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Differentiate by age the etiology and understand the pathophysiology of vomiting 2 buy wellbutrin 300mg without a prescription anxiety prescriptions. Differentiate by age the etiology and understand the pathophysiology of sudden flaccid paralysis 2 purchase wellbutrin 300 mg on line depression test francais. Plan diagnostic evaluation and initial intervention for patients with sudden flaccid paralysis 3 cheap wellbutrin 300mg online depression era recipes. Differentiate by age the etiology and understand the pathophysiology of wheezing 2 purchase 300 mg wellbutrin visa depression behavior test. Differentiate by age the etiology and understand the pathophysiology of weight loss 2. Plan diagnostic evaluation and initial intervention for patients with weight loss 3. Know pediatric out-of-hospital treatment protocols for basic life support and advanced life support personnel 4. Know essential pediatric equipment in the ambulances equipped for basic versus advanced life support 2. Know the purpose of regionalization of specialty-care hospitals, including pediatric trauma, burn, and critical care 2. Differentiate between on-line (direct) and off-line (indirect) medical direction 2. Know the role of field policies in the prehospital care of children, including policies specific to intubation, interfacility transport, unexplained infant death, and physician-on-scene 3. Know the epidemiology of pediatric illness and injury requiring prehospital care G. Know principles in providing emergency care in disasters, multi-casualty events, and mass gatherings 2. Know the special medicolegal problems faced by prehospital personnel caring for the minor patient, including consent, treatment refusal, and do-not-resuscitate orders 2. Know the role of the prehospital care provider in handling suspected domestic violence, physical abuse, sexual abuse, or neglect 10. Know the current guidelines for immunization of children and recognize the most common side effects 2. Know the indications, contraindications, and methods for administration of antivenin 3. Know the elements that define quality assurance in the emergency care of children B. Know the circumstances in which minors can consent to their own examination and treatment 3. Know the circumstances in which confidentiality must be upheld in the care of a minor 7. Know the circumstances in which confidentiality can be breached in the care of a minor 8. Know the concepts regarding medical malpractice: negligence, standard of care, harm 3. Know the appropriate procedures for obtaining consent for the participation of a minor in research 2. Know the regulations concerning the reporting of child abuse, child neglect, and sexual abuse 3. Know conditions that require reporting (communicable diseases, assaults, death) 4. Know the appropriate procedure for obtaining authorization of organ and tissue recovery for transplantation 6. Know the appropriate procedure for initiating a psychiatric commitment of a child 8. Know the application of ethical principles pertaining to the practice of emergency medicine 9. Know the terms of advance directive, living will, durable power of attorney for healthcare 12. Plan the key steps and know the potential pitfalls in performing restraint techniques c. Know the indications for protecting health professionals against hazardous exposures b. Plan the key steps and know the potential pitfalls in protecting health professionals against hazardous exposures B. Plan the key steps and know the potential pitfalls in performing basic life support procedures c. Know the anatomy and/or pathophysiology relevant to basic life support procedures 2. Know indications and contraindications for airway adjuncts, oxygen delivery, and suctioning the upper airway b. Plan the key steps and know the potential pitfalls in performing airway adjuncts, oxygen delivery, and suctioning the upper airway c. Know the complications associated with airway adjuncts, oxygen delivery, and suctioning the upper airway d. Know the anatomy and/or pathophysiology relevant to airway adjuncts, oxygen delivery, and suctioning the upper airway 3. Plan the key steps and know potential pitfalls in performing bag-mask ventilation c. Know the anatomy and/or physiology relevant to rapid sequence induction for intubation b. Know the indications and contraindications for rapid sequence induction for intubation c.
