Welcome to this week’s Health and Fitness.
A spoon, a spoon, what’s the difference? It’s a spoon. Well, in medicine, as in baking, it’s a big difference. The teaspoon and tablespoon that came with that dinner set aren’t accurate measures. When a prescription says a teaspoon, it means 5 ml, a tablespoon is 15 ml, not more not less. The reason is that too much or too little is bad for you and can be dangerous. Most over the counter cough and cold remedies come with a measured cap as a cup. If you get prescribe liquid medication, ask the pharmacist for a measured cup or spoon so you get the correct amount of medication. This especially important with children, as the article from the NYT notes, most over doses are medication errors. So just as in baking where you use a measuring spoon so the cake rises as it bakes, use a measured spoon or cup to take liquid medication.
Many people still use kitchen spoons to measure a dose of liquid medication. Now new research shows that the size of the spoon influences our ability to estimate the right dose – and most of the time, we get it wrong.
A 1992 study of dosing errors reported to poison control centers found that failing to distinguish between teaspoons and tablespoons was a major cause for overdosing of cough and cold medicines and liquid acetaminophen. Although too much cough medicine is typically not a major health worry, many liquid medications contain acetaminophen, the active ingredient in Tylenol. Acetaminophen overdose is a major health concern and can lead to serious illness, liver failure and even death. And while small dosing errors may not seem like a major concern, excessive doses can add up and make it relatively easy to exceed the recommended daily limit, now four grams.
Researchers at the Cornell University Food and Brand Lab have conducted several studies showing how large plate size, oversize ice-cream bowls and wide-rimmed drinking glasses can lead to overindulgence of foods and beverages. Given that so many parents use kitchen spoons to dispense liquid medication, the researchers decided to study how the size of a spoon influenced the amount of medication poured.
As is now custom, I’ll try to include the more interesting and pertinent articles that will help the community awareness of their health and bodies. This essay will not be posted anywhere else due to constraints on my time. Please feel free to make suggestions for improvement and ask questions, I’ll answer as best I can.
This an Open Thread
A type of bacteria that infects many insects may make mosquitoes more resistant to viruses that can be dangerous to humans, researchers have found.
The discovery could be helpful in the battles against two painful and sometimes fatal diseases, dengue and chikungunya.
Last year, researchers showed they could take Wolbachia bacteria from fruit flies and infect mosquitoes with it, cutting their already brief life spans by half. That discovery was important because most of the malaria transmitted by female mosquitoes is transmitted late in their lives. They must pick up the parasites by biting an infected human, and it takes days for them to mature and migrate to the salivary glands to infect the next human bitten.
Now, according a new report in the journal Cell, researchers from Australia and Brazil have shown that the Wolbachia infection makes the Aedes aegypti mosquito more resistant to dengue, which is also known as “breakbone fever,” and to chikungunya, known as “bending-up disease.”
GUANGZHOU, China (Reuters) – China, saddled with the world’s second largest tuberculosis burden after India, is fighting an uphill battle against drug-resistant forms of the disease which will only drain the country’s health budget.
Drug-resistant TB, far more expensive to treat, emerges when patients fail to follow treatment regimens and take substandard drugs or stop treatment too early.
Liu Zhongwu, a stonecutter working in southern China, for example, stopped taking his TB medication midway through a standard six-month course in 2007 because it was too costly.
“Even though one or two drugs were free, I had to pay 500 yuan ($73) a month for other drugs (to reduce side effects) and the side effects were bad, I suffered terrible gastric pain and had to stop work, I didn’t even have energy to walk,” said Liu.
HONG KONG (Reuters) – More than 2 billion people, or a third of the world’s total population, are infected with Mycobacterium tuberculosis, the bacteria that causes tuberculosis.
Tuberculosis is the world’s seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of three primary diseases that are closely linked to poverty, the other two being AIDS and malaria.
NEW YORK (Reuters Health) – Doctors are more likely to prescribe antibiotics to treat cough in patients who smoke, but smokers get no more benefit from the drugs than non-smokers do, a large study from Europe shows.
People who smoke get more respiratory infections, and are more likely to develop pneumonia, Dr. Naomi Stanton of Cardiff University in Wales and her colleagues note. But the jury’s out on whether chronic coughs last longer in smokers than in non-smokers, they add, and there is no evidence on whether smokers will get more benefit from antibiotic treatment for cough than smokers will.
