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Last Rose of Summer Tart

October 5, 2020

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Target Healthy Eating

Last week became the end of warm summer weather in New York City. As we reflected over this, a certain sorrow came over, memories of no summer to speak of, due to the Covid-19 pandemic. This is the first summer, of basically, nothing remembered except quarantine and stress. These feelings led to a beautiful old Irish song, The Last Rose of Summer, which I played for weeks, in order to slide into sleep, each night. I had wanted to share with you, apple recipes; however, the apples turned into sweet wistful roses. ©Joyce Hays, Target Health LLC
When you get a tart to look this beautiful, you sorta hate to eat it. However, no one had this issue, and all were gone rapidly. ©Joyce Hays, Target Health LLC
A neighbor's comment: “First of all, they are simply pretty - Thinly sliced apples and puff pastry rolled to form a delicate rose with just a touch of brown on the tip of the slices. I especially appreciated that they were not overly sweet. Delicious!“
Easy to Eat! ©Joyce Hays, Target Health LLC

Ingredients

2 sheets puffed pastry, thawed (2 sheets make 8 tarts)

2 apples, cored and sliced into 1/4“ thick wedges (keep skin on)

1/4 cup fresh lemon juice

1 teaspoon almond extract

1 cup boiling water

2 Tablespoons + 1/2 cup Honey, raw and unfiltered, if possible

3+ Tablespoons melted butter (to brush onto pastry) and to butter muffin tin.

Finely grated white chocolate for sprinkling after baked tarts have cooled down.

Serve with cool whip or whipped cream or vanilla ice cream. All are delicious with this rose tart.

Just a few easy ingredients to buy. ©Joyce Hays, Target Health LLC

Directions

1. Preheat oven to 3750F.

2. Do all coring, slicing, squeezing, boiling, grating, etc. first

3. Generously, butter a muffin tin. For one batch, I tried buttered paper cupcake cups. This comes out well, but it's more work, and for nothing, unless maybe you wanted to give these rose tarts as a gift. You can also bake in well buttered individual ramekins, which I tried. They look pretty served individually, but then, you can add vanilla ice cream, which I think is the best serving addition.

4. Mix the almond extract with the 1/2 cup honey (I stirred ingredients in a measuring cup)

5. Prepare the liquid ingredients for soaking the apple slices in a medium or large bowl: Boiling water, lemon juice and 2 Tablespoons honey.

6. Place apple slices into the bowl with boiling water, and allow to sit for 10 minutes until softened. After 10 minutes, allow to dry. Place each slice on paper towel. After 5 minutes, turn each slice over to dry for another 5 minutes.

7. With a sharp knife, cut each sheet of puffed pastry into 4 strips. Sprinkle some flour on a surface and with a rolling pin, roll out the width of each individual strip to 3 inches.  Place apple slices along the top half of each strip, overlapping each slice slightly. Brush the bottom half of the pastry with melted butter. Fold bottom half of pastry strip up and over the bottom half of the apple slices. (see photo below).

8. Now, roll the pastry/ apple strip, slowly and gently to create the “rose“ tart.

9. Place the rolled roses into a generously buttered muffin tin, or a pre-oiled (butter) ramekin. If you use ramekins, you can serve this dessert without removing the tart, right in the ramekin, Just be sure to allow it to cool down, then sprinkle grated white chocolate over the rose.

10. Slowly, drizzle remaining 1/2 cup of almond/honey over the top of the roses.

11. Bake for 40-45 minutes, or until golden brown. At 35 minutes, start to closely watch the tarts, so they don't burn, and still allow the edges of the petals to change color, slightly.

12. Allow to cool slightly before removing from tin. Use a knife to push around the outside of the tarts, to loosen them from the muffin tin.

13. Serve the rose tarts warm, with or without cool whip, whipped cream, vanilla ice cream, or simply sprinkle with finely grated white chocolate, after cooling down, a bit. You could also sprinkle with tiny bits of cinnamon, but I prefer not to change the original “look“ of these heavenly tarts, after coming out of the oven. The grated white chocolate, blends in better.

