Target Health Blog

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Simple Delicious Tuna Patties

April 6, 2020

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Target Healthy Eating

With much of the world in quarantine mode, we're all preparing meals under a certain amount of stress. We no longer have easy access to all the ingredients, we might want to use. With this in mind, we want to share with you, easier recipes with fewer ingredients, that we're getting great pleasure from. These tuna patties were made with items we already had on our kitchen shelves and spices we used regularly. Although, we live in an area where groceries were easily purchased, things have changed. We have to plan way ahead, and put an order into a specific time slot, which we don't receive until one week later, or more. ©Joyce Hays, Target Health LLC

Ingredients

  • Two 6-ounce cans tuna
  • 2 teaspoons Dijon mustard
  • 1/2 cup fresh or stale bread torn into small pieces, or substitute with Panko, or any flour, or left-over rice, or crushed crackers
  • 1 teaspoon lemon zest
  • 1 Tablespoon lemon juice
  • 1 Tablespoon liquid from the cans of tuna
  • 2 Tablespoons chopped fresh parsley
  • 2 Tablespoons chopped fresh shallots or 1 onion
  • 3 garlic cloves ground with 3 anchovy fillets
  • Pinch black pepper
  • Pinch chili flakes
  • 1 drop Worcester sauce
  • 2 eggs
  • 2 Tablespoons olive oil
  • 2 scallions, well chopped
  • Chopped chives for garnish (optional)
We had all of these simple ingredients, on our kitchen shelves, way before the pandemic struck. Hopefully, we'll be able to replace ingredients, like these. ©Joyce Hays, Target Health LLC

Directions

1. In a separate bowl, whisk the eggs then set aside.

In a separate bowl, whisk the eggs, then set aside. ©Joyce Hays, Target Health LLC

2. Drain the liquid from the tuna cans. If you are using tuna packed in water, reserve a Tablespoon of the tuna water, and add a teaspoon of olive oil to the tuna mixture in the next step.

Chopping onion and some extra garlic. ©Joyce Hays, Target Health LLC
With mortar & pestle, we're grinding the anchovies, together with garlic cloves. I like to use anchovies wherever possible, instead of salt. ©Joyce Hays, Target Health LLC
Decided to add more garlic. ©Joyce Hays, Target Health LLC
After trimming the scallions, we'll chop them well. ©Joyce Hays, Target Health LLC
Chopping fresh parsley. Feel free to substitute another herb you prefer, or is easier to obtain. ©Joyce Hays, Target Health LLC

3. In a large bowl, mix together all the ingredients, except for the whisked eggs. Taste the mixture before adding the eggs to see if it needs more seasoning to your taste. Finally, add the whisked eggs and mix, so all the ingredients are well combined.

Slowly adding all ingredients, except for the eggs. Add the tuna first, then crumbs, or flour, or Panko or crushed crackers, or whatever you wish, that's the consistency of Panko. Then chopped onion, garlic-anchovy paste, extra garlic. ©Joyce Hays, Target Health LLC
Adding well chopped scallions. ©Joyce Hays, Target Health LLC
Just added fresh parsley. ©Joyce Hays, Target Health LLC
You can zest the lemon right into the bowl. ©Joyce Hays, Target Health LLC
You can squeeze the lemon juice, right into the bowl. ©Joyce Hays, Target Health LLC

4. Divide the mixture into 4 to 6 parts, depending on how large you want each patty to be. With each part, form into a ball and then flatten into a patty. Place all the patties onto a tray, lined with wax paper. Put into refrigerator for an hour. Chilling, helps the patties stay together when you cook them.

Here are the number of tuna patties you can get from this recipe, so plan accordingly. If you double the recipe, you'll have made dinner and lunch for the next day, plus maybe a snack or two. These patties are delicious. ©Joyce Hays, Target Health LLC

5. In a skillet, heat the olive oil over a medium high flame. Gently place the patties in the pan, and cook until nicely browned, 3-4 minutes on each side.

Starting to cook the tuna patties and they smell wonderful! ©Joyce Hays, Target Health LLC
Flip over and cook for another 3 or 4 minutes. ©Joyce Hays, Target Health LLC

Serve with wedges of lemon and your favorite garden salad, or simply slices of tomato and carrot sticks, with a side dish of lentils, or rice or baked potato.

