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Sanctura XR

Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science


The effcacy of an aquatic program on physical ftness and aquatic skills in children with and without autism spectrum disorders . Chapel Hill: the University of North Carolina , Frank Porter Graham Child Development Institute , the National Professional Development Center on Autism Spectrum Disorders. The extinction procedure relies on accurately identifying the function of the behavior and the consequences that may be reinforcing its occurrence. The conse quence that is believed to reinforce the occurrence of the target challenging behavior is removed or withdrawn, resulting in a decrease of the target behavior. An initial increase in the challenging behavior (often called an “extinction burst) is common before eventually being extinguished. Other practices that are used in combination with extinction include differential reinforcement and functional behavior assessment. Decreasing self-injurious behavior in a student with autism and Tourette syndrome through positive attention and extinction. Schedule thinning following communication training: Using competing stimuli to enhance tolerance to decrements in reinforcer density. Reducing escape behavior and increasing task completion with functional communication training, extinction and response chaining. An evaluation of three methods of saying “no to avoid an escalating response class hierarchy. Using a fading procedure to increase fuid consumption in a child with feeding problems. The evaluation and treatment of ag gression maintained by attention and automatic reinforcement. Separate and combined effects of visual schedules and extinction plus differential reinforcement on problem behavior occasioned by transitions. Positive behavior support through family-school collabora tion for young children with autism. Comparison of behavioral intervention and sensory-integration therapy in the treatment of self-injurious behavior. Functional assessment of instruc tional variables: Linking assessment and treatment. Family imple mentation of positive behavior support for a child with autism: Longitudinal, single-case, experimen tal, and descriptive replication and extension. Escape behavior during academic tasks: A prelimi nary analysis of idiosyncratic establishing operations. Isolating the evocative and abative effects of an establishing operation on challenging behavior. Identifcation of compet ing reinforcers for behavior maintained by automatic reinforcement. Madison: University of Wisconsin, Wais man Center, the National Professional Development Center on Autism Spectrum Disorders. Evaluating the effects of functional communication training in the presence and absence of establish ing operations. Differential impact of response effort within a response chain on use of mands in a student with autism. Research in Developmental Disabilities: A Multidisciplinary Journal, 26(1), 77-85. The use of functional communication training without additional treat ment procedures in an inclusive school setting. Establishing discriminative control of responding using functional and alternative reinforcers during functional communication training. Using desktop videoconferencing to deliver interventions to a preschool student with autism. Functional communication training in the natu ral environment: A pilot investigation with a young child with autism spectrum disorder. An analysis of the effects of functional communication and a voice output communication aid for a child with autism spectrum disorder. Generalized reduction of problem behavior of young children with autism: Building trans-situational interventions. An evaluation of resurgence during treatment with functional communication training. A comparison of video modeling with in vivo modeling for teaching children with autism. Intervention targeting development of so cially synchronous engagement in toddlers with autism spectrum disorder: A randomized controlled trial. Treatment of elective mute behavior in two developmen tally delayed children using modeling and contingency management. The effects of modeling and praise on self-initiated behav ior across settings with two adolescent students with autism. Chapel Hill: the University of North Carolina, Frank Porter Graham Child Devel opment Institute, the National Professional Development Center on Autism Spectrum Disorders. These prac tices are designed to encourage specifc target behaviors based on learners interests by building more complex skills that are naturally reinforcing and appropriate to the interaction. Natural istic intervention occurs within typical settings, activities, and/or routines in which the learner participates.