Mixing the honey and almond extract in my measuring cup. ©Joyce Hays, Target LLC
Getting ready to grate the white chocolate. ©Joyce Hays, Target Health LLC
Put the grated white chocolate in a small bowl and set aside. ©Joyce Hays, Target Health LLC
Preparing the liquid ingredients in a bowl, for the apple slices to soak in. ©Joyce Hays, Target Health LLC
Adding fresh lemon juice to the liquid ingredients in the bowl. ©Joyce Hays, Target Health LLC
Even if the apples are slightly discolored when you buy them, it makes no difference after baking. ©Joyce Hays, Target Health LLC
Remove apple core and pits. Keep the skin on. ©Joyce Hays, Target Health LLC
Lovely smell while slicing. ©Joyce Hays, Target Health LLC
Including this photo, just because it's so pretty. ©Joyce Hays, Target Health LLC
Put all the apple slices into the prepared liquid soak. ©Joyce Hays, Target Health LLC
Soak the apple slices for 10 minutes. ©Joyce Hays, Target Health LLC
After 10 minutes of soaking, place each apple slice on paper towel and allow to dry off for another 10 minutes (turn after 5 minutes on one side). ©Joyce Hays, Target Health LLC
Before you place apple slices onto pastry strips, generously butter the muffin tin or individual baking ramekins. ©Joyce Hays, Target Health LLC
Cut the pastry dough into 4 equal strips. ©Joyce Hays, Target Health LLC
First sprinkle some flour under each pastry strip and on top, before you roll.  Roll each strip so that it measures 3 inches in width.  ©Joyce Hays, Target Health LLC
Before you place the apple slices, brush melted butter on the bottom half of each pastry strip. ©Joyce Hays, Target Health LLC
Place the apple slices along the top half of each pastry strip. Be sure you overlap each apple slice, in order to get lovely rose petals. Then carefully pull up and over the bottom half of the pastry, so that it covers half of the apple slices and leaves the other half, untouched, so that they form petals.  ©Joyce Hays, Target Health LLC
Finally, as you see above, roll each strip up until you get to the end. Put each rolled tart into the muffin tin. ©Joyce Hays, Target Health LLC
Here's one rolled up pastry with apple slices, placed into an individual baking cup or ramekin, ready to bake. ©Joyce Hays, Target Health LLC
Here are 12 hand-rolled tarts going into the oven. ©Joyce Hays, Target Health LLC
Just out of the oven, cooling. ©Joyce Hays, Target Health LLC
Here's a close-up of an apple rose tart, slightly cooled, about to be removed from the muffin tin. ©Joyce Hays, Target Health LLC
Ramekins out of oven and cooling down. ©Joyce Hays, Target Health LLC
Two beauties, sprinkled with grated white chocolate. ©Joyce Hays, Target Health LLC
Would a rose (tart) by any other name, taste as sweet? ©Joyce Hays, Target Health LLC
These are NOT hard to make and when you do, you'll want to show them off to everyone! ©Joyce Hays, Target Health LLC
Another neighbor: “The apple roses were the perfect balance between sweet and tartness. The pastry was wonderfully flaky but soft. The texture and flavor of the apple was perfect and subtle in the best way. The added white chocolate and whipped cream was a nice touch and complimented the pastry.“ ©Joyce Hays, Target Health LLC
“A rose is a rose, is a rose!“ ©Joyce Hays, Target Health LLC
Chilled Bailey's Irish Cream was perfect with the Last Rose of Summer Tarts. ©Joyce Hays, Target Health LLC

John McDermott- The Last Rose of Summer

Tianyou Ma performs Ernst's The Last Rose of Summer

Renee Fleming - “Tis The Last Rose Of Summer“

'Tis the last rose of summer,

Left blooming alone;

All her lovely companions

Are faded and gone;

No flower of her kindred,

No rose-bud is nigh,

To reflect back her blushes

Or give sigh for sigh!

I'll not leave thee, thou lone one.

To pine on the stem;

Since the lovely are sleeping,

Go, sleep thou with them;

Thus kindly I scatter

Thy leaves o'er the bed,

Where thy mates of the garden

Lie scentless and dead.

So soon may I follow,

When friendships decay,

And from love's shining circle

The gems drop away!

When true hearts lie wither'd,

And fond ones are flown,

Oh! who would inhabit

This bleak world alone?

"The Last Rose of Summer" is a poem by the Irish poet Thomas Moore. He wrote it in 1805, while staying at Jenkinstown Park in County Kilkenny, Ireland, where he was said to have been inspired by a specimen of Rosa 'Old Blush'. The poem is set to a traditional tune called “Aislean an Oigfear“, or “The Young Man's Dream“, which was transcribed by Edward Bunting in 1792, based on a performance by harper Denis Hempson (Donnchadh ? hAmhsaigh) at the Belfast Harp Festival. The poem and the tune together were published in December 1813 in volume 5 of Thomas Moore's A Selection of Irish Melodies. The original piano accompaniment was written by John Andrew Stevenson, several other arrangements followed in the 19th and 20th centuries.

You can carry on, the torch of peace and brotherhood and simply live by the Golden Rule!

Bon Appetit!

From   Our Table to Yours

Have a Great Week Everyone!

Drug Combination for Treating Mesothelioma

October 5, 2020

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Regulatory

Malignant pleural mesothelioma (MPM) is a life-threatening cancer of the lungs' lining caused by inhaling asbestos fibers that about 20,000 Americans are diagnosed with each year. MPM accounts for most mesothelioma diagnoses, and most patients have an unresectable (unable to be removed with surgery) tumor at time of diagnosis. With currently available therapy, overall survival is generally poor.

The FDA has approved Opdivo (nivolumab) in combination with Yervoy (ipilimumab) for the first-line treatment of adults with malignant pleural mesothelioma that cannot be removed by surgery. This is the first drug regimen approved for mesothelioma in 16 years and the second FDA-approved systemic therapy for mesothelioma.

