastatic melanoma. In 1786 he was appointed deputy surgeon to the British Army and in March 1790 he was made Surgeon General by the then Prime Minister, William Pitt. While in this post he instituted a reform of the system for appointment and promotion of army surgeons based on experience and merit, rather than the patronage-based system that had been in place. Hunter’s death in 1793 followed a heart attack during an argument at St George’s Hospital over the admission of students.

 

Hunter’s character has been discussed by biographers: His nature was kindly and generous, though outwardly rude and repelling. Later in life, for some private or personal reason, he picked a quarrel with the brother who had formed him and made a man of him, basing the dissension upon a quibble about priority unworthy of so great an investigator. Yet three years later, he lived to mourn this brother’s death in tears. He was described by one of his assistants late in his life as a man ‘warm and impatient, readily provoked, and when irritated, not easily soothed’. In 1771 Hunter married Anne Home, daughter of Robert Boyne Home and sister of Sir Everard Home. They had four children, two of whom died before the age of five. One of his infant children is buried in the churchyard in Kirkheaton, Northumberland. Their fourth child, Agnes, married General Sir James Campbell of Inverneill. In 1799 the government purchased Hunter’s collection of papers and specimens, which it presented to the Company of Surgeons. Hunter helped to improve understanding of human teeth, bone growth and remodeling; inflammation; gunshot wounds; venereal diseases; digestion; the functioning of the lacteals; child development; the separateness of maternal and fetal blood supplies; and the role of the lymphatic system.

 

 

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Bust of Hunter near where he lived in Leicester Square, London

 

Samuel Taylor Coleridge, a key figure in Romantic thought, science and medicine, saw in Hunter’s work the seeds of Romantic medicine, namely as regards his principle of life, which he felt had come from the mind of genius:

 

WHEN we stand before the bust of John Hunter, or as we enter the magnificent museum furnished by his labors, and pass slowly, with meditative observation through this august temple, which the genius of one great man has raised and dedicated to the wisdom and uniform working of the Creator, we perceive at every step the guidance, we had almost said, the inspiration, of those profound ideas concerning Life, which dawn upon us, indeed, through his written works, but which he has here presented to us in a more perfect language than that of words – the language of God himself, as uttered by Nature. That the true idea of Life existed in the mind of John Hunter I do not entertain the least doubt

 

Hunter was the basis for the character “Jack Tearguts“ in William Blake’s unfinished satirical novel, An Island in the Moon. He is a principal character in Hilary Mantel’s 1998 novel, The Giant, O’Brien. It is possible that his Leicester Square house was the inspiration for the home of Dr. Jekyll of the Robert Louis Stevenson novel The Strange Case of Dr. Jekyll and Mr. Hyde. Hunter’s house had two entrances, one through which the living area for his family was accessible, and another, leading to a separate street, which provided access to his museum and dissecting rooms. This pattern echoes that of the house in the story, in which the respectable Dr. Jekyll used one entrance to the house and Mr. Hyde the other, less prominent, one. Hunter is mentioned by Dr. Moreau in Chapter XIV of H.G. Wells’ The Island of Doctor Moreau (1896).

 

A bust of John Hunter stands on a pedestal outside the main entrance to St George’s Hospital in Tooting, South London, along with a lion and unicorn taken from the original Hyde Park Corner building, Lanesborough House. There is a bust of him in the South West corner of Lincoln’s Inn Fields, and one in Leicester Square near where his central London home and anatomy school were situated. The John Hunter Clinic of the Chelsea and Westminster Hospital in London is named after him. His birthplace in Long Calderwood, Scotland, has been preserved as Hunter House Museum.

 

In Retinitis Pigmentosa, a Blinding Eye Disease, Trash-Collecting Cells Go Awry

 

Retinitis pigmentosa, an inherited disorder that affects roughly 1 in 4,000 people, damages the retina, the light-sensitive tissue at the back of the eye. Research has shown links between retinitis pigmentosa and several mutations in genes for photoreceptors, the cells in the retina that convert light into electrical signals that are sent to the brain via the optic nerve. In the early stages of the disease, rod photoreceptors, which enable us to see in low light, are lost, causing night blindness. As the disease progresses, cone photoreceptors, which are needed for sharp vision and seeing colors, can also die off, eventually leading to complete blindness.

