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Background Physician decision-making skills training is a priority to improve adoption of the cerebral palsy (CP) clinical guideline and, through this, lower the age of CP diagnosis. Clinical guideline implementation aims to improve physician practice, but evaluating meaningful change is complex. Limitations in the validity evidence of evaluation instruments impact the evidence base. Validity frameworks, such as Kane’s, enable a targeted process to gather evidence for instrument scores, congruent to context and purpose. Yet, application of argument-based methodology to implementation validation is rare. Key-features examination methodology has established validity evidence supporting its use to measure decision-making skills, with potential to predict performance. We aimed to apply Kane’s framework to evaluate a pilot key-features examination on physician decision-making in early CP diagnosis. Methods Following Kane’s framework, we evaluated evidence across inferences of scoring, generalisation, extrapolation and implications in a study design describing the development and pilot of a CP diagnosis key-features examination for practising physicians. If found to be valid, we proposed to use the key-feature scores as an outcome measure of decision-making post education intervention to expedite CP diagnosis and to correlate with real-world performance data to predict physician practice. Results Supporting evidence for acceptance of scoring inferences was achieved through examination development with an expert group ( n  = 10) and pilot results ( n  = 10): (1) high internal consistency (0.82); (2) acceptable mean item-discrimination (0.34); and (3) acceptable reliability of examination scorers (95.2% congruence). Decreased physician acceptance of examination time (70%) was identified as a threat and prioritised in case reduction processes. Partial acceptance of generalisation, extrapolation and implications inferences were defensible with: (1) accumulated development evidence following established key-features methodology; (2) high pilot acceptance for authenticity (90%); and (3) plausibility of assumptions of score correlation with population register data. Conclusions Kane’s approach is beneficial for prioritising sources of validity evidence alongside the iterative development of a key-features examination in the CP field. The validity argument supports scoring assumptions and use of scores as an outcome measure of physician decision-making for CP guideline education implementation interventions. Scoring evidence provides the foundation to direct future studies exploring association of key-feature scores with real-world performance.

The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.

Retrospective reports of lifetime experience with mental disorders greatly underestimate the actual experiences of disorder because recall error biases reporting of earlier life symptoms downward. This fundamental obstacle to accurate reporting has many adverse consequences for the study and treatment of mental disorders. Better tools for accurate retrospective reporting of mental disorder symptoms have the potential for broad scientific benefits. We designed a life history calendar (LHC) to support this task, and randomized more than 1000 individuals to each arm of a retrospective diagnostic interview with and without the LHC. We also conducted a careful validation with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Results demonstrate that-just as with frequent measurement longitudinal studies-use of an LHC in retrospective measurement can more than double reports of lifetime experience of some mental disorders. The LHC significantly improves retrospective reporting of mental disorders. This tool is practical for application in both large cross-sectional surveys of the general population and clinical intake of new patients.

The immune system is implicated in Parkinson's disease aetiology and prognosis. Although there are effective symptomatic treatments for Parkinson's disease, there are currently no therapies that slow down disease progression. We aimed to investigate the clinical efficacy of the broadly acting peripheral immunosuppressant drug azathioprine for patients with early Parkinson's disease. We did a randomised, double-blind, placebo-controlled, proof-of-concept, phase 2 trial at a single site (the Parkinson's Disease Research Clinic) in Cambridge, UK. Eligible participants were aged 50–80 years and were within 3 years of Parkinson's disease diagnosis (as per UK Parkinson's Disease Society Brain Bank Diagnostic Criteria). Participants were randomly assigned (1:1) using a web-based system to receive daily oral azathioprine 2 mg/kg or placebo for 12 months. The primary outcome was change from baseline Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) gait-axial score in the off-state at 12 months, assessed in the intention-to-treat population, which included all randomly assigned patients who completed the baseline visit. Safety was assessed in all participants who were screened for eligibility. Mixed model repeated measures analysis was used to assess treatment effects. This study was registered with ISRCTN, 14616801, and EudraCT, 2018-003089-14. Between May 13, 2021, and July 28, 2022, 78 participants were screened, of whom 66 were randomly assigned to azathioprine (n=32) or placebo (n=34), and included in the intention-to-treat analysis. 23 (35%) of 66 patients were female and 43 (65%) were male. At 12 months, the mean change in MDS-UPDRS gait-axial score was 0·54 points (SD 2·43) in the azathioprine group and 0·13 points (2·09) in the placebo group (effect size 0·438 [95% CI –0·694 to 1·57]; p=0·78). 159 adverse events were reported in the azathioprine group and 156 in the placebo group. Eight participants had a serious adverse event in the azathioprine group (24%) and four patients in the placebo group (12%). The most common adverse events in both groups were infections (20 [61%] of 33 participants in the azathioprine group vs 26 [76%] of 34 participants in the placebo group) and gastrointestinal disorders (19 [58%] participants vs 17 [50%] participants). Azathioprine was well-tolerated in this population; however, the primary outcome was not met. Exploratory analyses suggested effects of azathioprine on peripheral and central immune biomarkers and on motor symptoms. Potential clinical effects could be greater in females than males, warranting further exploration. Cambridge Centre for Parkinson-Plus, Cure Parkinson's, National Institute for Health Research Biomedical Research Centre.