Opdivo and Yervoy are both monoclonal antibodies that, when combined, decrease tumor growth by enhancing T-cell function. This combination therapy was evaluated during a randomized, open-label trial in 605 patients with previously untreated unresectable MPM. Patients received intravenous infusions of Opdivo every two weeks with intravenous infusions of Yervoy every six weeks for up to two years, or platinum-doublet chemotherapy for up to six cycles. Treatment continued until disease progression, unacceptable toxicity or completion of two years. The objective was to determine if Opdivo in combination with Yervoy improved overall survival compared to chemotherapy.

Results showed that at the time of the analysis, patients who received Opdivo in combination with Yervoy survived a median of 18.1 months while patients who underwent chemotherapy survived a median of 14.1 months. The most common side effects of Opdivo in combination with Yervoy in patients with MPM include: fatigue, musculoskeletal pain, rash, diarrhea, dyspnea (difficulty breathing), nausea, decreased appetite, cough and pruritis (itching). Yervoy can cause serious conditions known as immune-mediated side effects, including inflammation of healthy organs, such as the lungs (pneumonitis), colon (colitis), liver (hepatitis), endocrine glands (endocrinopathies) and kidneys (nephritis). Patients should tell their healthcare providers if they have immune system problems, lung or breathing problems, liver problems, have had an organ transplant, or are pregnant or plan to become pregnant before starting treatment.

The FDA granted approval to Bristol-Myers Squibb Company.

This review was conducted under Project Orbis, an initiative of the FDA Oncology Center of Excellence. Project Orbis provides a framework for concurrent submission and review of oncology drugs among international partners. For this review, FDA collaborated with the Australian Therapeutic Goods Administration (TGA), the Brazilian Health Regulatory Agency (ANVISA), Health Canada, and Switzerland's Swissmedic. The application reviews are ongoing at the other regulatory agencies. FDA approval occurred approximately 5 months ahead of the goal date.

Source: FDA

Decline In Awareness, Treatment and Control of High Blood Pressure

October 5, 2020

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Cardiology

High blood pressure, also called hypertension, is a major risk factor for heart disease. According to the Centers for Disease Control and Prevention (CDC), nearly 108 million Americans have hypertension, with a blood pressure reading of 130/80 millimeters of mercury (mm Hg) or higher or are taking medication for their blood pressure, but only 27 million are considered to have their blood pressure under control, despite it being a condition that can be managed.

According to a recent study published online on Sept. 9 in JAMA, after nearly 15 years on an upward trend, awareness among Americans about high blood pressure and how to control and treat it is now on the decline,. Even with the help of blood pressure medications, some groups, including older adults, are less likely than they were in earlier years to adequately control their blood pressure. According to the authors, this trend could make longstanding efforts to fight heart disease and stroke - leading causes of death in the United States - even more challenging.

The study included 18,262 U.S. adults age 18 and older, with high blood pressure. The definition of hypertension at the time of the study was defined by a blood pressure reading of 140/90 mm Hg or higher or by treating the condition with blood pressure medications. Participants with a blood pressure reading of less than 140/90 mm Hg were categorized as having controlled blood pressure. With data from the National Health and Nutrition Examination Survey (NHANES) taken between 1999 and 2018, the study authors looked at 20-year trends in high blood pressure awareness and treatment and blood pressure control. At the beginning of the survey, participants had their blood pressure measured three times, then averaged. Participants answered yes or no when asked if their doctors told them they had high blood pressure and if they currently took prescribed medication for high blood pressure. Results showed that in 1999-2000, just 70% of participants showed an awareness of their condition. That number increased steadily to 85% in 2013-2014, but declined to 77% in 2017-2018. Of those “aware“ adults, the number who also were taking blood pressure medications remained relatively consistent - 85% in 1999-2000, 89% in 2013-2014, and 88% in 2017-2018.

Of all adults with high blood pressure, the number who managed to control their condition increased from 32% in 1999-2000 to 54% in 2013-2014, but then declined to 44% in 2017-2018. Of those adults with controlled blood pressure, the number taking blood pressure medication increased from 53% in 1999-2000 to 72% in 2013-2014, then declined to 65% in 2017-2018. According to the authors, these observations underscore the importance of continuity of care, including having a usual source of care and regularly scheduled healthcare visits that could increase high blood pressure awareness and treatment and blood pressure control among adults.

Interestingly, when broken down by age, between 2015 to 2018, adults age 60 and older, as well as African Americans as a group, were less likely than adults ages 18 to 44 and whites as a group to have controlled blood pressure. Also, participants with Medicaid as their health insurance, were more likely to have their blood pressure under control than those without health insurance.

According to the authors, the following are several effective strategies that may facilitate increases in blood pressure control rates and reduce health disparities identified in the current study:

1.     Educate patients and providers on blood pressure goals

2.     Add effective blood pressure medications when lifestyle changes aren't enough

3.     Reduce barriers to achieve high medication adherence in a variety of clinical practice settings

Source: NIH

Genes, Blood Type Tied to Risk of Severe COVID-19

October 5, 2020

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COVID-19

The following if from Dr. Francis Collins' Blog, Posted on June 18th, 2020.

