Severity of cognitive disability and mental health court determinations about fitness to stand trial.

BACKGROUND: Little is known about the socio-demographic, clinical and legal determinants of mental health court decisions of unsoundness of mind and unfitness to stand trial for people with cognitive disability. We aimed to estimate the association between severity of cognitive disability and mental health court determinations of unsoundness or unfitness and describe the socio-demographic, clinical and legal factors that predict these determinations. METHODS: Case file data were extracted on 92 individuals who had a criminal case referred to the Queensland Mental Health Court between 1 January 2013 and 31 December 2014 due to cognitive disability. We fit a modified multivariable Poisson regression model to estimate the association between severity of cognitive impairment and mental health court determination, controlling for socio-demographic, clinical and legal factors. RESULTS: Adjusting for covariate effects, severity of cognitive impairment was positively associated with being found unfit to stand trial (adjusted prevalence risk ratio = 1.57; 95% confidence interval: 1.07, 2.33; P = 0.023), and comorbid psychotic disorder predicted an increased risk of being found unsound of mind at the time of offence (adjusted prevalence risk ratio = 3.63; 95% confidence interval: 1.38, 9.54; P = 0.009) by the Queensland Mental Health Court. CONCLUSIONS: Severity of cognitive disability is associated with determinations of unfitness but does not predict determinations of unsoundness in the Queensland Mental Health Court. Psychiatric assessments of cognitive impairment play a pivotal role in mental health court determinations for people with cognitive disability.

Illustration of sampling-based methods for uncertainty and sensitivity analysis.

A sequence of linear, monotonic, and nonmonotonic test problems is used to illustrate sampling-based uncertainty and sensitivity analysis procedures. Uncertainty results obtained with replicated random and Latin hypercube samples are compared, with the Latin hypercube samples tending to produce more stable results than the random samples. Sensitivity results obtained with the following procedures and/or measures are illustrated and compared: correlation coefficients (CCs), rank correlation coefficients (RCCs), common means (CMNs), common locations (CLs), common medians (CMDs), statistical independence (SI), standardized regression coefficients (SRCs), partial correlation coefficients (PCCs), standardized rank regression coefficients (SRRCs), partial rank correlation coefficients (PRCCs), stepwise regression analysis with raw and rank-transformed data, and examination of scatter plots. The effectiveness of a given procedure and/or measure depends on the characteristics of the individual test problems, with (1) linear measures (i.e., CCs, PCCs, SRCs) performing well on the linear test problems, (2) measures based on rank transforms (i.e., RCCs, PRCCs, SRRCs) performing well on the monotonic test problems, and (3) measures predicated on searches for nonrandom patterns (i.e., CMNs, CLs, CMDs, SI) performing well on the nonmonotonic test problems.

Physical interaction between the MADS box of serum response factor and the TEA/ATTS DNA-binding domain of transcription enhancer factor-1.

Serum response factor is a MADS box transcription factor that binds to consensus sequences CC(A/T)(6)GG found in the promoter region of several serum-inducible and muscle-specific genes. In skeletal myocytes serum response factor (SRF) has been shown to heterodimerize with the myogenic basic helix-loop-helix family of factors, related to MyoD, for control of muscle gene regulation. Here we report that SRF binds to another myogenic factor, TEF-1, that has been implicated in the regulation of a variety of cardiac muscle genes. By using different biochemical assays such as affinity precipitation of protein, GST-pulldown assay, and coimmunoprecipitation of proteins, we show that SRF binds to TEF-1 both in in vitro and in vivo assay conditions. A strong interaction of SRF with TEF-1 was seen even when one protein was denatured and immobilized on nitrocellulose membrane, indicating a direct and stable interaction between SRF and TEF-1, which occurs without a cofactor. This interaction is mediated through the C-terminal subdomain of MADS box of SRF encompassing amino acids 204-244 and the putative 2nd and 3rd alpha-helix/beta-sheet configuration of the TEA/ATTS DNA-binding domain of TEF-1. In the transient transfection assay, a positive cooperative effect of SRF and TEF-1 was observed when DNA-binding sites for both factors, serum response element and M-CAT respectively, were intact; mutation of either site abolished their synergistic effect. Similarly, an SRF mutant, SRFpm-1, defective in DNA binding failed to collaborate with TEF-1 for gene regulation, indicating that the synergistic trans-activation function of SRF and TEF-1 occurs via their binding to cognate DNA-binding sites. Our results demonstrate a novel association between SRF and TEF-1 for cardiac muscle gene regulation and disclose a general mechanism by which these two super families of factors are likely to control diversified biological functions.

An in vitro assessment of the erosive potential of some designer drinks.

The aim of this study was to establish the amount of surface enamel lost following immersion in a number of designer drinks using surface profilometry. Orange juice was used as a positive control. Twenty four designer drinks were tested and it was found that 18 out of 24 of these drinks produced surface enamel loss that was significantly greater by between two and six times than the orange juice control. It was concluded that many of the commercially available designer drinks had considerable erosive potential.