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Eric Madril, John Culhane sent fake parking ticket to guy who called Madril a meter maid
It's no surprise that parking enforcement officers don't like being called meter maids -- especially the male ones. But Eric Madril's feelings about this label apparently went beyond displeasure to revenge. He and a fellow officer, John Culhane, have been convicted of getting even with one person Madril ticketed by smacking him with a second, much more expensive fine.
The bizarre tale is told in the arrest affidavits for Madril and Culhane, on view below. In August 2009, according to the documents, Madril issued a ticket to one Joshua Miscles, who'd parked his truck near a bank in order to cash a payroll check. When Miscles asked why he was being cited, Madril said it was because the truck didn't have a front license plate.
Turns out there was nowhere to connect the plate, which is why Miscles had placed the plate on his dashboard. But when he reached into the vehicle and showed off the plate, he says Madril smiled at him and told him to deal with it. In response, Miscles called Madril a "piece of shit meter maid."
This description made Madril so angry he tried to coax the driver into a fight, Miscles told police. But Miscles, who had his twelve-year-old son with him at the time, decided to get back in his truck and drive home rather than match knuckles with the officer.
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The incident seemed to be over at that point. But no: Miscles subsequently received a second ticket, for allegedly parking in a handicapped spot on the same day as his confrontation with Madril -- something he didn't do. Moreover, the ticket was sent in the mail after its due date, so that the already hefty fine was doubled.
Miscles contested the second ticket and was found not guilty -- and an internal investigation concluded that Culhane had written the handicapped-parking citation at Madril's behest.
A jury agreed. This week, Madril was found guilty of conspiracy to commit forgery, with Culhane hit with both a forgery and conspiracy to commit forgery conviction. Both will be sentenced in November. At that time, Madril faces punishment ranging from probation to a year and a half in prison, while Culhane could get probation to three years -- even though no one ever called him a piece of shit meter maid.
Not that this label is appropriate anymore. Madril and Culhane are former parking enforcement officers now.
Look below to full-size mug shots of the men, as well as the aforementioned arrest affidavits.
John Culhane.
Eric Madril.
More from our Colorado Crimes archive: "Shotgun Willie's offers corpse discount in wake of Weekend at Bernie's misadventure (PHOTOS)."
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Contest - National TV Photo Contest
This page contains discussions between members of this contest only (National TV Photo Contest). If you would like to discuss art related topics with all of the members of FineArtAmerica.com, please use the general discussion page.
Votes To Give
Posted by: Marc Crumpler on 05/26/2013 - 10:20 PM
Please take a look at my entries and I'd appreciate your vote.
Posted by: Marcia Colelli on 05/26/2013 - 10:29 PM
Wow, Beautiful pictures. Good Luck
I voted on Upper Yosemite #3
Hiere is my link. I would appreciate your vote
Posted by: Richard Bryce and Family on 05/26/2013 - 10:50 PM
Gorgeous shots, John! I gave you #4 for Hiking the Hills. Can you send one my way for the wolf? Thanks.
Good luck!
Posted by: Diane Bohna on 05/27/2013 - 12:02 AM
Mark, Love you hiker image, great sky. Take a look at the cowboy http://fineartamerica.com/contests/national-tv-photo-contest-2.html?tab=vote&artworkid=4229501 Thank you Diane
Posted by: Camilla Hansson on 05/27/2013 - 4:26 AM
Voted #7 Hiking the hills..
Voted #2 Tall grass..
Voted #5 Upper Yosemite
Good luck!
Posted by: Jasna Buncic on 05/27/2013 - 8:57 AM
Hi Mark, voted for the most beautiful to me, the Hills #8.
Plese vote for my entry and thank you:
Posted by: Simona Ghidini on 05/27/2013 - 9:58 AM
Hi Marc, voted for all three photos.
If you would like to reciprocate, here are my images:
Thank you and good luck!
Posted by: Anne Rodkin on 05/27/2013 - 10:50 AM
Wow Marc, that Yosemite Falls shot is awesome (vote #7).
Running out of votes to share, so only could vote on one.
Hope you'll reciprocate by giving me a vote too.
Thank you and good luck!!
Posted by: Don Schwartz on 05/27/2013 - 11:09 AM
Voted for Hiking the Hills, Marc. Great image.
Here's mine; http://fineartamerica.com/contests/national-tv-photo-contest-2.html?tab=vote&artworkid=5398236
Posted by: Martha Lyle on 05/27/2013 - 11:23 AM
have voted for all of the about, certainly some beauties there!!
thanks for your votes allso.
Posted by: Marcia Colelli on 05/27/2013 - 11:28 AM
Martha, I appreciate the vote for me very much
I am vote #12
Very beautiful image. Good luck
Posted by: Marcia Colelli on 05/27/2013 - 11:50 AM
I am putting your link in again for you. Yours is not click-able.
Well, I tried, not sure what the problem is
Posted by: Axko Color de paraiso on 05/27/2013 - 2:09 PM
voted # 9 yosemite fall
look mine http://fineartamerica.com/contests/national-tv-photo-contest-2.html?tab=vote&artworkid=7526458
Posted by: Fiona Kennard on 05/27/2013 - 11:48 PM
Posted by: Mike McGlothlen on 05/28/2013 - 12:13 AM
I am now down to needing 194 votes for my best vote getter, still need a lot of help. Vote because you like it, I have used all my votes already, thank you!
Posted by: Pedro L Gili on 05/28/2013 - 5:17 AM
Voted on all three, Marc!
Please do something with my submissions!
Thank you for your kind support!
Posted by: Shane Bechler on 05/31/2013 - 11:03 AM
Marc - Vote # 14 for Hiking The HIlls At Sunrise.
Here is mine:
Posted by: Gordon Wood on 06/01/2013 - 11:09 AM
Love Upper Yosemite. Voted #13
Here are my links:
Posted by: Isabelle Kuehn on 06/01/2013 - 11:13 AM
I'm vote # 16 for the hiker image. great shot! please vote for mine, too
Posted by: Vivian Krug Cotton on 06/01/2013 - 11:16 AM
I have a few votes left to give for those who want to trade votes, but it would be nice to be seen and get votes from those not participating if they like my entry. I would be happy to promote and like pages and images on FAA when I'm out of votes or to those who aren't participating in return.
Here is my entry of Port Harford in Avila Beach. Thanks everyone and Good luck!
Posted by: Mary Ellen Frazee on 06/01/2013 - 4:27 PM
I'm vote #17 for hiking the hills.
Posted by: Wildlife Fine Art on 06/01/2013 - 4:40 PM
voted for all 3 of yours please exchange votes. Thank you
Posted by: J C on 06/01/2013 - 10:02 PM
Posted by: George Paris on 06/03/2013 - 2:55 AM
Hi Marc, vote #19 to your entry "Hiking the Hills At..."
That's a perfect shot and i really like it..
Here's mine:
Posted by: Sabrina Hall on 06/03/2013 - 5:49 AM
Posted by: Randi Grace Nilsberg on 06/03/2013 - 6:35 AM
I've used all my votes, but need more votes for this image: http://fineartamerica.com/contests/national-tv-photo-contest-2.html?tab=vote&artworkid=7091676
Posted by: Fotosas Photography on 06/03/2013 - 11:33 PM
Posted by: David Hill on 06/03/2013 - 11:45 PM
Here's my link:
Thanks in advance!!
Posted by: Tim Ai on 06/05/2013 - 12:31 AM
Love your Yosemite image ... voted
Here is my link:
Posted by: Suzanne Luft on 06/05/2013 - 12:45 AM
Fave is Upper Yosemite #16
Mine is:
Posted by: Lj Lambert on 06/05/2013 - 2:27 PM
Are you returning votes?
Posted by: Exchange Votes on 06/06/2013 - 1:56 AM
giants hat that i see? #gogiants
vote for allen zhen *snap* done when it increases by 1
can you help me get more too, and will help u in return
just message me when u get more to help me then i can help u too
Posted by: Abril Gonzalez on 06/06/2013 - 2:15 AM
Voted for all three. Gorgeous images!
Here are mine
Thank you!
Posted by: Janet Watson Art Art on 06/06/2013 - 2:25 AM
Hello everyone. Thank you for looking :)
Thank you :)
Just voted for all above.
Best wishes,
Posted by: Exchange Votes on 06/06/2013 - 2:26 AM
5! ^^
http://www.lootsnap.com/home/entries/49 (snap "allen zhen's photo" please thanks)
can you help me get some more votes and will help u back too
Posted by: Kaleidoscope Klick Photography on 06/07/2013 - 9:14 PM
25 10 17
Please help me reach 250
Mine are back to back images Thank you. http://ow.ly/lGLeL
Posted by: Dave Glover on 06/07/2013 - 11:23 PM
I would apreciate some assistance with reaching 250. I have votes to reciprocate, just message me and tell me what number vote you were. Good luck to everyone there are a lot of great images here.
Posted by: Chrystyne Novack on 06/08/2013 - 12:04 AM
Absolutely stunning colors and sunbeams in Hiking Hills. Vote #26. Good Luck!
My two of which you vote for one or both whatever you chose:
Post Reply
Please login before posting a reply to this message. If you do not have an account on FineArtAmerica.com, click here to create one!

subset: commoncrawl


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This Sunday happened to be my cousins birthday and since I am always looking for an excuse to dress up I did exactly that even though it was only a family Sunday lunch type thing.
I decided to wear a basic white shirt and jeans since I had spent a bit if time trying to decide what to wear , at first I wore this shirt untucked and normal but before we left I got bored and tied it and the green accessories and the bag were a total coincidence .