Cloudy Bay is a delicious (well priced) savignon blanc, well chilled, that we had with the tuna patties, a baked stuffed potato, garden salad with avocado and grape tomatoes. Dessert was a simple jello cake with cool whip. Stay safe, dear friends and join hands with us, to all of you around the world. ©Joyce Hays, Target Health LLC

Bon Appetit!

From Our Table to Yours

Have a Great Week Everyone!

National Effort to Develop Blood-Related Therapies

April 6, 2020

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Regulatory

As part of the response to COVID-19 pandemic, the FDA is taking the lead on a national effort to facilitate the development of, and access to, two investigational therapies derived from human blood. These are called convalescent plasma and hyperimmune globulin and are antibody-rich blood products made from blood donated by people who have recovered from the virus. The products can be administered to individuals diagnosed with COVID-19. There are some limited data to suggest that convalescent plasma and hyperimmune globulin may have benefit in the COVID-19 illness. This is why evaluation of these therapies in the context of a clinical trial and expanded access program is so important.

Based on prior experience with respiratory viruses and on data that have emerged from China, these products have the potential to lessen the severity or shorten the length of illness caused by COVID-19. The FDA is facilitating access to convalescent plasma for treating COVID-19 using multiple pathways. The FDA's initial effort was focused on facilitating access to convalescent plasma for the treatment of COVID-19 disease through an emergency investigational new drug application (eIND) process. The FDA has provided information to help health care providers submit these applications to treat individual patients. The agency also is facilitating the conduct of well-controlled clinical trials at academic institutions to rigorously evaluate the safety and efficacy of convalescent plasma.

The FDA has led an effort, working collaboratively with our industry, academic, and government partners to develop and implement a protocol that will provide convalescent plasma to patients in need across the country who may not have access to institutions with clinical trials in place. This will allow for a simplified process for providers that will help to ensure patient safety, while also allowing for the collection of needed information about product efficacy. In this partnership, the Mayo Clinic will serve as the lead institution for the program and the American Red Cross will help collect plasma and distribute it for use in patients across the country. The program was developed with funding from the Biomedical Advanced Research and Development Authority (BARDA), a component of the U.S. Department of Health and Human Services' Office of the Assistant Secretary of Preparedness and Response. The FDA anticipates that this collaborative effort will be able to move thousands of units of plasma to the patients who need them in the coming weeks.

The FDA is also working with industry and its government partners to accelerate the development and availability of hyperimmune globulin for investigation for the potential treatment COVID-19. Hyperimmune globulin is a biological product manufactured from convalescent plasma. The FDA is helping to coordinate a study of hyperimmune globulin that will be conducted by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, as well as coordinating other efforts in this area. The FDA continues to provide advice, guidance, and technical assistance to help expedite the development of these products and intends to use regulatory flexibility in making these products and other critical medical countermeasures available to prevent and treat COVID-19.

People who have fully recovered from COVID-19 for at least two weeks are encouraged to consider donating plasma, which could potentially help save the lives of up to four patients. Those willing to donate are urged to visit the American Red Cross website at www.redcrossblood.org/plasma4covid or contact their local blood donor or plasma collection center.

Source: FDA

Gene Discovered for Rare Disease of Excess Bone Tissue Growth

April 6, 2020

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Rare Diseases

According to a study in the Journal of Experimental Medicine (31 March 2020), a second gene has been discovered that causes melorheostosis, a rare group of conditions involving an often painful and disfiguring overgrowth of bone tissue. The gene, SMAD3, is part of a pathway that regulates cell development and growth. The authors are now working to develop an animal model with a mutant version of SMAD3 to test potential treatments for the condition.

Melorheostosis affects  about 1 in 1 million people and its causes have long been unknown. DNA tests of blood and skin could not identify a mutation. The key to finding the gene was to biopsy the affected bone directly and compare it to unaffected bone. Earlier, the authors used this method to discover the gene  for “dripping candle wax bone disease,“ a form of melorheostosis in which excess bone growth appears to drip from the bone surface like hot wax. In that study, mutations in the gene MAP2K1 accounted for eight cases of the disease among 15 patients.