NEW YORK (Reuters Health) – While some research has suggested that moderate drinking may lower a person’s odds of suffering a stroke, a new study finds that it may have little long-term impact on stroke risk or stroke severity.
The findings, reported in the journal Stroke, come from a more than two-decade follow-up of nearly 22,000 U.S. male doctors. Researchers found that overall, there was no strong association between the men’s drinking habits and their odds of suffering a stroke.
Nor was there a clear connection between alcohol intake and the severity of disability following a stroke.
CHICAGO (Reuters) – The radiation risk from full-body scanners used to improve airport security is low and unlikely to raise an individual’s risk of cancer, U.S. experts said on Wednesday.
Airports in Britain, the Netherlands and Canada have said they plan to use full-body scanners to foil future terror attempts like the Christmas Day attempt to blow up a Detroit-bound flight.
NEW YORK (Reuters Health) – Getting enough selenium in your diet could help protect you from cancer of the esophagus, a large new study suggests.
People with the highest levels of this antioxidant mineral were at the lowest risk of developing squamous cell carcinoma of the esophagus, Dr. Jessie Steevens of Maastricht University Medical Center in The Netherlands and her colleagues found.
The amount of selenium in the soil where food is grown determines its selenium content. There’s some evidence for a link between selenium levels and stomach and esophageal cancer, and Steevens and colleagues say it’s important to look at subtypes of these cancers separately because they are likely to have different causes.
CHICAGO (Reuters) – Prolonged exposure to cocaine can cause permanent changes in the way genes are switched on and off in the brain, a finding that may lead to more effective treatments for many kinds of addiction, U.S. researchers said on Thursday.
A study in mice by Ian Maze of Mount Sinai School of Medicine in New York and colleagues found that chronic cocaine addiction kept a specific enzyme from doing its job of shutting off other genes in the pleasure circuits of the brain, making the mice crave the drug even more.
The study helps explain how cocaine use changes the brain, said Dr. Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health, which funded the study published in the journal Science.
LONDON (Reuters) – The more scientists look, the more complex cancer seems to become.
British scientists said on Wednesday they had found a batch of new gene mutations linked to kidney cancer, suggesting even this apparently “straightforward” cancer type can be divided into subtypes requiring tailored treatment.
Clear cell renal cell carcinoma (ccRCC), the most common type of kidney cancer, stands out from other cancers because it is remarkably consistent and the majority of cases are known to be driven by mutations in a single gene, called VHL.
Yet when researchers conducted a large DNA sequencing study of more than 3,500 genes from around 100 tumor samples, they found evidence that additional mutations in other genes were also driving cells to become cancerous.
Three of the genes were involved in modifying proteins called histones, which help package DNA into chromosomes and are critical to the functioning of cells, they reported in the journal Nature.
NEW YORK (Reuters Life!) – It may still seem to be in the realm of science fiction, but nearly half of Americans believe cloning organs will be routine by 2020, according to a new poll.
Forty-nine percent of 2,841 people questioned in a Zogby interactive survey said use of stem cells and cloned organs will be commonplace in the next decade.
“Also, more than one-third say it is likely by 2020 that computer chips will be implanted in humans, robots will perform manual labor, and virtual reality will be a staple of home entertainment,” the polling group said in a statement.
Twenty-eight percent of people questioned envisioned a cure for cancer in 10 years, 13 percent expect regular commercial travel to space and a equal number believe human life will be extended by 50 to 100 years.
EW YORK (Reuters Health) – Drinking warm water seems to relax the bowel and improve the comfort of colonoscopy, as well as the “completeness” of the procedure, hint findings of a study from Korea.
Colonoscopy involves inserting a thin, flexible scope into the colon to look for cancer or polyps, which are growths that can become cancerous. With colonoscopy, the entire length of the colon can be inspected. It is considered the most sensitive way to screen for colon cancer.
NEW YORK (Reuters Health) – If you’re planning a trek into the wild, you might want to pack jeans instead of shorts. A new study suggests that a layer of denim offers at least some protection from rattlesnake bites.
It might seem logical that any barrier between you and a rattlesnake’s fangs would be a good thing. But it has not been clear whether ordinary clothing can actually reduce the amount of venom that penetrates the skin.
In the new study, researchers at Loma Linda University in California looked at whether denim might offer some venom protection.