Anyway I am wearing an h&m shirt , asos denim and heels , the green cuff is from asos too and my bag is from reiss .
Thank you for taking the time out to stop by my little blog.
Leave any comment you want , I'm always excited to see what you all have to say of course .
Xxx, Beeba


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Glasshouse visits the mid-atlantic
Expand Messages
- Hey a cappella fans,
Glasshouse would like to let you know that we enjoyed our visit to
the mid-atlantic via the Harmony Sweepstakes. The groups from that
area that we performed with were amazing.
Also, Glasshouse's very first album is in production as we type and
is slated for release around the end of April/ early May.
Check www.glasshousemusic.org frequently for more information on our
premier album.
Thank you,
Randy Boone
Your message has been successfully submitted and would be delivered to recipients shortly.


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Attitudes towards prescribing cognitive enhancers among primary care physicians in Germany
Knowledge, attitudes, behaviors, education, and communication
Primary care physicians are gate keepers to the medical system having a key role in giving information and prescribing drugs to their patients. In this respect they are involved in claims of patients/clients for pharmacological Cognitive Enhancement (CE). Therefore, we studied the knowledge of primary care physicians about CE and their attitudes toward prescribing CE drugs to healthy subjects.
A self-report paper-and-pencil questionnaire and case vignettes describing a hypothetical CE drug were sent out to all 2,753 registered primary care physicians in Rhineland Palatine, Germany. 832, i.e. 30.2% filled in the questionnaire anonymously.
96.0% of all participating physicians had already heard about CE. However, only 5.3% stated to be very familiar with this subject and 43.5% judged themselves as being not familiar with CE. 7.0% had been asked by their clients to prescribe a drug for CE during the last week, 19.0% during the last month, and 40.8% during the last year. The comfort level to prescribe CE drugs was very low and significantly lower than to prescribe sildenafil (Viagra®). Comfort level was mainly affected by the age of the client asking for prescription of CE drugs, followed by the availability of non-pharmacological alternatives, fear of misuse of the prescribed drug by the client and the missing indication of prescribing a drug.
Although a relatively high proportion of primary care physicians have been asked by their clients to prescribe CE drugs, only a small proportion are well informed about the possibilities of CE. Since physicians are gate keepers to the medical system and have a key role regarding a drugs' prescription, objective information should be made available to physicians about biological, ethical and social consequences of CE use.
Primary care physicians play a crucial role in prescribing drugs. In many jurisdictions they are the first individuals who have to be contacted by the general public when a prescription is sought. Regarding covering costs by the health care system, in the United Kingdom patients have to register at a primary care physician who gives referrals to specialists. In Germany, patients can chose and change their primary care physician who gives referrals; however, patients have the opportunity to contact a specialist directly. In the United States, patients are able to obtain an appointment with a specialist without a referral from a primary care physician.
As such, depending on the national health care system, primary care physicians act more or less as "gatekeepers" for the medical system. Even if prescription drugs against somatic disorders are the most prevalently prescribed drugs among primary care physicians (e.g. non-steroidal anti-inflammatories, beta-blockers, etc.), they frequently are contacted for advice and counselling for mental disorders
The group of substances used by healthy subjects for CE purposes consists of over-the-counter- (OTC-) drugs (e.g. Ginkgo biloba, caffeine tablets, etc.) as well as illicit and prescription drugs. Among the drugs that require a prescription are stimulants such as methylphenidate (MPH) and amphetamines (AMPH) such as Adderall®, as well as other drugs such as modafinil, anti-dementia drugs, beta-blockers, and antidepressants for mood enhancement (ME)
Bergström and Lynöe found that more than 80.0% of 300 surveyed primary care physicians in Sweden were convinced that CE drugs should not be covered by the health insurance system and individuals should pay themselves for CE drugs
Previous studies on CE found large differences in prevalence rates for CE use ranging from > 1 – 20% among students
The present study presents data on the knowledge of, attitudes towards, familiarity with, frequency of being asked for, and comfort levels with prescribing CE drugs by primary care physicians in Germany.
Participants and procedure
Envelopes with paper-and-pencil questionnaires were sent out in June 2011 to all registered primary care physicians (n = 2,753) in Rhineland Palatine, a state in West Germany with about four million inhabitants. Participants were asked to complete the questionnaire anonymously and to return it in an anonymous, addressed and pre-paid envelope within one month. Physicians who did not answer were identified using a code, called twice via telephone and asked to send back the questionnaire. Those who did not possess the questionnaire any more were sent the questionnaire again. Participants also had the option of returning the questionnaires via email or fax.
The first wave of completed questionnaires were received between July and September 2011. Afterwards, the questionnaires were returned according to the order of the telephone calls.
530 physicians responded immediately by sending back their questionnaire (first response rate: 19.3%), 302 responded after telephone calls (second response rate: 11.0%) resulting in a total response rate of 832 (30.2%).
The questionnaire was based on the one used by Banjo and colleagues
Subsequently and identical to the original questionnaire of Banjo and colleagues, the second part of the introduction section reviewed briefly the following: "Research shows that normal decline in cognitive function in healthy individuals becomes evident in the later years of the fourth decade of life (late 30's). Widely accepted as a normal part of aging, this cognitive decline is not a disease and moreover is distinct from the prodromic cognitive decline that precedes dementia. In a society in which one's cognitive abilities are important determinants of self-esteem and respect from one's peers, the normal cognitive decline of aging can be disturbing".
Identical to Banjo and colleagues we asked for demographic data (age, gender). Beyond Banjo and colleagues, we asked for family status, hours worked per week and whether respondents were living with or without children based on the assumption that these factors could be associated with the dependent variables described below.
Furthermore, a question probing knowledge of CE, the source of knowledge about CE drugs, and the frequency being asked for a prescription of CE drugs developed by our group was asked. This was followed by a question of feeling familiar (very familiar, somewhat familiar and not familiar) with CE drugs.
A hypothetical case vignette was introduced identical to Banjo and colleagues: In this vignette, a hypothetical prescription drug approved for CE in healthy adults was introduced to the participants. The CE drug was characterized to be effective, safe and without remarkable adverse events. In order to assess the impact of patients giving reasons for requesting the drug upon physician attitudes, we presented three scenarios: a 25-year old graduate student seeking to cope with the stress of graduate school, a 45-year-old employee hoping to improve productivity, and a 65-year-old individual feeling concerns about his ability to perform everyday activities. Then, physicians were asked how comfortable they felt prescribing the hypothetical CE drug on a Likert scale (comfort level with anchors at 1 = very uncomfortable and 7 = very comfortable). Subsequently, participants were asked for the reasons that determined their comfort level.
Afterwards, we probed physicians' attitudes towards prescribing the hypothetical CE drug and three other drugs sometimes considered to be enhancers: sildenafil, modafinil, and MPH. Using the same Likert scale we asked for their comfort level to prescribe these drugs to a 40-year-old person reporting symptoms consistent with the label indications for each drug.
The study was approved by the local Ethics Committee (Landesärztekammer Rhineland Palatine No. 837.321.08 (6318)). Participation was explained to be optional; participants gave informed consent by returning the questionnaire.
Statistical analysis
Statistical analyses were performed using SPSS 17.0. Means are given with corresponding standard deviation (mean ± SD) and Pearson-Clopper confidence intervals (95% CI). Questions were analyzed using stepwise forward multiple logistic regression analysis with a selection level of 0.05. For evaluation of the results of the logistic regression analysis we used pseudo-R squared (Nagelkerke).
Participants' characteristics
Demographic data of the participating 832 physicians (= 100.0%) are given in Table
Knowledge about CE and familiarity with this topic
Knowledge about CE
In total, 96.0% (n = 799 of 832) physicians had already heard about the use of substances of any kind for CE. 29.1% (n = 242 of 832) had heard about CE by friends or relatives and 33.2% (n = 276 of 832) by colleagues. 71.2% (n = 592 of 832) were informed by print media (newspapers, magazines), 33.8% (n = 281 of 832) by digital media (TV, internet), and only 4.0% (n = 33 of 832) had not yet heard about CE.
Logistic regression analysis revealed that knowledge about CE was associated with the location of the doctors' office: Primary care physicians having their office in non-urban areas had heard about CE by colleagues significantly more often than those whose offices were in cities (p = 0.019; OR: 0.500; CI: 0.280 – 0.890; pseudo-R Squared: 0.045). Beyond that, the more years physicians worked in their office outside of the hospital setting, the greater their knowledge about CE derived from print media (p = 0.014; OR: 1.047; CI: 1.009 – 1.086; pseudo-R Squared: 0.031), and the more their general knowledge about CE (apart from the source of knowledge) (p = 0.018; OR: 0.957; CI: 0.923 – 0.993; pseudo-R Squared: 0.071). There were no associations between knowledge about CE and the following characteristics of the participants: gender, age, family status, living with children, having an additional Certificate of Added Qualification nor hours of work per week.
Physicians' knowledge about individual substances for the purpose of CE differed substantially (see Table
Being familiar with CE
Only 5.3% (n = 44 of 821) of all participants stated that they were very familiar with the topic of CE, 49.9% (n = 415 of 821) stated that they were somewhat familiar with CE and 43.5% (n = 362 of 821) stated that they were not familiar with CE.
Regarding feeling familiar with CE, there were no associations found for gender, age, years working in one's own doctor's office, working as a physician, hours of work per week, living with children, having an additional Certificate of Added Qualification, doctor's office being located in a city or family status.