In the current study, the authors scanned the exome -- the part of the genome that codes for proteins --  and found mutations in the affected bone. These mutations occurred during the patient's lifetime rather than being inherited from parents and are not present in all the cells of the body. The authors found SMAD3 mutations in four of the patients who did not have mutations in MAP2K1. SMAD3 is involved in a pathway crucial for skeletal development both before and after birth. The SMAD3 mutations increase the maturation of bone-forming cells and are involved in a cellular pathway distinct from the MAPK2K1 pathway.

Source: NIH

Single Mutation Leads to Big Effects in Autism-Related Gene

April 6, 2020

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Neurology

A study published in Neuron (2 April 2020) offers clues to why autism spectrum disorder (ASD) is more common in boys than in girls. The study found that a single amino acid change in the NLGN4 gene, which has been linked to autism symptoms, may drive this difference in some cases. The study compared two NLGN4 genes, (one on the X chromosome and one on the Y chromosome), which are important for establishing and maintaining synapses, the communication points between neurons.

Every cell in our body contains two sex chromosomes. Females have two X chromosomes; males have one X and one Y chromosome. Until now, it was assumed that the NLGN4X and NLGN4Y genes, which encode proteins that are 97% identical, functioned equally well in neurons. However, by using a variety of advanced technology including biochemistry, molecular biology, and imaging tools, the authors discovered that the proteins encoded by these genes display different functions. The NLGN4Y protein is less able to move to the cell surface in brain cells and is therefore unable to assemble and maintain synapses, making it difficult for neurons to send signals to one another. When the authors fixed the error in cells in a dish (in vitro), they restored much of its correct function.

According to the authors, there is a significant need to look at NLGN4X and NLGN4Y more carefully. The reason is that mutations in NLGN4X can lead to widespread and potentially very severe effects in brain function, and the role of NLGNY is still unclear. The authors discovered that the problems with NLGN4Y were due to a single amino acid. The authors also discovered that the region surrounding that amino acid in NLGN4X is sensitive to mutations in the human population. There are a cluster of variants found in this region in people with ASD and intellectual disability and these mutations result in a deficit in function for NLGN4X that is indistinguishable from NLGN4Y.

In females, when one of the NLGN4X genes has a mutation, the other one can often compensate. However, in males, diseases can occur when there is a mutation in NLGN4X because there is no compensation from NLGN4Y.

The current study suggests that if there is a mutation in NLGN4X, NLGN4Y is not able to take over, because it is a functionally different protein. If the mutations occur in regions of NLGN4X that affect the protein levels, that may result in autism-related symptoms including intellectual deficits. The inability of NLGN4Y to compensate for mutations in NLGN4X may help explain why males, who only have one X chromosome, tend to have a greater incidence of NLGN4X-associated ASD than females.

References:

TA Nguyen et al. A cluster of autism-associated variants on X-linked NLGN4X functionally resemble NLGN4Y. Neuron. April 2, 2020

Dr. Elie Metchnikov - Discoverer of Macrophages and the Immune System

April 6, 2020

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History of Medicine

Photograph of Nobel Prize winner, Ilya Ilyich Mechnikov, who discovered phagocytes.Photo credit: by Agence Rol - This image comes from Gallica Digital Library and is available under the digital ID btv1b6926750k/f1, Public Domain, https://commons.wikimedia.org

Ilya Ilyich Mechnikov (Elie Metchnikoff; 1845 - 1916) was a Russian zoologist best known for his pioneering research in immunology. In particular, he is credited with the discovery of phagocytes (macrophages) in 1882. This discovery turned out to be the major defense mechanism in innate immunity. Mechnikov and Paul Ehrlich were jointly awarded the 1908 Nobel Prize in Physiology or Medicine "in recognition of their work on immunity". He is also credited by some sources with coining the term gerontology in 1903, for the emerging study of aging and longevity. Mechnikov also established the concept of cell-mediated immunity, while Ehrlich established the concept of humoral immunity. Their works are regarded as the foundation of the science of immunology. In immunology, he is given an epithet the "father of natural immunity".

Mechnikov was born in the village Ivanovka, Kharkov Governorate, now Dvorichna Raion, Ukraine. He was the youngest of five children of Ilya Ivanovich Mechnikov, a Russian officer of the Imperial Guard. His mother, Emilia Lvovna (Nevakhovich), the daughter of the Jewish writer Leo Nevakhovich, largely influenced him on his education, especially in science. His elder brother Lev became a prominent geographer and sociologist.

