eSource Solutions and Risk-Based Monitoring (RBM)


Last week we attended CBI’s RBM 2016 Conference where we shared Target Health’s extensive clinical trials experience using our eSource solution which is fully integrated with Target e*CRF and fully integrated with our approach to RBM.


The presentation included the results of flawless regulatory inspections of Target Health and 8 clinical sites. The title of the presentation was “eSource and Risk-Based Monitoring – Learn to Monitor Clinical Trials with Real-Time Data.“ Other presenters from Pfizer, Abbvie and Janssen shared their experience and future plans. Our colleagues, Jim Streeter, Vice President, Life Sciences Product Strategy at Oracle and Sina Djali, Senior Director, Risk Management – Central Monitoring, Global Clinical Development Operations at Janssen R&D, co-chaired the meeting.


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



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Contact Lenses


Credit: Eitan Tal – Own work, CC BY 3.0, Wikipedia Commons


A contact lens, or simply contact or CL, is a thin lens placed directly on the surface of the eye. CLs are considered medical 1) ___ and can be worn to correct vision, or for cosmetic or therapeutic reasons. In 2004, it was estimated that 125 million people (2%) use CLs worldwide, including 28 to 38 million in the US. In 2010, worldwide CL-market was estimated at $6.1 billion, while the U.S. soft lens market was estimated at $2.1 billion. Multiple scientists estimated that the global market would reach $11.7 billion by 2015. As of 2010, the average age of CL wearers globally was 31 years old, and two thirds of wearers were female.


People choose to wear CLs for many reasons. Aesthetics and cosmetics are the main motivating factors for people who want to avoid wearing glasses or to change the appearance of their eyes. Others wear CLs for functional or optical reasons. When compared with spectacles, CLs typically provide better peripheral 2) ___, and do not collect moisture (from rain, snow, condensation etc.) or perspiration; this makes them ideal for sports and other outdoor activities. CL wearers can also wear sunglasses, goggles, or other eyewear of their choice without having to fit them with prescription lenses or worry about compatibility with glasses. Additionally, there are conditions such as keratoconus and aniseikonia that are typically corrected better with CLs than with glasses.


Contact lenses market is likely to grow due to the increasing occurrence of eye related conditions such as astigmatism, hypermetropia and myopia. The other drivers of this market are increasing population, fashion statement and technological advancement. By the end of 2020, the market value is predicted to reach US$13.50 billion. Recent research is focused on augmented contact lens with Wi-Fi connectivity. Contact lenses that display augmented reality (AR) imaging are in development. These new contact 3) ___ might contain the elements for display embedded into the lens including integrated circuitry, LEDs and an antenna for wireless communication. The first contact lens display was reported in 1999 and subsequently, 11 years later in 2010/2011. Another version of contact lenses, in development for the U.S. Military, is designed to function with AR spectacles, allowing soldiers to focus on close-to-the-eye AR images on the spectacles and distant real world objects at the same time. The futuristic short film Sight features contact lens-like augmented reality devices. A virtual retinal display (VRD) is a personal display device under development at the University of Washington’s Human Interface Technology Laboratory. With this technology, a display is scanned directly onto the 4) ___ of a viewer’s eye. The viewer sees what appears to be a conventional display floating in space in front of them.


Editor’s note: Did you know that the FBI is in the process of putting together a huge data base of retinal scans, with virtually no publicity about this ongoing venture and no public discussion. More about this issue in future publications of ON TARGET. Watch this space.