Frequency of being asked by patients to prescribe a drug for CE
Regarding the estimated frequency of being asked by clients to prescribe a drug for CE purposes, 99.3% (n = 826 of 832) answered this question. 7.0% (n = 58 of 826) stated that they had been asked at least once during the last week, 19.0% (n = 157 of 826) during the last month, and 40.8% (n = 337 of 826) during the last year. 9.4% (n = 78 of 826) of the physicians had been asked more than one year ago and only 23.7% (n = 196 of 826) indicated that they had never been asked to prescribe a drug for CE by healthy subjects.
Comfort levels of primary care physicians to prescribe drugs
a) Comfort levels regarding three scenarios
Comfort levels to prescribe CE drugs to individuals of certain characteristics (25-year old graduate student seeking to cope with the stress of graduate school, 45-year-old employee hoping to improve productivity, 65-year-old individual feeling concerns about his ability to perform everyday activities) were rated by using a 7-step Likert scale with anchors at 1 (= feeling very uncomfortable) and 7 (= feeling very comfortable).
Figure 1
Differences regarding comfort level to prescribe a drug to a 25-year-old graduate student, a 45-year-old-worker and a 65-year-old individual
Differences regarding comfort level to prescribe a drug to a 25-year-old graduate student, a 45-year-old-worker and a 65-year-old individual. Means of the comfort levels were calculated using Likert scales.
Logistic regression analysis revealed no significant influence regarding the tested dependent variables (age, hours of work per week, etc.) for all three scenarios.
b) Factors influencing comfort levels in prescribing CE drugs
c) Comfort levels to prescribe a potential CE drug like modafinil or methylphenidate as compared to sildenafil
Physicians were asked how comfortable they felt prescribing sildenafil, MPH, Modafinil, or the hypothetical CE drug as described above to a 40-year-old person reporting symptoms consistent with the label indications for each drug using a 7-step Likert scale with anchors at 1 (= feeling very uncomfortable) and 7 (= feeling very comfortable).
Figure 2
Comfort levels to prescribe Viagra®, Modafinil, Ritalin®, Cognitive Enhancer using Likert scales (comfort level with anchors at 1 = very uncomfortable and 7 = very comfortable)
Comfort levels to prescribe Viagra®, Modafinil, Ritalin®, Cognitive enhancer using Likert scales (comfort level with anchors at 1 = very uncomfortable and 7 = very comfortable).
There were significant differences between the disposition of the physicians to prescribe the different types of drugs. Physicians felt significantly more comfortable in prescribing Viagra® then prescribing modafinil, Ritalin® or the hypothetical CE drug. In addition physicians felt much more comfortable in prescribing the hypothetical enhancer than choosing modafinil or Ritalin®.
With respect to comfort levels of physicians regarding the prescription of sildenafil, modafinil, MPH or a hypothetical CE drug, logistic regression analysis revealed that male primary care physicians felt significantly more comfortable prescribing sildenafil than female physicians (p = 0.003; OR: 0.463; CI: 0.159 – 0.767; pseudo-R Squared: 0.026) as well as primary care physicians having their doctor's office in a city showed a higher comfort level for prescribing sildenafil (p = 0.048; OR: 0.321; CI: 0.003 – 0.640; pseudo-R Squared: 0.026). Regarding comfort levels of prescribing sildenafil, there were no associations with age, years working as a physician, years working in one's own doctor's office, hours of work per week, family status, living with children, and the location of one's own doctor's office.
Regarding modafinil, male primary care physicians and physicians having their office in a city felt more comfortable prescribing modafinil (p = 0.001; OR: 0.573; CI: 0.227 – 0.918 and p = 0.010; OR: 0.484; CI: 0.118 – 0.850; pseudo-R Squared: 0.045 respectively). There were no associations with age, years worked as a physician, years worked in own doctor's office, hours worked per week, family status, living with children, location of doctor's office.
For MPH and the hypothetical CE drug, we found the same positive association with male physicians as with sildenafil and modafinil (MPH: p = 0.030; CI: 0.040 – 0.786; OR: 0.413, pseudo-R Squared: 0.029; hypothetical CE drug: p = 0.034; CI: 0.028 – 0.682; OR: 0.354, pseudo-R Squared: 0.035). Further associations were not found for MPH as well as the putative CE drug (MPH: age, years worked as a physician, years working in one's own doctor's office, hours worked per week, family status, living with children, additional Certificate of Added Qualification, location of doctor's office. Putative CE drug: age, years worked as a physician, hours worked per week, family status, living with children, additional Certificate of Added Qualification, location of doctor's office).
This study investigated knowledge of, attitudes towards, familiarity with, frequency of being asked for prescriptions for, and comfort levels with prescribing CE drugs among 832 primary care physicians in Germany. The study showed an especially high knowledge level regarding CE among the participating subjects with MPH being the most widely known substance for CE. In contrast to this high knowledge level, only 5.3% of the physicians stated that they were very familiar with CE, and 43.5% described themselves as being not familiar with the subject. 40.8% of the surveyed primary care physicians had been asked for a prescription for CE during the last year followed by 19.0% which had been asked during the last month and 7.0% during the last week. Comfort levels to prescribe CE drugs are low among the surveyed physicians and significantly lower than to prescribe sildenafil (Viagra®). Another main finding is that comfort levels to prescribe a CE drug are mainly affected by the age of the asking subject followed by the availability of non-pharmacological alternatives, fear of misuse of the prescribed drug and the missing necessity of needing the drug.
We demonstrated that nearly all surveyed primary care physicians (96.0%) reported that they knew about the possibility of pharmacological CE. This is significantly higher proportion than among students in previous studies. Two studies among nearly 10,000 students reveal that about 80% of surveyed students knew about this possibility of CE
Although nearly all physicians had heard about the possibility of CE, only about half of the physicians felt they were not familiar with the topic of CE, and only a minority of physicians felt very familiar with CE. As compared to Banjo and colleagues, we obtained comparable results for feeling very familiar with CE (Banjo and colleagues: 4.0%, present study: 5.7%)
Compared to Hotze and colleagues, the percentage of primary care physicians who reported being asked for a prescription of a drug for CE during the last week was considerably lower in our study: 62% in the survey by Hotze and colleagues receive requests "to prescribe interventions for what they view as enhancement purposes" monthly and 12.0% daily as compared to 7.0% during the last week, 19.0% during the last month, and 41.0% during the last year in our study presented here. We can only speculate about the reasons for his difference. Age and sex of the participants of the two studies is comparable (Mean age in our study: 54.3 years, Hotze et al.: 52.6 years; sex in our study: male: 68.1%, female: 31.1%, Hotze et al.: male: 72.0%, female: n.a.). Unfortunately, neither Hotze and colleagues nor our study describes the requesting individuals (age, sex, students, workers, etc.). One possibility is that the requesting individuals in the study of Hotze and colleagues had different characteristics than the requesting individuals remembered by the surveyed primary care physicians in our study. Furthermore, in the introduction section of our questionnaire we defined CE drugs to be "substances which are used with the purpose to enhance one's own cognition and that CE drugs have been developed for the treatment of cognitive decline (e.g. dementia in elderly people) or cognitive disturbance in younger subjects (e.g. attention deficit hyperactivity disorder, ADHD)". Hotze and colleagues asked about "how often patients requested medicine or services that the physicians considered to be for enhancement rather than therapy"
Using vignettes of patients requesting a physicians' prescription of a CE drug, we probed participants about their behaviour in case of a healthy 25-, 45- and 65-year old individual having cognitive problems and therefore participants having a reason for prescribing a CE drug. We found age of the requesting patient/client to be the main factor determining comfort level of the surveyed primary care physicians. However, even if the aim of all three scenarios is cognition enhancement, the reasons for the requests are different (to cope with stress at graduate school, improve productivity at work, leading an active life to counteract subjective cognitive decline). This has to be considered when interpreting that age of the requesting person is the decisive associated factor. Further participants' characteristics were found to play no role (sex, etc.). This is in line with previous results of Banjo and colleagues who found that the age of the requesting patient/client as being a key determining factor
We found that fear of misuse, availability of non-pharmacological methods of achieving the same goals and the fact that the requesting individual does not need the drug to be the most relevant reasons affecting physicians comfort levels of prescribing CE drugs in case of the 25-year old college student and the 45-year old employee. These results confirm the results of Banjo and colleagues
The last set of questions was about a comparison of sildenafil, MPH, modafinil and a hypothetical CE drug prescribing to patients having the label indication. We found that the highest comfort level for prescribing these agents was for sildenafil (comfort level 7 = 13.1%) compared to MPH (comfort level 7 = 1.8%), modafinil (comfort level 7 = 2.5%) and the hypothetical CE drug (comfort level 7 = 1.9%). These results are similar to those of Banjo and colleagues
Beyond that, we found that male primary care physicians had a higher comfort level to prescribe sildenafil, modafinil, MPH or a hypothetical CE drug to patients having an indication for a prescription. This is in line with previous results by Ponnet and colleagues searching for determinants of physicians to prescribe MPH for CE using the theory of planned behaviour (TPB). They found that gender influenced attitudes towards prescribing MPH for CE, too: Compared to male physicians, female physicians had more negative attitudes towards prescribing MPH for CE
Finally, primary care physicians have a crucial role of the supply of prescription drugs for CE, they are meant to be gatekeepers to the medical system and they are the first who are contacted by the general public searching for a physicians' prescription. However, at the present time the prescription of CE drugs by primary care physicians is much less prevalent than the prescription of somatic medication to patients
At present primary care physicians have to decide what to do on their own regarding CE. Although nearly all of them reported that they knew about the phenomenon of pharmacological CE there is a lack of guidelines aimed at primary care physicians. One possibility is that the existing guidelines to neurologists for adult and paediatric populations could be adopted. The "Guidance of the Ethics, Law and Humanities Committee" for neurologists provides neurologists with an overview of ethical, legal, and social issues surrounding CE as well as practical guidance for responding to an adult patient's request for CE drugs developed by Larriviere and colleagues
Beyond that, "Ethical, legal, social, and neurodevelopmental implications" have been developed for pediatric CE
These position papers are primarily directed at neurologists, but the conclusions are indeed relevant to primary care physicians as well. What is missing from the discussion is the development of a more general set of guidelines that can apply to all physicians – neurologists, primary care physicians, and others – that will assist them in their decision-making with respect to prescribing CE. Much more data about the phenomenon of CE is needed. At least, medical education and post-graduate education of physicians should contain information about the pro-cognitive limitations, the fact of pro-cognitive placebo-effects and the relevant side effects as well as the safety profile of potential CE drugs as well as ethical and social implications. Clients claiming for a CE prescription should be elucidated by their physicians.
