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Blade runners: The future of prosthetics – WNDU-TV

Posted: November 26, 2019 at 9:49 am

They are called blade runners, elite athletes who are among the fastest in the world.

They are fastest running with only one or even no legs, and they are among the first to break records with a new generation of prosthetics.

In this Medical Moment, we examine the science behind the blades.

Running faster, stronger, longer that's what brings Alex and Jessica to University of Colorado Boulder and Dr. Alena Grabowski.

"I had a little baby foot, but that was amputated when I was a year old," Jessica Heims said.

"I had cancer when I was 8," Louisiana State University student Alex Klein said.

Grabowski is helping these amputees sprint onto the world stage.

"We're at a place right now where athletes are very high-caliber and they're working extremely hard to be able to compete at the highest levels, and I'm hoping that we can start to keep up with them," said Grabowski, who specializes in biomechanics.

She is focused on optimizing a prosthetics stiffness, height, weight, shape.

"How they move, how they walk, run, sprint, hop, jump," she continued.

Today they're using cameras and sensors to measure how these sprinters move, track their force and test these new carbon fiber blades.

"I'm on a sprinting blade, which, when I jog on it, it feels different because it's thicker," Heims said.

In one video, world class sprinter Blake Leeper, born without legs, is leading the way. He is being called the fastest human on earth, and in Grabowski's lab was clocked at about 25 mph.

She believes this is just the beginning, giving young sprinters around the world a chance to compete against the best in the world.

"I don't feel like anything is holding me back," Klein said. "I feel like I can do whatever, whenever I want."

"That first day I felt like I could just run forever and never stop," Heims said.

It's still to be decided if amputees like Leeper will be allowed to run in the 2020 Olympics in Tokyo. The International Association of Athletics Federations banned amputees from running against other runners after a German study concluded that blades allowed the runner to expend 25% less energy, even though researchers at Rice University concluded that was false, stating that blades put the runners at a disadvantage because they pushed off with less force than a biological limb would.

MEDICAL BREAKTHROUGHSRESEARCH SUMMARYTOPIC: 4663 BLADE RUNNERS: FUTURE OF PROSTHETICSREPORT: MB #4663

BACKGROUND: Prosthetics designed for athletes have a 40 year legacy. These ingenious "blade" prosthetics shied away from earlier heavy designs and focused on the mechanics of muscle movement. Their invention spurred an athletic renaissance in which amputees run competitive distances, climb mountains, and downhill ski. Running blades were invented by American inventor Van Phillips, who lost his lower leg in a water- skiing accident in 1976. Depressed by the limited athletic function of prosthetics at the time, he enrolled as a student at Northwestern University Medical School's Prosthetic-Orthotic Center. He quickly recognized that while most prosthetics tried to mimic human bones, he could focus on replicating ligaments and tendons. He came up with the idea for running blades by observing animals like kangaroos and cheetahs, as well as the mechanics of diving boards and pole vaulting. The result was Flex-Foot his model of carbon fiber blade prosthetics and the name of his company. His contribution to the history of prosthetic legs has inspired generations of athletic amputees. (Source: https://www.amputee-coalition.org/running-blade-prosthetics/)

CARE: A prosthesis can be particularly subject to perspiration as it is enclosed in a plastic socket. This can be a source of odor and bacteria, as well as the culprit behind skin problems. Sprinkling the residual limb with baking soda, or if needed, apply an over-the-counter antiperspirant such as CertainDri may help. The more consistently the prosthesis is worn, the more the residual limb will adjust to being inside the socket, with perspiration naturally subsiding. It's important to keep a good supply of prosthetic socks on hand. Swelling and volume fluctuation may occur but a shrinker sock is useful to reduce swelling and should be worn when you are not wearing your prosthesis. (Source: http://hangerclinic.com/limb-loss/resources/living-with/Pages/Limb-and-prosthesis-care.aspx)

NEW RESEARCH: Alena Grabowski, PhD, Biomechanics at CU Boulder talked about the hurdles for developing better a better prosthesis, "Running's a little bit trickier than walking because it's so much faster. So if I were to try to design a running-specific prostheses that would enhance running, it would be something that had a very lightweight motor, something that allowed very quick feedback, something that was actually connected to the person so the person could actually drive that prosthesis, not just react to it. And so, there's a lot of aspects that would have to be perfect to really make that prosthesis work the best." (Source: Alena Grabowski, PhD)

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Blade runners: The future of prosthetics - WNDU-TV

Mother who thought her Slimming World diet was working is diagnosed with pancreatic cancer – Stock Daily Dish

Posted: November 26, 2019 at 9:49 am

A mother-of-three was left devastated when her impressive turned out to be stage two pancreatic cancer.

Liz Oakley, 65, from East Kilbride, Scotland, felt smug when she noticed the pounds dropping off after she embarked on a low-fat diet in October 2017.

But, by the following December, she began feeling nauseous, with her urine turning an unusually dark hue.

By January last year, her skin had yellowed, leaving her looking tangoed, which prompted her to see a doctor.

She was then given the shock diagnosis on January 6 her third brush with cancer after she battled the disease in her breasts in 2007 and 2012.

Ms Oakley said: I am a resilient person, but this knocked the stuffing out of me. It came from nowhere.

I was referred to hospital and doctors said theyd found a blockage. I have no idea how, but in that moment, I just knew. I told them, Its cancer, isnt it?

I was told I was stage two, but if Id waited much longer, I wouldnt be here now. Thats how quick this disease is.

Ms Oakley, who has three grown-up children Louise, 35, Peter, 33, and Aiden, 30 fought off breast cancer with radiotherapy and then a mastectomy.

