Healthy US Research Articles

Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome

Physicians need information on how to use the first available high-sensitivity troponin (hsTnT) assay in the United States to identify patients at very low risk for 30-day adverse cardiac events (ACE). To determine whether a negative hsTnT assay at 0 and 3 hours following emergency department presentation could identify patients at less than 1% risk of a 30-day ACE. A prospective, observational study at 15 emergency departments in the United States between 2011 and 2015 that included individuals 21 years and older, presenting to the emergency department with suspected acute coronary syndrome. Of 1690 eligible individuals, 15 (no cardiac troponin T measurement) and 320 (missing a 0-hour or 3-hour sample) were excluded from the analyses. Serial hsTnT measurements (fifth-generation Roche Elecsys hsTnT assay). Serial blood samples from each patient were collected after emergency department presentation (once identified as a potential patient with acute coronary syndrome) and 3 hours, 6 to 9 hours, and 12 to 24 hours later. Adverse cardiac events were defined as myocardial infarction, urgent revascularization, or death. The upper reference level for the hsTnT assay, defined as the 99th percentile, was established as 19 ng/L in a separate healthy US cohort. Patients were considered ruled out for acute myocardial infarction if their hsTnT level at 0 hours and 3 hours was less than the upper reference level. Gold standard diagnoses were determined by a clinical end point committee. Evaluation of assay clinical performance for acute myocardial infarction rule-out was prespecified; the hypothesis regarding 30-day ACE was formulated after data collection. In 1301 healthy volunteers (50.4% women; median age, 48 years), the upper reference level was 19 ng/L. In 1600 patients with suspected acute coronary syndrome (48.4% women; median age, 55 years), a single hsTnTlevel less than 6 ng/L at baseline had a negative predictive value for AMI of 99.4%. In 974 patients (77.1%) with both 0-hour and 3-hour hsTnT levels of 19 ng/L or less, the negative predictive value for 30-day ACE was 99.3% (95% CI, 99.1-99.6). Using sex-specific cutpoints, C statistics for women (0.952) and men (0.962) were similar for acute myocardial infarction. A single hsTnT level less than 6 ng/L was associated with a markedly decreased risk of AMI, while serial levels at 19 ng/L or less identified patients at less than 1% risk of 30-day ACE.

Changes in Tonsil B Cell Phenotypes and EBV Receptor Expression in Children Under 5-Years-Old.

Palatine tonsils are principally B cell organs that are the initial line of defense against many oral pathogens, as well as the site of infection for others. While the size of palatine tonsils changes greatly in the first five years of life, the cellular changes during this period are not well studied. Epstein Barr virus (EBV) is a common orally transmitted virus that infects tonsillar B cells. Naïve B cells are thought to be the target of primary infection with EBV in vivo, suggesting that they are targeted by the virus. EBV enters B cells through CD21, but studies of older children and adults have not shown differences in surface CD21 between naïve B cells and other tonsil B cell populations. In this study, we used an 11-color flow cytometry panel to detail the changes in B cell subpopulations in human tonsils over the first five years of life from 33 healthy US children. We provide reference ranges for tonsil B cell subpopulations over this age range. We show that the frequency of naïve tonsil B cells decreases over the early years of life, and that naïve B cells expressed higher surface levels of CD21 relative to other tonsil B cell populations. We show that young children have a higher frequency of naïve tonsil B cells, and importantly that these cells express increased surface EBV receptor, suggesting that young children have a larger pool of cells that can be infected by the virus. © 2017 International Clinical Cytometry Society.