A few questions for further studies arise based upon the presented data and should be addressed in further studies to inform the debate about CE: We do not know if the clients asking for a prescription are younger students needing help to perform better in school and university or older ones complaining cognitive decline. This would be an important additional piece of information that could be used to characterize claims for CE and the prescription of CE drugs. Therefore, further studies among primary care physicians should address the question of characteristics of patients asking for a CE prescription. Furthermore, the present study does not assess if the clients ask for a special drug (e.g. MPH) which they want to get prescribed or if they ask for general pharmaceutical cognitive help. In this respect we do not know what requested primary care physicians do after having been requested for a prescription. The behaviour after being asked for a prescription should be addressed in further studies as well. Beyond that, we did not ask for interventions primary care physicians do after being asked for a prescription e.g. counselling regarding alternative possibilities to enhance cognition or mood and if they explain the small pro-cognitive effect as well as the (dangerous) side effect profile of the present drugs. To address these questions and questions to the close context in case of being asked for prescribing a CE drug may be contents for qualitative research (interview studies) among primary care physicians. Unfortunately, these questions cannot be addressed by the use of anonymous questionnaires (neither paper-and-pencil, nor web-based). Therefore, in depth interviews of primary care physicians should be done.
Some limitations of the study are worth identifying. A general problem of anonymous surveys is the possibility of misunderstanding questions and the interpretation of the questions by the participants. Together with the use of case vignettes this may lead to a certain kind of fuzziness of data obtained. Furthermore, the relevance perceived by the participants may influence the answers obtained. The more important aspect regarding understanding and interpretation of this survey may be the socially undesirable behaviour of misusing substances to enhance cognition which can be regarded to be comparable to the use of drugs for physical enhancement. Answering questions regarding such a stigmatizing subject – even if the survey is anonymous – may lead to socially desired answers depicting a bias of the present data.
The sample of primary care physicians of Rhineland-Palatine is large, but is neither representative of Germany nor other countries. Furthermore, the response rate was 30.2%. This response rate of only 1/3 means a selection bias. We can only speculate about the reasons of non responding to the questionnaire (e.g. lack of time, feeling that the topic is not important, socially non-desired opinions, etc.). These aspects make it difficult to generalize from the results.
Beyond that, the logistic regression analysis was the most appropriate method to analyse the data of this survey study. However, several times ORs are quite close to 1.0 and the analysis of pseudo-R Squared are smaller than 0.1 which limits the explanatory power of the analysis.
The data presented in this study confirm and extend previous studies of physician attitudes towards prescribing enhancement pharmaceuticals to physicians in Germany. Given the different social, legal and medical contexts in Germany, the present results are important in demonstrating that the general trends of physician attitudes towards enhancement are relatively stable: physicians view themselves as gatekeepers and are generally less comfortable prescribing CE for younger populations than for older individuals. Despite these observations, the study highlights the need for further education of physicians about the biological, ethical, and social consequences of CE use, and suggests that an organized international effort for outreach to physicians is both appropriate and timely.
AMA: American Medical Association; AMPH: (Prescription) Amphetamine(s); AQ: Anonymous questionnaire; ADHD: Attention deficit/hyperactivity disorder; CE: (Pharmacological) cognitive enhancement; CI: Confidence interval; ME: (Pharmacological) mood enhancement; MPH: Methylphenidate; OR: Odds ratio; OTC: Over the counter; RCT: Randomized controlled trial; RRT: Randomized response technique; SD: Standard deviation; TPB: Theory of planned behaviour.
Competing interests
All authors declare to have no competing interests.
Authors' contributions
AGF, KL and PBR participated in the conception and design of the study. AGF, CP and ES monitored data collection. AGF, KL, CP analysed and checked the data calculation. All authors participated in data interpretation, drafting, and revising the manuscript. All authors read and approved the final manuscript.
Authors' information
AGF, ES, CP and KL belong to the Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Germany. KL is a Professor for Psychiatry and Psychotherapy and the the head of the Department of Psychiatry and Psychotherapy. AGF is a research fellow at the Department for Psychiatry and Psychotherapy and has recently received a Professorship for Medicine in Social Work and Education at the University of Neubrandenburg; ES and CP are doctoral students of the Department of Psychiatry and Psychotherapy. PBR is a Professor for Neuroethics at the University of British Columbia (UBC), he is trained in neurobiology of behavioral states and the molecular underpinnings of neurodegenerative disease. He focuses his research in the area of neuroethics at the National Core for Neuroethics at the UBC in Vancouver (Canada).
The authors would like to thank the staff of the Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) of the University Medical Center of the Johannes-Gutenberg University Mainz for the mathematical support of the statistical analysis.
Financial project funding: German ministry of Research and Education (BMBF) No. 01GP0807 (2009 – 2011). The BMBF had no influence on the content of this manuscript.
"Doctor, would you prescribe a pill to help me … ?" a national survey of physicians on using medicine for human enhancement
Pharmacological neuroenhancement and brain doping: Chances and risks
Botox for the brain: enhancement of cognition, mood and pro-social behavior and blunting of unwanted memories
Pharmacological Neuroenhancement: Substances and Epidemiology
Enhancing concentration, mood and memory in healthy individuals: an empirical study of attitudes among general practitioners and the general population
Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount
Use of cognitive enhancement medication among northern italian university students
Randomized response estimates for the 12-month prevalence of cognitive-enhancing drug use in university students
Non-medical Use of prescription stimulants and illicit Use of stimulants for cognitive enhancement in pupils and students in Germany
Use of coffee, caffeinated drinks and caffeine tablets for cognitive enhancement in pupils and students in Germany
The use of prescription stimulants to enhance academic performance among college students in health care programs
Prevalence of stimulant use in a sample of US medical students
Cognitive-enhancing substance use at German universities: frequency, reasons and gender differences
Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample
Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration
Poll results: look who's doping
Use of illicit and prescription drugs for cognitive or mood enhancement among surgeons
What users think about the differences between caffeine and illicit/prescription stimulants for cognitive enhancement
Determinants of physicians' prescribing behaviour of methylphenidate for cognitive enhancement
Responding to requests from adult patients for neuroenhancements: guidance of the Ethics Law and Humanities Committee
Pediatric neuroenhancement: ethical, legal, social, and neurodevelopmental implications
Pre-publication history
The pre-publication history for this paper can be accessed here:


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Best known for presiding over the Spanish Steps which lead down into the Piazza di Spagna, construction of this church was completed in the early 1500s. Both the building and surrounding areas are property of the French state who commissioned the project in celebration of their successful invasion of Naples.
A very short-lived victory.


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I have received an email originating from China informing me that another company is attempting to register my own company's name in Asia as a domain brand name. Should I be concerned?
No. This type of unsolicited email is part of a growing trend in which U.S. companies who already have an Internet presence via an existing registration of a top level domain (TLD), such as yourcompany.com, are advised that if they do not immediately act, another entity will register their domain name in Asia. This third party attempt to register may not even be true, but the solicitor is hoping that you panic and decide to go through with the Chinese registration, which involves a nominal fee for the actual registration, but probably an exorbitant service fee charged by the solicitor for their "services". The solicitor is hoping that you are unaware of the differences between a TLD and a country code top level domain (ccTLD), such as yourcompany.cn, which represents China. Having a ccTLD is usually unnecessary since web users from anywhere in the world, even those in China, can still access your company's website via your TLD registration.
What is a trademark and what do the ®, SM, and ™ symbols mean?
A trademark identifies the source of goods or services. Simply using a mark gives an owner certain rights to prevent others from using it or similar marks. ™ is used with trademarks and SM with service marks to notify the public of an owner's rights in the mark. A mark used in interstate commerce may be registered with the U.S. Patent and Trademark Office if it is distinctive (not descriptive) and not confusingly similar to any marks. Registration entitles an owner to use ® to advise and warn the public of the owner's rights in the mark and to more easily enforce his/her rights in the mark. Marks used in intrastate commerce may be registered in a state registry, but may only use ™.
I had some photographs taken of my children at a photography studio. Can I have additional prints made at my local drugstore or scan the photograph and make my own prints without the permission of the original photographer?
No. You purchased and own only the particular prints supplied to you. All rights to reproduce the photographs (the copyrights) are retained by the photographer, who is typically an independent contractor. Some photographers make this clear by placing a copyright notice (©, owner's name, and possibly year) on the front or rear of the prints, but their copyright protection exists even if the copyright notice is missing. The federal copyright law gives strong protection to creators of works, and no transfers of copyrights are effective (except under certain employer/employee work-for-hire situations) unless they are made in writing.