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Write-downs Reducing the value of an asset as it is carried on a frms balance sheet because the market value has fallen . Scott , Nomura Professor and Director of the Program on International Financial Sys tems , Harvard Law School Joseph Stiglitz, Professor, Columbia Business School, Graduate School of Arts and Sciences (Department of Economics) and the School of International and Public Affairs John B. Blankfein, Chairman of the Board and Chief Executive Ofcer, Goldman Sachs Group, Inc. Securities and Exchange Commission Session : Current Investigations into the Financial Crisis—State and Local Ofcials Lisa Madigan, Attorney General, State of Illinois John W. Suthers, Attorney General, State of Colorado Denise Voigt Crawford, Commissioner, Texas Securities Board, and President, North American Securities Administrators Association, Inc. Sanford Professor of Economics, Princeton University Appendix B: List of Hearings and Witnesses 547 Session : Firm Structure and Risk Management Anil Kashyap, Edward Eagle Brown Professor of Economics and Finance and Richard N. Patricia Lindsay, Former Vice President, Corporate Risk, New Century Financial Corporation Susan Mills, Managing Director of Mortgage Finance, Citi Markets & Banking, Global Securi tized Markets Session : Citigroup Subprime-Related Structured Products and Risk Management Murray C. Robert Rubin, Former Chairman of the Executive Committee of the Board of Directors, Citi group, Inc. Levin, Former Executive Vice President and Chief Business Ofcer, Fannie Mae Daniel H. Mudd, Former President and Chief Executive Ofcer, Fannie Mae Session : Ofce of Federal Housing Enterprise Oversight Armando Falcon Jr. McDaniel, Chairman and Chief Executive Ofcer, Moodys Corporation Session : the Credit Rating Agency Business Model Brian M. Andrew Forster, Former Senior Vice President and Chief Financial Ofcer, American Interna tional Group, Inc. Habayeb, Former Senior Vice President and Chief Financial Ofcer, American Interna tional Group, Inc. Dinallo, Former Superintendant, New York State Insurance Department Gary Gensler, Chairman, Commodity Futures Trading Commission Clarence K. Alvarez, General Counsel, Board of Governors of the Federal Reserve System John H. Corston, Acting Deputy Director, Division of Supervision and Consumer Protection, U. Steel, Former President and Chief Executive Ofcer, Wachovia Corporation Session : Lehman Brothers Thomas C. Martin, Vice Chairman and Chief Executive Ofcer, Service st Bank of Nevada Appendix B: List of Hearings and Witnesses 551 Wally Murray, President and Chief Executive Ofcer, Greater Nevada Credit Union Philip G. Bogden, United States Attorney, State of Nevada Gail Burks, President and Chief Executive Ofcer, Nevada Fair Housing Center Brian Gordon, Principal, Applied Analysis Jay Jeffries, Former Southwest Regional Sales Manager, Fremont Investment & Loan Session : the Impact of the Financial Crisis on Nevada Public and Community Services Andrew Clinger, Director of the Department of Administration, Chief of the Budget Division, State of Nevada Jeffrey Fontaine, Executive Director, Nevada Association of Counties David Fraser, Executive Director, Nevada League of Cities Dr. Heath Morrison, Superintendent, Washoe County School District Session : Forum for Public Comment Public Hearing on the Impact of the Financial Crisis—Miami, Florida, Florida Inter national University, Modesto A. Thomas Cardwell, Commissioner, Ofce of Financial Regulation, State of Florida Wilfredo A. Mann, President and Chief Appraiser, Mann and Associates Real Estate Appraisers & Consultants Thomas C. Putnam, President, Putnam Housing Finance Consulting 552 Appendix B: List of Hearings and Witnesses Kevin Stein, Associate Director, California Reinvestment Coalition Benjamin B. Keith Johnson, Former President and Chief Executive Ofcer, Washington Mutuals Long Beach Mortgage Session : the Impact of the Financial Crisis on Sacramento Neighborhoods and Families Pam Canada, Chief Executive Ofcer, NeighborWorks Home Ownership Center–Sacramento Region Mona Tawatao, Regional Counsel, Legal Services of Northern California Bruce Wagstaff, Agency Administrator, County of Sacramento Countywide Services Agency Clarence Williams, President, California Capital Financial Development Corporation Henry W. S Department of Housing and Urban Development, “Joint Report on Recommendations to Curb Predatory Home Mortgage Lending (June 1, 2000. Financial Crimes Enforcement Network, Regulatory Policy and Programs Division, “Mortgage Loan Fraud: An Industry Assessment Based upon Suspicious Activity Report Analysis, November 2006. Federal Reserve Consumer Advisory Council Meeting, October 28, 2004, transcript, p. Fed Chairman Alan Greenspan, “The Economic Outlook, prepared testimony before the Joint Economic Committee, 109th Cong. Bernanke, “The Economic Outlook, prepared testimony before the Joint Economic Committee, U. Richard Bowen, email to