Determining approaches for patients who do not respond to initial treatment When a patient does not respond to a trial of a known effective formal therapy (e buy 300 mg wellbutrin with amex mood disorder background. If inadequately implemented cheap wellbutrin 300mg visa depression test beck, the therapy may be repeated with changes to ensure the fidelity to therapeutic steps buy wellbutrin 300mg otc depression the definition, treatment adherence generic wellbutrin 300 mg visa depression anxiety test online, and adequacy of treatment dose and duration. If the treatment was both appropriate and adequately implemented, rescreening the patient for other co-occurring disorders is indicated, as other unrecognized substance use or psychiatric disor ders can interfere with smoking cessation (698, 760, 781. The psychiatrist should also attempt to determine whether the relapse was related to withdrawal symptoms or other causes. If these approaches are also ineffective, the use of clonidine or nortriptyline could be considered. Although its side effects can limit its acceptability to some patients, nicotine nasal spray produces a more bolus-like effect that might better relieve withdrawal symptoms and craving (782), especially in heavy smokers who report that they relapsed to smoking both for withdrawal relief and for the positive effects of nicotine and tobacco (e. A nicotine inhaler has the added advantage of replicating the hand-to-mouth motor acts associated with smoking, which may further support its utility. A strategy of initially using nicotine nasal spray and then switching to a nicotine patch or con comitantly using nicotine nasal spray and patch has been proposed and received some empirical support from controlled studies (782a, 782b, 1563. Treatment of Patients With Substance Use Disorders 79 Copyright 2010, American Psychiatric Association. If the patient has relapsed because of a stressful life event and has not previously been treated with behavioral therapy, this type of therapy should be considered. If the patient has already had behavioral therapy, two choices are available: 1) more intensive behavioral therapy or 2) behavioral therapy within a different content or format (e. Whether these treatments are effective for those who have not responded to prior behavioral therapy has not been studied. Sometimes it is difficult to distinguish withdrawal versus nonwithdrawal causes of relapse. Un der such circumstances, the patient may be a candidate for combined pharmacological and be havioral therapy (783, 784. The results of three small controlled studies of acupuncture are promising (785�787), but due to methodological limitations, they do not justify the use of acupuncture for treating nicotine de pendence either alone or in combination with other treatments. Furthermore, a meta-analysis of 22 controlled studies suggests acupuncture lacks efficacy in promoting smoking cessation (788. When the treating psychiatrist does not have the knowledge necessary to implement the treatments outlined herein, or if the strategies are administered and the patient is not able to quit smoking, the psychiatrist should consider referring the patient to someone who specializes in treating nicotine dependence. Typically, nicotine patch therapy will begin with a high-dose patch (21 or 22 mg); however, patients who smoke <15 cigarettes per day are candidates for starting with an intermediate-dose patch (e. The 24-hour patch may better relieve morning craving but ap pears to cause insomnia in some patients (799, 800. Other common side effects are skin irri tation (which can be diminished by rotating patch placement sites), nausea, and vivid dreams; however, patients usually develop tolerance to these side effects (790, 801. The recommended duration of nicotine patch therapy is 6�12 weeks, with a tapering of the patch dose over that period; longer durations of patch therapy have not been found to be more effective (790. The 4-mg dose is recommended for heavy smokers (>25 cigarettes/day) or more nicotine-dependent smokers (790, 802, 803. The dose of nicotine replacement can be tapered over 6�12 weeks by decreasing the gum or lozenge dose. With nicotine gum, patients should be instructed to chew one piece of gum very slowly until a slight tingling or distinctive taste is noted, at which time the gum should be placed (�parked) between the cheek and gum until the taste or tingling is almost gone. Typical side effects of lozenges are minor but include nausea, heartburn, and mild throat or mouth irritation; side effects of the gum are jaw soreness or difficulty chewing (802, 804. In addition, the lozenge contains phenylalanine and should not be used by individuals with a his tory of phenylketonuria. Nicotine nasal spray and vapor inhaler systems provide faster delivery of nicotine than gum or lozenges, but still deliver nicotine more slowly and with lower peak nicotine levels than cigarettes. Nicotine nasal sprays produce droplets that average 1 mg per administration, and patients administer the spray to each nostril every 1�2 hours. Nicotine vapor inhalers are car tridges of nicotine that are placed inside hollow cigarette-like plastic rods and produce a nico tine vapor (0. The recommended dose is 6�16 cartridges daily, with the inhaler being used ad libitum for about 12 weeks. Short-term side effects from nicotine nasal spray include nasal and throat irritation, rhinitis, sneezing, coughing, and watering eyes in up to 75% of users (807�809), and nicotine inhaler use is most often associated with throat irritation or coughing in up to 50% of users (806, 810. Bupropion the antidepressant agent bupropion in the sustained-release formulation is a first-line pharma cological treatment for nicotine-dependent smokers who want to quit smoking. The medication is initiated at 150 mg/day 7 days prior to the target quit date; after 3�4 days, dosing is increased to 300 mg/day (150 mg b. The primary side effects associated with bupropion are headache, jitteriness, insomnia, and gastrointestinal symptoms (795. Caution is needed when prescribing bupropion to individu als with a history of seizures of any etiology, as seizures have also been observed with bupropion treatment. The use of bupropion, especially the short-acting preparation, is also discouraged in patients with a past, and particularly a current, diagnosis of an eating disorder. Other agents There is also support for the use of nortriptyline and clonidine as treatments for nicotine de pendence; however, given the number of other available treatments for which results are well validated, these should be viewed as second-line therapies. Nortriptyline may be particularly promising as a second-line nonnicotine pharmacotherapy, and its efficacy does not appear to depend on the presence of co-occurring depressive symptoms or major depressive disorder (795, 814. Clonidine Treatment of Patients With Substance Use Disorders 81 Copyright 2010, American Psychiatric Association.