Mechnikov entered Kharkiv Lycee in 1856 where he developed his interest in biology. Convinced by his mother to study natural sciences instead of medicine, in 1862 he tried to study biology at the University of Wurzburg, but the German academic session would not start by the end of the year. So he enrolled at Kharkiv University for natural sciences, completing his four-year degree in two years. In 1864 he went to Germany to study marine fauna on the small North Sea island of Heligoland. He was advised by the botanist Ferdinand Cohn to work with Rudolf Leuckart at the University of Giessen. It was in Leuckart's laboratory that he made his first scientific discovery of alternation of generations (sexual and asexual) in nematodes and then at Munich Academy. In 1865, while at Giessen, he discovered intracellular digestion in flatworm, and this study influenced his later works. Moving to Naples the next year he worked on a doctoral thesis on the embryonic development of the cuttle-fish Sepiola and the crustacean Nebalia.

A cholera epidemic in the autumn of 1865 made him move to the University of Gottingen, where he worked briefly with W. M. Keferstein and Jakob Henle. In 1867 he returned to Russia to get his doctorate with Alexander Kovalevsky from the University of St. Petersburg. Together they won the Karl Ernst von Baer prize for their theses on the development of germ layers in invertebrate embryos. Mechnikov was appointed docent at the newly established Imperial Novorossiya University (now Odessa University). Only twenty-two years of age, he was younger than his students. In 1868 he transferred to the University of St. Petersburg. In 1870 he returned to Odessa to take up the appointment of Titular Professor of Zoology and Comparative Anatomy.

In 1882, Mechnikov resigned from Odessa University due to political turmoil after the assassination of Alexander II. He went to Sicily to set up his private laboratory in Messina. He returned to Odessa as director of an institute set up to carry out Louis Pasteur's vaccine against rabies; due to some difficulties, he left in 1888 and went to Paris to seek Pasteur's advice. Pasteur gave him an appointment at the Pasteur Institute, where he remained for the rest of his life.

Research

Mechnikov became interested in the study of microbes, and especially the immune system. At Messina he discovered phagocytosis after experimenting on the larvae of starfish. In 1882 he first demonstrated the process when he inserted small citrus thorns into starfish larvae, then found unusual cells surrounding the thorns. He realized that in animals which have blood, the white blood cells gather at the site of inflammation, and he hypothesized that this could be the process by which bacteria were attacked and killed by the white blood cells. He discussed his hypothesis with Carl Friedrich Wilhelm Claus, Professor of Zoology at the University of Vienna, who suggested to him the term “phagocyte“ for a cell which can surround and kill pathogens. He delivered his findings at Odessa University in 1883.

Mechnikov's theory, that certain white blood cells could engulf and destroy harmful bodies such as bacteria, met with skepticism from leading specialists including Louis Pasteur, Behring and others. At the time, most bacteriologists believed that white blood cells ingested pathogens and then spread them further through the body. His major supporter was Rudolf Virchow, who published his research in his Archiv fur pathologische Anatomie und Physiologie und fur klinische Medizin (now called the Virchows Archiv). The discovery of these phagocytes ultimately won him the Nobel Prize in 1908. Mechnikov also worked with ?mile Roux on calomel (mercurous chloride) in ointment form in an attempt to prevent people from contracting the sexually transmitted disease syphilis.

In 1887, Mechnikov observed that leukocytes isolated from the blood of various animals were attracted towards certain bacteria. The first studies of leukocyte killing in the presence of specific antiserum were performed by Joseph Denys and Joseph Leclef, followed by Leon Marchand and Mennes between 1895 and 1898. Almoth E. Wright was the first to quantify this phenomenon and strongly advocated its potential therapeutic importance. The so-called resolution of the humoralist and cellularist positions by showing their respective roles in the setting of enhanced killing in the presence of opsonins was popularized by Wright after 1903, although Metchnikoff acknowledged the stimulatory capacity of immunosentisitized serum on phagotic function in the case of acquired immunity.