Robert Rubin, David Bushnell, Gary Crittenden, and Bonnie Howard, November 3, 2007. Angelo Mozilo, email to David Sambol, April 17, 2006, subject: re: Sub-prime seconds (cc Kur land, McMurray, and Bartlett. Bank Deregulation in Historical Perspective (Cambridge: Cambridge Uni versity Press, 2000), pp. Financial Services Industry, 1975–2000: Competition, Consolidation, and Increased Risks, University of Illinois Law Review (2002): 239–40. Kenneth Garbade, “The Evolution of Repo Contracting Conventions in the 1980s, Federal Reserve Bank of New York Economic Policy Review 12, no. To implement monetary policy, the Fed eral Reserve Bank of New York uses the repo market: it sets interest rates by borrowing Treasuries from and lending them to securities firms, many of which are units of commercial banks. Fed Chairman Alan Greenspan, “International Financial Risk Management, remarks before the Council on Foreign Relations, November 19, 2002. They also could not lend more than 10% of their capital to one subsidiary or more than 20% to all subsidiaries. Fed Chairman Alan Greenspan, prepared testimony before the House Committee on Banking and Financial Services, H. Those series available before 2009 showed no year-over-year na tional house price decline.

As a result , Goldmans marks could contribute to other companies recording “mark-to-market losses: that is , the reported value of their assets could fall and their earnings would decline . We need to survey our clients and take a shot at determining the most vulnerable clients, knock on implica tions, etc. When they added the higher-leveraged, higher-risk Enhanced Fund in they be came even busier. On March,, Tannin said in an email to investors, “we see an opportunity here—not crazy oppor tunity—but prudent opportunity—I am putting in additional capital—I think you should as well. They had little success selling them directly on the market, but there was another way. Later, commercial paper investors would refuse to roll over this particular paper; Bank of America ultimately lost more than billion on this arrangement. Crucially, if the value of a hedge funds portfolio declined, repo and other lenders might require more collateral. According to Ciof, a number of factors contributed to the April revision, and Goldmans marks were one factor. However, those lenders were the same large invest ment banks that Bear Stearns dealt with every day. The staff reported that the subprime market was “very unsettled and refected deteriorating fundamen tals in the housing market. These facts caused members to be concerned about whether they understood the scope of the problem. Meanwhile, Bear Stearns executives who supported the High-Grade bailout did not expect to lose money. On July,, they issued comprehensive rating down grades and credit watch warnings on an array of residential mortgage–backed securi ties. While the specifc securities downgraded were only a small fraction of the universe (less than of mortgage-backed securities issued in ), investors knew that more downgrades might come. Many investors were critical of the rating agencies, lam basting them for their belated reactions. By July, by one measure, housing prices had already fallen about nationally from their peak at the spring of. I mean, it cant be that all of a sudden, the performance has reached a level where youve woken up. Enacting the same inexorable dynamic that had taken down the Bear Stearns funds, repo lenders increasingly required other borrowers that had put up mortgage-backed securities as collateral to put up more, because their value was unclear or depressed. The problem that were going to face is that were going to have just enormous downgrades on the stuff that weve got. Everyone tells me that its trading and its two points lower and all the rest of it and how come you cant mark your book. And when he returned from vaca tion, he was instructed to not have any involvement in the issue, because Cassano wanted Forster to take the lead on resolving the dispute. The Goldman executives considered those models irrelevant, because the contracts required collateral to be posted if market value declined, irrespective of any long term cash losses. If we start buying the physical bonds back then any accountant is going to turn around and say, well, John, you know you traded at, you must be able to mark your bonds then. It made money by using less expensive short-term commercial paper to purchase higher-yielding long term securities, a strategy known as “securities arbitrage. Soon, panic seized the short-term funding markets—even those that were not exposed to risky mortgages. Any mortgage product that is not deemed to be conforming either cannot be sold into the secondary markets or are subject to egregious discounts. It is important to note that the company has experienced no disruption in fnancing its ongoing daily operations, including placement of commercial paper. The ratings agencies and the company itself would quickly