Drs. Shelton S. Herbert and William K. Hayes used latex gloves filled with saline to simulate a human appendage, then exposed the gloves to bites from small and large southern Pacific rattlesnakes. Some of the latex “limbs” were covered in a layer of denim.
BEIJING (Reuters) – The H1N1 strain of flu is rapidly spreading into China’s vast countryside and there could be a spike in cases around the Lunar New Year period when millions head back to their home towns, the health ministry said.
The world’s most populous nation has reported 648 deaths to date from what is often called swine flu, a tiny portion of the estimated 12,220 deaths around the globe, but has launched a massive vaccination campaign.
“Outbreaks in Beijing, Shanghai, other large cities and in schools have seen an obvious decline, but the virus continues to spread into villages and communities,” the Health Ministry said in a statement on its website (www.moh.gov.cn).
WASHINGTON (Reuters) – The United States has made no decision on whether to cancel or sell any of its orders for the H1N1 vaccine, unlike some European countries with a vast oversupply of shots, a federal health official said on Thursday.
Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said demand remains steady and the government’s focus is on getting as many people vaccinated as possible.
New infections of H1N1 influenza have fallen sharply in recent weeks, leaving some governments with an oversupply of vaccines ordered to protect against the virus that emerged last spring.
NEW YORK (Reuters Health) – Pregnant women tempted to induce labor for convenience rather than medical necessity may want to wait for nature to take its course.
Dr. J. Christopher Glantz at the University of Rochester School of Medicine found that inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.
NEW YORK (Reuters Health) – Young children whose mothers took folic acid supplements in late pregnancy may have an increased risk of developing asthma, a new study hints.
The findings, published in the American Journal of Epidemiology, appear to be the first to link mothers’ use of folic acid in pregnancy to their children’s later asthma risk.
Researchers emphasize that it is too early to give pregnant women any specific advice based on the results.
Moreover, the study does not implicate folic acid use in early pregnancy.
CHICAGO (Reuters) – Mammograms should begin at 40 for women with an average risk of breast cancer and by 30 for high-risk women, according to guidelines released on Monday by two groups that specialize in breast imaging, contradicting controversial guidelines from a U.S. advisory panel last year.
The joint recommendations from the American College of Radiology and the Society of Breast Imaging take into account the success of annual mammography screening starting at 40, said Dr. Carol Lee of Memorial Sloan-Kettering Cancer Center in New York, whose study appears in the Journal of the American College of Radiology.
WASHINGTON (Reuters) – Enzyme-blocking chemicals in pomegranates may reduce the risk of estrogen-fueled breast cancers, U.S. researchers said on Tuesday.
An acid found in pomegranates appears to block aromatase, an enzyme that converts androgen to estrogen, a hormone that plays a role in the development of breast cancer, the researchers wrote in the journal Cancer Prevention Research.
“We identified some of these chemicals in pomegranates that actually have properties that can suppress aromatase,” researcher Shiuan Chen, of the City of Hope cancer research and treatment center in Duarte, California, said in a telephone interview.
NEW YORK (Reuters Health) – White, middle-aged women working in British civil service jobs may want to keep an eye on their blood sugar. Those reporting high levels of job strain and little work-related social support appear to be at increased risk for developing type 2 diabetes, according to a new study.
Such clerical and support jobs usually involve high demands but limited control over job tasks and schedules, study investigator Alex Heraclides, a PhD student at University College London noted in an email to Reuters Health.
NEW YORK (Reuters Health) – A new study provides more evidence that acupuncture can help ease hot flashes in women with breast cancer who are being treated with the “anti-estrogen” drug tamoxifen. Acupuncture, researchers found, is free of side effects and has a side benefit for some women: an increased sex drive.
“Acupuncture appears to be at least as effective as drug therapy,” Dr. Eleanor M. Walker of Henry Ford Hospital in Detroit and her colleagues report, “and it may provide additional and longer-term benefits without adverse effects.”
Breast cancer patients with estrogen-sensitive tumors are typically given estrogen-blocking drugs for years at a time. These drugs, which include tamoxifen, bring on menopausal symptoms like hot flashes and night sweats.
NEW YORK (Reuters Health) – Injectable birth control is known to lower bone density, but women may be able to limit the loss by not smoking and getting even moderate amounts of calcium, a new study hints.
