Target Health Presenting at the DIA Annual Meeting


Target Health is pleased to announce that Vadim Tantsyura, DrPH, MA, MS, Director, Data Management at Target Health will be presenting at Annual DIA Meeting being held in Philadelphia, June 26-30, 2016. His topic is Lessons Learned in Implementing Risk-Based Monitoring and eSource: The Data Manager’s Expanded Role. The presentation will take place on Wednesday June 29, 2016, between 4:00pm – 5:15pm.


Dr. Tansyura has 15+ years of pharmaceutical experience, including a Head of Data Management role at Regeneron, Infinity Pharmaceuticals and Cincinnati Children’s Hospital. Dr. Tansyura has a MA in Economics from Yale, MS in Computer Engineering from Kiev State, MS in Biostatistics and a DrPH in Health Policy from NY Medical College.


Honey Bee Pollinating Cherry Tree Blossoms – James Farley Photography


Spectacular photo of a honey bee pollinating cherry tree blossoms. What more is there to say. James shot this magnificent photo on his Canon 5D Mark III with 100mm Macro f2.8 lens at f8.



Honey Bee Pollinating Cherry Blossoms ©JFarley Photography 2016



For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). 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



Filed Under News | Leave a Comment



Nurses encourage a patient to drink an oral rehydration solution to reduce the combination of dehydration and hypovolemia he acquired from cholera. Cholera leads to GI loss of both excess free water (dehydration) and sodium (hence ECF volume depletion – hypovolemia).


Because of runaway climate change, each year is hotter than the previous year. If you’re not aware of the changing nature of summer, everywhere on the planet, you could be caught without enough drinking water, a potentially dangerous situation. Make a point of staying well informed about states and/or countries with drought issues. Try to keep bottled water with you all the time, and simply refill it when you can. There are a variety of water bottle carriers; pick the one most convenient for you. Plants and animals (including people) are mostly water inside, and must drink water to live. It gives a medium for chemical reactions to take place, and is the main part of blood. It keeps the body temperature the same by sweating from the 1) ___. Water helps blood carry nutrients from the stomach to all parts of the body to keep the body alive. Water also helps the blood carry oxygen from the lungs to the body. Saliva, which helps animals and people digest food, is mostly water. Water helps make urine. Urine helps remove bad chemicals from the body. The human body is between 60% and 70% water.


Water that a person can drink is called “potable water“ (or “drinking water“.) The water in oceans is salt water, but lakes and rivers usually have unsalted water. Only about 3% of all the water on earth is 2) ___ water. The rest is salt water. Though a human being can survive for up to a three weeks without food, they can only survive for a day or two without water. A few desert animals can get enough water from their food, but the others must drink.


Dehydration refers to a deficit of total body water, with an accompanying disruption of metabolic processes. Dehydration is also a cause for hypernatremia. The term dehydration is distinct from hypovolemia (loss of blood volume, particularly plasma). Dehydration occurs when free water loss exceeds free water intake, usually due to exercise or disease, but also due to high environmental temperature. Mild dehydration can be also be caused by immersion diuresis and this may increase risk of decompression sickness in divers. Most people can tolerate a 3-4% decrease in total body water without difficulty or adverse health effects. A 5-8% decrease can cause fatigue and dizziness. Loss of over 10% of total body water can cause physical and mental deterioration, accompanied by severe thirst. Death occurs at a loss of between 15-20% of the body water. Mild dehydration is characterized by thirst and general discomfort and is usually resolved with oral rehydration. 3) ___ occurs when water intake is insufficient to replace free water lost due to normal physiologic processes (e.g. breathing or urination) and other causes (e.g. diarrhea or vomiting). Hypovolemia is a related condition specifically meaning a decrease in volume of blood plasma – not of total body water. Both (total body water and plasma volume) are regulated through independent mechanisms in humans and should not be conflated. Some authors have reported three types of dehydration based on serum sodium levels: hypotonic or hyponatremic (referring to this as primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremic (referring to this as primarily a loss of water), and isotonic or isonatremic (referring to this as equal loss of water and electrolytes). Indeed, in humans, it has been commonly thought that the most commonly seen type of dehydration (by far) is isotonic (isonatraemic) dehydration. A classic example of hyponatremia coexisting with hypovolemia is Addison’s disease where cortisol deficiency leads to ADH excess and hyponatremia but mineralocorticoid deficiency simultaneously leads to sodium loss and hypovolemia. The latter subjects are not dehydrated, on the contrary they are over-hydrated.