After enjoying a few years of good health, she started losing weight at the end of 2017.

I had joined a slimming group a couple of months before, so I was happy, as I thought it was working very well,Ms Oakley said.

I was actually feeling quite smug, telling people it was because I hadnt snacked on any mince pies before Christmas as I usually would.

Pancreatic cancer is one of the most lethal forms of the disease.

Around 95 percent of people who contract it die from it.

Joan Crawford, Patrick Swayze and Luciano Pavarotti all died of pancreatic cancer.

It is the fourth-leading killer in the United States.

Around 10,000 people are diagnosed with pancreatic cancer each year in the UK, and 50,000 in the US.

WHAT IS THE CAUSE?

It is caused by the abnormal and uncontrolled growth of cells in the pancreas a large gland in the digestive system.

WHO HAS THE HIGHEST RISK?

Most cases (90 percent) are in people over the age of 55.

Around half of all new cases occur in people aged 75 or older.

One in 10 cases are attributed to genetics.

Other causes include age, smoking and other health conditions, including diabetes.

WHY IS IT SO LETHAL?

There is no screening method for pancreatic cancer.

Pancreatic cancer typically does not show symptoms in the early stages, when it would be more manageable.

Sufferers tend to start developing the tell-tale signs jaundice and abdominal pain around stage 3 or 4, when it has likely already spread to other organs.

WHAT ARE THE TREATMENT OPTIONS?

The only effective treatment is removal of the pancreas.

This proves largely ineffective for those whose cancer has spread to other organs.

In those cases, palliative care is advised to ease their pain at the end of their life.

By the end of December, feeling nauseous and with a poor appetite, Ms Oakley noticed her urine was very dark.

After her daughter said her skin had turned an odd colour, she knew she had to see a doctor.

She asked me why I was such a yellowy, orange colour, Ms Oakley said.

I was wearing tinted glasses, so hadnt actually noticed, but when I took them off, I looked like Id been tangoed.

Calling the NHS 111 non-emergency number, Ms Oakley went to Kents Medway Maritime Hospital, where she was immediately admitted.

Doctors sprang into action, running a series of tests, and soon discovered a worrying blockage in her pancreas.

She was then officially diagnosed with pancreatic cancer and referred to south Londons Kings College Hospital for surgery.

The care I received was incredible. Everything just flowed, and my appointment for surgery was made right away, Ms Oakley said.

Back home after my diagnosis, I did what we all do and Googled my condition. I was reading all these awful stories and poor survival rate statistics, and just didnt want that to me be.

I couldnt see much about people getting through and coming out the other side of a diagnosis. My way of coping was just to isolate myself from those statistics.

Just 12 days after her diagnosis, Mrs Oakley went under the knife to remove her pancreas, duodenum, gall bladder and bile duct.

While she remains eternally grateful she was seen so quickly, she was astonished by her rapid deterioration as she waited for her surgery.

I lost over two stone in a few weeks. I was shocked at what a frail old lady I became, she said. But I feel so lucky to have received the care I did.

I want people to know it is possible. You read about misdiagnosis and getting fobbed off, but Im living proof you can survive if everythings done properly.

She continues to have regular scans and meets with consultants to discuss her ongoing care.

Due to the precarious position of her tumour near some blood vessels doctors cannot guarantee the disease has gone for good but, for now, Ms Oakley is feeling positive.

Since her diagnosis, she has been supported by the charity Pancreatic Cancer UK, and is backing their call for the Government to aim for all pancreatic cancer patients to be treated within 20 days of diagnosis.

And she hopes telling her story will raise awareness of the symptoms of pancreatic cancer such as back and abdominal pain, unexplained weight loss, changes to bowel habits, jaundice, nausea, and problems digesting food.

People know the signs of breast cancer, they know the signs of testicular, they know to see a doctor if they find a lump but they arent aware of pancreatic cancer, Ms Oakley.

I had no idea myself that my symptoms could be linked.

Pancreatic cancer is dreadful, and it takes more lives than it leaves, but not every story is doom and gloom. Here I am, a year on, doing things I never thought I would.

If it hits again five years down the line, thats still five years longer than I would have got. I absolutely believe that we can beat this if more people get diagnosed quicker.

Pancreatic Cancer UK is calling on the UK Government and devolved administrations to set a new ambition to treat all patients diagnosed with pancreatic cancer in 20 days by 2024.

More than 90,000 people have already signed the petition to Demand Faster Treatment which closes on 18 February. Sign the petition .

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Mother who thought her Slimming World diet was working is diagnosed with pancreatic cancer - Stock Daily Dish

5 Best Companies for Health Insurance in SC Benzinga – Benzinga

Posted: November 26, 2019 at 9:49 am

Getting health insurance for 2020 doesnt need to be a long or stressful process. Use our quick guide on everything you need to know about the best health insurance plans in South Carolina before you choose a health insurance provider.

How do you get health insurance for the upcoming decade? First, lets go over how health insurance works and the total amount youll pay for coverage.

Health insurance is a type of protection that safeguards your finances against the rising cost of health care. If you dont have health insurance and you get into a car accident, you might be responsible for paying tens of thousands of dollars in hospital bills. But if you have health insurance, your insurance will cover the bulk of your expenses. Health insurance is an absolute must-have because an accident can happen at any time to anyone.

Most Americans get their health insurance through their employer or through the governments Medicare program if theyre over 65 years old. However, if youre self-employed or an independent contractor, you can still buy an independent plan through the Affordable Care Act (ACA) marketplace. Create an account on Healthcare.gov to be directed to the marketplace and explore your choices.