Design and implementation of a cross-sectional nutritional phenotyping study in healthy US adults

BackgroundMetabolic imbalance is a key determinant of risk of chronic diseases. Metabolic health cannot be assessed solely by body mass calculations or by static, fasted state biochemical readouts. Although previous studies have described temporal responses to dietary challenges, these studies fail to assess the environmental factors associated with certain metabolic phenotypes and therefore, provide little scientific rationale for potentially effective intervention strategies.Methods/designIn this phenotyping study of healthy US adults, we are evaluating lifestyle, biological and environmental factors in addition to metabolic parameters to determine the factors associated with variations in metabolic health. A series of practical fitness, dietary, and emotional challenges are introduced and temporal responses in various areas of specialization, including immunology, metabolomics, and endocrinology, are monitored. We expect that this study will identify key factors related to healthy or unhealthy metabolic phenotypes (metabotypes) that may be modifiable targets for the prevention of chronic diseases in an individual.DiscussionThis study will provide novel insights into metabolic variability among healthy adults in balanced strata defined by sex, age and body mass index. Usual dietary intake and physical activity will be evaluated across these strata to determine how diet is associated with health status defined using many indicators including immune function, metabolism, body composition, physiology, response to exercise andmeal challenges and neuroendocrine assessment. A principal study goal is to identify dietary and other personal factors that will differentiate different levels of "health" among study participants.Trial registrationClinicalTrials.gov NCT02367287.

Deployed Sailor With an Acute Presentation of WIlson Disease

A 23 year old previously healthy US Sailor was evacuated from Bahrain after presenting to a local hospital with dyspnea on exertion, abdominal swelling, jaundice, cognitive decline, and months of fatigue. Patient had no past medical or surgical history and was an infrequent drinker. Family history was notable for an uncle with schizophrenia who died of cirrhosis presumed to be from alcohol in his early 40s. Examination demonstrated hypomimia, bradyphrenia, bradykinesia, Kayser-Fleischer rings, jaundice, new ascites, but no asterixis. Labs were notable for pancytopenia with platelets of 37K, an absolute neutrophil count (ANC) 111, and a coombs negative hemolytic anemia. Alkaline phosphatase was 133, Aspartate aminotransferase was 81, Alanine aminotransferase was 57, and total bilirubin was 1.9. Presentation INR was 2.8, with a calculated MELD sodium of 26. A contrast MRI showed multiple basal ganglia signal abnormalities. On arrival in Germany, ceruloplasmin was low at 8 mg/dL. 24 hour urine copper collection was performed and treatment was subsequently initiated with oral zinc based on a presumptive diagnosis of Wilson disease. Subsequent transjugular liver biopsy was performed with an elevated HVPG of 12 confirming portal hypertension. Small esophageal varices were noted on EGD. Wilson disease is a rare autosomal recessive disease with a worldwide incidence approaching 1 in 30,000 that results from copper accumulation and injury to affected tissues. Defects in the ATP7B gene, which encodes transmembrane transport of copper within hepatocytes, play a role in the disease. Key clinical features include liver disease, neuropsychiatric changes, Kayser-Fleischer rings, and coombs negative hemolytic anemia. However, given significant variability in disease presentation, both the European Association for the Study of Liver Disease (EASL) and the American Association for the Surgery of Liver Disease (AASLD) have proposed criteria to aid in diagnosis. Using the EASL criteria, the diagnosis was made approximately 8 days earlier, although ultimately the patient met the requirements from both societies. This atypical presentation of jaundice and constitutional symptoms in a deployed sailor highlights the potential advantages of the EASL criteria which do not require 24 hour urine copper which is not readily accessible in a deployed setting.

Objective Measures of Physical Activity and Cardiometabolic and Endocrine Biomarkers.

