We Are Legal Aid: Findings from the 2021 Legal Aid Census

Legal aid is a crucial component in the fabric of the justice system in England and Wales. It plays a key role in facilitating access to justice, helping to ensure legal needs are met and that individuals can establish or enforce their rights across various areas of law. Legal aid practitioners assist clients with a wide range of issues, including but not limited to those relating to criminal defence, family matters, education, housing, immigration, discrimination, debt and community care. Yet, the legal aid system is experiencing unprecedented pressures and challenges. A review of the legal aid landscape which elevates the perspectives of those working day-to-day in the sector is vital and long overdue. Pre-existing data on the specifics of legal aid practice has been piecemeal, lacking context and insufficiently able to elucidate conditions on the ground. As such, this report presents and analyses the results of the most comprehensive set of surveys of legal aid practitioners ever conducted in England and Wales. It provides a greater and more accurate understanding of a sector adversely impacted by repeated crises and challenges. In the aftermath of Covid-19 lockdowns and nine years since the enactment of LASPO, legal aid practitioners reveal the true extent of the current state of legal aid in response to the five surveys that make up the Legal Aid Census

Identification of the PS1 Thr147Ile Variant in a Family with Very Early Onset Dementia and Expressive Aphasia

Background: Early onset dementias have variable clinical presentations and are often difficult to diagnose. We established a family pedigree that demonstrated consistent recurrence of very early onset dementia in successive generations. Objective and Method: In order to refine the diagnosis in this family, we sequenced the exomes of two affected family members and relied on discrete filtering to identify disease genes and the corresponding causal variants. Results: Among the 720 nonsynonymous single nucleotide polymorphisms (SNPs) shared by two affected members, we found a C to T transition that gives rise to a Thr147Ile missense substitution in the presenilin 1 (PS1) protein. The presence of this same mutation in a French early-onset Alzheimer’s disease family, other affected members of the family, and the predicted high pathogenicity of the substitution strongly suggest that it is the causal variant. In addition to exceptionally young age of onset, we also observed significant limb spasticity and early loss of speech, concurrent with progression of dementia in affected family members. These findings extend the clinical presentation associated with the Thr147Ile variant. Lastly, one member with the Thr147Ile variant was treated with the PKC epsilon activator, bryostatin, in a compassionate use trial after successful FDA review. Initial improvements with this treatment were unexpectedly clear, including return of some speech, increased attentional focus, ability to swallow, and some apparent decrease in limb spasticity. Conclusions: Our findings confirm the role of the PS1 Thr147Ile substitution in Alzheimer’s disease and expand the clinical phenotype to include expressive aphasia and very early onset of dementia

Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTAT‐CHF

No abstract available

Maternal use of methamphetamine induces sex‐dependent changes in myocardial gene expression in adult offspring

Abstract Methamphetamine is a commonly abused illicit stimulant that has prevalent use among women of child‐bearing age. While there are extensive studies on the neurological effects of prenatal methamphetamine exposure, relatively little is known about the effect of prenatal methamphetamine on the adult cardiovascular system. Earlier work demonstrated that prenatal methamphetamine exposure sex dependently (females only) sensitizes the adult heart to ischemic injury. These data suggest that prenatal exposure to methamphetamine may induce sex‐dependent changes in cardiac gene expression that persist in adult offspring. The goal of this study was to test the hypothesis that prenatal methamphetamine exposure induces changes in cardiac gene expression that persist in the adult heart. Hearts of prenatally exposed female offspring exhibited a greater number of changes in gene expression compared to male offspring (184 changes compared with 74 in male offspring and 89 changes common between both sexes). Dimethylarginine dimethylaminohydrolase 2 and 3‐hydroxybutyrate dehydrogenase 1 (genes implicated in heart failure) were shown by Western Blot to be under expressed in adult females that were prenatally exposed to methamphetamine, while males were deficient in 3‐Hydroxybutyrate Dehydrogenase 1 only. These data indicate that prenatal methamphetamine exposure induces changes in gene expression that persist into adulthood. This is consistent with previous findings that prenatal methamphetamine sex dependently sensitizes the adult heart to ischemic injury and may increase the risk of developing cardiac disorders during adulthood