This attraction was soon proposed to be due to soluble elements released by the bacteria. Some 85 years after this seminal observation, laboratory studies showed that these elements were low molecular weight (between 150 and 1500 Dalton (unit)s) N-formylated oligopeptides, including the most prominent member of this group, N-Formylmethionine-leucyl-phenylalanine, that are made by a variety of replicating gram positive bacteria and gram negative bacteria. Mechnikov's early observation, then, was the foundation for studies that defined a critical mechanism by which bacteria attract leukocytes to initiate and direct the innate immune response of acute inflammation to sites of host invasion by pathogens.

Mechnikov also developed a theory that aging is caused by toxic bacteria in the gut and that lactic acid could prolong life. Based on this theory, he drank sour milk every day. He wrote The Prolongation of Life: Optimistic Studies, in which he espoused the potential life-lengthening properties of lactic acid bacteria (Lactobacillus delbrueckii subsp. bulgaricus). He attributed the longevity of Bulgarian peasants to their yogurt consumption.

Mechnikov died in 1916 in Paris from heart failure. According to his will, his body was used for medical research and afterwards cremated in Pere Lachaise Cemetery crematorium. His cinerary urn has been placed in the Pasteur Institute library.

Mechnikov was greatly influenced by Charles Darwin's theory of evolution. He first read Fritz Muller's Fur Darwin in Giessen. From this he became a supporter of natural selection and Ernst Haeckel's biogenetic law. His scientific works and theories were inspired by Darwinism.

Awards and Recognitions

Mechnikov with Alexander Kovalevsky won the Karl Ernst von Baer prize in 1867 based on their doctoral research. He shared the Nobel Prize in Physiology or Medicine in 1908 with Paul Ehrlich. He was awarded honorary degree from the University of Cambridge in Cambridge, UK, and the Copley Medal of the Royal Society in 1906. He was given honorary memberships in the Academy of Medicine in Paris and the Academy of Sciences and Medicine in St. Petersburg. The Leningrad Medical Institute of Hygiene and Sanitation, founded in 1911 was merged with Saint Petersburg State Medical Academy of Postgraduate Studies in 2011. This became the North-Western State Medical University named after Mechnikov.

COVID19 Impacts Conjunctivitis (Pink Eye)

April 6, 2020

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Quiz

An eye infected with viral conjunctivitis
Photo credit: by Joyhill09 - I took this photo with a Nikon D40 of my eye infected with conjunctivitis, CC BY-SA 3.0,
https://commons.wikimedia.org

1) _____, also known as pink eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may also occur. The affected eye may have increased tears or be “stuck shut“ in the morning. Swelling of the white part of the eye may also occur. Conjunctivitis can affect one or both eyes.

The most common infectious causes are 2) _____ followed by bacterial. The viral infection may occur along with other symptoms of a common cold. Both viral and bacterial cases are easily spread between people. Allergies to pollen or animal hair are also a common cause. Diagnosis is often based on signs and symptoms. Occasionally, a sample of the discharge is sent for culture.

Prevention is partly by handwashing. Treatment depends on the underlying cause. In the majority of viral cases, there is no specific treatment. Most cases due to a bacterial infection also resolve without treatment; however, antibiotics can shorten the illness. People who wear contact lenses and those whose infection is caused by gonorrhea or chlamydia should be treated. Allergic cases can be treated with antihistamines or mast cell inhibitor drops.

Pink Eye, or conjunctivitis, is often a symptom of COVID-19.  Besides causing COVID-19, the new coronavirus can also lead to 3) ___  ___, and Chinese researchers say the virus may be spread by tears. In a study of 38 patients with COVID-19, twelve (12) also had pink eye. In two patients, the coronavirus was present in both nasal and eye fluids. According to the authors, some COVID-19 patients have ocular symptoms, and maybe novel coronaviruses are present in the conjunctival secretions of patients with COVID-19. Since the 4) _____ is a thin, transparent layer of tissue that lines the inner eyelid and covers part of the white of the eye, the coronavirus may invade it in patients with severe 5) _____ pneumonia. That means the virus can be spread if someone rubs an infected eye and then touches someone else - or even during an eye examination.  According to an article published in JAMA Ophthalmology (31 March 2020), the more severe a patient's COVID-19 is, the more likely it is that he or she will also have pink eye. Given these findings, the authors recommend that doctors and nurses treating patients with COVID-19 should wear protective glasses as well as other protective clothing, caps and gloves. Thus, people should take steps to prevent pink eye, including avoiding touching their eyes and face, and using 6) _____ instead of 7) _____ lenses during the coronavirus outbreak. Clearly, this is a warning to people that the conjunctiva can be a source of spreading 8) _____.