Dehydration can be life-4) ___ when severe and lead to seizures or respiratory arrest, and also carries the risk of osmotic cerebral edema if rehydration is overtly rapid. The hallmarks of dehydration include thirst and neurological changes such as headaches, general discomfort, loss of appetite, decreased urine volume (unless polyuria is the cause of dehydration), confusion, unexplained tiredness, and even seizures. The symptoms of dehydration become increasingly severe with greater total body water loss. In people over age 50, the body’s thirst sensation diminishes and continues diminishing with 5) ___.


Many senior citizens suffer symptoms of dehydration. Dehydration contributes to morbidity in the elderly especially during conditions that promote insensible free water losses such as hot 6) ___. A Cochrane review on this subject defined water-loss dehydration as people with serum osmolality of 295 Osm/kg or more and found that the main symptoms in the elderly were expressing fatigue, missing drinks between meals and bioelectrical impedance analysis. However, this Cochrane review was also plagued by the same lack of clarity regarding the distinction between dehydration and hypovolemia seen in the literature, but confusion was avoided to a large extent by their use of hypertonicity to define dehydration. It must be pointed out that dehydration and hypovolemia may occur simultaneously in the same person at the same time and thus explains the lack of clarity in the literature regarding the symptoms and signs associated with these two conditions – however, their distinction is essential to guide therapy. Risk factors for dehydration include but are not limited to: exerting oneself in hot and humid weather, habitation at high altitudes, endurance athletes, elderly adults, infants and children and people living with chronic illnesses. In the elderly, blunted response to thirst and/or inadequate ability to access free water in the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration. Excess free water or hypotonic water can leave the body in two ways – sensible loss such as osmotic diuresis, sweating, vomiting and diarrhea, and insensible water loss, occurring mainly through the skin and respiratory tract. In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These occur through the following main mechanisms:


Water / hypotonic fluid loss (with decreased thirst and/or impaired access to free water)


Insensible respiratory losses

Fluid loss with a sodium plus potassium concentration less than that in the plasma, such as urinary losses in hyperglycemia (osmotic diuresis)

Transient hypernatremia can occur when water shifts intracellularly caused by activities, such as severe exercise, and on cessation of activities the sodium returns to normal within 5 to 15 minutes

Sodium excess

Hypertonic sodium intake without appropriate water intake leads to hypernatremia, as the sodium load is excreted in water, leading to free water loss.


For routine activities, thirst is normally an adequate guide to maintain proper hydration. With exercise, exposure to hot environments, or a decreased thirst response, additional water may be required. In resting, thermo-neutral individuals, whole-body insensible water loss is widely accepted to occur at about .03L/h and approximately 50% of this passes through the skin. The remaining 50% of normal insensible water loss occurs through the lungs as water vapor. Additional losses throughout the day occur through the kidneys as urine (some of which is obligatory water excretion that gets rid of solutes) and some water, in the absence of diarrhea, is also lost through the feces. In warm or humid weather or during heavy exertion, however, the water loss can increase markedly, because humans have a large and widely variable capacity for the active secretion of sweat. For example, whole-body sweat losses in men can exceed 2 L/h during competitive sport, with rates of 3-4 L/h observed during short-duration, high-intensity exercise in the heat. When such large amounts of water are being lost through perspiration, electrolytes, especially7) ___, are also being lost. In most athletes exercising and sweating for 4-5 hours with a sweat sodium concentration of less than 50 mmol/L, the total sodium lost is less than 10% of total body stores (total stores are approximately 2,500 mmol, or 58 g for a 70-kg person). These losses appear to be well tolerated by most people. On the other hand, the inclusion of some sodium in fluid replacement drinks has some theoretical benefits and the addition of sodium poses little or no 8) ___, so long as these fluids are hypotonic (since the mainstay of dehydration prevention is the replacement of free water losses).