When you compare plans, you might have trouble understanding what exactly youll pay for each plan. Lets go over the total cost of individual health insurance.

First, youll get a premium. Your premium is the amount of money you pay to your insurance company every month to keep your coverage current. You must pay your premium every month even if you dont use your benefits during a specific month. If you do need to use your health insurance, youll pay 100% of your health care costs until you reach your deductible. Your plan deductible can range from $0 to a few thousand dollars, depending on your plan provider.

Once you reach your deductible, you pay coinsurance. Your coinsurance is a percentage of your care costs you pay after you meet your deductible. Your insurance covers whatevers left over. For example, lets say you go to the doctor and receive a bill for $100. If you have a 20% coinsurance rate, youll pay $20 your insurance will pay the remaining 80%.

This continues until you hit your annual out-of-pocket maximum. Your out-of-pocket maximum is the maximum amount that youll pay for your health care costs in a single year. Once you reach your maximum, your insurance covers 100% of your health care costs after that point. Once the new year arrives, all of these numbers reset and you must reach your deductible again.

The average adult with an individual health insurance plan in South Carolina pays about $527 each month for his or her health insurance. You may qualify for subsidies through the Marketplace if you have very low income. Begin by creating an account on Healthcare.gov to see which subsidies you may qualify for.

When you start shopping for health insurance, youll likely see multiple types of plans offered by a single insurance company. Understand each acronym to help ensure that you choose the best plan for your needs. These are the 3 most common plan types youll see in the ACA Marketplace:

The ACA introduced a set of essential benefits that every long-term insurance provider must offer with each of its plans. Every plan on the Marketplace covers at least these required services:

Your plan must also cover FDA-approved birth control if youre a woman. This coverage extends from birth control pills to Plan B. You may not have access to this benefit if you get your insurance through your employer and you work for a religious institution or nonprofit.

By law, your insurance provider must only offer coverage for the essential benefits listed above. This means that most insurance providers dont extend their coverage beyond these benefits. Here are some exclusions youll likely see on your insurance plan.

Lets take a closer look at some of the best insurance providers youll see on the Marketplace.

Blue Cross and Blue Shield of South Carolina is the only South Carolina-native company that offers health insurance to residents of the Palmetto State.

Blue Cross and Blue Shield prides itself on its selection of affordable individual policies. It has individual health insurance options and $0 premiums available, though these plans do include higher deductibles and coinsurance percentages. Blue Cross and Blue Shield also offers access to one of the largest South Carolina-specific state networks. No matter where you live, youll be able to find a doctor near you.

BlueChoice is another statewide health insurance provider in South Carolina. It offers plans in most ZIP codes. BlueChoice plan holders get access to a number of benefits and discounts for additional health services which range from local fitness centers to Jenny Craig weight-loss programs.

Its mobile app contains all the information you need to use your benefits on the go, and it even offers virtual consultation functionality. You can also sign up for text messages to remind you of upcoming visits, appointments and due dates.

UnitedHealthcare might be right for you if youre looking for an insurance provider that offers a wide range of plan options. UnitedHealthcare offers ACA-compliant family and individual plans and group plans for business owners.

UnitedHealthcare also offers affordable short-term health insurance plans, dental and vision coverage and Medicare supplement options. UnitedHealthcare offers a plan for everyone, from standard individual policies to supplemental policies for those with special needs.

Absolute Total Care offers South Carolina residents a simpler way to get signed up for a plan and understand its benefits. Absolute Total Cares plans include discounts for taking proactive steps to improve your health, like joining a gym or losing weight.

Its Ambetter Telehealth service allows you to chat with a doctor on the phone at any hour of the day or night and its online resources allow you to quickly see which prescription drugs are included on each plan. These 2 factors can be a huge benefit if you take a higher-tier prescription medication that isnt covered under other insurance plans.

Aetna is another nationwide health insurance company that offers everything from individual ACA plans to Medicare supplemental options.

One of the biggest benefits of getting your insurance through Aetna is that you gain access to its useful and intuitive online health portal. You can search for prescription drugs, view doctors offices in your area that accept your insurance and manage your claims. Aetnas website is also helpful if youre new to the health insurance Marketplace. It offers plenty of information in easy-to-understand terms.

No matter which health insurance plan you choose, your journey begins with a trip to the ACA Marketplace. Begin by visiting Healthcare.gov and signing up for a Marketplace account. Just enter some information about your address, your income and your personal information and youll be matched up with plans that offer coverage in your area. Remember to leave yourself plenty of time to compare insurance options before you choose a plan Open Enrollment for 2020 ends December 15.

1

Q: Is health insurance required?

asked 2019-11-25

Sarah Horvath

1

The federal mandate that required health insurance has been lifted but some states have enacted state-level mandates that require residents to have health insurance. Even where not required, health insurance can protect your family against catastrophic healthcare costs and help make routine medical expenses more predictable. Get your most affordable quote through our top providers today.

answered 2019-11-25

Benzinga

1

Q: What does health insurance cover?

asked 2019-11-25

Sarah Horvath

1

Most health insurance plans provide the 10 essential health benefits that were part of Obamacare requirements. Coverages include preventative and wellness services, prescription drug coverage, emergency services, ambulatory services, lab services, pediatric services, and more. Many plans cover a wider range of healthcare expenses but may cost more than basic plans or may have higher out-of-pocket costs for some services.Get a custom health insurance quote to cover you and your family today.

answered 2019-11-25

Benzinga

1

Q: How can I save money on health insurance?

asked 2019-11-25

Sarah Horvath

1

For healthcare plans that comply with the Affordable Care Act, only a handful of rating factors affect your premium. These include age and location, at least one of which cant be changed. Smokers will pay more in most cases and your choice of plan level can affect premiums as well. Choosing a high deductible health insurance plan can reduce the cost of premiums. These plans can be combined with a health savings account to take advantage of tax-free savings for healthcare expenses. Get the cheapest health insurance premium from top providers.

answered 2019-11-25

Benzinga

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5 Best Companies for Health Insurance in SC Benzinga - Benzinga

A picky eater’s guide to surviving Thanksgiving – The Week Magazine

Posted: November 26, 2019 at 9:49 am

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For the first two decades years of my life, if I could have physically and nutritionally sustained myself on peanut butter and jelly sandwiches alone, I would have.

