Electronic Informed Consent (Target e*ICF™)

 

Target Health Inc. is pleased to announce that 65% of patients in a dermatology study, for a large big pharma company, seamlessly used Target e*ICF™. This multicenter center study, performed in the US and Japan, also used our full suite of software supporting the paperless clinical trial, including Target e*CTR® (eClinical Trial Record), our patented eSource solution fully integrated with Target e*CRF®.  For the entire duration of the study, patients, site staff and monitors go to one website and use any device with Internet access. In addition, we  provided full CRO services for this study. We are also pleased to announce that study enrollment was completed 2 days ahead of schedule. All of Target Health Inc.’s processes are tied into the workflow of a direct data entry and paperless study, which makes all the difference in duration and accuracy of the study. We have also confirmed that the study sites can see twice as many patients in a day with the same staff, so this is a win-win for all.

 

Target e*ICF™ is web-based, bring your own device (BYOD), and allows for questions and answers, language control and of course version control.  It is no longer possible to sign the wrong version of the informed consent form. Data cannot be entered into our EDC system without the signatures of the study participants and authorized site personnel. Target e*ICF™ can also be used as stand-alone software in a similar manner that our SAE management module can be used.

 

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

 

QUIZ

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Tuberculosis

Chest X-ray of a person with advanced tuberculosis: Infection in both lungs is marked by white arrow-heads, and the formation of a cavity is marked by black arrows. Sources: Centers for Disease Control and Prevention’s Public Health Image Library (PHIL), with identification number #2543. Public Domain, Wikipedia Commons

 

 

Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the 1) ___, but can also affect other parts of the body. Most infections do not have symptoms, known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those infected. The classic symptoms of active TB are a chronic 2) ___ with blood-containing sputum, fever, night sweats, and weight loss. The historical term “consumption“ came about due to the weight loss. Infection of other organs can also cause a wide range of symptoms.

 

Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke. Diagnosis of 3) ___ TB is based on chest X-rays, as well as microscopic examination and culture of body fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) or blood tests. Prevention of TB involves screening those at high risk, early detection and treatment of cases, and 4) ___ with the bacillus Calmette-Guerin (BCG) vaccine. Those at high risk include household, workplace, and social contacts of people with active TB. Treatment requires the use of multiple antibiotics over a long period of time. Antibiotic resistance is a growing problem with increasing rates of multiple drug-resistant tuberculosis(MDR-TB). One-third of the world’s population is thought to be infected with TB. New infections occur in about 1% of the population each year. Eight million people suffer from — and two million die from — tuberculosis every year. For HIV patients, tuberculosis is the leading cause of 5) ___. Antibiotics are currently used against tuberculosis, as no effective vaccine could be developed thus far — but with growing resistance to 6) ___, the cure for tuberculosis is threatened. The number of new cases each year has decreased since 2000. About 80% of people in many Asian and African countries test positive while 5-10% of people in the United States population tests positive by the tuberculin test. Tuberculosis has been present in humans since ancient times.

 

Researchers at Linkoping University in Sweden, have made a discovery that could contribute to developing new vaccines and treatment alternatives for tuberculosis in the future. Autophagy is an important process that occurs naturally in the 7) ___ to clean out defective proteins and components that could otherwise damage the cells and cause illness. Making use of this process — what is called ‘stimulated autophagy’ — could be one way of also protecting the body against intracellular microbes. Currently, the most common pharmacological activation of autophagy occurs through what is known as mTORC1 inhibition. “Strengthening the immune defense system can be done through things like what is known as ‘stimulated autophagy’. But research shows that the most common signal path for stimulating autophagy can be immediately dangerous,“ says Robert Blomgran, research fellow in medicinal microbiology at Linkoping University.