As reported, many people who contract COVID-19 have only a mild illness, or sometimes no symptoms at all. But others develop respiratory failure that requires oxygen support or even a ventilator. This happens more often in men than in women, as well as in people who are older or who have chronic health conditions. Thus, why does respiratory failure also sometimes occur in people who are young and seemingly healthy? A recent genome-wide association (GWAS) study, published online in the New England Journal of Medicine (24 February 2020), observed that gene variants in two regions of the human genome are associated with severe COVID-19 and correspondingly carry a greater risk of COVID-19-related death. The findings suggest that people with blood type A face a 50% greater risk of needing oxygen support or a ventilator should they become infected with the novel coronavirus. In contrast, people with blood type O appear to have about a 50% reduced risk of severe COVID-19. The study included 1,980 people undergoing treatment for severe COVID-19 and respiratory failure at seven medical centers in Italy and Spain.

The study analyzed patient genome data for more than 8.5 million so-called single-nucleotide polymorphisms, or SNPs. The vast majority of these single “letter“ nucleotide substitutions found all across the genome are of no health significance, but they can help to pinpoint the locations of gene variants that turn up more often in association with particular traits or conditions?in this case, COVID-19-related respiratory failure. To find these SNPs, the authors compared SNPs in people with severe COVID-19 to those in more than 1,200 healthy blood donors from the same population groups. Study results identified two places that turned up significantly more often in the individuals with severe COVID-19 than in the healthy folks. One of them is found on chromosome 3 and covers a cluster of six genes with potentially relevant functions. For instance, this portion of the genome encodes a transporter protein known to interact with angiotensin converting enzyme 2 (ACE2), the surface receptor that allows the novel coronavirus that causes COVID-19, SARS-CoV-2, to bind to and infect human cells. It also encodes a collection of chemokine receptors, which play a role in the immune response in the airways of our lungs.

The other association signal was found on chromosome 9, over the area of the genome that determines blood type. Whether a person is classified as an A, B, AB, or O blood type, depends on how one's genes instruct blood cells to produce (or not produce) a certain set of proteins. The authors did find evidence suggesting a relationship between blood type and COVID-19 risk, and that this area also includes a genetic variant associated with increased levels of interleukin-6, which plays a role in inflammation and may have implications for COVID-19 as well.

The hope is that these and other findings yet to come will point the way to a more thorough understanding of the biology of COVID-19, and that a genetic test and a person's blood type might provide useful tools for identifying those who may be at greater risk of serious illness.

Source: NIH

Oak Ridge National Laboratory

October 5, 2020

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History of Medicine

An aerial view of the Oak Ridge National Laboratory campus 2014. Photo credit: by Oak Ridge Office of Environmental Management, U.S. Department of Energy - http://energy.gov/orem/cleanup-sites/oak-ridge-national-laboratory, Public Domain; Wikipedia Commons; As a work of the U.S. federal government, the image is in the public domain

Oak Ridge National Laboratory (ORNL) is an American multiprogram science and technology national laboratory sponsored by the U.S. Department of Energy (DOE). Established in 1942, ORNL is the largest science and energy national laboratory in the Department of Energy system and is located in Oak Ridge, Tennessee, near Knoxville. ORNL's scientific programs focus on materials, neutron science, energy, high-performance computing, systems biology and national security. ORNL partners with the state of Tennessee, universities and industries, to solve challenges in energy, advanced materials, manufacturing, security and physics.

The laboratory has several of the world's top supercomputers; among these, Summit is ranked by the TOP500 as the world's second-most powerful supercomputer. The lab also is a leading neutron-science and nuclear-energy research facility that includes the Spallation Neutron Source and High Flux Isotope Reactor.

The town of Oak Ridge was established by the Army Corps of Engineers as part of the Clinton Engineer Works in 1942 on isolated farm land as part of the Manhattan Project. During the war, advanced research for the government was managed at the site by the University of Chicago's Metallurgical Laboratory. In 1943, construction of the “Clinton Laboratories“ was completed, later renamed to “Oak Ridge National Laboratory“. The site was chosen for the X-10 Graphite Reactor, used to show that plutonium can be created from enriched uranium. Enrico Fermi and his colleagues developed the world's second self-sustaining nuclear reactor after Fermi's previous experiment, the Chicago Pile-1. The X-10 was the first reactor designed for continuous operation.

After the end of World War II the demand for weapons-grade plutonium fell and the reactor and the laboratory's 1000 employees were no longer involved in nuclear weapons. Instead, it was used for scientific research. In 1946 the first medical isotopes were produced in the X-10 reactor, and by 1950 almost 20,000 samples had been shipped to various hospitals. Over time, ORNL switched part of its focus to biological research.

The Biosciences Division (BSD) at ORNL is focused on advancing science and technology to better understand complex biological systems and their relationship with the environment. The division has expertise and special facilities in genomics, computational biology, microbiology, microbial ecology, biophysics and structural biology, and plant sciences. This collective expertise includes collaborations within and outside ORNL and focuses on scientific challenges in biology for Department of Energy (DOE) missions in energy and the environment.