The EyeTap (also known as Generation-2 Glass) captures rays of light that would otherwise pass through the center of a lens of an eye of the wearer, and substitutes synthetic computer-controlled light for each ray of real light. The Generation-4 Glass (Laser EyeTap) is similar to the VRD (i.e. it uses a computer controlled laser light source) except that it also has infinite depth of focus and causes the eye itself to, in effect, function as both a camera and a display, by way of exact alignment with the eye, and resynthesis (in laser light) of rays of light entering the 5) ___. In January 2015, Microsoft introduced HoloLens, which is an independent smartglasses unit. Critics have said that of all the head-mounted displays tried in the past couple of decades, the HoloLens is the best in its class. First impressions and opinions have been generally that HoloLens is a superior device to the Google Glass, and manages to do several things “right“ in which Google Glass failed. New methods of combating microbial contamination are currently being developed. A silver-impregnated lens case has been developed which helps to eradicate any potentially contaminating 6) ___ that come in contact with the lens case. Additionally, a number of antimicrobial agents are being developed that have been embedded into CLs themselves. CLs with covalently attached Selenium molecules have been shown to reduce bacterial colonization without adversely affecting the cornea of a rabbit eye and octylglucoside used as a CL surfactant significantly decreases bacterial adhesion. These compounds are of particular interest to CL manufacturers and prescribing optometrists because they do not require any patient compliance to effectively attenuate the effects of 7) ___ colonization.


New research in the field of bionic lenses are visual displays that include built-in electric circuits and light-emitting diodes and can harvest radio waves for their electric power. Bionic lenses can display information beamed from a mobile device overcoming the small display size problem. The technology involves embedding nano and microscale electronic devices in lenses. These lenses will also need to have an array of microlenses to focus the image so that it appears suspended in front of the wearer’s eyes. The lens could also serve as a head-up display for pilots or gamers. Drug administration through CLs is also becoming an area of research. One application is a CL that releases anesthesia to the eye for post-surgery pain relief, especially after PRK (photorefractive keratectomy) in which the healing process takes several painful days. One experiment shows that silicone CLs that contain vitamin E deliver pain medication for up to 7 days compared with less than 2 hours in usual lenses. A prototype of the much-awaited telescopic CLs was recently unveiled at a meeting of the AAAS the American Association for the Advancement of Science in San Jose, CA. Giving wearers the ability to zoom in and out with the wink of an eye, this revolutionary CL identifies and differentiates winks from blinks, aiding wearers to shuffle between normal and magnified vision.


Since 2005, a device that films subcutaneous veins, processes and projects the image of the veins onto the skin has been used to locate veins. This device is called a near-infrared vein finder. Augmented Reality can provide the surgeon with information, which are otherwise hidden, such as showing the heartbeat rate, the 8) ___ pressure, the state of the patient’s organ, etc. AR can be used to let a doctor look inside a patient by combining one source of images such as an X-ray with another such as video. Examples include a virtual X-ray view based on prior tomography or on real time images from ultrasound and confocal microscopy probes, visualizing the position of a tumor in the video of an endoscope, or radiation exposure risks from X-ray imaging devices. AR can enhance viewing a fetus inside a mother’s 9) ___. It has been used for cockroach phobia treatment. Patients wearing augmented reality glasses can be reminded to take medications.


AR can help facilitate collaboration among distributed team members in a work force via conferences with real and virtual participants. AR tasks can include brainstorming and discussion meetings utilizing common visualization via touch screen tables, interactive digital whiteboards, shared design spaces, and distributed control rooms. Usage of augmented 10) ___ is increasing in the field of marketing. Games like Pokemon Go have helped businesses increase their number of footfalls to their shops. For clothing, accessory, and makeup companies, AR presents a new way to show customers what it will be like to use or wear their products. Virtual dressing rooms are a recent trend in e-commerce.


ANSWERS: 1) devices; 2) vision; 3) lenses; 4) retina; 5) eye; 6) microbes; 7) bacterial; 8) blood; 9) womb; 10) reality


The Contact Lens


Artist’s impression of Leonardo da Vinci’s method for neutralizing the refractive power of the cornea. Credit: Tbuffie (Uploads) – self-made, GFDL,



Leonardo da Vinci is frequently credited with introducing the idea of the contact lens (CL) in his 1508 Codex of the eye, Manual D, where he described a method of directly altering corneal power by either submerging the head in a bowl of water or wearing a water-filled glass hemisphere over the eye. Neither idea was practically implementable in da Vinci’s time. He did not suggest his idea be used for correcting vision, as he was more interested in learning about the mechanisms of accommodation of the eye.