Although physical activity is an established risk factor for chronic disease prevention, the specific mechanisms underlying these relationships are poorly understood. We examined the associations between total activity counts and moderate-vigorous physical activity (MVPA) measured by accelerometer, and physical activity energy expenditure measured by doubly labeled water, with plasma levels of proinsulin, insulin, c-peptide, insulin growth factor binding protein-3, insulin growth factor-1, adiponectin, leptin, and leptin-sR. We conducted a cross-sectional analysis of 526 healthy US women in the Women's Lifestyle Validation Study, 2010 to 2012. We performed multiple linear regression models adjusting for potential lifestyle and health-related confounders to assess the associations between physical activity, measured in quartiles (Q) and biomarkers. Participants in Q4 versus Q1 of total activity counts had lower proinsulin (-20%), c-peptide (-7%), insulin (-31%), and leptin (-46%) levels, and higher adiponectin (55%), leptin-sR (25%), and insulin growth factor-1 (9.6%) levels (all P trend ≤ 0.05). Participants in Q4 versus Q1 of MVPA had lower proinsulin (-26%), c-peptide (-7%), insulin (-32%), and leptin (-40%) levels, and higher adiponectin (31%) and leptin-sR (22%) levels (all P trend ≤ 0.05). Further adjustment for body mass index (BMI) attenuated these associations, but the associations with adipokines remained significant. Those in Q4 versus Q1 of physical activity energy expenditure had lower leptin (-21%) and higher leptin-sR (10%) levels (all P trend ≤ 0.05), after additional adjustment for BMI. In the sensitivity analysis, the associations were similar but attenuated when physical activity was measured using the subjective physical activity questionnaire. Our data suggest that greater physical activity is modestly associated with favorable levels of cardiometabolic and endocrine biomarkers, where the strongest associations were found with accelerometer-measured physical activity. These associations may be only partially mediated through BMI, further supporting the role of physical activity in the reduction of cardiometabolic and endocrine disease risk, independent of adiposity.

Pregnancy in women with nonclassic congenital adrenal hyperplasia: Time to conceive and outcome.

Nonclassic congenital adrenal hyperplasia (NCAH) is common among Ashkenazi Jews (1:400). It is associated with various degrees of postnatal virilization, irregular menses and infertility. Therapy of symptomatic subjects consists of physiologic doses of glucocorticoids. The objective of this study was to evaluate the effect of glucocorticoid treatment on fertility and on pregnancy outcome in women with NCAH. This retrospective study included 75 women diagnosed with NCAH who were followed in our clinic and sought fertility between 2008 and 2015. Seventy-two women succeeded in conceiving (187 pregnancies). Time to conception was 4.0±7months without and 3.3±3months with glucocorticoid therapy (P=.43). Seventeen pregnancies were achieved by glucocorticoid therapy after failure to conceive spontaneously. Time to conception before therapy initiation was 10.2±11.4months compared to 3.3±3.4months after therapy initiation (P=.02). Of 187 pregnancies, 135 (72%) resulted in live births, 38 (20.3%) ended in spontaneous miscarriages during the first trimester, seven (3.7%) were electively terminated, three (1.6%) were ectopic and four (2.1%) were ongoing during the study with similar rate in glucocorticoid treated and untreated pregnancies. The 96% pregnancy rate among our cohort of NCAH females was similar to the 95% rate reported for the normal population. Glucocorticoid therapy may shorten the time to conceive in a subgroup of women with NCAH. Glucocorticoid therapy did not affect the rate of first trimester miscarriage. Our 77% live birth rate was similar to the 72% live birth rate in the current healthy US population.

Reprint of: Thawing frozen capital markets and backdoor bailouts: Evidence from the Fed's liquidity programs

Abstract During the subprime crisis, the Federal Reserve introduced several emergency liquidity programs as supplements to the discount window (DW): TAF, PDCF, and TSLF. Using data on loans to large commercial banks and primary dealers, we find that the programs were used by relatively few institutions and thus provided limited relief to banks that relied on short-term debt markets. Although usage increased after Lehman's bankruptcy, most commercial banks avoided the DW and TAF. We also find that the programs were more often used by failed European banks than by healthy US banks, likely because these loans are expensive relative to private market funds. Our results also show that usage of PDCF and TSLF programs, while higher, was more often used by primary dealers in weaker financial position.

Intestinal Carriage of Third-Generation Cephalosporin-Resistant and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Healthy US Children.