PB&Js, though, are not a Thanksgiving food. And so, every fourth Thursday in November, I found myself getting stress-induced stomach aches when the turkey was put in the oven, dreading the eventual side-eye, the uninvited helpings scooped onto my plate, and the host's inevitable concerned queries of "don't you like it? Aren't you hungry?"

But don't worry, picky eaters: If I could get through it the mashed potatoes of uncertain textures, casseroles harboring who-knows-what beneath their crusts, suspicious stuffings, Brussels sprouts so can you. And if you're hosting a picky eater this year, think twice before you goad, "just try it."

Being an adult picky eater is a unique struggle, because it is a trait unfairly associated with underdevelopment and a lack of sophistication. Children are at least tolerated when they're fussy, but adults are supposed to have grown out of selective palettes; this, admittedly, is what eventually happened to me.

Still, I'm sympathetic to the millions of adult picky eaters out there because I can vividly remember the self-loathing, guilt, and humiliation that was exacerbated on Thanksgiving, the one secular holiday a year that revolves around consuming specific dishes. "It's a really scary thing to overcome," Stephanie Lucianovic, the author of Suffering Succotash: A Picky Eater's Quest to Understand Why We Hate the Foods We Hate, told The New York Times. "People aren't choosing to dislike food. There's a lot of shame involved. There's not a lot of empathy for picky eaters." Yet some 26 percent of adults self-identified as being "picky eaters" in a 2015 survey; even Anderson Cooper has outed himself as a Picky Eating Adult, or PEA.

But day-to-day coping strategies are useless on Thanksgiving, when there is a specific menu and intense pressure to eat some turkey, no seriously, just one bite, you'll like it. What's more, because most Thanksgiving dinners are homemade and lovingly prepared, there can be a risk of offending somebody you care about by refusing to eat their cooking.

Understandable, but there are ways to work around it! Here is what to keep in mind to help you get through the big day.

Don't expect your host to accommodate your hyper-specific tastes

Unless you're the one making Thanksgiving dinner (always a great option!), don't expect the host to have memorized your list of culinary dos and don'ts. Making a meal for a large group of people is stressful enough without having to factor in every cousins' preferences for that year. If you anticipate the dinner table being a minefield, prearrange with the host to bring a dish that you know you'll be able to fill up on. They'll probably be grateful for the help, as well as having one less mouth to worry about.

Scope out your safe foods

For many people, this would be the mashed potatoes. It wasn't for me; I'm a butter-and-roll girl, myself. Whatever your comfort level may be, make your "safe" food the object of your attention before and during dinner. You can relax knowing there is something on the table you can happily eat (and even get second helpings for!), and so long as everyone else sees you chewing they probably won't pay any attention to what, exactly, it is.

This way, you also always have the excuse ready when someone wants to foist their nasty-looking green beans on you: "Oh, they look and smell fantastic, but I don't want them to go to waste and I'm already so full." Another classic, "I'm saving room for dessert," also works, assuming you eat pumpkin pie.

Be prepared for the comments

Family tends to be particularly, uh, generous when it comes to offering unsolicited opinions. Often it seems as if every aunt, uncle, and grandmother-you-only-see-once-a-year needs to weigh in on what, and how much, you should be eating. Sometimes there is no avoiding it, so don't be blindsided by a snide remark. A redirect to what Thanksgiving ought to actually be about "as you know, I've never been a big foodie, but I am really grateful to get to spend this time with all of you" always seems to steer the conversation back in the right direction. You can quickly segue with another question directed at someone else: "Now I'm dying to know, how is writing your personal memoirs going, Aunt Martha?"

The big gulp strategy

When in doubt, have a drink at the ready. You can take polite nibbles and wash your mouth of the offending flavor with a swig of milk, wine, juice, or water afterward. Obviously making a big show of how disgusted you are is even more offensive than refusing a dish entirely, so do be subtle.

Move at your own pace, and seek help if you need it

I will never admit this in the presence of a lifelong foodie, but sometimes they have a point. Your taste buds do change over time; the food that used to make you gag could be your new favorite dish. If you're feeling adventurous, there is no better meal than Thanksgiving for branching out of your comfort zone. It's not a question of being brave or not brave, though; it's as simple as doing things on your own terms.

Most important of all, be honest with yourself about your situation. At a certain point, picky eating can be severe enough to become a medical disorder called Avoidant-Restrictive Food Intake Disorder (ARFID), which can result in weight loss and even the failure of the body to maintain its normal functions. It is important to be clear: Do you just hate casseroles, or are your eating habits inhibiting other parts of your life and making you feel unwell? Or are you avoiding food for an entirely different reason?

Whatever your answer may be, there is help available: You can always reach out to the National Eating Disorders Association helpline, and use the text message or online chat functions if you're unable to make a call.