 

What the researchers discovered was that when the tubercule bacilli are few — which they are, when the illness has not yet broken out — stimulated 8) ___ through mTORC1 inhibition is harmful. Instead, the process leads to the tubercule bacilli multiplying within the host cell, which in patients could involve the risk that the tuberculosis worsens. If the TB patient also has HIV, that illness worsens. This is why the researchers looked more closely at what effects the induction of autophagy has in immune cells infected with both 9) ___ and tuberculosis. The experiments showed that autophagy was then exceptionally dangerous, with an uncontrolled growth of tubercule bacilli as a result. How autophagy is stimulated needs to be reviewed so that over the long term it can have the desired effect in patients with 10) ___, and in the extra sensitive patient group with both tuberculosis and HIV. If this is taken into consideration when new medicines are tested, setbacks could be prevented. The research group will now be working further on research concerning other ways to stimulate autophagy and strengthen immune defense cells such as macrophages and dendritic cells, thus controlling the tubercule bacilli. Sources: Linkoping Universitet, Sweden; ScienceDaily.com; Wikipedia; Journal Reference: Anna-Maria Andersson, Blanka Andersson, Christoffer Lorell, Johanna Raffetseder, Marie Larsson, Robert Blomgran. Autophagy induction targeting mTORC1 enhances Mycobacterium tuberculosis replication in HIV co-infected human macrophages. Scientific Reports, 2016; 6: 28171.

 

ANSWERS: 1) lungs; 2) cough; 3) active; 4) vaccination; 5) death; 6) antibiotics; 7) body; 8) autophagy; 9) HIV; 10) tuberculosis

 

Carl Tanzler (1877-1952): Who Knew Bacteriologists Were So Interesting!

Tanzler in 1940

 

 

Carl Tanzler, or sometimes called, Count Carl von Cosel (February 8, 1877 July 3, 1952), was a German-born bacteriologist at the United States Marine Hospital in Key West, Florida. He developed an obsession for a young Cuban-American tuberculosis patient, Elena “Helen“ Milagro de Hoyos (July 31, 1909 – October 25, 1931), that carried on well after the disease had caused her death. In 1933, almost two years after her death, Tanzler removed Hoyos’s body from its tomb, and lived with the corpse at his home for seven years until its discovery by Hoyos’s relatives and authorities in 1940.

 

Tanzler went by many names; he was listed as Georg Karl Tanzler on his German marriage certificate. He was listed as Carl Tanzler von Cosel on his United States citizenship papers, and he was listed as Carl Tanzler on his Florida death certificate. Some of his hospital records were signed Count Carl Tanzler von Cosel. He was born as Karl Tanzler or Georg Karl Tanzler on February 8, 1877 in Dresden, Germany. Around 1920 he married Doris Anna Shafer (1889-1977) and he was listed as “Georg Karl T?nzler“ on the marriage certificate. Together they had two children: Ayesha Tanzler (1922-1998), and Crystal Tanzler (1924-1934), who died of diphtheria. Tanzler grew up in Germany. The following “Editorial Note“ accompanying the autobiographical account “The Trial Bay Organ: A Product of Wit and Ingenuity“ by “Carl von Cosel“ in the Rosicrucian Digest of March and April 1939, gives details about his stay in Australia before and during World War I and his return to Germany after the war:

 

Many years ago, Carl von Cosel travelled from India to Australia with the intention of proceeding to the South Seas Islands. He paused in Australia to collect equipment and suitable boats, and to become acquainted with prevailing weather and sea conditions. However, he became interested in engineering and electrical work there, bought property, boats, an organ, an island in the Pacific?so that he was still in Australia at the end of ten years. He had just begun to build a trans-ocean flyer when the war broke out and the British military authorities placed him in a concentration camp for ‘safe-keeping’ along with many officers India and China who were prisoners of war. Later he was removed to Trial Bay to a castle-like prison on the cliffs, and there the work in this narrative was accomplished. At the end of the war no prisoner was permitted to return to his former residence, but all were shipped to the prisoner’s exchange in Holland. When Carl von Cosel was released he set out to find his mother from whom he had not heard since the beginning of the war. Finding her safe, he remained with her for three years, witnessing the chaos that followed in the wake of the war. Finally, she suggested that her son return to his sister in the United States.

 

Tanzler’s account of Trial Bay Gaol, his secret building of a sailing boat, etc., is confirmed by Nyanatiloka Thera, who mentions that he planned to escape from the Gaol with “Count Carl von Cosel“ in a sailing boat, and provides other information about the interment of Germans in Australia during WWI. Tanzler emigrated to the United States in 1926, sailing from Rotterdam on February 6, 1926 to Havana, Cuba. From Cuba he settled in Zephyrhills, Florida, to where his sister had already emigrated, and was later joined by his wife and two daughters. Leaving his family behind in Zephyrhills in 1927, he took a job as a radiologic technologist at the U.S. Marine Hospital in Key West, Florida under the name Carl von Cosel.