The epidemiology of antibiotic-resistant Enterobacteriaceae intestinal carriage in healthy US children has not been well characterized. Children between 14 days and 14 years of age were enrolled during well-child visits in Oakland, California, Kansas City, Kansas, and Nashville, Tennessee, between December 2013 and March 2015. Data on recent antibiotic use by the child and travel and hospitalization history of all members of each child's household were obtained with a risk-factor survey. Stool specimens collected from the subjects were screened for extended-spectrum β-lactamase-producing (ESBL-P) bacteria using CHROMagar ESBL medium. Putative ESBL-P Escherichia coli and Klebsiella colonies underwent phenotypic confirmation by double-disk synergy testing; confirmed third-generation cephalosporin-resistant (3GCR) isolates underwent additional antibiotic-susceptibility testing. In 519 subjects, the overall 3GCR Enterobacteriaceae carriage rate was 4.4% (n = 23) and ranged from 3.4% to 5.1% among the study sites. The ESBL-P Enterobacteriaceae carriage rate was 3.5% (n = 18). The rates of 3GCR Enterobacteriaceae carriage was highest in 1 to <2 year olds at 6.5%, and was 5.2% in <5 year-olds vs 1.7% in ≥5-year-olds (P = .11). 3GCR and ESBL-P Enterobacteriaceae carriage was associated with international travel within the previous year; 11.1% of ESBL-P Enterobacteriaceae carriers reported this history compared with 1.6% of noncarriers (P = .004). No other queried factor was found to increase risk. Of the 24 analyzed 3GCR isolates, 58% were multidrug resistant. The 3GCR Enterobacteriaceae carriage rate exceeds 5% in healthy US children <5 years of age. International travel within the previous year increased the risk of 3GCR and ESBL-P Enterobacteriaceae carriage. In contrast, we found no differences in the rates of hospitalization or recent antibiotic exposure between carriers and noncarriers. Young children, who have the highest prevalence of colonization, might be a sentinel population to study to gain a better understanding of community sources of antibiotic-resistant Enterobacteriaceae.

Antibody-dependent NK cell control of Plasmodium falciparum infection

Abstract Plasmodium falciparum (P.f) infection is a major cause of morbidity and mortality world-wide where symptoms and death occur as a result of the blood stage of the P.f. life cycle. To date, there is no effective blood stage malarial vaccine. Natural Killer (NK) cells are key players in the control of hematopoietic cancers and viral infections, however their role in blood stage malaria is unknown. We undertook a comprehensive analysis of NK cell phenotype and function in a cohort of subjects from a malaria clinical study in Mali, Africa. Using an unbiased analysis of different NK cell subsets, we found that ‘adaptive’ NK cells (lacking FcR gamma chain) increased with age and correlated with reduced malaria risk. Adaptive NK cells had enhanced antibody dependent cellular cytotoxicity (ADCC) function relative to other NK cell subsets. Antibodies are known to be protective in malaria, however the mechanism of this protection is still being elucidated. We hypothesized the protective mechanism of adaptive NK cells may be adaptive NK cells pairing with malaria antibodies to clear infected RBCs via ADCC. In a parallel study, we have shown that NK cells from healthy US donors can inhibit the growth of Plasmodium falciparum 3D7 strain in vitro in the presence of IgG from malaria-exposed adults. Adaptive NK cells from Mali also have enhanced ADCC to infected RBCs. This work indicates that protective antibodies may pair with the strong ADCC activity of adaptive NK cells to protect human subjects from malaria symptoms. These findings thus open a new avenue for vaccine development exploring antibody-dependent cell mediated killing of malaria parasites.

A healthier US diet could reduce greenhouse gas emissions from both the food and health care systems

The standard US diet contributes to greenhouse gas emissions (GHGE) from both the food system, and from the health system through its contribution to non-communicable diseases. To estimate the potential for diet change to reduce GHGE and improve public health, we analyzed the effect of adopting healthier model diets in the USA on the risk of disease, health care costs, and GHGE. We found that adoption of healthier diets reduced the relative risk of coronary heart disease, colorectal cancer, and type 2 diabetes by 20–45%, US health care costs by US$B 77–93 per year, and direct GHGE by 222–826 kg CO2e capita−1 year−1 (69–84 kg from the health care system, 153–742 kg from the food system). Emission reductions were equivalent to 6–23% of the US Climate Action Plan’s target of a 17% reduction in 2005 GHGE by 2020, and 24–134% of California’s target of 1990 GHGE levels by 2020. However, there is potential for investment of health care savings to result in rebound up to and greater than 100%, which would increase net GHGE. Given the urgency of improving public health and of mitigating GHGE over the short term, the potential contribution of diet change, and the options for reducing rebound, deserve more research in support of policy.