The radiologist will decide on the best way to place the needle into your joint in order to perform the injection/aspiration discount 300 mg wellbutrin otc anxiety of influence. This may be done using either ultrasound or x-rays to guide the needle into the joint cheap 300mg wellbutrin overnight delivery depression symptoms behaviour. Local anaesthetic may be injected into the area to numb the skin and surrounding tissues wellbutrin 300 mg amex anxiety 8 yr old boy. If x-rays are being used to guide the needle into your joint a small amount of contrast buy cheap wellbutrin 300 mg on-line depression symptoms heart pain, (a colourless liquid that shows up on the x-rays) may be injected into the joint to check the position of the needle. If you are having a joint injection, the steroid (to reduce infammation) and local anaesthetic will be injected into the joint at this point. If you are having an aspiration, a syringe will be used to remove some of the fuid from the joint. For patients who have had a steroid injection, after a few days the local anaesthetic will wear of. It is important that you monitor and keep a record of any changes in your pain over the next few weeks. A joint injection/aspiration is a common examination that has little risk; however, there is a very small risk of an infection being introduced into the joint. Some of your questions should have been answered by this booklet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you. Do please satisfy yourself that you have received enough information about the procedure, before you sign the consent form. Indications for Arthrocentesis If you think about it, you probablyy y p y should do it Never assume what is going on in the joint! Contraindications to Arthrocentesis Contraindications for arthrocentesis are few Established overlying infection. At this point the needle is in the synovial sheath and you can inject 21 10/22/2008 Post Injection Counseling May recommend joint rest or rest ofy j affected area for at least 1 day after steroid injection Caution as the use of lidocaine may also make symptoms improve and then ppatient pursues more activity than theyp y y should, increasing injury risk What Do I Do with the Fluid The Rational Use of Steroid Injections in Arthritis and Nonarticularj Musculoskeletal Pain Syndromes. Objectives: To be able to perform knee joint effusion aspiration properly with no or minimal risk of complication(s), and to be able to differentiate between different appearance and consistencies of the synovial fluid. The students will be performing this procedure on a manikin in the education center skill lab, under the supervision of the orthopedic surgeon assigned. Rule out infection like septic arthritis, subacute or chronic arthritis) Rule out inflammatory causes (Rheumatoid arthritis. Therapeutic (Rare) Relief of pain by aspirating effusion or blood Injection of medications. Contraindications: Relative contraindications include the following: Cellulitis overlying the joint. Approach: Lateral suprapatellar approach o Remember that in 10% of the population, the suprapatellar bursa does not communicate with the knee joint. Patient advice after therapeutic aspiration/injection: Advise the patient to rest the joint for 1-2 days and to avoid strenuous use for five days (rest the joint. Possible scenarios for knee aspirates: Thick pus (septic arthritis): patient must be admitted for emergency knee joint washout and Intravenous broad spectrum antibiotic therapy. Data suggests that this has lead to; � Delays in referral to specialities � Distorted microbiology results caused by the administration of antibiotics prior to joint (2) aspiration Knee Aspiration � Aspiration of the knee joint may be performed for the diagnosis of an unexplained effusion or (3) the evacuation of a painful effusion � Several approaches documented in the literature (superior lateral approach used within this setting) � Steps: � Patient in supine position with knee in extension � Palpate the knee to identify the and mark the site � Clean and prep the area � Strict aseptic non-touch technique � Attach a large (20-60ml) syringe to an 18-20 gauge needle � Stretch the skin with the one hand and insert the needle in to the joint whilst gently aspirating � Withdraw the needle once completed � Place sample correct sample pots as required by the trust � Dispose of needle in sharps bin � Dress the injection site � Accurately label the samples and sent to the lab accordingly Near Peer Tutoring � Passage of knowledge between persons at similar stage of training � Typically two to five years ahead of (4) the trainee � Comparable insights and (4) experience (5) � Well-accepted amongst trainees � Useful for tutors to improve their (5) teaching skills Aim � Address the lack of knowledge and technical ability, and the lack of confidence in performing knee joint aspiration by Foundation Doctors Method (6) � We designed a teaching session incorporating a mixed educational approach � Two separate teaching sessions, each lasting two hours, were given to a group of foundation year 2 (F2) doctors from Royal London, Whipps Cross, St Barts and Newham General hospitals � Facilitated by consultants, registrars and clinical skills trainers � the aim was to achieve a low trainee to trainer ratio Course Outline � Pre course evaluation and questionnaire � Case based scenarios in a lecture format � Tutorial on knee aspiration � Practical sessions � Post course evaluation and questionnaire Pre Course Evaluation � Only one trainee had aspirated a knee joint prior to the session � 26. However the majority of trainees do not feel confident in doing so � Near Peer tutoring was identified as a effective teaching method � Real-time feedback, interactive discussion and simulation based training was used to provide comprehensive � Overall improvement in knowledge, technique and confidence was achieved, as evidenced by pre and post course questionnaires and evaluation forms References 1. Farah Z, Reddy V, Giles I (2014) To aspirate or not to aspirate: A trainee doctors dilemma, Scientific Abstracts, 164 3. Its purpose is to provide details of the content of such programmes, the groups targeted, the materi als used and the training implemented, in order to assist users in selecting the programme best suited to their needs and to offer guidance as to the kind of programmes available. The programmes appear in descending order of the level of scientifc evidence on which they are based. There are two main reasons for this: frstly, while efforts in the area of prevention to help and support others are undoubtedly founded on good intentions, research has shown that good intentions can sometimes cause unintended harm. Secondly, of existing evidence-based programmes to specifc cultural that research not only shows that evidence-based programmes settings. Research shows that the cultural adaptation of are effective and have a positive impact but also indicates how evidence-based family skills training programmes helps to those results are achieved. However, it is important to fore offer the assurance that positive results will be obtained, avoid changing the structure and content of the programmes too that the programme will beneft those targeted and that close much, since doing so may eliminate those components that adherence to the programme structure and content will ensure make the programmes effective. This translates into translate the programme materials into local languages and to huge savings in terms of the funds used to implement such modify the graphs, pictures and examples to represent the local programmes. The development of new programmes requires culture and religion and, most importantly, the families who evaluation over a period of many years in order to obtain will participate in the programme. For more information on suffcient information as to their effectiveness and safety, and cultural adaptation, please see the Guide to Implementing Family such evaluation is costly. Age of children While acknowledging and respecting the diversity of family the children targeted by Triple P studies types and cultural backgrounds, the programme aims to empower range in age, from infants to teenagers, and families by building on existing parenting strengths and focusing display a variety of behavioural on self-regulation of parental skill in order to enhance parents and emotional problems. All parents interested in information about general parenting issues and promoting their childs development. Targets anger Level 2 management problems, dysfunctional attributions and other Selected Triple P factors associated with abuse. All parents interested in parenting education and information about promoting their childs development, or parents with specifc concerns about their childs development or behaviour Sessions (number, length and interval) (e. Level 1 Level 3 Universal Triple P Primary Care Triple P A coordinated information campaign using print and electronic Parents with specifc concerns about their childs behaviour or media and health promotion strategies to raise awareness of development who require brief consultations or active skills parenting issues and normalize participation in parenting training.