 

During his childhood in Germany, and later while traveling briefly in Genoa, Italy, Tanzler claimed to have been visited by visions of a dead ancestor, Countess Anna Constantia von Cosel, who revealed the face of his true love, an exotic dark-haired woman, to him.

 

On April 22, 1930, while working at the Marine Hospital in Key West, Tanzler met Maria Elena “Helen“ Milagro de Hoyos (1909-1931), a local Cuban-American woman who had been brought to the hospital by her mother for an examination. Tanzler immediately recognized her as the beautiful dark-haired woman that had been revealed to him in his earlier “visions.“ By all accounts, Hoyos was viewed as a local beauty in Key West. Elena was the daughter of local cigar maker Francisco “Pancho“ Hoyos (1883-1934) and Aurora Milagro (1881-1940). She had two sisters, Florinda “Nana“ Milagro Hoyos (1906-1944), who married Mario Medina (c.1905-1944) and also succumbed to tuberculosis; and Celia Milagro Hoyos (1913-?). Medina, Nana’s husband, was electrocuted trying to rescue a coworker who hit a powerline with his crane at a construction site. On February 18, 1926, Hoyos married Luis Mesa (1908-?), the son of Caridad and Isaac Mesa. Luis left Hoyos shortly after Hoyos miscarried the couple’s child, and moved to Miami. Hoyos was legally married to Mesa at the time of her death. Hoyos was eventually diagnosed with tuberculosis, a typically fatal disease at the time, that eventually claimed the lives of almost all of her entire immediate family. Tanzler, with his self-professed medical knowledge, attempted to treat and cure Hoyos with a variety of medicines, as well as x-ray and electrical equipment, that were brought to the Hoyoses’ home. Tanzler showered Hoyos with gifts of jewelry and clothing, and allegedly professed his love to her, but no evidence has surfaced to show that any of his affection was reciprocated by Hoyos.

 

The corpse of Maria Elena Milagro de Hoyos (1910-1931) encased in wax and plaster circa 1940. Source: Wikipedia Commons

 

 

Despite Tanzler’s best efforts, Hoyos died of terminal tuberculosis at her parents’ home in Key West on October 25, 1931.Tanzler paid for her funeral, and with the permission of her family he then commissioned the construction of an above ground mausoleum in the Key West Cemetery, which he visited almost every night. One evening in April, 1933, Tanzler crept through the cemetery where Hoyos was buried and removed her body from the mausoleum, carting it through the cemetery after dark on a toy wagon, and transporting it to his home. He reportedly said that Elena’s spirit would come to him when he would sit by her grave and serenade her corpse with a favorite Spanish song. He also said that she would often tell him to take her from the grave. Tanzler attached the corpse’s bones together with wire and coat hangers, and fitted the face with glass eyes. As the skin of the corpse decomposed, Tanzler replaced it with silk cloth soaked in wax and plaster of Paris. As the hair fell out of the decomposing scalp, Tanzler fashioned a wig from Hoyos’s hair that had been collected by her mother and given to Tanzler not long after her burial in 1931. Tanzler filled the corpse’s abdominal and chest cavity with rags to keep the original form, dressed Hoyos’s remains in stockings, jewelry, and gloves, and kept the body in his bed. Tanzler also used copious amounts of perfume, disinfectants, and preserving agents, to mask the odor and forestall the effects of the corpse’s decomposition.

 

In October, 1940, Elena’s sister Florinda heard rumors of Tanzler sleeping with the disinterred body of her sister, and confronted Tanzler at his home, where Hoyos’s body was eventually discovered. Florinda notified the authorities, and Tanzler was arrested and detained. Tanzler was psychiatrically examined, and found mentally competent to stand trial on the charge of “wantonly and maliciously destroying a grave and removing a body without authorization.“ After a preliminary hearing on October 9, 1940 at the Monroe County Courthouse in Key West, Tanzler was held to answer on the charge, but the case was eventually dropped and he was released, as the statute of limitations for the crime had expired. Shortly after the corpse’s discovery by authorities, Hoyos’s body was examined by physicians and pathologists, and put on public display at the Dean-Lopez Funeral Home, where it was viewed by as many as 6,800 people. Hoyos’s body was eventually returned to the Key West Cemetery where the remains were buried in an unmarked grave, in a secret location, to prevent further tampering. The facts underlying the case and the preliminary hearing drew much interest from the media at the time (most notably, from the Key West Citizen and Miami Herald), and created a sensation among the public, both regionally and nationwide. The public mood was generally sympathetic to Tanzler, whom many viewed as an eccentric “romantic“.