Currently, the guidelines from the American Academy of 9) _____ recommend regular eye exams not be performed during the pandemic. Of course, any 10) _____ that can affect vision still need to be treated immediately.

Sources: Wikipedia; webmd.com

ANSWERS: 1) Conjunctivitis; 2) viral; 3) pink eye; 4) conjuctiva; 5) COVID-19; 6) glasses; 7) contact; 8) infection; 9) Ophthalmology; 10) emergencies

COVID-19 Clinical Trials in the Time of Crisis

April 6, 2020

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What's New

This is what was sent to all of our staff at Target Health, as well as to our friends and colleagues on LinkedIn.

TO THE BEST TEAM IN THE INDUSTRY, THANK YOU AND BE SAFE

Target Health has not skipped a beat during this most difficult time for all of us, both at home and around the world. Because we are an international company with employees, families, colleagues and friends from all over the planet, clearly, COVID-19 has impacted all of us, including our dear friends at dMed in China. Everyone should know that dMed has been involved in several local COVID-19 studies in China. Bravo!

We are also honored that Target Health has been chosen to help run 2 COVID-19 studies in the US. We have had discussions with several of our clients and academic researchers who have several very creative ideas on how to deal with very sick patients during the current pandemic.

Fortunately, each department has been able to work remotely and so far, modern technology has served us well. Therefore, we are up and running on all cylinders and full speed ahead.

Please all be safe, and reach out to friends and colleagues so as not to be alone during this most difficult time. We will get through this together.

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. The Target Health software tools are designed to partner with both CROs and Sponsors. Also visit the Target Health Eating Website to see all of the fantastic recipes since 2012.

Joyce Hays, Founder and Editor in Chief of On Target

Dr. Jules T. Mitchel, Editor

Shut-Down Apple Comfort Cake

March 30, 2020

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Target Healthy Eating

With few ingredients, since we're all shut-in these days, here is a delicious apple cake that you won't regret making and savoring. ©Joyce Hays, Target Health LLC
Follow my easy directions and you will have a winner each time. I've made this many times, and it never disappoints. That's what you need these days, a special but simple food that delivers delicious flavor to your taste buds. ©Joyce Hays, Target Health LLC
Added pleasure, it fills your kitchen with the aroma of warm cinnamon and apples. ©Joyce Hays, Target Health LLC
This moist apple cake is good cold, however, it's ten times better always warm or warmed up. ©Joyce Hays, Target Health LLC

Ingredients

1 and 1/2 cups sugar

4 Tablespoons cold butter

1 and 1/2 cups flour (I've used chickpea flour, almond flour, rice flour, reg flour)

2 teaspoons baking powder

Wet ingredients

1 teaspoon vanilla

2 eggs

1 cup milk

Filling Ingredients

1 Tablespoon lemon juice

1 Tablespoon sugar

1/2 teaspoon ground cinnamon

2 Granny Smith (green) apples

Extras

Cool whip for serving, or whipped cream or vanilla ice cream

Chopped nuts (optional)

Directions

  1. With some extra butter, grease very well, a baking dish (8“ x 8“ x 3“) or pie dish.
  2. Preheat the oven to 350 degrees
  3. Cube the cold butter. Peel & core apples, cut into quarters, then slice very thin. Measure out fresh lemon juice. Set out all ingredients, so you're well organized

First dry ingredients:

  1. In a large bowl, mix the sugar, flour, baking powder.
  2. Cut cold butter into small cubes and add to the flour mixture. With your fingers, work the butter into the flour mixture until it's completely disbursed and the flour mixture takes on a grainy texture. Set aside

Wet ingredients:

  1. Use a small size whisk, if you have it. Into another medium bowl add the two eggs and beat well for 5 minutes. You won't want to beat them this long, but please do, until the eggs are very frothy. Only when the eggs are this frothy, will they lend a special light quality to this delicious cake.
  2. Next add vanilla and beat some more.
  3. Add the milk slowly, while beating. Add the milk in three stages, while beating the whole time. Set aside

Filling ingredients

  1. Into a third bowl, add the fresh lemon juice. Add ? the sliced apples and mix the lemon juice onto the apple slices. Add the rest of the sliced apples and again, mix the lemon juice onto all the apple slices. Take the time to cover all apple with lemon juice.
  2. Sprinkle the cinnamon over the apples and mix it in well.
  3. Sprinkle the sugar over the apples and mix it in well. Now mix for 5 minutes until each slice has a brownish color.