Someone registered my trademark as his domain name (URL). What can I do?
There are two main paths to "taking your name back" from the cybersquatter: the Uniform Domain Name Dispute Resolution Policy (UDRP) and the Anticybersquatting Consumer Protection Act (ACPA). Both actions focus on the confusing similarity between your mark and the URL, the URL owner's use of the site, and the URL owner's bad faith. In both actions, the bad faith factors are similar and center on why the URL owner registered the name. The URL owner has various defenses to these factors, such as preexisting rights or fair use. Due to ACPA jurisdictional requirements, the UDRP is particularly useful in connection with foreign registrants. While both actions provide for URL transfer, money damages are only available under the ACPA.
Is it possible to obtain trademark rights for something other than the brand name of my product?
Yes. Typically, we think of trademarks as words, whether found in a dictionary or coined by trademark owners. However, some of the best known trademarks do not involve words or letters at all. Trademarks can take the form of distinctive graphical designs or logos, the fanciful use of colors, non-functional product configuration or packaging, or even sounds. While it is difficult, time-consuming and costly to create an association between these types of non-traditional trademarks and the source of those goods, they are often more valuable in the long run. Non-traditional trademarks are also extremely useful in symbolizing the goodwill associated with an owner's brand.
I would like to register a federal trademark for a product or service that I am planning to market in the future. What are my options?
Trademark protection in the United States is use-based, meaning that only goods, which are sold or transported and services which are rendered in commerce are eligible for protection. However, U.S. Trademark law allows applicants with a good faith intent to use the mark in commerce for specific goods or services to file an "intent-to-use" application. If an intent-to-use application meets the statutory requirements for trademark protection, the United States Patent and Trademark Office will publish the mark in the Official Gazette for opposition. If no opposition is filed, a Notice of Allowance is issued. The Office requires that a Statement of Use be filed within 6 months of the date of the Notice of Allowance verifying that the mark is in use in commerce in connection with an actual product or service. This deadline can be extended to three years from the mailing date of the Notice of Allowance to obtain a Certificate of Registration (with payment of the proper extension fees). A cautionary note: it is improper to file an intent-to-use application for the sole purpose of "reserving" or "staking a claim" to a mark. You may be required to show proof of your good faith intent to use a mark in an opposition, cancellation, or civil action involving a Federal trademark, which is based upon a bona fide intent to use the mark.


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by Maria Ramirez
(South Jersey)
I lost my husband August 15, 2012 He was only 35. He had been admitted to the hospital with a possible blood clot. He had a rare genetic blood disorder called Factor V lieden. Anyway, he was admitted and all sorts of tests were performed but nothing was found. So the night/morning that he was being released he buzzed his nurse at 4am for pain meds. She came in had a conversation with him, laughing and joking then at 4:39am he coded... His heart monitor went crazy so they rushed in, attempted CPR, shocked him so many times they burned him and even gave him 4 shots of adrenaline to no eval. He was pronounced dead at 5:09am... My world ended right that second. We were only together 6 yrs and married for 4. (our 5th wedding anniversary is actually this fri June 7th) we never got around to having kids but we were trying. I lost my best friend and now my world is just empty. I count down the minutes til i can see him again. I like many others am so mad at god. I understand he was suffering and in pain but why take him from this world why not just heal him and let him enjoy life. He was only 35. There was so much more for him. He should be by my side right now. Not in an urn on my shelf. I have no one. His family completely shut me out like it was my fault that he was gone. The day of his memorial which they planned for themselves and totally ignored what i was planning to go along with his wishes, they had his previous girlfriend sit with them in church, like she was the grieving widow as i sat with my mom brother and sister and cried hysterically and silently prayed to god to take me too .. Every night i pray he takes me because my life ended the day he took Carlos away from me. Ill never be able to love anyone the way i love him and ill never let anyone get that close to me again. So whats the point of being here. Im 32 and have to live with my parents because i cant make it on my own without my Carlos. He was my first my last my everything and i just cant do this thing called life without him. It will be 10 months on the 15th and everyday i look at my phone and i wait for him to text or call me and tell me hes alright...that he just needed time to fix himself and hes ready to live the rest of our life together. I try to put on a brave face for my friends and family and i even try not to talk about Carlos in fear that they are all sick of hearing about him. I'm afraid if i stop talking about him, everyone will forget and that will hurt me more than anything....he was unforgettable in my eyes even though he was by no means an angel...he had his demons as.most of us do...but he was my everything..and i will never find that. I knew the first time we kissed on March 26, 2006 that we would be together forever...and when he asked me to be his girlfriend on April 3, 2006 i said yes and a month later on may 27, 2006 when he asked me to be his wife on the boardwalk in AC...I said yes without a bit of hesitation because i knew from our first.kiss that we were soul mates! And that i will never find again. Why would God bring such a wonderful creature into my life only to tear him away 6 short yrs later... I wish i knew...
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A new fetal RHD genotyping test: Costs and benefits of mass testing to target antenatal anti-D prophylaxis in England and Wales
Postnatal and antenatal anti-D prophylaxis have dramatically reduced maternal sensitisations and cases of rhesus disease in babies born to women with RhD negative blood group. Recent scientific advances mean that non-invasive prenatal diagnosis (NIPD), based on the presence of cell-free fetal DNA in maternal plasma, could be used to target prophylaxis on "at risk" pregnancies where the fetus is RhD positive. This paper provides the first assessment of cost-effectiveness of NIPD-targeted prophylaxis compared to current policies.
We conducted an economic analysis of NIPD implementation in England and Wales. Two scenarios were considered. Scenario 1 assumed that NIPD will be only used to target antenatal prophylaxis with serology tests continuing to direct post-delivery prophylaxis. In Scenario 2, NIPD would also displace postnatal serology testing if an RhD negative fetus was identified. Costs were estimated from the provider's perspective for both scenarios together with a threshold royalty fee per test. Incremental costs were compared with clinical implications.
The basic cost of an NIPD in-house test is £16.25 per sample (excluding royalty fee). The two-dose antenatal prophylaxis policy recommended by NICE is estimated to cost the NHS £3.37 million each year. The estimated threshold royalty fee is £2.18 and £8.83 for Scenarios 1 and 2 respectively. At a £2.00 royalty fee, mass NIPD testing would produce no saving for Scenario 1 and £507,154 per annum for Scenario 2. Incremental cost-effectiveness analysis indicates that, at a test sensitivity of 99.7% and this royalty fee, NIPD testing in Scenario 2 will generate one additional sensitisation for every £9,190 saved. If a single-dose prophylaxis policy were implemented nationally, as recently recommended by NICE, Scenario 2 savings would fall.
Currently, NIPD testing to target anti-D prophylaxis is unlikely to be sufficiently cost-effective to warrant its large scale introduction in England and Wales. Only minor savings are calculated and, balanced against this, the predicted increase in maternal sensitisations may be unacceptably high. Reliability of NIPD assays still needs to be demonstrated rigorously in different ethnic minority populations. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may.
In white Caucasian populations about 10% of all pregnancies involve a mother with rhesus (Rh) D negative blood group and an RhD positive fetus, potentially placing the mother at risk of sensitisation and future babies at risk of haemolytic disease of the fetus and newborn. Anti-D prophylaxis (anti-D IgG) can be given to prevent a woman producing antibodies against fetal RhD-positive blood cells and becoming sensitised. Prophylaxis following delivery was introduced in the 1960s, with a blood cord serology test used to identify the baby's RhD status. This dramatically reduced maternal sensitisations and cases of rhesus disease in babies
Non-invasive prenatal diagnosis (NIPD) of fetal
Several authors have recently recommended a wider roll-out of NIPD testing to the remaining, non-sensitised pregnancies
To date the costs and implications of large scale NIPD testing to target antenatal prophylaxis have not been determined. The aim of the present study was to estimate the cost savings (if any) in England and Wales for two implementation strategies compared to the current two-dose RAADP programme (and a possible future single-dose policy). The research was undertaken as part of the SAFE Network of Excellence funded by the European Commission
Design of the study
Costs were estimated for the following strategies for implementing NIPD:
The cost analysis was undertaken from the perspective of the National Health Service (NHS healthcare provider) in England and Wales. It was assumed that NIPD testing could be fitted into current antenatal care without increasing the number of prenatal visits, so costs such as patient time, travel etc. were not expected to differ significantly. A primary costing approach and financial modelling were used to estimate the incremental cost of moving from the status quo (RAADP) to one of the two scenarios. The consequences of implementing each scenario were also estimated, based on a range of parameters. All costs are expressed in 2009 prices.
Test costs
A unit test cost (base case) was determined for NIPD. Laboratory resource use data were collected in the International Blood Group Reference Laboratory, Bristol, UK
An in-house testing service might also incur a royalty payment (fetal DNA presence in maternal blood: United States Patent 6258540). This has not yet been negotiated in any country. An alternative to an in-house test would be use of a commercial kit (Institut de Biotechnologies Jacques Boy, France) which has recently been CE marked for use in Europe
Cost of Status Quo Antenatal Anti-D Prophylaxis
The cost of current anti-D prophylaxis was estimated based on available anti-D IgG products, their UK market share, and the proportion of women receiving prophylaxis. The cost of administering anti-D was based on published estimates
Financial Benefits of Implementation Scenarios 1 and 2
The incremental cost of moving from the status quo (universal anti-D prophylaxis) to NIPD targeted prophylaxis was estimated. In both scenarios it was assumed that 80% of all RhD negative women will be tested and, as a result, 62% will receive antenatal anti-D; the latter figure allows for the false positive rate (2%) for RhD NIPD tests
Clinical Consequences and Cost-effectiveness of Implementation Scenarios 1 and 2
The consequences of implementing scenarios 1 and 2 were estimated. These included consideration of parameters such as: false negative and false positive rates; additional sensitisations; and risk of infection from anti-D blood product. Since definitive prospective trial outcomes data is not available for all parameters, some drew on international experts and a review of the literature
Test costs
Table 1
Base Case: Unit Test Cost1 (In-House Laboratory Protocol)
Cost per sample (£)
Blood sampling (phlebotomy)
3.00 2
Sample transport & registration
1.10 3
Laboratory consumables
Laboratory equipment
1.02 5
Laboratory labour
Result reporting
Laboratory overheads
Unit Test Cost
1 Figures excluding any royalty fee.
2 See
3 Based on current charges in West Midlands for mailing 4 samples. Figure will be lower if existing transportation system used; and higher if < 4 samples mailed.