 

Though not reported contemporaneously, research (most notably by authors Harrison and Swicegood) has revealed evidence of Tanzler’s necrophilia with Hoyos’s corpse. Two physicians (Dr. DePoo and Dr. Foraker) who attended the 1940 autopsy of Hoyos’s remains recalled in 1972 that a paper tube had been inserted in the vaginal area of the corpse that allowed for intercourse. Others contend that since no evidence of necrophilia was presented at the 1940 preliminary hearing, and because the physicians’ “proof“ surfaced in 1972, over 30 years after the case had been dismissed, the necrophilia allegation is questionable. While no existing contemporary photographs of the autopsy or photographs taken at the public display show a tube, the necrophilia claim was repeated by the HBO Autopsy program in 2005.

 

In 1944, Tanzler moved to Pasco County, Florida close to Zephyrhills, Florida, where he wrote an autobiography that appeared in the Pulp publication, Fantastic Adventures, in 1947. His home was near his wife Doris, who apparently helped to support Tanzler in his later years. Tanzler received United States citizenship in 1950 in Tampa. Separated from his obsession, Tanzler used a death mask to create a life-sized effigy of Hoyos, and lived with it until his death on July 3, 1952. His body was discovered on the floor of his home three weeks after his death. He died under the name “Carl Tanzler“. It has been recounted that Tanzler was found in the arms of the Hoyos effigy upon discovery of his corpse, but his obituary reported that he died on the floor behind one of his organs. The obituary recounted: “a metal cylinder on a shelf above a table, in it wrapped in silken cloth and a robe was a waxen image“. It has been written (most notably by Swicegood) that Tanzler had the bodies switched (or that Hoyos’s remains were secretly returned to him), and that he died with the real body of Elena.

 

Even Low-Intensity Smokers are at Increased Risk of Earlier Death

 

Smoking has many harmful effects on health, which have been detailed in numerous studies since the U.S. Surgeon General’s 1964 report linking smoking to lung cancer. The health effects of consistent low-intensity smoking, however, have not been well studied and many smokers believe that low-intensity smoking does not affect their health.

 

To better understand the effects of low-intensity smoking on mortality from all causes and for specific causes of death, a study, reported online in JAMA Internal Medicine (5 December 2016), analyzed data on over 290,000 adults in the NIH-AARP Diet and Health Study. Low-intensity smoking was defined as 10 or fewer cigarettes per day. All participants were age 59 to age 82 at the start of the study. Participants were asked about their smoking behaviors during nine periods across their lives, beginning with before they reached their 15th birthday until after they reached the age of 70 (for the older participants). Among current smokers, 159 reported smoking less than one cigarette per day consistently throughout the years that they smoked; nearly 1,500 reported smoking between one and 10 cigarettes per day.

 

Results showed that people who consistently smoked an average of less than one cigarette per day over their lifetime had a 64% higher risk of earlier death than never smokers, and those who smoked between one and 10 cigarettes a day had an 87% higher risk of earlier death than never smokers. Risks were lower among former low-intensity smokers compared to those who were still smokers, and risk fell with earlier age at quitting.

 

When the authors looked at specific causes of death among study participants, a particularly strong association was observed for lung cancer mortality. Those who consistently averaged less than one cigarette per day over their lifetime had 9x the risk of dying from lung cancer than never smokers. Among people who smoked between one and 10 cigarettes per day, the risk of dying from lung cancer was nearly 12x higher than that of never smokers. The authors also looked at risk of death from respiratory disease, such as emphysema, as well as the risk of death from cardiovascular disease. People who smoked between one and 10 cigarettes a day had over 6x the risk of dying from respiratory diseases than never smokers and about 1.5x the risk of dying of cardiovascular disease than never smokers.