The treatment for minor dehydration, often considered the most effective, is drinking water and stopping fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished. Solid foods can contribute to fluid loss from vomiting and diarrhea. Urine concentration and frequency will customarily return to normal as dehydration resolves. In more severe cases, correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy or fluid replacement by intravenous therapy). As oral rehydration is less painful, less invasive, less expensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration must be isotonic or hypotonic. Pure water injected into the veins will cause the breakdown (lysis) of red blood cells (erythrocytes). When fresh water is unavailable (e.g. at sea or in a desert), seawater and ethanol will worsen the condition. Urine contains a similar solute concentration to seawater, and numerous guides advise against its consumption in survival situations. For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is the norm in all but the most extreme cases.


ANSWERS: 1) skin; 2) fresh; 3) Dehydration; 4) -threatening; 5) age; 6) weather; 7) sodium; 8) risk


20160613-7; Arctic Ocean Ice Daily Update



Professor Paul Beckwith, University of Ottowa

Professor discusses climate computer models

Possibility of irreversible climate change. Noam Chomsky

UCLA, CalTech: research on climate change

Climate change urgency

Climate scientists interviewed 2016

2016: Some island nations are now underwater

Update on Climate

UN Climate Summit in Paris

More from U.S. climatologist, James Hansen

James Hansen, tries to set the record straight (Paris summit)

Noam Chomsky: Will the human species survive?


Ancient Greek Origins of Sports Medicine


Father of Medicine, including Sports Medicine: Hippocrates of Kos, 460 BCE – 370 BCE


Even though pantheism was slowly giving way to logical reasoning, people still called on their gods to heal sports injuries at the Asklepion. Eventually, these temples became health spas, gymnasiums, public baths, and sports stadiums. The history of physical education shows sport and medicine to have a long-standing and close relationship. Indeed, if one takes into account the participation of doctors of medicine on national teams and the sporting reputations of some hospitals and medical faculties, a sympathy for sport seems to be almost a tradition of the medical profession. Perhaps the association of health with physical activity, or a common interest in the function of the human body is the reason for this link, but, whatever the cause, it seems at odds with the histories of sport and medicine that Sports Medicine as a specialist field should appear so late on the contemporary medical scene.


The first international congress of sports medicine was held in 1928, but the Federation Internationale de Medico-Sportive et Scientifique (FIMS) was not formed until 1933. The British Association of Sport and Medicine was not established until 1953 and its counterpart in the US, the American College of Sports Medicine, not until 1954. It would seem reasonably safe, therefore, to claim that most practitioners regard Sports Medicine as ?something new’. In fact, some claim that scientific medicine arose from the practice of sport – in particular from the athletic activities of ancient Greece – is not without some, if only conjectural, foundation. A contemporary of Socrates, Hippocrates (469-399 BC) is considered to be the ?Father of Medicine’. He is the most famous of all the Greek physicians. He was born on the island of Kos, and during his lifetime he travelled throughout the Greek world of the 5th century, eventually dying at Larissa in Northern Greece. He is thought to have been an army physician at one time. His theories of medicine have been described by Plato, Aristotle and Meno, but the works that bear his name do not conform to the descriptions given by these philosophers. The attribution of the Corpus Hippocraticum is a matter of considerable dispute. Certainly Hippocrates could not have written all 70 volumes which form this heterogenous collection brought together in Alexandria around 300 BCE. Some of the works predate Hippocrates. Others, like parts of the Iliad, were written perhaps a hundred years after the death of the author to whom they are attributed.


From examinations of the content of the first four works, researchers have proposed that the author (who may or may not have been Hippocrates) was a bone-setter rather than a physician. Some believe that the Father of Medicine was predominantly concerned with athletic injuries. Note for example what Hippocrates has to say about injury to the spine: “But the outward curvatures, due to falls, usually occur when the patient comes down on his buttocks or falls on his shoulders“. Or about the hip: “When the head of the thigh bone is dislocated from the hip it is dislocated in one of four ways, far more frequently inwards; and, of the others the most frequent is outwards. Dislocation backwards and forwards occurs, but it is rare.“ This appears to be the opposite of modern experience and both quotations point toward injuries that were likely to have occurred in Greek wrestling and pankration. That Hippocrates specialized in athletic injuries is further suggested by those injuries to the head that are 197 described in the books on Fractures and Joints. It would be expected that an army physician would have been concerned more with injuries received from weapons, but the descriptions to be found in these volumes focus on dislocations, fractures of the lower jaw, broken noses and similar injuries. Neither the town nor the military life of the period would have yielded the high proportion of bone setting and dislocation to warrant the author’s dwelling on such injuries. But the heavy events of Greek athletics, especially boxing, were likely to have been the cause of numerous injuries of this kind, and were possibly the reason for Hippocrates’ concentration upon them.