Descartes proposed another idea in 1636: a glass tube filled with liquid placed in direct contact with the cornea. The protruding end was to be composed of clear glass, shaped to correct vision; however, the idea was impracticable since it rendered blinking impossible. In 1801, Thomas Young made a basic pair of CLs based on Descartes’ model. He used wax to affix water-filled lenses to his eyes, which neutralized its refractive power. He then corrected for it with another pair of lenses. However, like da Vinci’s, Young’s device was not intended to correct refraction errors. Sir John Herschel, in a footnote of the 1845 edition of the Encyclopedia Metropolitana, posed two ideas for the visual correction: the first “a spherical capsule of glass filled with animal jelly“, and “a mold of the cornea“ that could be impressed on “some sort of transparent medium“. Though Herschel reportedly never tested these ideas, they were both later advanced by several independent inventors such as Hungarian Dallos with Istv?n Komaromy (1929), who perfected a method of making molds from living eyes. This enabled the manufacture of lenses that, for the first time, conformed to the actual shape of the eye.


Early contact lenses were made of ground glass and the glass lens covered the entire eye. Oxygen could not pass through the glass lens, and wearers could not blink. It’s thus no surprise that no one could stand them for more than two hours. The 1930s saw a contact lens composed of plastic mixed with glass. Just ten years later, an all-plastic, glass-free contact lens was created. It was not until 1887 that German glassblower F. E. Muller produced the first eye covering to be seen through and tolerated.



Adolf Fick; Wikipedia Commons



In 1888, German ophthalmologist Adolf Gaston Eugen Fick constructed and fitted the first successful contact lens. While working in Zurich, he described fabricating a focal scleral contact shells, which rested on the less sensitive rim of tissue around the cornea, and experimentally fitting them: initially on rabbits, then on himself, and lastly on a small group of volunteers. These lenses were made from heavy blown glass and were 18-21 mm in diameter. Fick filled the empty space between cornea/callosity and glass with a dextrose solution. He published his work, “Contactbrille“, in the journal Archiv fur Augenheilkunde in March 1888. Fick’s lens was large, unwieldy, and could only be worn for a couple of hours at a time. August M?ller in Kiel, Germany, corrected his own severe myopia with a more convenient glass-blown scleral contact lens of his own manufacture in 1888. In 1887, Louis J. Girard invented a similar scleral form of contact lens. Glass-blown scleral lenses remained the only form of contact lens until the 1930s when polymethyl methacrylate (PMMA or Perspex/Plexiglas) was developed, allowing plastic scleral lenses to be manufactured for the first time. In 1936, optometrist William Feinbloom introduced plastic lenses, making them lighter and more convenient. These lenses were a combination of glass and plastic. In 1940, German optometrist Heinrich Wohlk produced plastic lenses, based on experiments performed during the 1930s.


In 1949, the first “corneal“ lenses were developed. These were much smaller than the original scleral lenses, as they sat only on the cornea rather than across all of the visible ocular surface, and could be worn up to sixteen hours a day. PMMA corneal lenses became the first CLs to have mass appeal through the 1960s, as lens designs became more sophisticated with improving manufacturing (lathe) technology. Early corneal lenses of the 1950s and ’60s were relatively expensive and fragile, resulting in the development of a market for CLs insurance. Replacement Lens Insurance, Inc. (now known as RLI Corp.) phased out its original flagship product in 1994 after contacts became more affordable and easier to replace. One major disadvantage of PMMA lenses is that they allow no oxygen to get through to the conjunctiva and cornea, causing a number of adverse and potentially serious clinical effects. By the end of the 1970s, then through the ’80s and ’90s, a range of oxygen-permeable but rigid materials were developed to overcome this problem. Chemist Norman Gaylord played a prominent role in the development of these new, oxygen-permeable CLs. Collectively, these polymers are referred to as “rigid gas permeable“ or “RGP“ materials or lenses. Though all the above CL types – sclerals, PMMAs and RGPs -could be correctly referred to as “rigid“ or “hard“, the latter term is now used to the original PMMAs, which are still occasionally fitted and worn. Whereas, “rigid“ is a generic term for all these lens types, thus hard lenses (PMMAs) are a subset of rigid CLs. Occasionally, the term “gas permeable“ is used to describe RGPs, which is somewhat misleading as soft CLs are also gas permeable in that they allow oxygen to get through to the ocular surface.