BSD is home to the Center for Bioenergy Innovation, a DOE Bioenergy Research Center focused on developing plants and microbes for a new generation of cost-effective, environmentally friendly, and industrially-relevant bioproducts and biofuels. Research also focuses on Plant-Microbe Interfaces, examining the exchange of energy, information, and materials between plants and microbial communities. Understanding the biological processes transforming mercury into the toxin methylmercury in the environment is another focus area.

Scientists in BSD use high-performance computing, artificial intelligence, and genomic algorithms to uncover networks of genes that contribute to complex traits critical in bioenergy, human health, and other focus areas. They leverage ORNL's neutron science capabilities to increase understanding of the myriad structures and interactions inside cells. Researchers are examining the way proteins fold and how the cycling of disordered proteins between various three-dimensional shapes affects how genes are expressed. Fundamental science discoveries about the human microbiome are helping to inform the development of new diagnostics and new treatments for a range of diseases.

Herd Immunity

October 5, 2020

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Quiz

The top box shows an outbreak in a community in which a few people are infected (shown in red) and the rest are healthy but unimmunized (shown in blue); the illness spreads freely through the population. The middle box shows a population where a small number have been immunized (shown in yellow); those not immunized become infected while those immunized do not. In the bottom box, a large proportion of the population have been immunized; this prevents the illness from spreading significantly, including to unimmunized people. In the first two examples, most healthy unimmunized people become infected, whereas in the bottom example only one fourth of the healthy unimmunized people become infected. Graphic credit: by Tkarcher - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=56760604

The primary way to boost levels of immunity in a population is through 1) _____.

Herd immunity (also called herd effect, community immunity, population immunity, or social immunity) is a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity. Immune individuals are unlikely to contribute to disease transmission, disrupting chains of infection, which stops or slows the spread of disease. The greater the proportion of immune individuals in a community, the smaller the probability that non-immune individuals will come into contact with an infectious individual.

Individuals can become immune by recovering from an earlier infection or through vaccination. Some individuals cannot become immune because of medical conditions, such as an immunodeficiency or immunosuppression, and for this group herd immunity is a crucial method of protection. Once the herd immunity threshold has been reached, disease gradually disappears from a population. This elimination, if achieved worldwide, may result in the permanent reduction in the number of infections to zero, called 2) _____. Herd immunity created via vaccination contributed to the eventual eradication of smallpox in 1977 and has contributed to the reduction of other diseases. Herd immunity applies only to contagious disease, meaning that it is transmitted from one individual to another. Tetanus, for example, is infectious but not contagious, so herd immunity does not apply.

Herd immunity was recognized as a naturally occurring phenomenon in the 1930s when it was observed that after a significant number of children had become immune to measles, the number of new infections temporarily decreased, including among the unvaccinated. Mass vaccination to induce herd immunity has since become common and proved successful in preventing the spread of many infectious diseases. Opposition to vaccination has posed a challenge to herd immunity, allowing preventable diseases to persist in or return to populations with inadequate vaccination rates.

Some individuals either cannot develop immunity after vaccination or for medical reasons cannot be vaccinated. Newborn infants are too young to receive many vaccines, either for safety reasons or because passive immunity renders the vaccine ineffective. Individuals who are immunodeficient due to HIV/AIDS, lymphoma, leukemia, bone marrow cancer, an impaired spleen, chemotherapy, or radiotherapy may have lost any immunity that they previously had and vaccines may not be of any use for them because of their immunodeficiency.

A portion of those vaccinated may not develop long-term immunity. Vaccine contraindications may prevent certain individuals from being vaccinated. In addition to not being immune, individuals in one of these groups may be at a greater risk of developing complications from infection because of their medical status, but they may still be protected if a large enough percentage of the population is immune.

High levels of immunity in one age group can create 3) _____ immunity for other age groups. Vaccinating adults against pertussis reduces pertussis incidence in infants too young to be vaccinated, who are at the greatest risk of complications from the disease. This is especially important for close family members, who account for most of the transmissions to young infants. In the same manner, children receiving vaccines against pneumococcus reduces pneumococcal disease incidence among younger, unvaccinated siblings. Vaccinating children against pneumococcus and rotavirus has had the effect of reducing pneumococcus- and rotavirus-attributable hospitalizations for older children and adults, who do not normally receive these vaccines. Influenza (flu) is more severe in the elderly than in younger age groups, but influenza vaccines lack effectiveness in this demographic due to a waning of the immune system with age. The prioritization of school-age children for seasonal flu immunization, which is more effective than vaccinating the elderly, however, has been shown to create a certain degree of protection for the elderly.

Evolutionary pressure: Herd immunity itself acts as an evolutionary pressure on certain viruses, influencing viral evolution by encouraging the production of novel strains, in this case referred to as escape mutants, that are able to “escape“ from herd immunity and spread more easily. At the molecular level, viruses escape from herd immunity through antigenic drift, which is when mutations accumulate in the portion of the viral genome that encodes for the virus's surface antigen, typically a protein of the virus capsid, producing a change in the viral epitope. Alternatively, the reassortment of separate viral genome segments, or antigenic shift, which is more common when there are more strains in circulation, can also produce new serotypes. When either of these occur, memory T cells no longer recognize the virus, so people are not immune to the dominant circulating strain. For both influenza and norovirus, epidemics temporarily induce herd immunity until a new dominant strain emerges, causing successive waves of epidemics. As this evolution poses a challenge to herd immunity, broadly neutralizing antibodies and “universal“ vaccines that can provide protection beyond a specific serotype are in development.