In the fifth century BC Greeks spent much of their time in the palaestra, or wrestling school. These institutions were numerous in Greek cities up to the end of Imperial Rome and a Greek would have joined a palaestra as readily as a young man today would join a club. Plato provides a description of the middle-aged Socrates and the young Alcibiades engaging in bouts of wrestling with each other as readily as today they would play a game of billiards or a round of golf. Without doubt, wrestling was the most popular sport amongst the athletes. A match was held for the best of three falls, a fall being determined when the shoulders of one of the contestants touched the ground, but where a modern contest is divided into rounds, in ancient times the bout was continuous and even after a fall the combatants re-engaged immediately. Various terms were used to describe specific techniques. For example, wrestling ?akrocheirizomai’ was a style used when the struggle was commenced, or conducted at arms length. Hands, wrists or arms only were grasped and attempts to throw the opponent were made by sudden twists. Leontiskos, of Messene, was described by Pausanias as having won two victories at Olympia (456 and 452 BCE) by using this technique to bend his opponent’s fingers backwards. It has been suggested that this wrestler broke his opponent’s fingers, thereby preventing him from continuing to wrestle and, as similar incidents are not reported in subsequent literature, the ploy was probably made illegal.


Homer provides a vivid account of a match between Aias and Odysseus: “The third bold game Achilles next demands, And calls the wrestlers to the level sands: A massive tripod for the victor lies, Of twice six oxen its reputed price; And next, the loser’s spirits to restore, A female captive valued but at four. Scarce did the chief the vigorous strife propose, When tower-like Aias and Odysseus rose. Amid the ring each nervous rival stands, Embracing rigid with implicit hands: Close locked above, their heads and arms are mixed, Below their planted feet at distance fixed: Like two strong rafters which the builder forms, Proof of the wintry winds and howling storms, Their tops connected, but at wider space Fix’d on the center stands their solid base; Now to the grasp each manly body bends; The humid sweat from every pore descends; Their bones resound with blows; sides, shoulders, thighs Swell to each grip and bloody tumors rise.“ Milo, of Croton – a town famous for its athletes – was the most renowned of all Greek wrestlers. He won five successive Olympic crowns from 536 to 520 BCE. As well as these victories he won many others at Delphi, Corinth and Nemea. Pankration was the only other sport practiced in the palestra. It has been described as a mixture of boxing, wrestling and judo, a kind of scientific unarmed combat. Its object was to bring an opponent to a point where he was compelled to admit defeat, which he signified by holding up his arm. Locks and strangleholds were therefore permitted, but biting and gouging were forbidden. Vase painting and sculpture of pankratiasts indicate that the sport may have resembled karate, but unlike competitions in this martial art, the combats of Ancient Greece did not require blows to be ?pulled’. Arrichion, of Phigaleia, was the most famous of the 6th century pankratiasts. He won three times at Olympia in 572, 568 198 and 564 BCE. On the last occasion his opponent leaped upon his back, scissors his waist with his legs, hooking a foot behind each of Arrichion’s knees from inside his legs. At the same time he applied a stranglehold and began to throttle the champion. With his last gasp, Arrichion threw himself sideways, simultaneously flexing a knee to grip one of his opponent’s feet and then, by violently extending his hip, he dislocated the trapped ankle. His opponent threw up an arm to signify submission, but the cumulative effect of the stranglehold and the cost of his last effort proved fatal to the champion. Nevertheless, it is recorded that the judges awarded him a posthumous victory and his Elean compatriots crowned the dead body.