Depressive Symptoms Are Positively Associated with Time Spent Sedentary in Healthy Young US Adults

Introduction: Sedentary time and depressive symptoms are positively associated in elderly adults and adults with chronic disease; however, little is known about this relationship in generally healthy young adults. The purpose of this study was to investigate the association between objectively measured sedentary time and depressive symptoms in a large sample of healthy young adults. Methods: Time spent sedentary and in moderate-to-vigorous physical activity (MVPA) was measured in 430 participants (49% men; 28 ± 4 years; 25.5 ± 3.3 kg/m2) using the SenseWear Mini Armband over a 10-day period. The Profile of Mood States depression scale was administered to assess depressive symptoms. Independent samples t tests investigated differences in MVPA, time spent sedentary, and Profile of Mood States scores between males and females. Linear regression analyses, adjusting for MVPA, sex, and body mass index, were employed to examine associations between sedentary time and depressive symptoms. Results: Mean time spent sedentary while awake was 681 ± 94 min/d. Holding MVPA constant, depressive symptoms were positively associated with sedentary time (β = 1.80; P < 0.01; R2 = 0.54). This association was statistically significant in males (β = 2.06; P < 0.01; R2 = 0.59) but not females (P = 0.10). Conclusions: Depressive symptoms are positively associated with time spent sedentary in healthy young US adults, independent of MVPA, particularly in men. A reduction in sedentary time may provide a valuable, low cost, option in the prevention of depressive symptoms.

Red cell distribution width and risk of cardiovascular mortality: Insights from National Health and Nutrition Examination Survey (NHANES)-III

IntroductionRed cell distribution width (RDW) has been linked to cardiovascular disease. We sought to determine whether addition of RDW improved the Framingham risk score (FRS) model to predict cardiovascular mortality in a healthy US cohort. MethodsWe performed a post-hoc analysis of the National Health and Nutritional Examination Survey-III (1988–94) cohort, including non-anemic subjects aged 30–79years. Primary endpoint was death from coronary heart disease (CHD). We divided the cohort into three risk categories: <6%, 6–20% and >20%. RDW>14.5 was considered high. Kaplan-Meier survival curves and Cox proportional hazards models were created. Discrimination, calibration and reclassification were used to assess the value of addition of RDW to the FRS model. ResultsWe included 7005 subjects with a mean follow up of 14.1years. Overall, there were 233 (3.3%) CHD deaths; 27 (8.2%) in subjects with RDW>14.5 compared to 206 (3.1%) in subjects with RDW≤14.5 (p<0.001). Adjusted hazard ratio of RDW in predicting CHD mortality was 2.02 (1.04–3.94, p=0.039). Addition of RDW to FRS model showed significant improvement in C-statistic (0.8784 vs. 0.8751, p=0.032) and area under curve (0.8565 vs. 0.8544, p=0.05). There was significant reclassification of FRS with a net reclassification index (NRI) of 5.6% (p=0.017), and an intermediate-risk NRI of 9.6% (p=0.011). Absolute integrated discrimination index (IDI) was 0.004 (p=0.02), with relative IDI of 10.4%. ConclusionsOur study demonstrates that RDW is a promising biomarker which improves prediction of cardiovascular mortality over and above traditional cardiovascular risk factors.