Careful Arranging

  1. Take the bowl with flour and visually divide the contents into thirds. Take a knife and actually, mark the flour so that a line, divides 1/3 of the flour from 2/3. Take a Tablespoon and slowly spoon out the 1/3 of flour and sprinkle it over the bottom of your buttered baking dish. Try to sprinkle the flour evenly. Now take a fork and smooth over the bottom layer of flour so that it's very evenly distributed, but don't press down on the fork. You do NOT want to lose air. Like step of whisking the frothy eggs, you want all ingredients to be light and airy.
  2. With care, add the apple slices over the first layer of flour. Overlap the apples. Try to get three rows of overlapped apple slices. Figure about 15 slices in each row. At the end, if you have extra apple slices, simply squeeze them into a space that looks slightly open.
  3. Return to the flour bowl and carefully add the rest of the flour, over the rows of apple slices. Try to distribute the flour evenly WITHOUT PRESSING down on the flour. When you've finished, give your baking dish a shake, just to get all the flour as even as possible.
  4. Take your bowl of wet ingredients and give it a couple of beats. Slowly, add all of the contents of this bowl, over the last layer of flour. Do NOT try to help the liquid go between the apples. After adding the last drop of liquid, as evenly as you can, simply let the baking dish sit for a minimum of 10 minutes, on your kitchen counter, so that the liquid finds its own way down and around the other ingredients.
  5. Finally, put the Apple Cake into the oven and bake for 55 minutes. Your oven may not be like mine, so after cake has baked for 45 minutes, keep you eye on the cake so that it never gets darker than a glorious golden brown.
  6. Remove from oven and let cool slightly for 10 minutes, then serve as is, or add whipped cream, cool whip or vanilla ice cream.

Enjoy!

Clean, core, and peel the apples. ©Joyce Hays, Target Health LLC
Don't worry about any brown spots, by the time you take the apple cake out of the oven, they'll never show. And, you won't want to stop eating this wonderful cake. ©Joyce Hays, Target Health LLC


Squeezing fresh lemon juice. ©Joyce Hays, Target Health LLC
Apples have been covered with the fresh lemon juice. Now, apples will be completely covered with the cinnamon and sugar. ©Joyce Hays, Target Health LLC
After whisking for five minutes, the eggs look frothy, like this. ©Joyce Hays, Target Health LLC
Frothy eggs being whisked with the vanilla extract. ©Joyce Hays, Target Health LLC
Here's the bowl of dry ingredients, and now butter is added. Got a little lazy in this step and didn't make smaller cubes of butter, the way I usually do. Smaller cubes make it easier to combine the butter with the flour mixture, and in less time. Cake turned out just fine, though. ©Joyce Hays, Target Health LLC
Adding first layer of flour to well buttered pie dish. ©Joyce Hays, Target Health LLC
Sliced apples laid over first layer of flour. Now, adding the rest of the flour, over the sliced apples. ©Joyce Hays, Target Health LLC
Wet ingredients added last. Now, will set aside for at least 10 minutes, before putting in oven to bake. You CANNOT skip the 10 minutes rest that this cake takes, to slowly allow the wet ingredients to merge with the rest of the cake. Do NOT speed up this step. ©Joyce Hays, Target Health LLC
Just out of the oven. Smells wonderful. Let it cool a little, then serve while still warm. This cake is good cold, but it's beyond delicious, served warm. ©Joyce Hays, Target Health LLC
Here's an earlier attempt, just as delicious each time it's baked. ©Joyce Hays, Target Health LLC
We're all missing the beautiful Springtime. Well, we're all in this planet pandemic together and we wish everyone good luck and good health wherever you are. Stay strong and stay in touch.
We'll be happy to print any anecdote and/or photo, you care to share, with our over 6500 subscribers around the world. ©Joyce Hays, Target Health LLC
Saturday night we found an icy bottle of Baileys way in the back of our fridge. What a welcome find! ©Joyce Hays, Target Health LLC

Bon Appetit!

From Our Table to Yours

Have a Great Week Everyone!