 

The study relied on people recalling their smoking history over many decades, which introduced a degree of uncertainty into the findings. Also, despite the large number of people surveyed, the number of consistent low-intensity smokers was relatively small. Another limitation of the study is that the participants were mostly white and in their 60s and 70s, so the smoking patterns collected in the study reflect only a particular set of age groups in the United States. Future studies among younger populations and other racial and ethnic groups are needed, particularly as low-intensity smoking has historically been more common among racial and ethnic minorities in the US. The study also lacked detailed information about usage patterns among participants who reported smoking less than one cigarette per day. Hence, the authors could not compare the effects of smoking every other day, every few days, or weekly, for example.

 

“According to the authors, these findings indicate that smoking even a small number of cigarettes per day has substantial negative health effects and provide further evidence that smoking cessation benefits all smokers, regardless of how few cigarettes they smoke.

 

NIH Competition Seeks Wearable Device To Detect Real-Time Alcohol Levels

 

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is once again challenging the biotech community to design a wearable device capable of measuring blood alcohol level (BAC) in near real-time. The ideal device would be capable of measuring alcohol concentration in the blood or interstitial fluid that surrounds the body’s cells, which differs from existing technology that detects alcohol released through the skin in sweat or vapor. The creators of the winning prototype will be awarded $200,000 and second place will receive $100,000 through Challenge.gov, which lists federal incentive prizes and competitions.

 

Many alcohol studies rely on self-report to measure drinking, which can be unreliable. The wearable alcohol biosensor competition was conceived primarily to aid researchers in collecting more accurate data. This could help in the understanding and treatment of alcohol use disorder, as well as conditions affected by alcohol use, such as liver disease and HIV/AIDS. In addition to its potential for researchers, alcohol biosensors could also be a tool for consumers who wish to track their own personal drinking patterns. While initiating this second challenge, NIAAA hopes to continue to collaborate with the winners of the first competition to develop a viable prototype to use in NIAAA studies.

 

Competition submissions (a working prototype, data proving functionality/reliability, and photos/videos) will be accepted until May 15, 2017. Judging is expected to take place May 16, 2017 – July 26, 2017, with winners announced on or after August 1, 2017. Click here for more details about the competition.

 

In May 2016, NIAAA announced that BACTrack had won the first Wearable Alcohol Biosensor Challenge with its Skyn prototype. The wrist-worn device detects BAC using a fuel cell technology similar to that in devices used by law enforcement for roadside alcohol testing. MILO, Inc., won second prize with its design using disposable cartridges to continuously track BAC.

 

Competition contacts are M. Katherine Jung, Ph.D., acting director, NIAAA Division of Metabolism and Health Effects; and for email, contact F.L. Dammann, special assistant to the executive officer, NIAAA: NIAAAChallengePrize@mail.nih.gov.

 

FDA Takes Action Against 4 Tobacco Manufacturers for Illegal Sales of Flavored Cigarettes Labeled as Little Cigars or Cigars

 

The Tobacco Control Act, which was passed by Congress and signed by the President in 2009, banned cigarettes containing certain characterizing flavors, such as candy or fruit flavors, to reduce the number of youth who start to smoke and who become addicted to dangerous tobacco products. The FDA began enforcing that provision in September 2009.

 

The FDA has issued warning letters to four tobacco manufacturers: Swisher International Inc., Cheyenne International LLC, Prime Time International Co. and Southern Cross Tobacco Company Inc., for selling flavored cigarettes that are labeled as little cigars or cigars, which is a violation of the Family Smoking Prevention and Tobacco Control Act. The companies received warning letters for products under the “Swisher Sweets,“ Cheyenne,“ “Prime Time“ and “Criss-Cross“ brands in a variety of youth-appealing flavors, including grape, cherry, wild cherry and strawberry.

 

According to FDA, flavored cigarettes appeal to kids and disguise the bad taste of tobacco, but they are just as addictive as regular tobacco products and have the same harmful health effects. Also, because about 90% of adult daily smokers smoked their first cigarette by the age of 18, continued enforcement of the ban on cigarettes with characterizing flavors is vital to protect future generations from a lifetime of addiction.