Eradication of diseases: The last confirmed case of rinderpest occurred in Kenya in 2001, and the disease was officially declared eradicated in 2011. If herd immunity has been established and maintained in a population for a sufficient time, the disease is inevitably eliminated - no more endemic transmissions occur. If elimination is achieved worldwide and the number of cases is permanently reduced to zero, then a disease can be declared 4) ____. Eradication can thus be considered the final effect or end-result of public health initiatives to control the spread of infectious disease. The benefits of eradication include ending all morbidity and mortality caused by the disease, financial savings for individuals, health care providers, and governments, and enabling resources used to control the disease to be used elsewhere. To date, two diseases have been eradicated using herd immunity and vaccination: rinderpest and 5) _____. Eradication efforts that rely on herd immunity are currently underway for poliomyelitis, though civil unrest and distrust of modern medicine have made this difficult. Mandatory vaccination may be beneficial to eradication efforts if not enough people choose to get vaccinated.

Free riding: Herd immunity is vulnerable to the free rider problem. Individuals who lack immunity, particularly those who choose not to 6) _____, free ride off the herd immunity created by those who are immune. As the number of free riders in a population increases, outbreaks of preventable diseases become more common and more severe due to loss of herd immunity. Individuals may choose to free ride for a variety of reasons, including the perceived ineffectiveness of a vaccine, believing that the risks associated with vaccines are greater than those associated with infection, mistrust of vaccines or public health officials, band-wagoning or group-thinking, social norms or peer pressure, and religious beliefs. Certain individuals are more likely to choose not to receive vaccines if vaccination rates are high enough so as to convince a person that he or she may not need to be vaccinated, since a sufficient percentage of others are already immune.

Individuals who are immune to a disease act as a barrier in the spread of disease, slowing or preventing the transmission of disease to others. An individual's immunity can be acquired via a natural infection or through artificial means, such as vaccination. When a critical proportion of the population becomes immune, called the 7) ____ ____ ____ ____ or herd immunity level (HIL), the disease may no longer persist in the population, ceasing to be endemic. The critical value, or threshold, in a given population, is the point where the disease reaches an endemic steady state, which means that the infection level is neither growing nor declining exponentially. This threshold can be calculated from the effective reproduction number 8) _____, which is obtained by taking the product of the basic reproduction number R0, the average number of new infections caused by each case in an entirely susceptible population that is homogeneous, or well-mixed, meaning each individual can come into contact with every other susceptible individual in the population, and S, the proportion of the population who are susceptible to infection, and setting this product to be equal to 1.

When the effective reproduction number Re of a contagious disease is reduced to and sustained below 1 new individual per infection, the number of cases occurring in the population gradually decreases until the disease has been eliminated. If a population is immune to a disease in excess of that disease's HIT, the number of cases reduces at a faster rate, outbreaks are even less likely to happen, and outbreaks that occur are smaller than they would be otherwise. If the effective reproduction number increases to above 1, then the disease is neither in a steady state nor decreasing in incidence, but is actively spreading through the population and infecting a larger number of people than usual.

An assumption in these calculations is that populations are 9) _____, or well-mixed, meaning that every individual comes into contact with every other individual, when in reality populations are better described as social networks as individuals tend to cluster together, remaining in relatively close contact with a limited number of other individuals. In these networks, transmission only occurs between those who are geographically or physically close to one another. The shape and size of a network is likely to alter a disease's 10) _____, making incidence either more or less common.

ANSWERS: 1) vaccination; 2) eradication; 3) herd; 4) eradicated; 5) smallpox; 6) vaccinate; 7) herd immunity threshold (HIT); 8) RE; 9) homogeneous; 10) HIT

A Lesson Learned from History on How to Address the COVID-19 Pandemic

October 5, 2020

,
What's New

Wear Masks and Socially Distance - Lessons from the Past: Almost 700 years ago, the overwhelmed physicians and health officials fighting a devastating outbreak of bubonic plague in medieval Italy had no notion of viruses or bacteria, but they understood enough about the Black Death to implement some of the world's first anti-contagion measures. Starting in 1348, soon after the plague arrived in cities like Venice and Milan, city officials put emergency public health measures in place that foreshadowed today's best practices of social distancing and disinfecting surfaces. The Adriatic port city of Ragusa (modern-day Dubrovnik, Croatia) was the first to pass legislation requiring the mandatory quarantine of all incoming ships and trade caravans in order to screen for infection. The order, which survived in the Dubrovnik archives, reads that on July 27, 1377, the city's Major Council passed a law “which stipulates that those who come from plague-infested areas shall not enter [Ragusa] or its district unless they spend a month on the islet of Mrkan or in the town of Cavtat, for the purpose of disinfection.“

For more information about Target Health, contact Kathleen Kane Tremmel, Vice President, Business Development. For those who have been working with Warren Pearlson, Director, New Business Development, please continue to do so. 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