Otto Wichterle (pictured) and Drahoslav L?m introduced modern soft hydrogel lenses in 1959. Credit: Wikipedia Commons



The principal breakthrough in soft lenses was made by Czech chemists Otto Wichterle and Drahoslav L?m who published their work “Hydrophilic gels for biological use“ in the journal Nature in 1959. In 1965 National Patent Development Corporation (NPDC) bought the American rights to produce the lenses and then sublicensed the rights to Bausch & Lomb which started to manufacture them in the United States. The Czech scientists’ work led to the launch of the first soft (hydrogel) CLs in some countries in the 1960s and the first approval of the Soflens material by the U.S. Food and Drug Administration (FDA) in 1971. These softs were soon prescribed more often than rigids, due to the immediate and much greater comfort (rigids require a period of adaptation before full comfort, if any, is achieved). Polymers from which soft lenses are manufactured improved over the next 25 years, primarily in terms of increasing oxygen permeability, by varying the ingredients. In 1972, British optometrist Rishi Agarwal was the first to suggest disposable soft CLs.


In a slightly modified molecule, a polar group is added without changing the structure of the silicone hydrogel. This is referred to as the Tanaka monomer because it was invented and patented by Kyoichi Tanaka of Menicon Co. of Japan in 1979. Second-generation silicone hydrogels, such as galyfilcon A (Acuvue Advance, Vistakon) and senofilcon A (Acuvue Oasys, Vistakon), use the Tanaka monomer. Vistakon improved the Tanaka monomer even further and added other molecules, which serve as an internal wetting agent. Comfilcon A (Biofinity, CooperVision) was the first third-generation polymer. Its patent claims that the material uses two siloxy macromers of different sizes that, when used in combination, produce very high oxygen permeability (for a given water content). Enfilcon A (Avaira, CooperVision) is another third-generation material that is naturally wettable; its water content is 46%. Soft contact lenses were introduced in 1971, followed in 1978 by gas permeable lenses, allowing the transfer of oxygen. Just three years later, the FDA approved extended-wear soft lenses, which hit the market in 1986. A few months later, in accordance with the ever-spreading phenomenon of planned obsolescence in the U.S., the industry introduced disposable soft lenses. In 1987, gas permeable lenses became available in next-generation fluorosilicone acrylate materials. This new material increased oxygen penetration and reduced protein buildup. In 1996, one-day disposable soft lenses were introduced. Why go to the expense of daily throw-aways? Disposables reduce the risk of infection, and some people are willing to pay more for that added benefit. Close to 2000, silicone-hydrogel contact lenses were introduced and touted for increased oxygen flow and greater comfort. Silicone-hydrogel works so well that it is used for most of today’s soft contact lenses.


In 1998, an important development was the launch of the first silicone hydrogels onto the market by Ciba Vision in Mexico. These new materials encapsulated the benefits of silicone – which has extremely high oxygen permeability – with the comfort and clinical performance of the conventional hydrogels that had been used for the previous 30 years. These CLs were initially advocated primarily for extended (overnight) wear, although more recently, daily (no overnight) wear silicone hydrogels have been launched.


According to the Centers for Disease Control (CDC), more than 30 million people in the U.S. wear contact lenses. The FDA and CDC, important regulatory agencies, continue to monitor the quality of contact lenses sold in America.


New Method for Performing Aortic Valve Replacement Proves Successful in High-Risk Patients


Aortic valve stenosis involves the narrowing of the heart’s aortic valve which reduces blood flow through the heart. For about 85% of patients with this condition, TAVR is typically performed through the femoral artery in the leg. But for the other 15%, a different access route must be found. The most common alternative routes are through the chest, which requires surgery and are associated with significantly more complications.


According to an article published online in the Journal of the American College of Cardiology (31 October 2016), a new, less invasive way has been developed to perform transcatheter aortic valve replacement (TAVR), a procedure widely used to treat aortic valve stenosis, a lethal heart condition. The new approach, known as transcaval access, that will make TAVR more available to high risk patients, especially women, whose femoral arteries are too small or diseased to withstand the standard procedure.