Don't let anyone make you feel bad about what you eat

At the end of the day, nobody gets to choose the foods they like and don't like. Nevertheless, the intense feelings of guilt and shame experienced by picky eaters come from really, really wishing you could simply enjoy the meal like everyone else. "[T]he older I get, the more I'm realizing that the worst part of being a picky eater isn't really the fact that everyone else hates it it's the fact that I hate this part of myself," writes Julie Bogen for Refinery29, adding: "I know I'm not going to change what I eat overnight. But ... I deserve to try new things or avoid them without feeling any embarrassment ... What I choose to put on my plate should only matter to me."

Exactly. Be kind to yourself; as Lucianovic puts it in her book, "Stand picky, stand proud." You are far from alone.

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A picky eater's guide to surviving Thanksgiving - The Week Magazine

CIBC – The 15 Billion Dollar Question – Seeking Alpha

Posted: November 26, 2019 at 9:49 am

Like all the big five Canadian banks CIBC (NYSE: CM) looks like a great value. PE is 9x, the yield is above 5% and ROTE is 18%.

However, also like all other Canadian banks the problem is the "crash factor". Canada has looked like an accident waiting to happen for some time.

Household debt stands at an enormous 180% of disposable income, second only to Australia among G20 countries, and has been on an upward trajectory for years. House prices have soared, especially in Toronto and Vancouver and the nationwide house price index is 23% above its 2015 level. This is the biggest pace of increase in the G20 after China.

To put these numbers into perspective, US household debt is a frugal 107% of disposable income and house prices are up a modest 15% since 2015.

Source: Statistics Canada

Source: OECD

These issues are no secret to anyone. Forecasters have been prophesying an impending bust in Canada for years, even most Canadians. And bank investors haven't been exactly falling over themselves to buy Canadian banks, certainly not CIBC, the most domestically-geared of the big 5, which is up just 2% over 1-year during a period which JPM, for example, is up 23%

The question is not whether the risk of a crash exists. Clearly it does. It is how to factor it into valuations.

In CIBC's case the issue is especially pertinent because it has much less diversification outside Canada than its peers. As of 3Q19, domestic loans accounted for 85% of the loan book, the majority being Canadian residential mortgages (52%). Canadian credit card and unsecured consumer loans accounted for a further 14%.

If Canada does keel over under the weight of personal sector debt and the bursting of the house price bubble, CIBC will be the first casualty.

Source: company 3Q19 earnings supplement

This article tries to put a number on the size of potential losses CIBC might incur in a crash scenario. Given the peculiar risks CIBC and other Canadian banks face it's not just enough to say they're cheap on PE or P/TNAV. The question that needs to be answered is whether they're still cheap if Canada goes over the cliff.

If you just looked at CIBC's credit quality statistics you'd quickly conclude everything in the garden is rosy.

Impaired loans have been rising but at an almost imperceptible pace and they remain at very modest levels at just 45bps of total loans. Indeed this ratio is inflated by recent rapid growth in the US C&I market, where loss rates are structurally higher. If we just look at the stats for Canada, which is dominated by CIBC's big residential mortgage portfolio, the impaired loan ratio is 22bps. It's risen from 10bps at the end of 2017 but in absolute terms, 22bps is still a negligibly low number.

Source: company 3Q19 earnings supplement

The same is true of write-offs, which are flat to falling. On the $205bn mortgage portfolio, write-offs for 9m19 stand at just $17m.

Source: company 3Q19 earnings supplement

However, the problem with banks' credit quality statistics is they tend to be backward looking. This is especially true for the way banks provision for future loan losses.

The IFRS 9 accounting standard brought in during 2017 was supposed to fix the problem. Unlike the way things worked in the past, banks now have to make a loss allowance for loans when they are issued, not just when they become impaired as was the rule the previous IAS 39 "incurred loss" methodology.

This is known as "Stage 1" impairment and it is supposed to capture the future risk of currently performing loans going bad (as opposed to "Stage 2", which is impairments for performing but potentially problematic loans, and "Stage 3" which is impairments for non-performing exposures).

However, "Stage 1" allowances only need to be booked for expected losses over the next 12 months, not the lifetime of the loan. And there is a large element of discretion left to the banks as to how they assess and quantify 12 month expected losses.

Particularly for banks like CIBC, where the recent past has been one of trouble-free performance with little or no loan losses, the inclination is to assume the same will continue at least for the next 12 months, especially in secured lending categories like residential mortgages.

This explains why, in spite of most people thinking Canada is a powder keg, CIBC's allowances for loan losses are de minimus. There are currently allowances of just $0.6bn on the $207bn mortgage book, under 0.3%. Across the whole portfolio allowances are just 0.5% of total loans.

Source: company 3Q19 earnings supplement

If the recent past has taught investors anything it is that when things go wrong in bank-land they tend to go spectacularly wrong. In particular, housing market corrections are rarely slight, they are mostly abrupt and brutal. It is inconceivable that if Canada goes over the cliff CIBC will only experience losses of 0.3% on its mortgage book or 1.3% on its unsecured consumer book, as its current allowances imply.

How big could the losses be? The US experience post-2008 is a good one to look at. The markets aren't exactly the same. Notably, Canada has nothing like the scale of sub-prime mortgages the US had. But as a rough reference point for the broad magnitude of possible loss rates it's a reasonable comparison.

US delinquency rates on residential mortgages peaked in late-2009, not at CIBC's current provisioning level of 0.3% but at 10%.

Mortgages are secured so even if 10% of borrowers default, the bank won't lose 10% of its money. It will only lose the portion it can't reclaim on repossessed collateral. So the magnitude of the housing market price fall is as important as the delinquency rate.

For example, assuming a mortgage book with a loan-to-value of 100% and a 50% drop in average house prices the loss on delinquent loans would be 50%. Assuming 10% of the book defaults, the loss or write-off across the portfolio would therefore sum to 5%.