The findings, say researchers, show that not all women are at equal risk of bone loss from using depot medroxyprogesterone (DMPA) — better known by the brand-name Depo Provera.
DMPA is given by injection about once every three months, and is generally considered an effective, convenient and low-cost form of birth control. The contraceptive can, however, lead to significant bone loss.
GENEVA (Reuters) – One in 10 of the some 130 million births around the world each year is premature, the vast majority in poorer countries where chances of survival are low, the World Health Organization (WHO) said on Monday.
An article in the U.N. agency’s January bulletin also reported a “dramatic rise” in pre-term births in a range of richer countries over the past 20 years, especially in North America and parts of Europe.
NEW YORK (Reuters Health) – Overweight middle-aged men may have a higher risk of heart problems, diabetes and strokes and die earlier than their thinner peers — even in the absence of some traditional risk factors, a new study suggests. Of course, these men can manage these diseases with the help of men’s socks, medications and exercise, however, it can be certainly tough at times.
Some past research has suggested that when obese and overweight adults do not have the so-called metabolic syndrome, their risks of diabetes, heart disease, and stroke are no higher than those of normal-weight people.
NEW YORK (Reuters Health) – Two disorders that seem completely unrelated except that each is the focus of massive drug company ad campaigns may actually have something in common: Older men who suffer from restless legs syndrome at night are almost twice as likely to have erectile dysfunction as those without restless legs, researchers report.
Dr. Xiang Gao, of the Harvard School of Public Health, Boston, and his colleagues studied more than 23,000 male dentists, optometrists, veterinarians and other health professionals, who would complete health-related surveys at regular intervals.
NEW YORK (Reuters Health) – A new study provides further evidence that the measles-mumps-rubella vaccine is not associated with an increased risk of autism.
Concerns that the MMR shot could cause autism were first raised a decade ago by British physician Andrew Wakefield, who, based on a study of 12 children, proposed that there was a link between the vaccine and bowel disease and autism.
That research has since been widely discredited, and numerous international studies have failed to find a connection between MMR vaccination and autism.
NEW YORK (Reuters Health) – While some studies have implicated gas appliances in children’s risk of respiratory ills, a new report suggests that gas cooking stoves may have only a small effect on most children’s lung function.
Studies over the years have come to conflicting conclusions as to whether gas stoves affect children’s lung function. But some research has suggested that the appliances can worsen existing asthma, or possibly raise children’s risks of developing asthma, allergies or other respiratory ills.
Gas appliances, particularly when not properly ventilated, can release nitrogen dioxide into the home. Nitrogen dioxide is a pollutant produced by fuel-burning appliances that is known to irritate the airways and eyes.
NEW YORK (Reuters Health) – Earlier bedtimes make for happier teens, a new study in the journal Sleep suggests.
Adolescents whose parents enforced bedtimes of 10 p.m. or earlier were significantly less likely to be depressed and to have suicidal thoughts than their peers whose parents allowed them to go to bed at midnight or later, Dr. James E. Gangwisch of Columbia University Medical Center in New York City and his colleagues found.
“It’s kind of a common idea that older adolescents don’t need as much sleep as younger adolescents, but that’s really not true–they still need about 9 hours of sleep at night,” Gangwisch told Reuters Health.
WASHINGTON (Reuters) – A study in mice suggests using cellphones may help prevent some of the brain-wasting effects of Alzheimer’s disease, U.S. researchers said on Wednesday.
After long-term exposure to electromagnetic waves such as those used in cell phones, mice genetically altered to develop Alzheimer’s performed as well on memory and thinking skill tests as healthy mice, the researchers wrote in the Journal of Alzheimer’s Disease.
The results were a major surprise and open the possibility of developing a noninvasive, drug-free treatment for Alzheimer’s, said lead author Gary Arendash of the University of South Florida.
NEW YORK (Reuters Health) – US adults being treated for mental illness are more likely to be prescribed two or more drugs today than a decade ago.
Although little is known about whether they work or what the long-term side effects might be, psychiatric drug combinations are increasingly being used to treat a wide range of mental illness including anxiety, depression, panic disorder, posttraumatic stress disorder, bipolar disorder and schizophrenia, a report published Monday suggests.
“We have to figure out if these combinations are adding any benefits to patients,” Dr. Ramin Mojtabai of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland told Reuters Health.