Pankration was always a favorite amongst spectators. Pindar wrote eight odes celebrating victors in this event. The rules for boxing were drawn up about 688 BCE. Each protagonist attempted to force his opponent to admit defeat or to knock him out and the bout continued uninterrupted until this happened. There were no weight divisions, so size and strength was all important. The Aeneid provides a vivid description of a match between Epeus and Euryalus. The latter receives a dreadful blow that drops him ?nerveless and extended’ to the ground and Virgil describes the picture of the boxer being dragged from the ring by his friends: “Nodding, his head hangs down his shoulder o’er: His mouth and nostrils pour the clotted gore: Wrapt round in mists he lies, and lost to thought; His friends receive the bowl, too dearly bought.“ In the early competitions boxers wore soft leather thongs designed not to inflict injury but to protect the fingers. In training they wore large soft pads called sphairai (spheres) to allow vigorous combat but avoid damage. To this end they also wore ear-guards which Plutarch considered more suitable for children in the proximity of a bout to prevent them from hearing the bad language that frequently accompanied the sport! The soft thongs were ultimately replaced by the ?sharp thongs’. These comprised a thin inner glove to which a pad of hard leather was intricately bound. The thonging was carried up the forearm over a separate piece of sheepskin which was used, like the wrist-bandage some tennis players wear today, as a device to wipe sweat quickly away from the brows. The Pugilist by Apollonius, displays not only the structure and binding of the sharp thongs but also reveals the injuries suffered by the boxers of the first century BC. The face is scarred, the nose has been broken and the frontal and zygomatic bones have also been fractured at some time. Both ears are swollen.


Whereas the statue by Apollonius portrays some nobility, the unkempt hair, beard and sullen expression of a statue called, Satyros, by Silanion, is more indicative of the brutality to which the sport had descended by Hellenistic times. No doubt many injuries occurred in athletics. Some are described in the literature but few are illustrated in the plastic arts. One of the distinctions between the black and red figure vase painting of athletic subjects is that the former style illustrated competition whilst the latter shows scenes of training. But it is in the latter style that an example of injury in pancration is depicted. One vase painting reproduces a scene of two pancratiasts in action. Blood pours from the nose of one of the contestants, who also bears the imprint of a bloodstained hand on his back. Unfortunately, although these details can be seen in the original they are faint and reproduce badly. It is not surprising that injury should have been rarely depicted in athletic art of the fifth century, for this was 199 The Cauliflower Ear From the Archaic (700-500 BCE) to the Hellenistic (320 BCE -+) period the bruised ear was the identifying sign of an athlete. It was, therefore, the most frequently depicted athletic injury in the sculpture and painting of Ancient Greece. It is evident in a sixth century head in the Jacobsen Collection in Copenhagen. That both ears in this work are crushed has lead experts to conclude the head to be that of a boxer. Many historians maintain that the swollen ear was representative of athletes in general, for it was a realistic professional characteristic. Nevertheless, it seems strange to find crushed ears on works that seek to portray physical perfection. For the sculptor to have incorporated such disfigurements into the otherwise ideal features of the boxer wearing ear guards, seems almost uncanny, since this was the period when art was dominated by a search for the ideal.


The works of Ageladas Polyklitos and Myron sought to portray men not as they were, but as they should be. Thus it was that the physiognomy of a work of athletic art of this period did not display distortion arising from injury. One feature, however, was excluded from this search for perfection. It was the swollen ear. The cauliflower ear appeared in many early and late Classic works. Interesting that swollen ears were common in Hellenistic works, even on boy boxers. They also appear on representations of gods and demigods. Herakles is frequently shown with such an ear and the gods Ares and Diomede, who practiced gymnastics and wrestling, also display this abnormality. Yet, it seems that bruised ears were something to be avoided if possible. Ear guards, were used in training and boxing skill also served as some protection. Plato used the term for cauliflower ear slightingly, to describe those who imitated Spartan customs for the Spartans never boxed scientifically but fought with bare fists and without rules. Medicine and Athletic Training in Ancient Greece If Hippocrates was expert in athletic injuries much of his knowledge would have come from Herodocus, who is described as not only a trainer of athletes, but also the doctor from whom Hippocrates learned his art. In the Republic, Plato refers to Herodocus as “an athletic trainer whose health failed and who proceeded to make first and foremost himself, and then many others after him, miserable by a combination of medicine and physical training“. Plato also informs us that it was not until Herodocus that “doctors made use of the modern methods of nursing disease.“ Trainers of athletes occupied an important place in Greek society. They prepared their charges both physically and psychologically, taught skills and supervised exercise and diet. Their methods are described by various writers and it seems clear that they were well aware of systems that were relatively new to modern training methods.