Diverse evolutionary patterns of pneumococcal antigens identified by pangenome-wide immunological screening

Characterizing the immune response to pneumococcal proteins is critical in understanding this bacterium's epidemiology and vaccinology. Probing a custom-designed proteome microarray with sera from 35 healthy US adults revealed a continuous distribution of IgG affinities for 2,190 potential antigens from the species-wide pangenome. Reproducibly elevated IgG binding was elicited by 208 "antibody binding targets" (ABTs), which included 109 variants of the diverse pneumococcal surface proteins A and C (PspA and PspC) and zinc metalloprotease A and B (ZmpA and ZmpB) proteins. Functional analysis found ABTs were enriched in motifs for secretion and cell surface association, with extensive representation of cell wall synthesis machinery, adhesins, transporter solute-binding proteins, and degradative enzymes. ABTs were associated with stronger evidence for evolving under positive selection, although this varied between functional categories, as did rates of diversification through recombination. Particularly rapid variation was observed at some immunogenic accessory loci, including a phage protein and a phase-variable glycosyltransferase ubiquitous among the diverse set of genomic islands encoding the serine-rich PsrP glycoprotein. Nevertheless, many antigens were conserved in the core genome, and strains' antigenic profiles were generally stable. No strong evidence was found for any epistasis between antigens driving population dynamics, or redundancy between functionally similar accessory ABTs, or age stratification of antigen profiles. These results highlight the paradox of why substantial variation is observed in only a subset of epitopes. This result may indicate only some interactions between immunoglobulins and ABTs clear pneumococcal colonization or that acquired immunity to pneumococci is an accumulation of individually weak responses to ABTs evolving under different levels of functional constraint.

Association between telomere length and complete blood count in US adults.

IntroductionTelomere length (TL) is related to age-related health outcomes, but little is known about the relationship between TL and complete blood count (CBC) parameters. We aimed to determine the relationship between TL and CBC in a sample of healthy US adults.Material and methodsParticipants in the National Health and Nutrition Examination Survey (NHANES) recruited between 1999 and 2002 who had essential data on total CBC and TL were studied. We computed age- and race-adjusted mean values for total CBC using analysis of covariance (ANCOVA). All statistical analyses accounted for the survey design and sample weights by using SPSS Complex Samples v22.0 (IBM Corp, Armonk, NY).ResultsOf the 8892 eligible participants, 47.8% (n = 4123) were men. The mean age was 41.8 years overall, 41.0 years in men and 42.6 in women (p = 0.238). The sex-stratified ANCOVA showed no significant difference in the total CBC across TL quartiles (all p > 0.05) in both sexes. In the adjusted model, there was a significant negative relationship with monocyte count (β = –0.051, 95% CI: –0.422; –0.142), mean cell hemoglobin (β = –0.051, 95% CI: –0.038; –0.011) and red cell distribution width (β = –0.031, 95% CI: –0.054; –0.003), while there was a significant positive relationship with basophil ratio (β = 0.046, 95% CI: 0.049–0.171).ConclusionsThese results support the possibility that telomere attrition may be a marker for reduced proliferative reserve in hematopoietic progenitor cells.

The Medical Cost Savings of Changes to Healthier US Diets

The Medical Cost Savings of Changes to Healthier US Diets

Immediate Hypersensitivity Reaction Related to Rabies Post-Exposure-Prophylaxis in Thailand with Subsequent Rabies Vaccine Change to Avoid Polygeline Vaccine Excipient with Successful Challenge and Treatment Tolerance in the United States