 

Spider-like cells inside the brain, spinal cord and eye hunt for invaders, capturing and then devouring them. These cells, called microglia, often play a beneficial role by helping to clear trash and protect the central nervous system against infection. However, according to a study published online in EMBO Molecular Medicine (2 July 2015), these same microglia cells can also accelerate damage wrought by blinding eye disorders, such as retinitis pigmentosa.

 

The authors studied mice with a mutation in a gene that can also cause retinitis pigmentosa in people, and observed that very early in the disease process, the microglia infiltrate a layer of the retina near the photoreceptors, called the outer nuclear layer, where they don’t usually venture. The microglia then create a cup-like structure over a single photoreceptor, surrounding it to ingest it in a process called phagocytosis. The research team caught this dynamic process on video. The whole feast, including digestion, takes about an hour.

 

Phagocytosis is a normal process in healthy tissues and is a key way of clearing away dead cells and cellular debris. However, in retinitis pigmentosa it was found that the microglia target damaged living photoreceptors, in addition to dead ones. To confirm that microglia contribute to the degeneration process, the authors genetically eliminated the microglia, which slowed the rate of rod photoreceptor death and the loss of visual function in the mice. Inhibiting phagocytosis with a compound had a similar effect. The microglia seem to ignore cone photoreceptors, which fits with the known early course of retinitis pigmentosa.

 

What triggers microglia to go on this destructive feeding frenzy? The authors found evidence that photoreceptors carrying mutations undergo physiological stress. The stress then triggers them to secrete chemicals dubbed “find me” signals, which is like ringing a dinner bell that attracts microglia into the retinal layer. Once there, the microglia probe the photoreceptors repeatedly, exposing themselves to “eat me” signals, which then trigger phagocytosis. In response to all the feasting, the microglia become activated. That is, they send out their own signals to call other microglia to the scene and they release substances that promote inflammation.

 

Other potential treatments for retinitis pigmentosa, such as gene therapy, are progressing, but are not without challenges. Gene therapy requires replacing defective genes with functional genes, yet more than 50 distinct genes have been linked to the disease in different families, so there’s no one-size-fits-all gene therapy. A therapy targeting microglia might complement gene therapy because it’s an approach that’s independent of the specific genetic cause of retinitis pigmentosa.

 

A clinical trial (NCT02140164) is already underway to see if the anti-inflammatory drug minocycline can block the activation of microglia and help slow the progression of retinitis pigmentosa. The trial is currently recruiting participants.

 

Injustice at Work and Leukocyte Glucocorticoid Sensitivity

 

Organizational justice refers to perceived fairness at the workplace. Low organizational justice has been identified as a major source of distress and a predictor of poor health. Impaired regulation of immunological and inflammatory pathways may, in part, underlie these health effects. As a result, a study published in Psychosomatic Medicine (2015; 77:527-538) was performed to study the association of organizational justice with leukocyte glucocorticoid sensitivity in vivo. For the study, organizational justice was assessed among 541 male factory workers (mean age = 46 years) by questionnaire. Cortisol release was measured at three time points before blood collection and summed as the area under the curve. Blood was used to assess leukocyte (white blood cell [WBC] count) subsets (neutrophils [%WBC], lymphocytes [%WBC], and the neutrophil/lymphocyte ratio). Glucocorticoid sensitivity was operationalized as the correlation between cortisol release and these hematologic parameters. Associations were adjusted for demographics, work characteristics, and life-style variables.

 

Results showed a dose-response relationship between organizational justice and glucocorticoid sensitivity. Cortisol and hematologic parameters showed the expected significant association among individuals reporting high (p values <0.001) or medium organizational justice (p values <0.050), but not among those reporting low organizational justice. These regression slopes also differed significantly between organizational justice groups (p values for interaction <0.050). According to the authors, low justice at work is associated with an impaired ability of endogenous cortisol to regulate leukocyte distribution in vivo and that these findings identify a novel biological pathway by which organizational justice may affect health.

 

FDA Approves New Treatment for Cystic Fibrosis

 

Cystic Fibrosis (CF), which affects about 30,000 people in the United States, is the most common fatal genetic disease in Caucasians. CF results in the formation of thick mucus that builds up in the lungs, digestive tract and other parts of the body leading to severe respiratory and digestive problems, as well as other complications such as infections and diabetes. The F508del mutation is the most common cause of CF. People who have two copies of the F508delmutation, one inherited from each parent, account for approximately half of the CF population in the U.S.