CHICAGO (Reuters) – Mild to severe depression might be better treated with alternatives to antidepressant drugs, which do not help patients much more than an inactive placebo, researchers said Tuesday.
Combining data from six studies that examined the effectiveness of two commonly prescribed antidepressants — paroxetine and imipramine — found the drugs produced benefits only slightly greater than a placebo in patients with mild to severe depression.
“They would have done just as well or just about as well with a placebo,” said Robert DeRubeis, a psychologist at the University of Pennsylvania, Philadelphia, who with colleagues performed the meta-analysis.
NEW YORK (Reuters Health) – People who take newer drugs for schizophrenia and other psychotic conditions are supposed to have their blood sugar and cholesterol levels checked regularly but many don’t, according to a study released today.
These so-called “second-generation” antipsychotic drugs, which include olanzapine (Zyprexa), risperidone (Risperdal) and aripiprazole (Abilify), were developed because older antipsychotics have significant side effects. However, the newer drugs are known to significantly increase blood sugar and cholesterol levels, raising the risk for diabetes and heart disease.
TORONTO (Reuters Health) – Less than a quarter of Americans eats the five daily servings of fruits and vegetables that the National Cancer Institute recommends, but online programs may help boost those numbers, a new study hints.
As part of the Making Effective Nutrition Choices study, some 2500 people logged on to a website providing information on the benefits of eating more fruits and vegetables and ways to incorporate these healthy foods into their diets.
Three months into the study about 70 percent of subjects were eating five or more servings of fruits and vegetables on an average day, up from 20 percent at the starting point. That increase held for the rest of the year-long study.
NEW YORK (Reuters Health) – Offering young kids a vegetable choice at dinner may not prompt them to eat more of these healthy foods, hint findings from a Dutch study.
Since vegetable eating is generally not popular among youngsters, Dr. Cees de Graaf, at Wageningen University in the Netherlands, and colleagues compared whether offering 4 to 6 year old children their choice of a vegetable before or at dinner, or no choice, might alter the amount of vegetable the kids actually ate.
NEW YORK (Reuters Health) – A number of studies have linked chronic sleep deprivation to a heightened risk of obesity, diabetes and heart disease. Now, a small study suggests that low levels of physical activity during the day may partly account for the connection.
In a study of 15 healthy men, researchers found that a couple nights of grabbing only four hours of sleep caused the men to curtail their physical activity compared with days where they had gotten the standard eight hours the night before.
In contrast, there was no evidence that sleep loss altered blood levels of appetite-regulating hormones or caused the men to eat more the next day — effects that have been seen in a number of previous studies.
For the salad:
2 heads frisée, tender light green leaves only, washed and dried (about 6 cups), or 6 cups mixed baby lettuces, washed and dried
1 tablespoon chopped fresh herbs, such as parsley, tarragon or chives
1 sweet red pepper, very thinly sliced
6 thin slices baguette or whole grain bread, toasted, rubbed with a cut clove of garlic and cut into squares
6 large or extra-large eggs
1 tablespoon vinegar (any kind)
Salt and freshly ground pepper to taste
1 teaspoon fresh thyme leaves
For the dressing:
2 tablespoons sherry vinegar, champagne vinegar or red wine vinegar
1 teaspoon balsamic vinegar
Salt to taste
1 teaspoon Dijon mustard
1 small garlic clove, minced or pureed
1/3 cup extra virgin olive oil, or 1/4 cup extra virgin olive oil and 2 tablespoons walnut oil
1. Combine the lettuce, herbs, red pepper and croutons in a large bowl.
2. Poach the eggs. Fill a lidded frying pan with water, and bring to a boil. Add 1 tablespoon vinegar to the water. One at a time, break the eggs into a teacup, then tip from the teacup into the pan (do this in batches if necessary). Immediately turn off the heat under the pan and cover tightly. Leave for four minutes. Lay a clean dish towel next to the pan, and using a slotted spoon or spatula, carefully remove the poached eggs from the water. Set on the towel to drain.
3. Whisk together the vinegars, salt, mustard and garlic. Whisk in the oil. Toss with the salad until thoroughly coated, and distribute among six salad plates. Top each serving with a poached egg. Season the egg with salt and pepper to taste, sprinkle with some thyme leaves and serve.
Yield: Serves six.