For more information about Target Health, contact Kathleen Kane Tremmel, Vice President, Business Development. For those who have been working with Warren Pearlson, Director, New Business Development, please continue to do so. 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

Peach & Burrata Salad with Candied Pecans & Hot Honey

September 9, 2020

,
Target Healthy Eating

Labor day weekend is always filled with mixed feelings: a wistful summer goodbye, and a hello to new challenges. This different and delicious salad is my summer farewell, never to be forgotten. ©Joyce Hays, Target Health LLC
A neighbor's response: “A delicious salad, served at room temperature, with a beautiful presentation. The flavors of turmeric, chili flakes and basil (fresh and locally grown) were distinct, yet subtle, a nice counterpoint to the creamy Burrata. The candied pecans added a sweet and pleasant crunch. I asked for Seconds!“ ©Joyce Hays, Target Health LLC
No one will be satisfied with one serving. You might as well make double the amount, and let it be the star of the meal. ©Joyce Hays, Target Health LLC
Mmmmmm! ©Joyce Hays, Target Health LLC
An exquisite summer salad. You won't believe how delicious it is! Remember, only use the best sweet juicy peaches, otherwise, wait until they are available. ©Joyce Hays, Target Health LLC

Ingredients

Hot honey

1/2 cup honey (your choice)

1/2 teaspoon turmeric

2 pinches chili flakes (more or less, to your taste)

1 teaspoon extra virgin olive oil

2 garlic cloves

1 anchovy fillet

Candied Pecans (or walnuts)

1/4 cup granulated sugar

2/3 cup toasted pecans or walnuts (you toast them)

Pinch black pepper

Pinch salt (optional)

Main salad

3 medium peaches, washed, dried, then sliced

3/4 cup fresh basil leaves

Burrata (only burrata) - 4 ounces

Lemon wedge

Fresh mint leaves for garnish

Extra virgin olive oil at table (optional)

The only ingredient that might be challenging is finding sweet, juicy, ripe, flavorful peaches. The right delicious peach, is the foundation for this wonderful recipe. Otherwise, I think you will love my farewell to summer salad. ©Joyce Hays, Target Health LLC

Directions

Hot honey

  1. In 1 teaspoon extra virgin olive oil, cook the 2 garlic cloves and the 1 anchovy fillet in a small pot over medium heat. As the garlic becomes soft, begin to mash it with a fork. Also mash the anchovy with fork. Mix everything together to form a paste. The paste should take about 3 minutes to cook
  2. Next, add to the small pot with the paste in it, the honey and bring honey to a simmer. Add the chili flakes, turmeric, pinch black pepper. Stir to combine all ingredients. Reduce to low heat and continue cooking until you see the honey start to bubble. Cook until the bubbling reaches a high point, which should take about 3 minutes, after adding all the ingredients. Now remove from heat and let the honey cool down until it's no longer even warm.
Start by making the garlic/anchovy paste. ©Joyce Hays, Target Health LLC
Honey and all ingredients are reaching a high boil. Now time to remove from heat and allow to cool down completely. ©Joyce Hays, Target Health LLC

Pecans

  1. Toast the pecans (or walnuts) first
  2. Line a baking sheet with parchment.
  3. Using low heat, and a large pot, pour the sugar into an even layer. Heat the sugar until nearly melted.
  4. Add the pecans, pinch salt, pinch black pepper and stir constantly until the melted sugar covers each pecan completely. When caramel begins to smoke, immediately remove from heat.
  5. Now, transfer the pecans to the baking sheet with parchment. Carefully, use 2 nonstick spatulas to separate each pecan and allow to cool completely.
Toast the nuts first. Don't skip this step because they'll taste much better by doing this first. ©Joyce Hays, Target Health LLC
Just getting ready to separate each pecan, then set aside. ©Joyce Hays, Target Health LLC

Salad

  1. Prepare the peaches. Wash, dry with paper towel, then slice.
  2. Heat your honey up with a little olive oil
  3. Here's the fun: Design your salad on a serving platter. Spread the basil leaves into an even layer. Arrange the peach slices as you wish. Squeeze the fresh lemon over the peaches.
  4. Either place the burrata in the center of the platter, with peaches around the platter, or spoon out the burrata on top of the arranged peach slices.
  5. Sprinkle the candied nuts all over the peaches and burrata
  6. Drizzle with the honey/oil mixture. Use a spatula so you do not waste a drop.
  7. Garnish with the fresh mint leaves
  8. Serve with an icy white wine, like Pinot Grigio or Pouilly Fuisse
About to dry the basil leaves, after washing them. ©Joyce Hays, Target Health LLC
Hopefully, you know a good source for juicy ripe, flavorful peaches. It's worth finding out where to get the very best tasting peaches because so many stores carry completely bland, tasteless peaches, which will detract from an otherwise delicious late summer salad. I hate to say this, but if I were you, I would eat one peach first, before buying 3. Unless the flavor is great, I would wait to make this recipe. I don't want anyone to be disappointed or I would never introduce such negativity. ©Joyce Hays, Target Health LLC
Slice your peaches, to about this size. ©Joyce Hays, Target Health LLC
Goodbye Summer Salad ©Joyce Hays, Target Health LLC
Dear Friends, here's a toast to you and to all of us who have weathered a deadly, invisible enemy, that has caused havoc through out the world. To those who have succumbed and/or suffered greatly, our hearts and tears go out to all of you. This tiny virus is bringing disaster to global economies, as well. There will be much wreckage and many pieces to pick up. Hopefully, there will be the recognition that the only solution, to bring back some semblance of order, is for all nations to work cooperatively. There's no other answer but cooperation. ©Joyce Hays, Target Health LLC