They realized the value of progressive resistance exercise. For example, Milo, of Croton, previously mentioned as a five times Olympic victor, trained by carrying a bull around a field each day from its birth until it was four years old! Incidentally, Milo’s daughter is said to have married the sports doctor, Democedes, who has been called the earliest known practitioner in national health service. He was employed by the island of Aegina as a public physician. He was, however, lured to Athens by an offer of higher pay and subsequently tempted by a yet larger salary to move to the island of Samos. Unfortunately, this island fell to the invaders during the first Persian war and Democedes was taken as a slave to Susa where he impressed Darius by reducing the king’s dislocated ankle after native doctors had failed to do so. No doubt Democedes had had plenty of experience of such accidents for, as Milo’s son-in-law, he must have accompanied the famous athlete to many athletic contests.


Trainers and sports physicians, also supervised the diet of their athletes. In early days this was a simple regimen of porridge, cheese, figs and meal cakes. Meat was only eaten occasionally. Towards the middle of the fifth century BCE a meat diet was introduced by Stymphalos, an ex-athlete who had won two Olympic victories in the long-distance race. Another story attributes the philosopher Pythagoras of Croton as the instigator of a meat diet for Eurymenes of Samos, an athlete he is said to have trained. This claim may be considered more than a little dubious as a meat diet was contrary to the Pythagorean advocacy of vegetarianism. However, enormous quantities of meat were eaten.


The science of gymnastics was closely connected with that of medicine, but Philostratos (107-244 CE) accused medical science of coddling athletes and being responsible for the decline of athletics. He maintained that it was practice to gorge athletes with food, thereby making gluttons of them. Effects of this overfeeding were borne out by Euripides who denied any merit to athletic training, saying of it that: “Of all the countless evils throughout Hellas none is worse than the race of athletes. Slaves of their belly and their jaw they know not how to live well. In youth they strut about in splendor, the idols of the city, but when bitter old age comes they are cast aside like worn-out cloaks. I blame the custom of the Hellenes who gather to see such men honoring useless pleasures.“ Plutarch was even more caustic, ascribing to trainers and coaches the belief that intelligent conversation at meals spoiled the food and gave the diners a headache! The ancient link between medicine and sport is said to be best exemplified in Galen (130-201 CE). His writings on the value of exercise and hygiene are often taken to be the first scientific works of this kind. But a close relationship between athletics and medical practice can be found 700 years before and may be traced to Hippocrates, the Father of Medicine himself. Sports Medicine might therefore be said to be not the newest, but the oldest branch of medicine in the field. Sources:


Standard Blood Pressure Target is Sufficient for Treating Some Strokes


Annually, more than 795,000 people in the U.S. have a stroke, and approximately 10% of strokes are caused by acute intracerebral hemorrhage, a type of stroke caused by bleeding into the brain. Chronic high blood pressure is the greatest risk factor for these types of strokes and studies have shown that controlling blood pressure reduces the chances of having all types of strokes. Although hemorrhagic stroke is associated with higher rates of death or disability than the more common form caused by brain blood clots, there is a need for scientifically proven emergency treatments for hemorrhage strokes. Some studies have suggested that rapid, intensive blood pressure lowering may lead to better outcomes. Nonetheless, the ideal target blood pressure to minimize hemorrhage growth safely and effectively has not been established. As a result, a study published online in the New England Journal of Medicine (8 June 2016), has helped answer the decades old question about emergency blood pressure management options.


The Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH II) trial addressed this issue by randomly assigning 1,000 participants with elevated blood pressure following their stroke to either standard or intensive blood pressure treatments used for acute stroke. The participants, who on average were 62 years old, were treated within four and a half hours of a stroke at medical centers in the U.S., Japan, Taiwan, China, South Korea and Germany. On average, the participants entered the trial with a blood pressure level of 200.6 mm Hg and their high levels were lowered by intravenous injections of nicardipine, a blood pressure medication.