Coronavirus (COVID-19) Update (as of 27 March 2020)

March 30, 2020

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Regulatory

The FDA has announced the following actions taken in its ongoing response effort to the COVID-19 pandemic:

  1. The FDA is working closely with manufacturers to make sure that they continue to notify the agency of any permanent discontinuance or interruption of drug and biological product manufacturing in a timely manner. Today, the agency published guidance for immediate implementation about the importance of these notifications, the timelines for drug and biologic manufacturers to follow when notifying the FDA, and the details for manufacturers to provide about the discontinuance or interruption in manufacturing. Along with the requirements in the statute and implementing regulations, the guidance requests that applicants and manufacturers provide additional details and follow additional procedures to make sure the FDA has the specific information it needs to help prevent or mitigate shortages.
  2. The FDA issued a Consumer Update, Food Safety and Availability During the Coronavirus Pandemic, to describe the many ways the agency is working to help ensure the foods you, your family, and your pets eat are safe and available.
  3. The FDA issued a letter to stakeholders about the imminent threat to the health of consumers who may take chloroquine phosphate products used to treat disease in aquarium fish, thinking the products are interchangeable with FDA-approved drugs (used to treat malaria and certain other conditions in humans) that are being studied as a COVID-19 treatment for humans. Chloroquine products sold for aquarium use have not been evaluated by the FDA to determine whether they are safe, effective, properly manufactured, and adequately labeled for use in fish--let alone humans.
  4. Diagnostics update to date: During the COVID-19 pandemic, the FDA has worked with more than 220 test developers who have said they will be submitting emergency use authorizations (EUA) requests to FDA for tests that detect the virus. To date, 19 emergency use authorizations have been issued for diagnostic tests. Additionally, the FDA has been notified that more than 110 laboratories have begun testing under the policies set forth in our COVID-19 Policy for Diagnostic Tests for Coronavirus Disease-2019 during the Public Health Emergency Guidance. The FDA also continues to keep its COVID-19 Diagnostics FAQ up to date.
Virus is Stable for Hours on Surfaces, Similar to Original SARS Virus

March 30, 2020

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Coronavirus

According to an article published in The New England Journal of Medicine (17 March 2020), the virus that causes coronavirus disease 2019 (COVID-19) is stable for several hours to days in aerosols and on surfaces. The authors found that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects. The study information was widely shared during the past two weeks after the authors placed the contents on a preprint server to quickly share their data with colleagues.

For the study, the authors from from the National Institute of Allergy and Infectious Diseases' Montana facility at Rocky Mountain Laboratories, compared how the environment affects SARS-CoV-2 and SARS-CoV-1, which causes SARS. SARS-CoV-1, like its successor now circulating across the globe, emerged from China and infected more than 8,000 people in 2002 and 2003. SARS-CoV-1 was eradicated by intensive contact tracing and case isolation measures and no cases have been detected since 2004. SARS-CoV-1 is the human coronavirus most closely related to SARS-CoV-2. In the stability study the two viruses behaved similarly, which unfortunately fails to explain why COVID-19 has become a much larger outbreak.

The current study attempted to mimic virus being deposited from an infected person onto everyday surfaces in a household or hospital setting, such as through coughing or touching objects. The authors then investigated how long the virus remained infectious on these surfaces.

The authors highlighted additional observations from their study:

-- If the viability of the two coronaviruses is similar, why is SARS-CoV-2 resulting in more cases? Emerging evidence suggests that people infected with SARS-CoV-2 might be spreading virus without recognizing, or prior to recognizing, symptoms. This would make disease control measures that were effective against SARS-CoV-1 less effective against its successor.

-- In contrast to SARS-CoV-1, most secondary cases of virus transmission of SARS-CoV-2 appear to be occurring in community settings rather than healthcare settings.  However, healthcare settings are also vulnerable to the introduction and spread of SARS-CoV-2, and the stability of SARS-CoV-2 in aerosols and on surfaces likely contributes to transmission of the virus in healthcare settings.

The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2:

1. Avoid close contact with people who are sick.

2. Avoid touching your eyes, nose, and mouth.

3. Stay home when you are sick.

4. Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

5. Clean and disinfect frequently touched objects and surfaces using a regular household

cleaning spray or wipe.

Source NIH.gov

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