Background Untreated rabies is fatal, globally killing 60,000 persons/years. Rabies vaccine (RV) is life-saving, of various types and used in high-risk rabies exposure (HRRE) as a post-exposure prophylaxis (PEP) series of initial (RV-i) and completion (RV-c) doses. Polygeline has been implicated in immediate allergic reactions to tick-borne encephalitis vaccine and is an excipient in Rabipur, a purified chick embryo vaccine (PCECV) as part of Thai Red Cross (TRC) RV protocol. In United States, RVs are Rabavert (PCECV), containing polygeline, and Imovax Rabies, a human diploid cell vaccine (HDCV) that does not. RV-associated adverse reactions occur up to 6% as mostly non-IgE/skin-limited or immune complex and rarely nonfatal anaphylaxis. We describe TRC-RV-immediate allergic reaction in a male child traveling in Thailand and how after his return to United States , we were able to overcome RV-PEP delays and demonstrate safe treatment tolerance with a different RV.Methods Review of literature, Thai/US RV and Allergy Protocols, Pink Book/RV InsertsResultsA healthy 4-years old US boy had HRRE from feral cat bite in Thailand with immediate disseminated hives at 1 hour post-TRC-RVi (Day 0), resolved with oral antihistamine. Upon US return (Days 3-8), clinicians stopped RV-PEP due to RV allergy fears; Day 6 rabies-immunoglobulin given. On Day 9, US academic Allergist/Infectious Disease referral done: no other medical problems found; HDCV skin prick test (negative); TRC-RV (not available); two-step HDCV-RV challenge performed (10%, then full); Days 13 and 20, HDCV-RV-c full tolerated; Days 30+, asymptomatic; serum tryptase 3.2 ng/ml; Rapid Fluorescent Foci Inhibition Test (RFFIT)Conclusion RV type I hypersensitivity reactions are uncommon, components to RVs vary worldwide and such adverse RV reactions should not stop RV-PEP. Analysis of vaccine content, exposures, and relevant testing is critical to deducing likely reaction type and candidate antigens as excipients in non-RVs and across RV types. IgE-vaccine tests may not be reliable/possible and mid-series RV change to non-polygeline type may be a viable option when RV-c must be done to reach timely RV-c-PEP treatment tolerance and avoid hypersensitivity reactions.Disclosures All authors: No reported disclosures.

Thawing frozen capital markets and backdoor bailouts: Evidence from the Fed's liquidity programs

During the subprime crisis, the Federal Reserve introduced several emergency liquidity programs as supplements to the discount window (DW): TAF, PDCF, and TSLF. Using data on loans to large commercial banks and primary dealers, we find that the programs were used by relatively few institutions and thus provided limited relief to banks that relied on short-term debt markets. Although usage increased after Lehman's bankruptcy, most commercial banks avoided the DW and TAF. We also find that the programs were more often used by failed European banks than by healthy US banks, likely because these loans are expensive relative to private market funds. Our results also show that usage of PDCF and TSLF programs, while higher, was more often used by primary dealers in weaker financial position.

Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample.

BackgroundShort sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity.MethodsWe examined various aspects of sleep in relation to adiposity in 2005–2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression (N = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass.ResultsSnoring was associated with higher BMI (adjusted difference in kg/m2 comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted.ConclusionIn a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.Electronic supplementary materialThe online version of this article (doi:10.1186/s40608-016-0128-y) contains supplementary material, which is available to authorized users.

Medicare expenditure higher in least healthy US cities

Medicare expenditure higher in least healthy US cities

The Role of Body Habitus in Predicting Cardiorespiratory Fitness: The FRIEND Registry.

This study aimed to validate and cross-validate a non-exercise prediction model from a large and apparently healthy US cohort of individuals who underwent an analysis of body habitus (waist circumference (WC) and body mass index (BMI)) with measured CRF. The large cohort (5 030 individuals) was split into validation (4 030) and cross-validation (1 000) groups, whereby waist circumference and maximal aerobic capacity (VO2max) were assessed by rigorously approved laboratories. VO2max was estimated in 2 multiple regression equations using age, sex and either WC (r=0.77; standard error of the estimate (SEE) 6.70 mLO2∙kg(-1)∙min(-1)) or BMI (r=0.76; SEE 6.89 mLO2∙kg(-1)∙min(-1)).Cross-validation yielded similar results. However, as VO2max increased, there was increased bias, suggesting VO2max may be underestimated at higher values. Both WC and BMI prediction models yielded similar findings, with WC having a slightly smaller SEE. These measures of body habitus appear to be adequate in predicting CRF using non-exercise parameters, even without a measure of physical activity. Caution should be taken when using these equations in more fit individuals.