Results showed that standard and intensive blood pressure treatments were equally effective in the emergency treatment of acute intracerebral hemorrhage. Patients whose systolic blood pressure was reduced rapidly in emergency rooms to standard levels used to treat acute stroke (140-179 mm Hg) did as well as patients whose pressure was reduced to intensive levels (110-139 mm Hg). Brain scans taken 24 hours after treatment showed no difference in the rates of hemorrhage growth between the two groups. The results also showed that after 90 days the rate of death or severe disability was equal, about 38%, for either treatment. Patients in the intensive treatment group had a slightly higher rate of serious adverse events in the 90 days following the stroke.


The study was designed to enroll 1,280 patients. However, the trial was stopped after analyzing data from the first 1,000 patients, because there were no differences between the treatments. The 90-day death and severe disability rates of this study were lower than those seen in other hemorrhagic stroke studies, 38% versus an expected rate of 60%. The authors suggested that the difference may be due to including patients who had relatively minor strokes and therefore a better chance of good results. Initial patient examinations showed that over half had mild stroke as determined by the Glasgow Coma Scale. The authors also suggested that, by participating in the trial, the patients received better overall care.


For more information, visit:


Peanut Allergy Prevention Strategy is Nutritionally Safe


Peanut allergy is a type of food allergy to peanuts and is different from generalized nut allergies. Physical symptoms of the allergic reaction can include itchiness, urticaria, swelling, eczema, sneezing, asthma, abdominal pain, drop in blood pressure, diarrhea, and cardiac arrest. Anaphylaxis may also occur. Peanut allergy is due to a type I hypersensitivity reaction of the immune system in susceptible individuals and is recognized as one of the most severe food allergies due to its prevalence, persistency, and potential severity of allergic reaction. In the United States, peanut allergies are present in 0.6% of the population. In Western cultures, peanut allergy is the most common cause of food-related anaphylaxis death.


According to an article published online in the Journal of Allergy and Clinical Immunology (10 June 2016), Introducing peanut-containing foods during infancy as a peanut allergy prevention strategy does not compromise the duration of breastfeeding or affect children’s growth and nutritional intakes, These findings are a secondary result from the Learning Early About Peanut Allergy (LEAP) clinical trial, which was conducted by the NIAID-funded Immune Tolerance Network and led by researchers at King’s College London.


Primary results from the LEAP trial, published in 2015, showed that introducing peanut products into the diets of infants deemed at high risk for peanut allergy led to an 81% relative reduction in subsequent development of the allergy compared to avoiding peanut altogether. The goal of the current analysis was to determine whether eating high doses of peanut products beginning in infancy would have any adverse effects on infant and child growth and nutrition. At the beginning of the LEAP trial, investigators randomly assigned 640 infants aged 4 to 11 months living in the United Kingdom to regularly consume at least 2 grams of peanut protein three times per week or to avoid peanut entirely. These regimens were continued until the children were 5 years old. The study then monitored the children at recurring health care visits, and asked their parents and caregivers to complete dietary questionnaires and food diaries.


In the current analysis, the authors compared the growth, nutrition and diets of the LEAP peanut consumers and avoiders. Many of the participants were breastfeeding at the beginning of LEAP. An important and reassuring finding was that peanut consumption did not affect the duration of breastfeeding, thus countering concerns that introduction of solid foods before six months of age could reduce breastfeeding duration. In addition, the researchers did not observe differences in height, weight or body mass index — a measure of healthy weight status — between the peanut consumers and avoiders at any point during the study. This was true even when the authors compared the subgroup of children who consumed the greatest amount of peanut protein with those who avoided peanut entirely.


In general, the peanut consumers easily achieved the recommended level of 6 grams of peanut protein per week, consuming 7.5 grams weekly on average. They made some different food choices than the avoiders. For example, consumers ate fewer chips and savory snacks. Both groups had similar total energy intakes from food and comparable protein intakes, although the peanut consumers had higher fat intakes and avoiders had higher carbohydrate intakes. According to the authors, overall, the findings indicate that early-life introduction of peanut-containing foods as a strategy to prevent the subsequent development of peanut allergy is both feasible and nutritionally safe, even at high levels of peanut consumption.