Syron said one of the reasons that Andrukonis was fred was that Andrukonis was concerned about relaxing underwriting standards to meet mission goals buy generic wellbutrin 300 mg on line depression gi symptoms. Rather discount wellbutrin 300mg on-line la depression test, year after year buy wellbutrin 300mg on line mood disorder lamps, the regulator said that both companies had adequate capital order wellbutrin 300mg online mood disorder or depression, strong asset quality, prudent credit risk management, and qualifed and active ofcers and directors. Mudd wrote, �The old political reality [at Fannie] was that we always won, we took no prisoners. At least initially, while house prices were still increasing, the strategic plan to in crease risk and market share appeared to be successful. Newer alternative products, offered to a broader range of customers than ever before, ac counted for about of that years purchases. The company increased risk and market share while maintaining the same net income for and, billion. Its March report noted that Fannies new initiative to purchase higher-risk products included a plan to cap ture of the subprime market by. But overall asset quality in its single-family business was found to be �strong, and the board members were �qualifed and active. At the same time, Fannie would support the housing market by increasing liq uidity. Chief Risk Ofcer Dallavecchia did not agree, especially in light of a planned cut in his budget. A strategic plan from March highlighted �pressure on the franchise and the �risk of falling below our return aspirations. Mudd testifed that by, when the housing market was in turmoil, Fannie Mae could no longer balance its obligations to shareholders with its affordable hous ing goals and other mission-related demands: �There may have been no way to sat isfy of the myriad demands for Fannie Mae to support all manner of projects [or] housing goals which were set above the origination levels in the marketplace. Executives from Fannie, including Mudd, pointed to a �mix of reasons for the purchases, such as reversing the declines in market share, responding to originators demands, and responding to shareholder demands to increase market share and profts, in addition to fulflling the mission of meeting affordable housing goals and providing liquidity to the market. On the other hand, he said that most Alt-A loans were high-income oriented and would not have counted toward the goals, so those were purchased solely to increase profts. The organizations also had administrative and other costs related to the housing goals. In June Freddie Mac staff made a presentation to the Business and Risk Committee of the Board of Directors on the costs of meeting its goals. From to, the cost of the targeted goal loans was effectively zero, as the goals were reached through �proftable expansion of the companys multifamily business. From through, Freddies costs of complying with the housing goals averaged million annually. The fnal report to Fannie Maes top management, called Project Phineas, found that the explicit cost of compliance with the goals from to was close to zero: �it is hard to discern a fundamen tal marginal cost to meeting the housing goals on the single family business side. In calculating these costs, the consultants computed the difference between fees charged on goal-qualifying loans and the higher fees suggested by Fannies own mod els. Across its portfolio, Fannie charged lower fees than its models computed for goals loans as well as for non-goals loans. As a result, goals loans, even targeted goals loans, were not solely responsible for this cost. These included mortgages acquired under the My Community Mortgage program, mortgages underwritten with looser standards, and manufactured housing loans. For, as the market was peaking, Fannie Mae estimated the cash fow cost of the loans to be million and the opportunity cost of the targeted goals loans million, compared to net income that year to Fannie of. While the outstanding billion of these targeted af fordable loans was only of the total portfolio, these were relatively high-risk loans and were expected to account for of total projected losses. The Securities and Exchange Commission failed to adequately enforce its disclosure requirements governing mortgage securities, exempted some sales of such securities from its review, and preempted states from applying state law to them, thereby failing in its core mission to protect investors. Lax mortgage regulation and collapsing mortgage-lending standards and practices created conditions that were ripe for mortgage fraud. But this fail-safe lost force as the amount of managers investment per transaction declined over time. While acknowledging the point that every synthetic deal neces sarily had long and short investors, Wagner saw having the short investors select the referenced collateral as a serious confict and for that reason declined to participate. Eisman realized that he could pick what he considered the most vulnerable tranches of the mortgage-backed bonds and bet millions of dollars against them, relatively cheaply and with considerable leverage. By the end of, Eisman had put millions of dollars into short positions on credit default swaps. The purchasers of credit default swaps illustrate the im pact of derivatives in introducing new risks and leverage into the system. Although these investors profted spectacularly from the housing crisis, they never made a single subprime loan or bought an actual mortgage. Finally, they allowed spec ulators to make bets for or against the housing market without putting up much cash. While its competitors did the same, few did so as aggressively or, ultimately, with such losses. In many cases Citigroup would hedge the associated credit risk from these tranches by obtaining credit protection from a monoline insurance com pany such as Ambac. Because these hedges were in place, Citigroup presumed that the risk associated with the retained tranches had been neutralized. Money to pay them would come frst from wiping out long investors who had bought tranches that were below triple-A. The securities sitting in the warehouse facility had relatively attractive yields�often. But Citigroup would also be on the hook for any losses incurred on assets stuck in the warehouse. Citigroup had a complex corporate structure and, as a result, faced an array of supervisors. Moreover, Citigroup did not really align its various businesses with the legal entities.