4 Based on 88 samples per run, includes 20% discount for bulk purchase.
5 Assumes 44,000 samples processed annually per set of equipment
Use of a commercial kit is calculated to increase testing costs to £46.50 per patient sample. If, as indicated with this kit, a second confirmatory test is required later in pregnancy for all RhD negative results, this would increase costs further to an average of more than £65 per patient. Other test costs were estimated at: postnatal serology test (£3.78); Kleihauer test (£2.87); and associated phlebotomy cost (£3).
Cost of Status Quo Antenatal Anti-D Prophylaxis
Table 2
Annual Cost for Routine Antenatal Anti-D Prophylaxis (England & Wales)
Market Share (%)
1 st Dose (Injections/Year)
2 nd Dose (Injections/Year)
Cost per Dose (£)
Total Cost for RAADP 1 (£/year)
D-Gam (BPL) 2 × 500 IU
19.50 2
D-Gam (BPL) 1 × 1500 IU
Rhophylac (CSL) 1 × 1500 IU
Partobulin (Baxter) 2 × 1250 IU
1 Based on an estimated 74,783 women receiving routine antenatal prophylaxis.
2 Bulk of BPL product used in NHS hospitals purchased at price of £ 19.50/500iu [Dr E Gascoigne, Bio Products Laboratory (BPL), UK, personal communication]. BPL list price of £27/500iu dose is only applicable to private hospitals.
Financial Benefits of Implementation Scenarios 1 and 2
Figure 1
Annual Cost of Scenarios 1 and 2 for Different NIPD Unit Test Costs vs. Cost of Current RAADP Policy
Annual Cost of Scenarios 1 and 2 for Different NIPD Unit Test Costs vs. Cost of Current RAADP Policy.
Clinical Consequences and Cost-effectiveness of Implementation Scenarios 1 and 2
Although annual cost savings of up to £162,258 (Scenario 1) and £656,720 (Scenario 2) are potentially feasible with zero royalty fee, any financial benefit should be considered against possible clinical consequences following NIPD introduction. For example, if an RhD positive fetus is misdiagnosed as RhD negative, due to sub-optimal RhD NIPD test performance
Table 3
Additional Sensitisations (England & Wales) for Different Test Sensitivities
Additional Sensitisations/Year 1
Incremental Cost-Effectiveness Ratio 2
RhD NIPD sensitivity 3
Scenario 1 4
Scenario 2 5
Scenario 1 (£/sensitisation)
Scenario 2 (£/sensitisation)
94.8% 6
3,005 (235)
883 (682)
3,863 (302)
1,146 (885)
5,234 (409)
1,527 (1,179)
7,727 (604)
2,320 (1,793)
9,545 (747)
2,906 (2,244)
16,226 (1,269)
4,658 (3,597)
20,282 (1,586)
5,812 (4,488)
27,043 (2,115)
7,726 (5,966)
54,086 (4,231)
15,636 (12,075)
162,258 (12,692)
46,908 (36,225)
1 Assuming current serology is 100% accurate.
2 Incremental cost i.e. £ sterling saved per additional sensitisation produced. Figures in brackets ( ), assumes royalty fee negotiated at £2.00 per test.
3 Sensitivity range based on values reported in literature
4 Antenatal anti-D prophylaxis directed by RhD NIPD results & postnatal anti-D by serology (1.3% risk)
5 Postnatal anti-D prophylaxis based on RhD NIPD antenatal result (13.2% risk)
6 Meta-analysis figure for diagnostic accuracy
The figures for different test sensitivities are compared with the predicted incremental cost saving in the final columns, both with a zero royalty fee and a fee of £2.00 per sample. If mass testing is introduced as described in Scenario 1 and a test sensitivity of 99.7% can be achieved
Management of non-sensitised RhD negative pregnancies has become considerably more effective over time with the sequential introduction of post-delivery and antenatal anti-D prophylaxis
The cost analysis presented in this paper shows that the net financial benefit of implementing mass NIPD testing as an add-on using in-house tests (while maintaining current postnatal testing) will be negligible in England and Wales. The level of royalty fee negotiated will be a major influence on this with zero saving predicted above a fee of £2.18 per test. If antenatal NIPD were to also displace postnatal testing, higher net savings could be realised and the royalty fee might rise to nearly £9 per test before these disappear. Use of a commercial kit, such as that currently being marketed in Europe
Our analysis also indicates that NIPD implementation is unlikely to produce important clinical benefits. The number of sensitisations will not fall appreciably and in fact might rise if NIPD test sensitivity is below 99.9%. This is especially true for the scenario in which postnatal blood cord serology is eliminated in order to maximise any net cost saving. Introduction of NIPD typing must also meet the needs of testing in a diverse population
Based on our findings it is difficult to argue that NIPD targeted antenatal prophylaxis will be sufficiently cost-effective to warrant its large scale introduction. Increased magnitude of savings will be at the expense of additional sensitisations. Even the maximum amount of £9,190 saved per additional sensitisation is much lower than the figure of £15,903 - £17,668 judged acceptable for avoiding a sensitisation by NICE
However, if NIPD testing could be carried out earlier in pregnancy cost-effectiveness might be improved. For example, adherence to prophylaxis guidelines for 'high risk' antenatal events might be improved if women are identified as carrying an RhD positive child early in their pregnancy
During the development of the original 2002 NICE guidelines, questions were raised about the safety of anti-D IgG because of isolated cases of hepatitis C infection in the early 1990's
A final advantage put forward is linked to anti-D supply. In England and Wales, where anti-D IgG is produced using plasma purchased from the USA, there have been no supply problems. However, in countries such as the Netherlands where in-country sourcing requires the purposeful hyperimmunisation of volunteers, decreased use of anti-D has been viewed as an ethical benefit in its own right
The main limitation in the present study is uncertainty over the level of royalty fee for in-house NIPD tests. The speed of development and diffusion of recombinant anti-D IgG may also affect the conclusion drawn, but this is difficult to estimate without information on the eventual cost of this product. Further new technologies which might influence cost-effectiveness include NIPD markers for conditions such as haemoglobinopathies or Trisomy 21 (Down's syndrome) which appear to be nearing final development
Our analysis does not support routine implementation of RhD NIPD testing in England and Wales at present for non-sensitised pregnancies. Annual savings will be relatively small and balanced against this increased maternal sensitisations may be unacceptably high. First trimester testing is unlikely to alter this picture significantly although other emerging technologies may. There is also a need to demonstrate the reliability of assays in different ethnic minority populations.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
AS, LO and KF conceived the idea for the study. LO obtained the data and completed the analysis. AS and LO wrote the manuscript which was reviewed by all authors. All authors had full access to all data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis. All authors read and approved the final manuscript.
We would like to thank the following for providing us with data and clinical information: Prof. Tobias Legler, Universitätsmedizin Göttingen, Germany; Dr. Kirstin Finning, National Blood Service, Bristol, UK; Dr. Antonio Borrell, Hospital Clinic, Barcelona, Spain; Carl Holland, Pathology Service, University Hospitals Coventry and Warwickshire NHS Trust, UK; Dr. Edwin Massey, National Blood Service, Bristol, UK; Prof. Peter Soothill, University of Bristol, UK; Dr. Geoff Daniels, National Blood Service, Bristol, UK; Prof Stan Urbaniak, Academic Transfusion Medicine Unit, University of Aberdeen, UK; and Dr. Ernie Gascoigne, Bio Products Laboratory, UK. We also would like to thank all SAFE partners who helped us collect necessary data for the project and Dr. Stavros Petrou, National Perinatal Epidemiology Unit, Oxford, for valuable feedback.
This work was supported by the European Commission funds allocated to the SAFE Network of Excellence under the 6th Framework. Project Number: LSHB-CT-2004-503243.
Ethics Approval
This study did not require ethics approval.