Advance preparation: You can poach the eggs up to a day ahead. Keep in a bowl of water in the refrigerator. Drain on a kitchen towel before assembling the salad. The lettuces can be washed and dried, and held in plastic bags in the refrigerator overnight.
1 pound waxy potatoes, cut in 1-inch dice
2 tablespoons finely minced red onion, soaked for five minutes in cold water, then drained, rinsed, and drained on paper towels
2 tablespoons sherry vinegar
1 tablespoon freshly squeezed lemon juice
Salt to taste
1 small garlic clove, green shoot removed, minced or pureed
1 teaspoon Dijon mustard
1/3 cup extra virgin olive oil
3 tablespoons plain low-fat yogurt
Freshly ground pepper to taste
2 tablespoons finely chopped fresh herbs, such as parsley, tarragon, chives, chervil or dill
6 ounces green beans, trimmed and broken in half
2 ounces feta cheese, crumbled
1 6-ounce bag baby spinach
1. Steam the potatoes above 1 inch boiling water for 10 minutes or until tender. Meanwhile, whisk together the vinegar, lemon juice, salt, garlic, Dijon mustard, olive oil and yogurt.
2. When the potatoes are tender, remove from the heat and toss at once with 1/4 cup of the dressing, the onion, herbs, and salt and pepper to taste.
3. Add the green beans to the steamer pot, and steam for five minutes. Remove from the heat, refresh briefly with cold water, drain well and toss with the potatoes, 2 more tablespoons of the dressing and the feta. In a separate bowl, toss the spinach with the remaining dressing. Top with the potatoes and beans, and serve.
Yield: Serves four as a main dish or six as a side dish.
Advance preparation: You can prepare everything several hours ahead. Reverse the order of preparation if you want the potatoes to be warm, steaming them at the last minute.
8 large eggs, hard-boiled (see below) and finely chopped
1 cup finely chopped fresh herbs, such as parsley, dill, tarragon, chervil or chives
2 celery stalks, finely chopped
1 small red onion, finely chopped, soaked for five minutes in cold water, drained and rinsed
Salt and freshly ground pepper to taste
1 tablespoon white wine vinegar or sherry vinegar
2 tablespoons freshly squeezed lemon juice
1/3 cup plain low-fat yogurt or buttermilk
1 tablespoon Hellmann’s or Best Foods mayonnaise
1 garlic clove, green shoot removed, minced
1 teaspoon Dijon mustard
2 tablespoons extra virgin olive oil
1 6-ounce bag baby arugula
To hard-boil the eggs, place in a saucepan, cover with cold water and bring to a boil. Cover the pan tightly, and turn off the heat. Let sit for 12 minutes. Fill a bowl with ice water, drain the eggs and chill immediately in the ice water.
1. Combine the chopped eggs, herbs, celery and red onion in a large bowl, and season to taste with salt and pepper.
2. Whisk together the vinegar, lemon juice, yogurt, mayonnaise, mustard and olive oil. Season to taste with salt and pepper. Toss with the egg mixture.
3. Line plates or a platter with arugula, top with the egg salad and serve.
Yield: Serves four to six.
Couscous tabbouleh is popular throughout France. In summer, add a pound of finely chopped tomatoes to the mix.
1 cup couscous
Salt to taste
1/2 teaspoon ground cumin
1/2 cup freshly squeezed lemon juice
1 cup warm water
1/4 cup extra virgin olive oil
1 cup finely chopped flat-leaf parsley
1/4 cup finely chopped mint
1 red bell pepper, seeded and diced
1 small cucumber, diced
Small romaine lettuce leaves for scoops
1. Put the couscous in a glass or ceramic bowl, and toss with the salt and cumin. Mix together 1/4 cup of the lemon juice and the water, and pour over the couscous. Let sit for 30 minutes, stirring the mixture from time to time or rubbing between your fingers and thumbs to prevent it from lumping. Cover with a plate, and microwave on 100 per cent power for one minute; or line a steamer with a kitchen towel, place the couscous in it and steam for 10 minutes. Carefully remove the plate, or remove from the steamer, and return to the bowl. Stir in the remaining lemon juice and the olive oil, and allow to cool. Toss with the remaining ingredients, except the lettuce leaves. Taste and adjust seasonings. Refrigerate until ready to serve. Serve, using the romaine lettuce leaves as scoopers.
Yield: Serves four to six.
Advance preparation: The salad will hold for several hours in the refrigerator.