 

The FDA determined that, although labeled as little cigars or cigars, the products meet the definition of cigarettes in the Tobacco Control Act, because they are likely to be offered to, or purchased by, consumers as cigarettes based on their overall presentation, appearance, and packaging and labeling. Additionally, since the products meet the definition of a cigarette, the FDA determined that the products are adulterated because they contain a natural or artificial characterizing flavor, or misbranded if they only purport to do so.

 

The FDA has requested the manufacturers respond to the warning letters within 15 working days of receiving the letter. Failure to obey federal tobacco law may result in the FDA initiating further action, including, but not limited to, civil money penalties, criminal prosecution, seizure, and/or injunction. The agency expects many of these products to remain available for purchase by consumers at retail establishments while the FDA works with the manufacturers to ensure the products are in compliance with the requirements of the law.

 

Consumers and other interested parties can report a potential tobacco-related violation of the FD&C Act by using the FDA’sPotential Tobacco Product Violation Reporting Form.

 

Individual Turkey Pies with Thyme & Mushroom Curry Gravy

 

One turkey pie (without gravy) is perfect to pass around at a party, as finger food or as a perfect appetizer (with gravy). Like last week’s recipe, I was trying to use up left-over Thanksgiving turkey, in a creative way. Hope you enjoy making this; it’s worth it, because of the delicious intermingling flavors. ©Joyce Hays, Target Health Inc.

 

One is an appetizer; two is good enough for dinner with crunchy asparagus or broccoli. ©Joyce Hays, Target Health Inc.

 

I made this recipe three time last week, just to get it exactly right for this newsletter, and of course for our own palate. ©Joyce Hays, Target Health Inc.

 

 

Ingredients

 

1 Tablespoon extra virgin olive oil

1 pound left-over light or dark meat, cut into bite-size pieces

1 Onion, chopped

15 fresh garlic cloves, chopped (not squeezed)

1/2 cup chicken stock or broth

1/2 cup sweet baby peas (frozen is fine)

1/2 cup carrots or other veggie cooked with the turkey, cut in small pieces

Pinch salt

Pinch black pepper

Pinch chili flakes

1/4 teaspoon ground thyme

1 Pinch chili flakes

1 teaspoon turmeric

1/4 cup fresh parsley, well chopped

1/4 cup fresh dill, well chopped

1.5 cups sharp cheddar cheese, shredded (about 8 ounces)

 

Pie Mixture

 

1 cup almond flour

1 1/2teaspoon baking powder

2 teaspoons canola oil

1/2 cup almond milk, another drop if needed 

2 eggs, beaten together, in a small cup 

 

Directions

 

1. Heat oven to 375?F. Spray 12 regular-size muffin cups with cooking spray.

2. Chop everything that needs chopping, shredding, grating, slicing, cutting, beating.

 

About to wash, dry and chop these beautiful herbs. ©Joyce Hays, Target Health Inc.

 

Grate the cheese then set aside. ©Joyce Hays, Target Health Inc.

 

I used frozen sweet baby peas (BirdsEye), but 1 large fresh carrot, cut into cubes ( the next day, changing my recipe slightly, I grated the carrot, which was better. Here I am cooking the carrots in chicken broth, until they’re soft. I also cooked the grated carrots in broth. ©Joyce Hays, Target Health Inc.

 

 

3. In 10-inch nonstick skillet, heat oil over medium-high heat and cook the onion and garlic, until soft. Next add all spices and herbs, stirring while you add. Now add the chicken stock (or broth), stirring as you add.

 

Add oil to a large skillet, over a medium flame, then add the garlic & onions. Next add all the seasonings and herbs; after which add the chicken stock or broth. ©Joyce Hays, Target Health Inc.

 

 

4. To the skillet, add all the left-over turkey and combine with all other ingredients in the pan. Add the peas and the other veggie and heat until hot, stirring occasionally until almost all liquid is absorbed. Remove from heat.

 

Next step: to the mixture in the above photo, add the turkey, peas, precooked carrots and stir everything together. Note: the pan is different, because this is the first time I experimented with my recipe. (day before). ©Joyce Hays, Target Health Inc.