The clinical effectiveness and cost effectiveness of routine anti-D prophylaxis for RhD-negative women in pregnancy
Rate of RhD sensitisation before and after implementation of a community based antenatal prophylaxis programme
Thirty-five years of Rh prophylaxis
Routine antenatal anti-D prophylaxis and patient compliance with the two-dose regimen
Compliance with routine antenatal rhesus D prophylaxis and the impact on sensitisations: observations over 14 years
Pregnancy - routine anti-D prophylaxis for rhesus negative women (review of TA41)
Quantitative analysis of fetal DNA in maternal plasma and serum: implications for noninvasive prenatal diagnosis
Non-invasive fetal RHD exon 7 and exon 10 genotyping using real-time PCR testing of fetal DNA in maternal plasma
Prediction of fetal D status from maternal plasma: introduction of a new noninvasive fetal RHD genotyping service
Non-invasive prenatal diagnosis and determination of fetal Rh status
Large-scale pre-diagnosis study of fetal RHD genotyping by PCR on plasma DNA from RhD-negative pregnant women
Prenatal fetal RhD blood group typing to enhance efficiency of antenatal anti-D immunoprophylaxis in RhD negative pregnant women
Diagnostic accuracy of noninvasive fetal Rh genotyping from maternal blood-a meta-analysis
Routine fetal RHD genotyping with maternal plasma: a four-year experience in Belgium
Non-invasive fetal RHD genotyping tests: a systematic review of the quality of reporting of diagnostic accuracy in published studies
Effect of high throughput RHD typing of fetal DNA in maternal plasma on use of anti-RhD immunoglobulin in RhD negative pregnant women: prospective feasibility study
Evaluation of molecular tests for prenatal diagnosis of chromosome abnormalities
Non-invasive antenatal RHD typing
Routine antenatal anti-D prophylaxis for RhD-negative women: a systematic review and economic evaluation
Non-Invasive Prenatal Diagnosis (NIPD): Fetal RHD Genotype: Early-HTA Report
UK National Statistics
Fetal blood group genotyping: present and future
The prevention of Rh haemolytic disease of the fetus and newborn--general background
A Review of Evidence on Non-invasive Prenatal Diagnosis (NIPD): Tests for Fetal RHD Genotype
Workshop report on the extraction of foetal DNA from maternal plasma
The SiriusWeb Staff Costs Calculator
Hematos System Description
The determination of the fetal D status from maternal plasma for decision making on Rh prophylaxis is feasible
NHS Reference Costs
Free DNA Fetal Kit® RhD. Kit de génotypage foetal RhD à partir d'ADN foetal libre du sang maternel
A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus-negative
The scientific basis of antenatal prophylaxis
The Yorkshire antenatal anti-D immunoglobulin trial in primigravidae
Midwives and anti-D. Enabling choice
Fetal rhd genotyping from maternal plasma in a population with a highly diverse ethnic background
Access to health care for ethnic minority populations
The Rh blood group system in review: a new face for the next decade
Prevalence of RhD variants, confirmed by molecular genotyping, in a multiethnic prenatal population
Frequency of ABO and Rh blood groups in major ethnic groups and casts of Pakistan
Cost implications of routine antenatal administration of Rh immune globulin
Equality Act 2010
The economics of routine antenatal anti-D prophylaxis for pregnant women who are rhesus negative
Detection and prevention of pregnancy immunisation. The OPZI-study. Doctoral Thesis
Efficacy of RhD monoclonal antibodies in clinical trials as replacement therapy for prophylactic anti-D immunoglobulin: more questions than answers
Reliable test for prenatal prediction of fetal RhD type using maternal plasma from RhD negative women
Serial analysis of fetal DNA concentrations in maternal plasma in late pregnancy
Fetal RHD genotyping in maternal serum during the first trimester of pregnancy
SensiGene Fetal RHD Genotyping
Long-term persistence of hepatitis C virus antibodies in a single source outbreak
Hepatitis C viraemia in recipients of Irish intravenous anti-D immunoglobulin
Modern plasma fractionation
Partitioning of TSE infectivity during ethanol fractionation of human plasma
vCJD donor deferral measures. Montreal
Revised preventive measures to reduce the possible risk of transmission of Creutzfeldt-Jakob disease (CJD) and variant Cruetzfeldt-Jakob disease (vCJD) by blood and blood products
Rhogam: evidence from midwives
Final Report Health Care Efficiency Research Programme
Emerging technologies in the management of RhD negative pregnant women
Lessons learnt from many years of experience using anti-D in humans for prevention of RhD immunization and haemolytic disease of the fetus and newborn
Symphogen. Sym001 (anti-RhD)
New technologies to replace current blood typing reagents
The safety of RhIG in the prevention of haemolytic disease of the newborn
Prenatal Diagnostics
Lab Prepares Launch of Trisomy 21 Diagnostic Test
A non-invasive test for prenatal diagnosis based on fetal DNA present in maternal blood: a preliminary study
Digital PCR for the molecular detection of fetal chromosomal aneuploidy
Prenatal diagnosis using cell-free nucleic acids in maternal body fluids: a decade of progress
The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation
A survey of the current use of anti-D immunoprophylaxis and the incidence of haemolytic disease of the newborn in Italy
Pre-publication history
The pre-publication history for this paper can be accessed here:


text:
Champion Pack - Game Eight
Konami Unleashes Champion Pack 8 on Duelists Everywhere
Legal for local events: 5th January 2009
Legal for Premier Events: 5th January 2009
//thx to ness00 for the complete list
CP08-EN001 Gravity Behemoth
DARK/Beast - Effect/6/2300/2000
If it is not the first turn of the Duel and there are no cards on the field, you can Normal Summon this card without Tributing. You can destroy all Field Spell Cards on the field. This card cannot attack the turn you activate this effect.
Ultra Rare
CP08-EN002 Prohibition
Super Rare
CP08-EN003 Mind Crush
Super Rare
CP08-EN004 Dimensional Fissure
Super Rare
CP08-EN005 Lumina, Lightsworn Summoner
Super Rare
CP08-EN006 Magician's Valkyria
CP08-EN007 Silent Magician LV4
CP08-EN008 Great Shogun Shien
CP08-EN009 Herald of Creation
CP08-EN010 Burial from a Different Dimension
CP08-EN011 Necro Gardna
CP08-EN012 Mushroom Man
Normal Monster
CP08-EN013 Royal Oppression
CP08-EN014 Beckoning Light
CP08-EN015 Neo-Spacian Dark Panther
CP08-EN016 Alien Mother
CP08-EN017 Alien Warrior
CP08-EN018 Vanity's Ruler
CP08-EN019 Miraculous Rebirth
CP08-EN020 Cell Explosion Virus
shriek | Champion Pack | 27. Feb, 17:46


text:
The Sun is reporting today that since almost everybody in football knows that Newcastle are trying to sign a top striker this month, agents are only too willing to oblige and have offered 26 year-old Corinthians star striker Alexandre Pato.
Fans will remember the Brazilian played at AC Milan from 2007 until 2012.
Corinthians star striker Alexandre Pato
Another striker who has been offered to the Tyneside club is Miler Bolanos who plays for Emelec in Ecuador.
Of those two players Alexandre Pato seems to be the most interesting, but it´s difficult to know how he would do in England, since he's now been back in Brazil since 2013 playing his football.
He looked an up-and-coming very good striker when he was younger playing in Italy and has played 27 times for Brazil with 10 goals.
There was also news last month that Barcelona were interested in signing the player for around £10M, but the Spanish giants have been linked with many players this mointh..
Pato has been at the Sao Paulo based Corinthians sine 2013 and spent last season on loan at Sao Paulo.
The Times recently reported Pato was keen to play in the Premier League (who isn´t these days with all that money) and that his agents were trying to persuade Premier League Champions Chelsea to sign him.
And Bolanos has been at Emelec since 2013 and would be a bigger risk – especially with Newcastle still in a precarious position in the Premier League – although we did have a great 2-1 win yesterday against West Ham.
Newcastle get lots of offers from agents in every transfer window, as they try to make a buck by completing a deal for their clients, but very few of the players are what Newcastle want or need.
However, Pato looks an interesting possibility – he played 150 times for AC Milan with 63 goals.
What do you think?
Comments welcome.


text:
Separate names with a comma.
Discussion in 'Hardscaping' started by 02DURAMAX, Jun 11, 2007.
Here is a small front walk-way job i did...let me know what you guys think..
After...I will be filling the edge with dirt and seeding tommorow...
few more...the last two may look better as of color...
looks very very good man, nice work!
I agree, very nice!!!
thanks guys!!!....and sorry for posting it on the wrong section..
nah, either forum is ok to post it in. just figured it would give you the most exposure here where i'm sure all the hardscaping guys really look.
i think those homeowners made a big improvement to their landscape by electing to have their walkway re-done. they should be really pleased.
that's quite an improvement! looks good!
Much better!
Looks nice...
I'm completely ignorant on this stuff, so a question for my own "education", lol...
Are those all individual bricks?
And what is the black thingie on the edge in your 2nd and 3rd pictures of your last post?
And what is the


text:
Expedito Enlightenment Center is an island of spiritual relief on Okeechobee Blvd. in West Palm Beach. As residents pass back and forth, some duck into the Center for a moment of spiritual healing, for readings from SarahSpiritual, and for guidance on their spiritual journey. Welcome!
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The Eighth Annual International Meeting for Autism Research (IMFAR), held this year in Chicago, Ill., kicked off on Thursday with scientists from around the world gathering to share their latest research information. The goal of those in attendance is to use research methodology to develop means of helping individuals living with autism and their families have a better quality of care and life.
Throughout the day there were over three hundred presentations in oral or written form. Some of the many themes of the first day's sessions included psychiatric co-morbidity issues, intervention methods, oxidative stress, and the role of under-studied neural networks in autism such as the motor system. Below are just a few select studies from last Thursday's many presentations. A full report of the conference will be issued in Autism Speaks e-speaks newsletter this week. Click here to register for e-speaks.