reverse their positions. On August, Mozilo reported to the board during a specially convened meeting that, as the meeting minutes recorded, “the secondary market for virtually all classes of mortgage securities (both prime and non-prime) had unexpectedly and with almost no warning seized up and. They noted that the data did not indicate a collapse of the housing mar ket was imminent and that, if the more optimistic scenarios proved to be accurate, they might look back and be surprised that the fnancial events did not have a stronger impact on the real economy. One participant, in a paraphrase of a quote he attributed to Winston Churchill, said that no amount of rewriting of history would exonerate those present if they did not prepare for the more dire scenarios discussed in the staff presentations. On the same day, Fed staff, who had supervised Countrywides holding company until the bank switched to a thrift charter in March, sent a confdential memo to the Feds Board of Governors warning about the companys condition: the company is heavily reliant on an originate-to-distribute model, and, given current market conditions, the frm is unable to securitize or sell any of its non-conforming mortgages. The ability of the company to use [mortgage] securities as collateral in [repo transactions] is consequently uncertain in the current market environment. The Fed did not intervene: “Substan tial statutory requirements would have to be met before the Board could authorize lending to the holding company or mortgage subsidiary, staff wrote. A reporter “came out with a photographer and, you know, interviewed the people in line, and he created— it was just horrible. Both companies denied rumors that the nations biggest bank would soon acquire the mortgage lender. On January,, Bank of America issued a press release announcing a “defnitive agreement to purchase Countrywide for approximately billion. Lenders quickly withdrew from pro grams with similar provisions, which shrank that market from billion to bil lion between May and August. In a fight to qual ity, investors dumped their repo and commercial paper holdings and increased their holdings in seemingly safer money market funds and Treasury bonds.

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All biopsy speci Cervix mens should be entirely submitted , and it is often useful to routinely request that multiple levels be examined by the histology laboratory . Loop Electrocautery Excisions Endometrial biopsies should be handled simi larly to curettage specimens . Their use is increasing in the treatment of squamous Endocervical and endometrial curettings consist intraepithelial lesions. Depending on the type of of multiple small fragments of epithelium, which loop used and on the depth of the excision, the are often admixed with blood and mucus. The specimen may be large enough to allow one to surgeon may put the curettings on Telfa pads or orient, open, and process it like a conventional 146 147 148 Surgical Pathology Dissection cone biopsy, as described later. However, many on the fact that most cervical lesions arise on of these specimens arrive in the surgical pathol the anterior and posterior surfaces, rather than ogy laboratory already xed in formalin and/or laterally. The endocervical margin will board with the epithelial surface upward, using sometimes be submitted separately, and an pins placed through the stroma on both sides. Examine the mucosal surface, and look for any If multiple fragments are submitted, identify lesions, especially along the squamocolumnar the mucosal surface, and try to distinguish the junction. Divide perpendicular to the mucosal surface in the plane the fragments into strips with sections perpen of the endocervical canal. For apex as a pivot, and angle the cuts to provide shallow, saucer-shaped specimens, divide the a continuous line from the endocervical mucosa specimen radially as illustrated. For small conical specimens that compass the squamocolumnar junction and will are already well xed, divide the specimen into demonstrate the extent of the transformation anterior and posterior halves, and section each zone. All ting the biopsy this way is similar to the handling sections should be submitted sequentially and of the perpendicular sections of the distal urethral designated as to their clock-face orientation. Although cautery artifact may make the limits of resection of these specimens dif cult Important Issues to Address to evaluate, it is always best to ink the mucosal in Your Surgical Pathology margins and exposed stroma for histologic Report on the Cervix evaluation. A cervical cone biopsy is a conical excision of the • Is adenocarcinoma in situ present If so, what is to the endocervical canal, the diameter at the the depth of invasion from the base of the epithe ectocervical margin, and the diameter at the en lium, either surface or glandular, from which it docervical margin. What is the horizontal is described as a clock face with