 

 

5. Cool 5 minutes; stir in the shredded cheese then set aside.

 

Make the batter

 

6. In medium bowl, stir the two dry baking ingredients together. Then add the canola oil and milk and whisk everything until well combined. Finally, add the 2 beaten eggs and stir until all ingredients are well blended together. That’s it. That’s your batter.

 

Easy to make batter. ©Joyce Hays, Target Health Inc.

 

 

Getting Ready to Bake (3 layers in each muffin tin)

 

7. Spoon 1 Tablespoon flour/egg mixture into each muffin cup. This is the bottom layer. Over the bottom layer, add a Tablespoon of the turkey (or chicken) mixture. This is the second or middle layer. Finally, spoon 1 Tablespoon flour/egg mixture over the chicken mixture in each muffin cup. This is the third, top layer in each muffin cup.

 

One Tablespoon of batter in bottom of tin, then bake for 5 minutes and remove to cool for 5 minutes. ©Joyce Hays, Target Health Inc.

 

After bottom layer cools, add the turkey/veggie layer over it. ©Joyce Hays, Target Health Inc.

 

Before baking, the last step is adding the rest of the batter over the turkey/veggie mixture. ©Joyce Hays, Target Health Inc.

 

 

8. Bake the 12 turkey pies for 25 to 30 minutes or until toothpick inserted in center comes out clean. Cool 5 minutes.

9. With thin knife, loosen sides of pies from pan; remove from pan and place top sides up on cooling rack. Cool 10 minutes longer, and serve.

 

Just out of the oven and cooling for 5 minutes. Pies come out of tin easily. ©Joyce Hays, Target Health Inc.

 

 

10. While the pies are baking, make a simple curry mushroom gravy to serve at the table.

 

All the ingredients for the mushroom curry gravy. ©Joyce Hays, Target Health Inc.

 

 

Easy Gravy Recipe

 

1 Onion

4 fresh garlic cloves, sliced

Extra virgin olive oil for cooking

1 box of mushrooms, cleaned and chopped (chop them more than I did)

1 teaspoon turmeric

Pinch salt

Pinch black pepper

Pinch chili flakes

Several pinches curry powder (to your taste)

1 cup chicken broth, (stock or canned)

1 Tablespoon almond flour

1 Tablespoon sour cream

 

 

Directions

 

1.     Sautee the onions & garlic in olive oil in large skillet

2.     Add the chopped mushrooms and cook until soft

3.     Add all the spices and stir in

4.     Add the chicken broth and stir all ingredients together.

5.     In a measuring cup, mix the sour cream with the almond flour

6.     Last, add the sour cream mixture to the mushrooms and combine well.

7.     Cover until you plan to serve the whole recipe

8.     Just before you plan to serve, warm the gravy and pour into a bowl for table.

 

I used this.  ©Joyce Hays, Target Health Inc.

 

Chop the mushrooms into smaller pieces than I did.  ©Joyce Hays, Target Health Inc.

 

First sautee onion and garlic, then add mushrooms, chicken broth, all spices and stir well.  Cook until mushrooms are soft.  ©Joyce Hays, Target Health Inc.

 

In a measuring cup, combine the sour cream and the almond flour.  ©Joyce Hays, Target Health Inc.

 

Cover to keep the gravy warm; but just before serving turn the flame on for another 3 minutes. ©Joyce Hays, Target Health Inc.

 

Serve the gravy in a bowl on the table.  ©Joyce Hays, Target Health Inc.

 

Really delicious!  You’re gonna love this!  ©Joyce Hays, Target Health Inc.

 

Discovered a new red you might like Poggio il Castellare, ”Cervio” Cabernet Sauvignon Sant’ Antimo , 2010. We loved it. Following is a short wine review:

 

“Offers pungent aromas of cassis, bell pepper, licorice and tar, focused by a dense texture and firm structure. Concentrated and intense, this builds to a long, cassis-infused aftertaste.“ -Wine Spectator (93 Points)

 

It’s similar to Stags Leap cab, which we had last night at The Water Club, in Manhattan, with friends, after going to a great show, “Holiday Inn.“ BTW, try to see this production at Studio 54, the famous disco now turned into a beautiful Broadway theater.  This is a musical for the whole family, especially appropriate at this holiday time.

 

 

From Our Table to Yours !

 

Bon Appetit!