Highlights from Day One: Thursday, May 7, 2009
Mark Bear, Ph.D. (MIT), opened the conference with a keynote address that demonstrated how understanding the basic workings of the brain can lead to potential treatments for autism – some of which, he explained to the audience of over 1400 – are being tested today. As a neurobiologist, his research to understand the role of connections between neurons, called synapses, led him to study Fragile X syndrome, a genetic disorder that is frequently accompanied by autism. The syndrome is caused by a mutation in a single gene, that results in the loss of a protein called FMRP, which is critical for slowing down the manufacture of other proteins at synapses. Without FMRP, protein synthesis goes into overdrive. Dr. Bear has shown that a drug that interacts with a specific type of receptor at the synapse (called the metabotropic glutamate receptors) can put the brakes on this runaway protein synthesis, and reverse autism-like behaviors in mice engineered to have the Fragile X mutation. Similar drugs are now being developed and tested for people with Fragile X.
As Dr. Bear led the audience through the research and thought processes that have brought scientists from the discovery of the Fragile X gene to clinical trials in less than 20 years, he suggested the approach may work for other causes of autism, too, because other single gene mutations responsible for genetic syndromes showing features of autism all involve the same pathways governing protein synthesis in a cell. Dr. Bear hypothesized that the vast majority of autism cases for which a genetic cause is currently unknown may similarly result from perturbations to protein synthesis at synapses. If different mutations all have a similar effect at the synapse, this would provide researchers with a shortcut in designing treatments.
Dr. Bear was introduced by Autism Speaks Chief Science Officer Geri Dawson, Ph.D., who announced their 2009 Strategic Plan for Science. The Autism Speaks Strategic Plan, developed in consultation with its Scientific Advisory Committee and outside advisors, is focused on innovation and an emphasis on translating discoveries into diagnosis and treatments for individuals living with autism today. View the plan here: www.autismspeaks.org/science.
Psychiatric Issues Common in Autism
Disentangling psychiatric disorders from the core symptoms of autism is of critical importance because current treatments for these conditions can potentially improve function and quality of life for people with autism, and this provided another central theme throughout the first day of the meeting. Tony Charman, Ph.D. (Institute of Child Health, UK), reported that two-thirds of children with autism (10-14 years old) also have at least one psychiatric disorder, such as social anxiety disorder or ADHD, which impairs their function beyond that due to autism. He argues that these conditions are six times more frequent than in the general population, and that people with autism should be routinely screened for them. Many other presentations today supported this view, finding evidence for obsessive compulsive disorder, mood disorders, specific phobias, as well as anxiety disorder and ADHD in people with autism. One presentation in particular emphasized the idea that these disorders are indeed separate from autism. Deborah Fein, Ph.D. (Univ. of Conn.), presented data from her studies of individuals who have recovered from autism. Interestingly, she finds that although they had lost their autism diagnoses, 80% of these individuals had psychiatric disorders, most commonly anxiety or ADHD. (Read an Associated Press story about Dr. Fein's research here; international coverage here.)
Progress in identifying the earliest signs of autism has created the need for intervention methods adapted for very young children, and two sessions were devoted to presenting research currently in progress to measure the success of a variety of intervention strategies. Rebecca Landa, Ph.D. (Kennedy Krieger Inst.), reported the effectiveness of a classroom-based intervention for two year olds. Delivered by a teacher and supplemented with parent education on the core teaching goals, the intervention lasted for six months, after which many children had made gains in cognitive function and language abilities. These gains could last six months or more afterwards. For even younger ages, Jessica Brian, Ph.D. (York Univ.), presented a newly developed "Social ABCs" intervention that was given to babies 14-18 months old. Parents were trained to administer this intervention, which was based on Pivotal Response Training. After six months, gains were apparent in communication skills, and parents reported it was practical to implement the intervention in their homes. Throughout the day scientists reiterated that parental involvement in these interventions, particularly at such young ages, is an increasingly important and promising avenue for autism treatment.
Another study by Brian Reichow, Ph.D. (Yale Univ.), and colleagues compared the effects of behavioral and naturalistic strategies on speech development in preverbal children with autism (3-6 years old) who had fewer than 10 spoken words. Behavioral strategies reinforce correct responses that a child gives when prompted by a teacher, for example, to imitate a movement. Naturalistic approaches seek to instruct through play-based routines that use objects or activities that are highly motivating to the child with autism. After 12 weeks, children in each type of intervention made similar gains in the frequency and diversity of words spoken. In both groups, however, there were children who did not benefit, raising the possibility that they might respond to a different intervention style. These preliminary results were based on very small number of children, and further research will help scientists form a better idea of the benefits of these two approaches.
As families have no doubt discovered, the increased prevalence of autism has led to a shortage of autism therapists. There is a great need to find methods to train new ones, especially in communities that may not be fortunate to have many service providers. One presentation by Laurie Vismara, Ph.D. (M.I.N.D. Institute), found that additional therapists could be trained at a distance by using technologies now readily available, including teleconferences and print and video materials provided on a DVD. A range of professionals (psychologists, speech language pathologists, occupational therapists, case managers) and parents were trained on the Early Start Denver Model intervention. Through this distance "learning package," improvements in therapist and parent skill use were associated with gains in social imitation and attention by children with autism.
Oxidative Stress in the Brain
Several presentations at the meeting explored the possibility that the brains of people with autism are under oxidative stress that exceeds normal levels. Oxidative stress is a condition in which reactive oxygen molecules, called free radicals, form inside the cell and overwhelm the proteins that normally quench them, leading to cell damage and even death. One very preliminary study by Elizabeth Sajdel-Sulkowska, Ph.D. (Harvard Medical School), looked directly at postmortem brain tissue for evidence of oxidative damage in two individuals that had had autism. Using a molecular marker called 3 nitrotyrosine, she found signs of oxidative damage in multiple brain areas, including regions important for speech and emotional and cognitive processing.
Excess free radicals may result from malfunctioning mitochondria, the energy powerhouses of cells. This fact, combined with a small number of autism cases shown to also have mitochondrial disorders, spurred Jacob McCauley, Ph.D. (Univ. of Miami), to search for mitochondria-related gene variations associated with autism. When scanning the DNA localized to mitochondria, no genetic variations were associated with autism; however, when scanning DNA taken from the cell nucleus, which contains instructions for the rest of the cell as well as some mitochondrial proteins, the study confirmed an association previously found between autism and a protein that transports molecules in and out of mitochondria. Future detailed studies are planned to look DNA base pair by DNA base pair at the entire mitochondrial genome for variants linked to autism.
Finally, oxidative stress may also be caused by over-activation of the immune system. One presentation by Mazhar Malik, Ph.D. (NYS Institute for Basic Research in Developmental Disabilities), and colleagues showed that several immune system molecules, called cytokines, were elevated in brain samples from people with autism, indicating a potentially damaging inflammatory response. Many other studies exploring the link between the immune system and autism will be presented in the next two days of the meeting.
Predictors of Outcome
Faced with a range of interventions and enrollment in school, parents often wonder if characteristics of their children can predict how they'll fare in the future. For example, some children make large developmental gains when given 20-40 hours per week of early intensive behavioral intervention, but some do not. Before undertaking such an intensive (and expensive) route, it would be of great use to know which children are likely to respond. To this end, Tristram Smith, Ph.D. (Univ. of Rochester), presented data on 71 children before and after a year long intensive behavioral intervention, and found that those who had some social communication abilities beforehand were more likely to benefit. In contrast, repetitive behaviors did not predict any outcomes.
Several other research presentations focused on discovery of other types of predictors. For example, Vanessa Rivera (Univ. of Wash.) and her colleagues reported on predictors for academic achievement in school. Fewer problem behaviors at age 6 predicted better spelling at age 9; similarly, higher social skills predicted better word reading at age 9. This type of study can help pinpoint key skills needed to maximize the benefit for a child with autism in a school environment.
Finally, Teri Todd, Ph.D. (Calif. State Univ.), and colleagues showed that adults with autism report more satisfaction and have fewer on the job problem behaviors when their employment directly fits their interests. In a community in northern California, nine micro-businesses were formed based on the interests of adults with autism, including a yard maintenance service, a bird feeder service, even a mobile document shredding service. This demonstrates that with a person-centered approach and some creative thinking, adults with autism can be included in the community in meaningful ways.
Motor Systems
Although autism is most often thought of as a disorder of social function, it involves a wide array of brain systems. During the first day of the conference entire sessions were devoted to the study of both sensory and motor systems in autism. One study presented by Gianluca Esposito, Ph.D. (Univ. of Trento, Italy), suggests that movements made by a five-month-old infant can signal that something is amiss in the brain and distinguish children who will go on to develop autism. By analyzing home videos of infants lying on their backs, he found that those who later developed autism more frequently assumed an asymmetric position, with arms or legs unmatched, than did the infants who were typically developing or developmentally delayed.
Another presentation by Stewart Mostofsky, M.D. (Kennedy Krieger Inst.), showed that children with autism learn movements differently than do typically developing children. To reach out and touch a target accurately, for example, the brain commands the arm to move, then evaluates the arm position relative to the target using vision and proprioception – a sense of the arm's position in space that is registered through touch receptors in joints and muscles. This study found that in contrast to typically developing children that mainly use visual feedback to target their movements, those with autism rely primarily on proprioceptive cues when performing a reaching task. Harnessing the differences in how people with autism learn may build their movement skills, which not only improves coordination, but enhances their imitation abilities, which are thought to be crucial for understanding the actions of others. Moreover, Marianna Murin, Ph.D. (Great Ormond Street Hospital for Children), even found that a small but significant cause of peer-rejection of high-functioning individuals with autism is related to their motor difficulties, thus highlighting the need for increased attention to motor skills in autism.
View a recap of day two, Friday, May 8 here.
View a recap of day three, Saturday, May 9 here.
Read a press release about the conference here.
View press coverage of the conference here.
To read individual abstracts, please visit: http://imfar.confex.com/imfar/2009/webprogram/start.html