FDA Approves Vaccine to Prevent Cholera for Travelers


Cholera, a disease caused by Vibrio cholerae bacteria, is acquired by ingesting contaminated water or food and causes a watery diarrhea that can range from mild to extremely severe. Often the infection is mild; however, severe cholera is characterized by profuse diarrhea and vomiting, leading to dehydration. It is potentially life threatening if treatment with antibiotics and fluid replacement is not initiated promptly. According to the World Health Organization, serogroup O1 is the predominant cause of cholera globally. While cholera is rare in the U.S., travelers to parts of the world with inadequate water and sewage treatment and poor sanitation are at risk for infection. Travelers to cholera-affected areas have relied on preventive strategies recommended by the CDC to protect themselves against cholera, including safe food and water practices and frequent hand washing.


The FDA has approved Vaxchora, a vaccine for the prevention of cholera caused by serogroup O1 in adults 18 through 64 years of age traveling to cholera-affected areas. Vaxchora is the only FDA-approved vaccine for the prevention of cholera. Vaxchora is a live, weakened vaccine that is taken as a single, oral liquid dose of approximately three fluid ounces at least 10 days before travel to a cholera-affected area.


Vaxchora’s efficacy was demonstrated in a randomized, placebo-controlled human challenge study of 197 U.S. volunteers from 18 through 45 years of age. Of the 197 volunteers, 68 Vaxchora recipients and 66 placebo recipients were challenged by oral ingestion of Vibrio cholerae, the bacterium that causes cholera. Vaxchora efficacy was 90% among those challenged 10 days after vaccination and 80% among those challenged three months after vaccination. The study included provisions for administration of antibiotics and fluid replacement in symptomatic participants. To prevent transmission of cholera into the community, the study included provisions for administration of antibiotics to participants not developing symptoms.


Two placebo-controlled studies to assess the immune system’s response to the vaccine were also conducted in the U.S. and Australia in adults 18 through 64 years of age. In the 18 through 45 year age group, 93% of Vaxchora recipients produced antibodies indicative of protection against cholera. In the 46 through 64 years age group, 90% produced antibodies indicative of protection against cholera. The effectiveness of Vaxchora has not been established in persons living in cholera-affected areas.


The safety of Vaxchora was evaluated in adults 18 through 64 years of age in four randomized, placebo-controlled, multicenter clinical trials; 3,235 study participants received Vaxchora and 562 received a placebo. The most common adverse reactions reported by Vaxchora recipients were tiredness, headache, abdominal pain, nausea/vomiting, lack of appetite and diarrhea.


The FDA granted the Vaxchora application fast track designation and priority review status. These are distinct programs intended to facilitate and expedite the development and review of medical products that address a serious or life-threatening condition. In addition, the FDA awarded the manufacturer of Vaxchora a tropical disease priority review voucher, under a provision included in the Food and Drug Administration Amendments Act of 2007. This provision aims to encourage the development of new drugs and biological products for the prevention and treatment of certain tropical diseases.


Vaxchora is manufactured by PaxVax Bermuda Ltd., located in Hamilton, Bermuda.


Summer Shrimp Appetizer


Cool, easy, and tasty. ©Joyce Hays, Target Health Inc.





One 8-ounce container Tofutti

Pinch black pepper, (grind to your taste)

Pinch salt (optional)

2 garlic cloves, juiced

1 teaspoon lemon zest

1 Tablespoon sherry
1/2 cup extra virgin olive oil (best olive oil)

1 teaspoon agar

2 Tablespoons chopped onion

1 1/2 lb. shrimp, shelled, deveined, and cooked parsley, for garnish only



Along with the shrimp spread, serve baguettes warmed, either whole or cut into small slices. ©Joyce Hays, Target Health Inc.



French baguettes (warm) served on table





Add all ingredients except shrimp to a 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 spread.


Serve this appetizer with icy white wine.



Here, my brother-in-law, Mark, Jules and I are about to raise our glasses in a toast to our wonderful visit together. Mark has become a gracious guinea pig along with my dear husband, for trying out recipes, slated for the ON TARGET, newsletter. We’re all enjoying the adventure of trying out various Pouilly-Fuisse brands, and to this day, have not found any better than the Louis Jadot, we’re drinking, above. ©Joyce Hays, Target Health Inc.



This weekend has been beautiful, here in the Big Apple and we wish all of our readers an equally lovely week.




From Our Table to Yours !


Bon Appetit!