the most superior spread (in millimeters) Is there any evidence midpoint of the anterior lip designated as 12 of capillary–lymphatic space invasion This point is usually marked with a stitch • If no precursor lesion or invasive tumor is iden by the gynecologist. Make a longitudinal incision through the outer stroma to the inner canal at the 3-oclock Uterus position, and open the specimen so that the inner mucosal surface is exposed. The convention of the uterus is removed for a wide variety of incising the cervix at either 3 or 9 oclock is based reasons. Common indications for hysterectomy 149 150 Surgical Pathology Dissection include uterine prolapse, leiomyomas, endometrial Orient the uterus by identifying the stubs of hyperplasia, cervical cancer, and endometrial the round ligaments that insert anterior to the cancer. The ovaries should lie posteri cesses and the variation in the appearance of orly. In addition, because the anterior peritoneum the uterus due to the hormonal environment, re ects onto the bladder, the anterior perito it is important to know both the clinical indica neum does not extend as far inferiorly along the tion for the surgery and the patients reproduc uterus as does the posterior peritoneum. Vaginal tive status when evaluating a hysterectomy and abdominal hysterectomies may be distin specimen. The peri components: (1) the uterine corpus and (2) the toneum appears V-shaped in a vaginal and U uterine cervix. Weigh the left cornual regions are located superolaterally, uterus, and record the following measurements: at the insertion of the fallopian tubes. The inferior fundus to ectocervix, cornu to cornu, and anterior 1 to 2 cm of the corpus is referred to as the isthmus to posterior. This region is a from the level of the internal os to the ectocer bridge between the cervix and the uterus and vix and the diameter of the cervix from side to demonstrates a gradual transition from endocer side and from anterior to posterior. The cervix encom the uterus can now be evaluated with a sys passes the lower portion of the uterus, beginning tematic examination of each of its main compo at the internal os. These may be seen more frequently on squamocolumnar junction moves in and out of the posterior aspect. This section provides an approach to the eval Beginning at the cervix, incise the uterus with a uation of hysterectomy specimens in four cate large blade using the probe as a guide to divide gories: (1) hysterectomies for nonmalignant it into anterior and posterior halves. Another disease, (2) hysterectomies for endometrial can method for bivalving the uterus is to use a pair of cer, (3) radical hysterectomies for cervical cancer, scissors to cut along the lateral margins from the and (4) pelvic exenterations with vaginectomies ectocervix to the cornu. At this point, the uterus may be photographed and then pinned to Hysterectomy for a wax tablet for xation. Always include sections demonstrat versely, a thick endometrium in a premenopausal ing the border between the leiomyoma and the woman may re ect only the normal secretory surrounding myometrium or overlying endome phase. In these cases, the general corpus and lower uterine segment, and record rule of one section per 1 cm of tumor diameter the maximum myometrial thickness. Smooth muscle tumors less intramural leiomyomas or evidence of adeno than 5 cm do not need to be sampled, as they myosis. Adenomyosis is usually more extensive rarely metastasize, regardless of their micro in the posterior wall and may be recognized by scopic appearance. If no lesions are identi ed, standard sections Important Issues to Address of the uterus include longitudinal sections of in Your Surgical Pathology the anterior and posterior cervix (including the Report on Hysterectomies for transformation zone) and full-thickness sec tions of the anterior and posterior walls of the Non-Malignant Disease uterus to include endometrium, myometrium, and serosa. At our institution, sections of the anterior • What procedure was performed, and what and posterior lower uterine segment regions are structures/organs are present If functional, In the case of endometrial hyperplasia, the en specify whether it is in the proliferative or tire endometrium may need to be evaluated to secretory phase. Multiple thin strips • Myometrium: Are any leiomyomas or regions of endometrium with only a small amount of of adenomyosis identi ed Specify whether underlying myometrium can be submitted in the leiomyomas are submucosal, intramural, a limited number of tissue cassettes.


  • http://www.intellectbase.org/e_publications/proceedings/IHART_Spring_2011a.pdf
  • https://bit.ly/2r0k6xt
  • https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID2836581_code466937.pdf?abstractid=2632333
  • https://www.theatrealberta.com/wp-content/uploads/2011/08/17SCN.pdf
  • http://www.ahandfulofleaves.org/documents/Encyclopedia%20of%20Buddhism_2%20Vols_%20Buswell.pdf

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