Transcaval access, which can be performed in awake patients, involves electrifying a small wire so that it crosses between neighboring blood vessels in the abdomen. The technique calls for making large holes in both the abdominal aorta and the inferior vena cava, which physicians previously considered dangerous because of the risk of fatal bleeding. The new method was developed by researchers at the National, Heart, Lung and Blood Institute (NHLBI) and tested in a trial on 100 patients at 20 hospitals across the United States. According to the authors, the procedure was successful in 99 of the 100 patients.


According to the authors, this is a seminal study in that it challenged conventional wisdom, which objected to the idea of safe passage between the vena cava and the aorta. More importantly, it is the first of many non-surgical minimally-invasive tissue-crossing, or so-called transmural catheter procedures developed at NIH that can be applied to diverse fields of medicine. The authors developed the method to address a specific clinical need, even though they knew it would be a challenging proposition for most surgeons and physicians to accept. The proposed and counterintuitive mechanism of action is that bleeding from the aorta spontaneously decompresses into a corresponding hole the physician makes in the vein, because the surrounding area behind the peritoneum has higher pressure than the vein.


The results of the study, which were independently confirmed by a committee of outside cardiologists, showed that the procedure not only has a high success rate, but also an acceptable rate of bleeding and vascular complications, particularly in the high risk patients studied. The study builds on the access technique that the team developed and first tested in animals in 2012 and first applied with Henry Ford Hospital physicians to help patients in 2013.


How Parkinson’s Disease Alters Brain Activity Over Time


Parkinson’s disease (PD) is a neurodegenerative disorder that destroys neurons in the brain that are essential for controlling movement. While many medications exist that lessen the consequences of this neuronal loss, none can prevent the destruction of those cells. Clinical trials for PD have long relied on observing whether a therapy improves patients’ symptoms, but such studies reveal little about how the treatment affects the underlying progressive neurodegeneration. As a result, while there are treatments that improve symptoms, they become less effective as the neurodegeneration advances.


An article, published online in Neurology (15 July 2016) on how PD alters brain activity over time, may provide a new tool for testing experimental medications aimed at alleviating symptoms and slowing the rate at which the diseases damage the brain. The new study could remedy this issue by providing researchers with measurable targets, called biomarkers, to assess whether a drug slows or even stops the progression of the disease in the brain.


For the study, the authors used functional magnetic resonance imaging (fMRI) to measure activity in a set of pre-determined brain areas in healthy controls, individuals with Parkinson’s disease, and patients with two forms of “atypical Parkinsonism“ — multiple systems atrophy (MSA) and progressive supranuclear palsy (PSP) — that have symptoms similar to those of PD. The authors selected the specific brain regions, which are critical for movement and balance, based on the findings of past studies in people with these three conditions. The participants each underwent two scans spaced a year apart, during which they completed a test that gauged their grip strength.


Results showed that healthy controls had no changes in neural activity after a year, whereas the participants with PD showed reductions in the response of two brain regions called the putamen and the primary motor cortex. Previous research had shown reduced activity in the primary motor cortex of PD patients, but the new study is the first to suggest that this deficit worsens over time. Activity also decreased in MSA patients in the primary motor cortex, the supplementary motor area, and the superior cerebellum, while the individuals with PSP showed a decline in the response of these three areas and the putamen. The authors hope to use its newly discovered biomarkers, in addition to one it had previously identified, to test whether an experimental medication known to improve PD symptoms also slows the progression of those brain changes. According to the authors, the new markers of disease allow for the evaluation of disease-modifying therapeutics because it is now known that the control group doesn’t change over a year but patient groups do. The authors added that if it can be shown that a therapeutic prevents that change from occurring, it would suggest that it might have a disease-modifying effect.“


FDA Approves New Device for Prevention of Recurrent Strokes in Certain Patients


The cause of most strokes can be identified, such as poorly controlled high blood pressure, narrowed blood vessels due to cholesterol deposits and scar tissue (atherosclerosis), or a blood clot caused by an abnormal heart rhythm (atrial fibrillation). However, in some patients, medical tests cannot identify the cause of the stroke, which is referred to as a cryptogenic stroke. About 25-30% of Americans have a patent foramen ovale (PFO), which typically causes no health problems and does not require treatment. However, in a small percentage of these patients, it is believed that the PFO provided a path for a blood clot to travel to the brain where it blocked a blood vessel resulting in a stroke. As a result, patients with a cryptogenic stroke and a PFO may be at an increased risk of having a second stroke.