These costs were only computed on the narrow set of loans specifcally purchased to achieve the goals cheap wellbutrin 300 mg with amex depression screening test, as opposed to goal-qualifying loans purchased in the normal course of business cheap wellbutrin 300 mg amex bipolar depression 5htp. In fact 300 mg wellbutrin for sale depression test scores, Fannies discount was actually smaller for many goal-qualifying loans than for the others from to generic 300 mg wellbutrin amex depression symptoms mothers. Facing more aggressive goals in and, Fannie Mae expanded initiatives to purchase targeted goals loans. In fact, as of late, they had accounted for only of losses�meaning that they had performed better than expected in relation to the whole portfolio. The companys major losses came from loans acquired in the normal course of business. Potential investors were not fully informed or were misled about the poor quality of the mortgages contained in some mortgage-related securities. The Federal Reserve failed to recognize the cataclysmic danger posed by the housing bubble to the fnancial system and refused to take timely action to con strain its growth, believing that it could contain the damage from the bubbles collapse. These factors helped keep the mortgage market going long after house prices had begun to fall and created massive expo sures on the books of large fnancial institutions�exposures that would ultimately bring many of them to the brink of failure. The subprime mortgage securitization pioneer Lewis Ranieri called the willing suspension of prudent standards �the madness. They provided easier opportunities for bullish and bearish investors to bet for and against the housing boom and the securities that de pended on it. And managers sometimes had help from customers in selecting the collateral�including those who were bet ting against the collateral, as a high-profle case launched by the Securities and Ex change Commission against Goldman Sachs would eventually illustrate. More than had been the case three or four years earlier, in picking the collateral the managers were infuenced by the underwriters�the securities frms that created and marketed the deals. The equity in vestors�who often initiated the deal in the frst place�also infuenced the selection of assets in many instances. Early in, it announced that it would not manage any new deals, in part be cause of the deterioration in the credit quality of mortgage-backed securities. By the very nature of the credit default swaps bundled into these synthetics, customers on the short side of the deal were betting that the assets would fail. The pay-as-you-go swap also enabled a second major development, introduced in January : the frst index based on the prices of credit default swaps on mortgage backed securities. Investors who believed that the bonds in any given category would fall behind in their payments could buy protection through credit default swaps. Lippmann said that between and he brokered deals for at least and maybe as many as hedge funds that wanted to short the mezzanine tranches of mortgage-backed securities. With the ad vent of credit default swaps, it was no longer clear who�if anyone�had that incentive. According to court documents, Magnetar was also involved in selecting assets for Norma. When asked about Goldmans contention that Paulsons picking the collateral was immaterial because the collateral was disclosed and because Paulson was not well-known at that time, Wagner called the argument �ridiculous. Home prices in the hottest markets in California and Florida had blasted into the stratosphere; it was hard for skeptics to believe that their upward trajectory could continue. Mai and Hockett saw the rating agencies as �the root of the mess, because their ratings re moved the need for buyers to study prices and perform due diligence, even as �there was a massive amount of gaming going on. But the closer he looked, the more he wondered about the fnancing that supported this booming mar ket. Burry decided that some of the newfangled adjustable rate mortgages were �the most toxic mortgages created. As [home] prices had increased on the back of virtually no accompanying rise in wages and incomes, I came to the judgment that in two years there will be a fnal judgment on housing when those two-year [adjustable rate mortgages] seek refnancing. On the other hand, it can be argued that credit default swaps helped end the hous ing and mortgage-backed securities bubble. In addition, some market partic ipants have contended that without the ability to short the housing market via credit default swaps, the bubble would have lasted longer. The adage �We are in the moving business, not the storage business suggests that they were struc turing and selling securities, not buying or retaining them. However, as the biggest commercial banks and investment banks competed in the securities business in the late s and on into the new century, they often touted the �balance sheet that they could make available to support the sale of new securi ties. Citigroup reported these tranches at values for which they could not be sold, rais ing questions about their accuracy and, therefore, the accuracy of reported earnings. But keeping the tranches on the books at these prices improved the fnances for creating the deal. As we saw in an earlier chapter, under the Re course Rule, one of the attractions of triple-A-rated securities was that banks were re quired to hold relatively less capital against them than against lower-rated securities. And if the bank held those assets in their trading account (as opposed to holding them as a long-term investment), it could get even better capital treatment under the Market Risk Amendment. That rule allowed banks to use their own models to determine how much capital to hold, an amount that varied according to how much market prices moved. As a result, Citigroup held little regulatory capital against the super-senior tranches. If the referenced mortgage collat eral underperformed, the short investors would begin to get paid. During the ramp-up period, the collateral securities would pay interest; depending on the terms of the agreement, that interest would either go exclusively to Citigroup or be split with the manager. Co-head of Global Fixed Income Randolph Barker made about million in that same year. But despite Citigroups eventual large losses, no compensation was ever clawed back under this policy.
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