Source: US Federal Reserve

I've kept these numbers simple to illustrate the mechanics. Few if any banks have LTVs of 100% on their mortgage books and a 50% house price crash would be severe (but not unimaginable - it was the peak-to-trough fall experienced in Ireland post-2008 for example).

But it's also true that most of the losses happen at the margin, not at the average i.e. they occur on newer loans where LTV's are higher than the average of the book and where buyers are more likely to have paid an overgenerous price for the house. So a 5% write-off across an entire portfolio is not an extreme assumption.

Indeed this number is supported by the US write-off experience, which over the period 2008-2010 totaled 5.7% of aggregate residential mortgages. I've also included the data for the other main lending categories in the following table, showing that cumulative crisis-period write-offs on US credit card loans were 15%, 24% on other unsecured consumer loans and 2.6% on C&I loans.

US financial crisis loan write-off rates

Source: author's calculations based on US Federal Reserve data

If this style of crash were replicated in Canada it's a pretty easy calculation to tot up the hypothetical losses for the banks.

I've done the numbers for CIBC below. I've just stressed the Canadian part of the loan book, assuming this is an idiosyncratic crash isolated largely to the domestic mortgage and consumer lending markets.

Source: author's calculations based on US Federal Reserve data, CIBC disclosures

The US experience would imply CIBC could see cumulative write-offs of $25bn, the largest element being ~$12bn of losses on the Canadian mortgage book and a further ~10bn on the Canadian unsecured consumer book.

The company has some buffers to absorb these losses. The current loan loss allowance sitting on the balance sheet is $1.9bn. It looks woefully inadequate for this type of scenario but at least it's something. In addition, CIBC has some surplus capital as it operates with a CET1 ratio of 11.4% against a regulatory requirement of only 9.5%. That's a further $4bn buffer.

However, even allowing for these items, this stress calculation suggests shareholders would still be on the hook for ~$15bn of post-tax losses.

Remarkably, this may already be priced-in

CIBC's market cap is currently $68bn so at first glance $15.5bn of stress losses doesn't look great, implying possible 25% downside if this scenario came to pass, even before factoring in that the shares would inevitably overshoot on the downside.

However, things aren't necessarily so bleak. There's a strong case for saying CIBC is undervalued against its current fundamentals, which is probably because the market is already factoring in a turn for the worse.

ROTE for 9m19 was 18%. Using a 9% cost of equity and 2% growth factor this would give fair value P/TNAV of 2.3x whereas the shares currently trade on 1.7x.

On current TNAV of $68 per share a 2.3x multiple would get to a share price target of $153 compared to the current trading price of $115.

In absolute dollar amounts, that's a fair value market cap of $68bn compared to a current market cap of only $52bn, implying there's a ~$17bn imbedded discount in the company's valuation, probably reflecting the sort of risks I've described in this article.

$17bn of imbedded discount against stress-scenario losses of $15.5bn sounds like the market is already there in terms of pricing CIBC for a 2008-style housing crash.

For long-term holders of CIBC this is a comforting conclusion. If they're happy to ride out a likely short-term overshoot they'll probably emerge on the other side at a valuation not far from today's.

For shorter-term investors though, the idea of $15bn of losses is likely to be stomach-churning, knowing the shares would plummet first and only stage a slow recovery over several years as the losses were crystallized and booked to equity.

In conclusion, therefore, CIBC may already in theory be priced for a Canada crash. But it's not a stock I'll be hurrying to buy.

Source: author's calculations based on US Federal Reserve data, CIBC disclosures

Disclosure: I am/we are long JPM. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

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CIBC - The 15 Billion Dollar Question - Seeking Alpha

Boston College Football: One More Game To Go. Then What? – Sports Illustrated

Posted: November 26, 2019 at 9:49 am

The Boston College Eagles have one more game left, against the Pittsburgh Panthers and the implications of this game couldn't be greater. Sitting at 5-6, multiple outcomes could happen depending on how the game ends. Let's look at some of the scenarios of what could happen on Saturday. This is all based on my gut feelings and intuition, as the administration has been mum about Addazio this season.

If Boston College loses at Pittsburgh on Saturday, a few scenarios could play out. They are currently nine point underdogs at the time of this writing:

* The Eagles would sit at 5-7 and technically would not be bowl eligible. This would leave Martin Jarmond, Father Leahy and the Boston College Board of Trustees with two options. The first is that they could choose to move on from Steve Addazio after seven seasons and go in a different direction. We all know the stats right now, and they paint a pretty bleak picture of Addazio's tenure: 1-17 versus the Top 25, 21-34 against the ACC.

* The other option is the administration could look at the season, and look at different factors that impacted the year and caused the decline, including a very young defense and a big injury to quarterback Anthony Brown. You would have to take think that if the administration does move on from Addazio this will be done quickly so that BC can get a crack at some of the candidates that would best fit the Eagles, meaning BC would make an announcement shortly after the loss. But it is important to note that there haven't been any rumblings, or sources that have said anything one way or another.

* There is also the chance that BC could still make a bowl at 5-7 if there aren't enough bowl eligible teams. The way bowl committees decide is to look at APRs, and if you follow Boston College Athletics, you know they have one of the higher scores in the nation. This would put the administration in a tougher situation. On one hand they made a bowl, on the other they would sit at just five wins.

* The Eagles will be bowl eligible and most likely will head to a lower tier ACC bowl like the Independence Bowl in Shreveport or Quick Lane Bowl in Detroit. If Boston College wins on Saturday it in all likelihood would mean that Addazio's job will be safe as he reached the program's goal of another bowl game. His job would most likely be safe in my opinion if the Eagles do get that sixth win, and give him an opportunity for a seventh win in a bowl game.