The FDA has approved the Amplatzer PFO Occluder device to reduce the risk of a stroke in patients who previously had a stroke believed to be caused by PFO, and then traveled to the brain. The device is inserted through a catheter that is placed in a leg vein and advanced to the heart. It is then implanted close to the hole in the heart between the top right chamber (right atrium) and the top left chamber (left atrium). The device had been on the market more than a decade ago under a humanitarian device exemption (HDE), but was voluntarily withdrawn by the manufacturer in 2006 after the FDA concluded that the target population for this device was greater than 4,000 patients and that the device no longer qualified for an HDE approval. For the past 10 years, no FDA-approved heart occluder devices have been on the market specifically indicated to close PFOs to reduce the risk of a recurrent stroke in patients with a prior cryptogenic stroke.


In approving the Amplatzer PFO Occluder, the FDA concluded that the device demonstrated a reasonable assurance of safety and effectiveness. The safety and efficacy was assessed in a randomized study that evaluated 499 participants aged 18 to 60 years old who were treated with the Amplatzer PFO Occluder plus blood-thinning medications compared to 481 participants who were treated with blood-thinning medications alone. While the rate of new strokes in both treatment groups was very low, the study found a 50% reduction in the rate of new strokes in participants using the Amplatzer PFO Occluder plus blood-thinning medications compared to participants taking only blood-thinning medications. Adverse effects associated with the device or the implantation procedure include injury to the heart, irregular and/or rapid heart rate (atrial fibrillation), blood clots in the heart, leg or lung, bleeding and stroke.


The Amplatzer PFO Occluder device should not be used in patients with a heart valve infection or other untreated infections, or a heart tumor or blood clot at the implant site. The device is also contraindicated in patients with other abnormal connections between the heart chambers or in whom the cardiovascular anatomy or blood clots would interfere with the ability to move the catheter used to deliver the device to the heart. Patients should discuss with their medical team (consisting of a neurologist and a cardiologist) the risks and benefits of PFO closure in comparison to using medications alone.


The Amplatzer PFO Occluder device is manufactured by St. Jude Medical Inc. based in Plymouth, Minnesota.


Hearty Chickpea Salad with Artichoke Heart, Tomato & Arugula


Half a cup of chickpeas supplies about half a milligram of cancer-fighting B vitamin, which doesn’t sound like much. But you only need a little more than 3.5 milligrams daily for healthy benefits. And in a recent study, people from many different walks of life seemed to benefit from ample B6. No one will get pellagra with chickpeas in their diet.



White and Green dried chickpeas.  Credit: Sanjay Acharya – Own work, CC BY-SA 3.0, Wikipedia Commons



Easy to make, chickpeas, tomatoes, onion, garlic and fresh cilantro.  Credit: Wikipedia Commons



It is one of the earliest cultivated legumes: 7,500-year-old remains have been found in the Middle East. The name “chickpea“ traces back through the French chiche to cicer, Latin for ?chickpea’ (from which the Roman cognomen Cicero was taken). The Oxford English Dictionary lists a 1548 citation that reads, “Cicer may be named in English Cich, or ciche pease, after the Frenche tonge.“ The dictionary cites “Chick-pea“ in the mid-18th century; the original word in English taken directly from French was chich, found in print in English in 1388 and became obsolete in the 18th century.


The word garbanzo came to English as “calavance“ in the 17th century, from Old Spanish (perhaps influenced by Old Spanish garroba or algarroba), though it came to refer to a variety of other beans. The Portuguese word for chickpea arvanco has suggested to some that the origin of the word garbanzo is in the Greek erebinthos. But the Oxford English Dictionary mentions a possible origination in the word garbantzu, from Basque – a non-Indo-European tongue – in which it is a compound of garau, seed + antzu, dry. Domesticated chickpeas have been found in the aceramic levels of Jericho along with Cayonu in Turkey and in Neolithic pottery at Hacilar, Turkey. They are found in the late Neolithic (about 3500 BCE) at Thessaly, Kastanas, Lerna and Dimini. In southern France Mesolithic layers in a cave at L’Abeurador, Aude have yielded wild chickpeas carbon dated to 6790+90 BCE.