I've been obsessed with Bel Canto opera this week. Either ignore these, or join  me with three of the most exquisite duets ever written. Music has helped us get through the Spring and Summer of 2020.

"Qual cor tradisti"..Finale act IV Norma by Vincenzo Bellini

Jose Carreras climbs up to Eb5 against Montserrat Caball?'s huge C6 from Lucia di Lammermoor by Gaetano Donizetti

Gioacchino Rossini pays Tribute to Vincenzo Bellini in his Divine Tenor Duet

You can carry on, the torch of peace and brotherhood and simply live by the Golden Rule!

Bon Appetit!

From Our Table to Yours

Have a Great Week Everyone!

Automated Insulin Delivery and Monitoring System for Use in Young Pediatric Patients

September 9, 2020

,
Regulatory

Patients with Type 1 diabetes, or their caregivers, must consistently monitor their glucose levels throughout the day and inject insulin with a syringe, pen or pump to maintain adequate glucose levels in order to avoid becoming hyperglycemic (high glucose levels) or hypoglycemic (low glucose levels).

The FDA has approved the MiniMed 770G System, a hybrid closed loop diabetes management device that is intended to automatically monitor glucose (sugar) and provide appropriate basal insulin doses with little or no input from the users or their caregivers for use by individuals aged 2 to 6 with type 1 diabetes. The 770G System is a first-of-a-kind device for patients aged 2 to 6 years. It is the first legally marketed device that can automatically adjust insulin delivery based on continuous glucose monitor values for this patient population.

The MiniMed 770G System, a bluetooth-enabled version of the previously approved MiniMed 670G System (with other modifications), is a hybrid closed loop system that works by measuring glucose levels in the body every five minutes and automatically adjusting insulin delivery by either administering or withholding insulin. The system includes: a sensor that attaches to the body to measure glucose levels under the skin; an insulin pump strapped to the body; and an infusion patch connected to the pump with a catheter that delivers insulin. While the device automatically adjusts insulin levels, users need to manually request insulin doses to counter carbohydrate consumption at mealtime.

The FDA evaluated data from a clinical trial that included 46 children aged 2 to 6 years old with type 1 diabetes. Study participants wore the device for approximately three months to evaluate the performance of the device during both the at-home periods, as well as a hotel period, to stress the system with sustained daily exercise. That study found no serious adverse events and that the device is safe for use. Data from that study was used to help support the expanded indication for patients 2 to 6 years old.

Risks associated with use of the system may include hypoglycemia, hyperglycemia, as well as skin irritation or redness around the device's infusion patch. As part of this approval, the FDA is requiring the device manufacturer to conduct a post-market study to evaluate device performance in real-world settings in children between the ages of 2 and 6. This device is not approved for use in children younger than 2 years old and in individuals who require less than eight units of insulin per day.

The approval of the MiniMed 770G hybrid closed loop system was granted to Medtronic.

Source: FDA

The Intellectually and Developmentally Disabled are Disproportionately Affected by COVID-19

September 9, 2020

,
COVID-19

According to a paper out of the Intellectual and Developmental Disabilities Research Centers (IDDRC) Network, and published in the American Journal of Psychiatry (28 August 2020), the COVID-19 pandemic has taken a disproportionate toll on people with intellectual and developmental disabilities (IDDs)

A large number of people with IDD who require in-person care have lost the support of trained caregivers and community service providers due to the pandemic. The authors note that the Centers for Disease Control and Prevention and others have issued guidelines for group homes, schools, and others entrusted with the care of people with IDD. According to the authors, it is vital to ensure that when they return to work, care staff exercise techniques and procedures to protect their clients from infection. Moreover, people with IDD depend on caregivers and loved ones to help them bridge gaps in intellectual and communication abilities. In the absence of this human contact, the authors call for virtual care and support, where viable. Those who cannot benefit from screen-based supports should be prioritized to receive in-person services.

Suspension of classroom time also disproportionately affects children with IDD, who often require special educational services, increased teacher-student ratios, and specialized interventions, many of which need to be administered in person. It is difficult for families to take on these tasks, and qualified in-home surrogates should be mobilized whenever possible to meet this need and to support parents' efforts. Also, people with IDD often cannot verbalize their symptoms during telemedicine appointments, and physicians need to use their best judgement in providing in-person care for them when necessary, according to the authors. The article emphasizes that people with IDD who are infected with COVID-19 should receive equal access to testing and appropriate medical care.

Source: NIH

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