* There is also the possibility BC wins on Saturday and still moves on from Addazio. The only way I could see this happening though is if there is a candidate that the administration feels would take BC to the next level.

***

In the grand scheme of things it is rather absurd that a decision about the future of Boston College football may come down to one game.

There are seven years worth of results, along with data that should help the program make a decision that is in the best interest of all involved. Hopefully when addressing where the program should go and be, those involved don't just put weight on an end of the season game against Pittsburgh. But here we are, Saturday's game could have huge ramifications for the Eagles.

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Boston College Football: One More Game To Go. Then What? - Sports Illustrated

Upon further review: Takeaways from Penn States loss to Ohio State – The Athletic

Posted: November 26, 2019 at 9:49 am

COLUMBUS, Ohio When quarterback Sean Clifford hobbled to the sideline and hopped on the bicycle, Will Levis kept telling himself that all the stretching and warm-up throws and his usual desire to stay loose during a game were for real this time.

The Penn State backup quarterbacks most meaningful collegiate reps to date just so happened to come in the third quarter on the road against the No. 2 team in the country. Chase Young and the smothering Ohio State defense awaited him.

My first instinct is to go to the offensive line, go to the receivers and instill my confidence in them and make sure that theyre on the same page as me, the redshirt freshman said. I told them I was gonna go out there and were going to push that ball right down the field and were gonna score and were gonna get the ball back and were going to score. Thats just the mentality you have to do, regardless of what the situation is.

Levis...

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Upon further review: Takeaways from Penn States loss to Ohio State - The Athletic

Experts weigh in on weight loss app for kids – News 5 Cleveland

Posted: November 26, 2019 at 9:48 am

CLEVELAND Weight Watchers has helped adults lose weight for years, now, it is turning its attention to kids. It developed an app called Kurboa food tracker that uses color coding to let kids know if the food theyre eating is good or bad.

The color green is used to indicate healthy foods such as vegetables and fruits, yellow will pop up for foods you shouldnt overindulge on, and red for junk food.

Weight Watchers said the app is science based, doesnt count calorie, and helps kids build healthy eating habits. However, some experts believe the app will do more harm than good.

This makes children self conscious about food and about their bodies. When we label foods as good, medium and bad, we are giving their very concrete, little kids the wrong idea, said Dr. Jennifer Guidiani, an eating disorder expert.

Theres no debate around the benefits of building healthy habits.

They definitely need to eat foods that are healthy, not just junk food, said Rachel Madiri, a mom and teacher.

According to a report from the Robert Wood Johnson Foundation, 1 in 6 children aged 10 to 17 in Ohio are obese, the 10th highest in the nation.

But Madiri thinks healthy habits are better learned at home than on a device.

My son will want to sit down and I say Nope, you gotta go outside, she said.

For her, its about leading by example.

As adults we need to be eating healthy for them, as well as exposing them to a variety of different foods, said Madiri.

University Hospitals psychologist, Dr. Carolyn Levers- Landis said leading by example is even deeper than just diet and exercise.

You have to be so careful about how you yourself speak about your body and your appearance, she said.

She specializes in body image issues with kids and said her patients are getting younger and younger.

Children are aware of how society views appearance and attractiveness, and they internalize that and they feel like I have to fit up to those standards, said Dr. Levers-Landis.

While most experts agree Kurbo could be harmful to children and their relationship with food, weight loss and body image is not black and white.

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Experts weigh in on weight loss app for kids - News 5 Cleveland

Weight Loss Most Likely to Improve -Cell Function in Patients With Obesity, IFG – Endocrinology Advisor

Posted: November 26, 2019 at 9:48 am

Short-term weight loss improves -cell function in patients with obesity who have either normal or impaired fasting glucose (IFG). However, despite initial improvements, -cell function commonly deteriorates over the course of 2 years, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

The study included 58 participants with body mass index 35 kg/m2 (14 with normal fasting glucose, 24 with IFG, and 20 with type 2 diabetes [T2D]) and 13 normal-weight participants with normal fasting glucose. Patients with obesity were recruited from the University of Michigan Weight Management Program, an intensive 2-year intervention aimed at improving weight loss and reducing complications of obesity. For this study, participants underwent 3-hour mixed-meal tolerance tests to estimate insulin sensitivity, insulin secretion, and -cell function, which the researchers defined as model-based insulin secretion adjusted for insulin sensitivity. After 3 to 6 months of follow-up, all 58 participants with obesity were restudied, and 27 completed a follow-up mixed-meal tolerance test at 2 years after baseline.

After 3 to 6 months on a very-low-energy diet, participants with obesity had a mean weight loss of 20 kg and a mean decrease in body mass index of 6 kg/m2.

Compared with baseline, insulin sensitivity significantly improved among participants with obesity and normal fasting glucose (ratio of geometric means, 2.48; 95% CI, 1.64-3.74; P =.0004), IFG (ratio of geometric means, 2.52; 95% CI, 1.80-3.53; P <.0001), and T2D (ratio of geometric means, 2.43; 95% CI, 1.78-3.33; P <.0001). In addition, insulin secretion decreased significantly among participants with normal fasting glucose (ratio of geometric means, 0.58; 95% CI, 0.48-0.71; P <.0001) and IFG (ratio of geometric means, 0.62; 95% CI, 0.53-0.73; P <.0001). Among participants with T2D, insulin secretion showed a trend toward decreasing (ratio of geometric means, 0.84; 95% CI, 0.69-1.01; P =.061).