By the Bronze Age, chickpeas were known in Italy and Greece. In classical Greece, they were called erebinthos and eaten as a staple, a dessert, or consumed raw when young. The Romans knew several varieties such as venus, ram, and punic chickpeas. They were both cooked down into a broth and roasted as a snack. The Roman gourmet Apicius gives several recipes for chickpeas. Carbonized chickpeas have been found at the Roman legion fort at Neuss (Novaesium), Germany in layers from the first century CE, along with rice.


Chickpeas are mentioned in Charlemagne’s Capitulare de villis (about 800 CE) as cicer italicum, as grown in each imperial demesne. Albertus Magnus mentions red, white and black varieties. Nicholas Culpeper noted “chick-pease or cicers“ are less “windy“ than peas and more nourishing. Ancient people also associated chickpeas with Venus because they were said to offer medical uses such as increasing sperm and milk, provoking menstruation and urine and helping to treat kidney stones. “White cicers“ were thought to be especially strong and helpful.


Hearty Chickpea Salad with Artichoke Heart, Tomato & Arugula



Sunday supper after a weekend of theater, vodka cocktails and rich food. Nice to have a simple, easy to prepare meal that’s also delicious. ©Joyce Hays, Target Health Inc.





One 15-oz. can chickpeas, rinsed and drained (if you want to soak & cook your own, do it the day before you make this salad)

One frozen package Artichoke hearts (steam for 8-10 minutes, drain, & towel dry)

1 stalk celery, finely chopped

2 ripe Tomatoes, cut into small pieces

1/2 to 1/3 cup thinly sliced black olives

1 avocado, cut into cubes

2 to 4 fresh garlic cloves, juiced (throw the pulp away)

1 Onion, chopped very fine

1/4 cup finely chopped fresh parsley

1/3 cup chopped cilantro

1 teaspoon turmeric

Zest & Juice from 1/2 a lemon (or lime)

2 Tablespoons Olive oil

1 cup baby arugula, stuff them down into the cup (wash these leaves very well, dry with paper towels)

1 cup grated soy Mozzarella or crumbled feta cheese, or crumbled gorgonzola cheese

Several grinds Black pepper & (optional) salt




1. Rinse, drain, steam cut, slice, zest everything that needs chopping, etc. Get all the ingredients ready to use.

2. In a small bowl make the dressing. Add the olive oil, garlic juice, chopped onion, turmeric, lemon zest and lemon juice, several grinds of black pepper (salt if desired)

3. In your salad serving bowl, toss together chickpeas, artichoke hearts, celery, tomatoes, olives, cilantro and parsley.

4. Now add to the chickpea mixture the dressing and stir well.

5. Next stir in slowly the arugula, avocado, and the cheese you selected to use. Taste to check the seasoning and add more grinds of pepper, or anything else, if needed.


Serve this salad with garlic-y hummus, warm pita bread and/or a grainy bread and a nice chilled white wine. We’ve discovered anothjer lovely Italian wine, that’s like a combo of three favorite whites: Sauvignon Blanc, Pinot Grigio and Chardonnay.



La Scolca was the perfect wine for this simple repast. This is a wine that will not

disappoint. ©Joyce Hays, Target Health Inc.




It’s hard to write about anything other than politics, these days. Many Americans are shocked and confused over events leading up to the presidential election this coming Tuesday. We have given our employees extra time to vote, as all companies should do. And the whole world is on edge waiting to see if the planet’s one super power, will elect a person qualified enough to lead. A vote is too powerful to waste, by not casting one. One of the greatest supports of a democracy, it should never be taken for granted. Whatever you do, get out and vote!


We are all winners, when we support our democracy!



From Our Table to Yours !


Bon Appetit!