 

The FDA has approved the first drug for CF directed at treating the cause of the disease in people who have two copies of the F508del mutation. Orkambi (lumacaftor 200 mg/ivacaftor 125 mg) is now approved to treat CF in patients 12 years and older, who have the F508del mutation, which causes the production of an abnormal protein that disrupts how water and chloride are transported in the body. Having two copies of this mutation (one inherited from each parent) is the leading cause of CF. Orkambi received FDA’s breakthrough therapy designation because the sponsor demonstrated through preliminary clinical evidence that the drug may offer a substantial improvement over available therapies. The FDA also reviewed Orkambi under the priority review program. A priority review is conducted over six months, or less, instead of the standard 10 months, and is employed for drugs that may offer significant improvement in safety or effectiveness in treatment over available therapy in a serious disease or condition. In addition, the FDA granted Orkambi orphan drug designation because it treats CF, a rare disease. Orphan drug designation provides financial incentives, like clinical trial tax credits, user fee waivers, and eligibility for market exclusivity to promote rare disease drug development.

 

The safety and efficacy of Orkambi was studied in two double-blind, placebo-controlled clinical trials of 1,108 participants with CF who were 12 years and older with the F508del mutation. In both studies, participants with CF who took Orkambi, two pills taken every 12 hours, demonstrated improved lung function compared to those who took placebo. The efficacy and safety of Orkambi have not been established in patients with CF other than those with the F508delmutation. If a patient’s genotype is unknown, an FDA cleared CF mutation test should be used to detect the presence of the F508del mutation on both alleles of the CFTR gene. The most common side effects of Orkambi include shortness of breath, upper respiratory tract infection, nausea, diarrhea, and rash. Women who took Orkambi also had increased menstrual abnormalities such as increased bleeding. Orkambi is made by Vertex Pharmaceuticals Inc., of Boston.

 

Refreshing Leafy Salad with Honeydew, Pistachios, Cheese, Cranberries and a Light Citrus Garlic Dressing

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A Perfect Summer Salad!  ©Joyce Hays, Target Health Inc.

 

Salad Ingredients

 

2 cups, assorted baby lettuce, shredded, approximately 5-6 ounces

2 cups, baby spinach, shredded

2 small to medium cucumbers, peeled

1/2 cup very fresh mozzarella, cubed

1/3 cup dried cranberries

1/3 cup pistachios

1/4 of a honeydew melon, cut bite-size

 

Dressing Ingredients

 

2 Tablespoons grapeseed oil

1 or 2 fresh garlic cloves, squeezed

Juice from 1/2 of an Orange

Juice from 1/2 of a Lemon

Pinch salt

Pinch black pepper

Pinch chili flakes

 

 

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Fresh summer ingredients.  ©Joyce Hays, Target Health Inc.

 

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Ingredients getting cut up. Notice how little dressing is needed. ©Joyce Hays, Target Health Inc.

 

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Make enough; this salad will go fast!  ©Joyce Hays, Target Health Inc.

 

This meal was a delicious low calorie comfort food fest with some of our favorite dishes. First we clinked our glasses of chilled Stag’s Leap sauvignon blanc, just because we were enjoying the lazy long 4th of July weekend.

 

The recipe above was the first course and a delicious change from our usual tomato/avocado salad. Then we had eggplant parmesan, a recipe that was shared on this newsletter, long ago, and simple but good, baked garlic-y mini red potatoes. For dessert, peach cake, made with fresh peaches, and an added kick of peach schnapps drizzled over the cake with cool whip on top.

 

We tried out new exercise equipment (a leg press) and recumbent bike, in addition to our usual exercise routine, and felt good about adding additional time to exercising 5 days a week. And, we saw a new Broadway musical, Amazing Grace, which tells the true story of who composed this song, and how it came to be written. All of the many voices in this production are well trained and truly beautiful. A lot of imagination went into the direction and production of this show and we enjoyed it. One scene in particular is amazing, but we won’t spoil it by telling about it here. We know that tastes vary when it comes to the arts, but we don’t think anyone would be disappointed by this musical.

 

This long weekend was good for us and we hope for you also.

 

 

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Icy Stag’s Leap Sauvignon Blanc   ©Joyce Hays, Target Health Inc.

 

 

From Our Table to Yours!

 

Bon Appetit!