For participants with obesity and normal fasting glucose, -cell function trended toward improvement at 3 to 6 months after baseline (ratio of geometric means, 1.23; 95% CI, 0.94-1.61; P =.13). Among those with IFG, -cell function also showed a trend toward improvement (ratio of geometric means, 1.17; 95% CI, 0.93-1.47; P =.18).

After 2 years of follow-up, and despite maintaining significant weight loss, the researchers found that -cell function declined among participants with normal fasting glucose (ratio of geometric means, 0.82; 95% CI, 0.41-1.61; P =.40) and T2D (ratio of geometric means, 0.95; 95% CI, 0.66-1.35; P =.73). However, for those with IFG, -cell function remained significantly improved compared with baseline (ratio of geometric means, 0.77; 95% CI, 0.64-0.92; P =.0076), indicating that these patients experienced the most persistent benefits of weight loss with regard to metabolic health.

The study had several limitations, including the use of insulin over C-peptide to assess -cell function and the relatively small number of participants who completed follow-up at 2 years.

This suggests that there is a window of opportunity to improve -cell function in subjects with IFG, but that there is an irreversible fall in -cell function with time in subjects with obesity and [T2D], the researchers wrote.

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Reference

Rothberg AE, Herman WH, Wu C, et al. Weight loss improves -cell function in people with severe obesity and impaired fasting glucose: a window of opportunity [published online November 13, 2019]. J Clin Endocrinol Metab. doi:10.1210/clinem/dgz189

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Weight Loss Most Likely to Improve -Cell Function in Patients With Obesity, IFG - Endocrinology Advisor

Weight loss: The best snacks to eat that burn fat while you sleep revealed – Express

Posted: November 26, 2019 at 9:48 am

Losing weight for many is an ongoing battle of ups and downs, butonekey to successful weight loss or maintaining a healthy weight is incorporatinghealthysnacks into your daily regime. After all, snacks can help maintain energy levels throughout the day and could also help prevent slimmers from overeating once its mealtime. So, why not try some fat burning snacks to lose weight while you sleep?

Snacking is one of the main causes of unwanted weight gain. Previously, in research conducted by USDA, it has shown that when someone is snaking they tend to add extra calories to their diet while neglecting to add any nutrients.

Of course, often there are different diet plans which fight for and against counting calories but the main problem with snacking is that when theyre consumed, more often than not, the snacks contain high levels of carbohydrates, that arent the good kind, meaning that they can drive overeating and increase the risk of obesity.

According to Helena Griffiths, fitness and nutritionist, snacking can keep slimmers hunger levels down and reduce excess calorie intake.

She said: "Snackingcan help keep your hunger levels on an even keel, especially on days when your meals are spaced further apart.

READ MORE:Harry Melling:Harry Potter 'Dudley Dursley' actor unrecognisable after dropping 4st 5lb

"However, it's important to make healthy snack choices and there are some miracle snacks that can really help with weight loss. If consumed in moderation."

Eating snacks with the right ratio of nutrients and calories will help to keep a body energised as well as stimulate weight loss.

Protein plays a huge role in this as it helps to fuel the growth of lean muscle mass. This, in turn, boosts metabolic rate and increases calorie burn.

Some of these snacks bellow also contain healthy amounts offibre. This helps to improve digestion and keeps you from going crazy on the unhealthy fats and sugars.

DON'T MISS

1. An apple and almond milk

When trying to lose weight, often slimmers will go on fad or crazy diets to stimulate quick weight loss.

When trying to lose weight there is no need to cut out or reduce dairy intake, unless its full-fat dairy.

A great alternative to milk is almond milk. After a bit of getting used to it will transform a slimmers life. Not only is it vegan, but it is also low in calories, its nutritious and high in vitamin D.

Apples are a great snack due to their high levels of fibre as well their ability to satisfy and quench hunger.

So, why pair it with almond milk?

Having an apple and almond milk before bed, boosts the protein levels in a slimmers system allowing the food to stimulate and increase ones metabolism, therefore encouraging natural weight loss while slimmers slumbers.

2. Cottage cheese-filled avocado

Avocados are a super fruit that when consumed increases the rate at which fat in the body is burned. As well as having properties which reduce appetite and decreases the desire to eat.

A study also found that by introducing cottage cheese into a diet helps decrease body weight, as it is high in protein and increases the feeling of fullness.

So, why pair the pair?

Mixinganavocado with full-fat cottage cheese can provide a slimmer with a great snack fully loaded with the nutrients that a body needs to lose weight as well as increase a slimmers feeling of fullness, preventing them from overeating and gaining further weight.

3. Tuna on whole wheat cracker

In moderation, tuna is a healthy, low-calorie protein source that is rich in omega-3-fatty acids, which are essential nutrients that aid your heart, brain, and immune system.

So, why should it be paired with a whole-wheat cracker?

Tuna provides great taste while still balancing out calorie intake since its low in fat and rich in proteins and nutrients. Paired with a whole-wheat cracker, which is full of fibre, allows a slimmer a well-balanced snack that stimulates fat-burning in the body.

4. Warm pear with cinnamon and ricotta cheese

Cinnamonis said to increase insulin sensitivity and decrease blood sugar - both key components forlosing weight. Cinnamonis also thought to boost metabolism because your bodyusesmore energy to process the spice than it does for other foods.

Pearsare rich in essential antioxidants, plant compounds, and dietary fibre, they pack all of these nutrients in afat-free, cholesterol-free, 100 calorie package.

So, why pair these with ricotta cheese?

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Weight loss: The best snacks to eat that burn fat while you sleep revealed - Express


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