This article proposes a number of recommendations for the treatment of generalized social phobia, based on a systematic literature review and meta-analysis. An optimal treatment regimen would include a combination of medication and psychotherapy, along with an assertive clinical management program. For medications, selective serotonin reuptake inhibitors and dual serotonin-norepinephrine reuptake inhibitors are first-line choices based on their efficacy and tolerability profiles. The nonselective monoamine oxidase inhibitor, phenelzine, may be more potent than these two drug classes, but because of its food and drug interaction liabilities, its use should be restricted to patients not responding to selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. There are other medication classes with demonstrated efficacy in social phobia (benzodiazepines, antipsychotics, alpha-2-delta ligands), but due to limited published clinical trial data and the potential for dependence and withdrawal issues with benzodiazepines, it is unclear how best to incorporate these drugs into treatment regimens. There are very few clinical trials on the use of combined medications. Cognitive behavior therapy appears to be more effective than other evidence-based psychological techniques, and its effects appear to be more enduring than those of pharmacotherapy. There is some evidence, albeit limited to certain drug classes, that the combination of medication and cognitive behavior therapy may be more effective than either strategy used alone. Generalized social phobia is a chronic disorder, and many patients will require long-term support and treatment.

The aim of this study was to assess whether self-reported mental health status, measured using the SF-36 questionnaire, was associated with fish consumption, assessed using a food-frequency questionnaire. The cross-national data were collected in the 1996/97 New Zealand Health Survey and 1997 Nutrition Survey, which were conducted using the same sampling frame. Survey respondents were categorised into those who consumed no fish of any kind and those who consumed some kind of fish, at any frequency. Data were adjusted for age, household income, eating patterns, alcohol use and smoking. Other demographic variables and potential confounding nutrients were included in the preliminary analyses but were not found to have a significant relationship with fish consumption. Data from a nationally representative sample of 4644 New Zealand adults aged 15 years and over were used in this analysis. Fish consumption was significantly associated with higher self-reported mental health status, even after adjustment for possible confounders. Differences between the mean scores for fish eaters and those who never eat fish were 8.2 for the Mental Health scale and 7.5 for the Mental Component score. Conversely, the association between fish consumption and physical functioning was in the opposite direction. This is the first cross-sectional survey to demonstrate a significant relationship between fish intake and higher self-reported mental health status, therefore offering indirect support for the hypothesis that omega-3 polyunsaturated fatty acids may act as mood stabilisers.

One of the central controversies in the judicial behavior literature is the extent to which judges' ability to act according to their ideological preferences is affected by their location in the judicial hierarchy. Judges on intermediate appellate courts have different decisionmaking environments than high court judges. As a result, the goals of lower appellate court judges may differ from those of their superiors: the quest for legal accuracy may compete with the desire to pursue policy preferences. Analysis of the reversal rate of the U.S. circuit courts of appeals offers insight into the extent to which these judges balance the pressures of their own policy preferences with the desire to achieve the legally accurate result in cases they decide.

PurposeThis study aims to investigate how sports customers adopted over-the-top (OTT) services to consume sport content. Inspired by the technology acceptance model (TAM), the study aims to understand users' behavior when consuming sporting events and users' perceptions toward OTT services.Design/methodology/approachThe participants of the study are Chinese sports consumers that use streaming services to watch live sport content. An online survey was distributed through HUPU Sports, a Chinese online communication community where sports fans can share opinions. To make sure all responses qualified to take part in the study, skip logic questions were added at the beginning of the questionnaire to ask participants to answer whether they used streaming services for watching sports. A total of 352 responses were received and there were 327 useable questionnaires.FindingsThe results revealed that viewing convenience, free of commercials and viewing quality were the main reasons impacting them to adopt OTT services. In terms of users' perceptions, paid users rated higher in perceived enjoyment, perceived value, perceived usefulness (PU) and ease of use than nonpaid users. OTT users' fandom and PU could predict the time the users spent on using these services, while the users' fandom and perceived value are positively related to the money users spent on these services. In addition, this study also found that users' fandom, perceived value, content quality, and ease of use are positively associated with users' intention to continue to use the service.Originality/valueThe study is one of the first attempts to explore how sports audiences adopted OTT services to consume sport content and explore the audiences' perceptions toward OTT usage. Previous studies have already investigated how users adopted music streaming services (Fernandes and Guerra, 2019) and other online streaming services (Shin and Park, 2021), but little attention has been given to sports streaming services specifically. Therefore, the findings of the study fill the gap in the extant knowledge of sport consumers' behavior and provide more insights to their online behaviors. Moreover, the authors also contribute to the growing digital media literature by advancing our understanding perceptional differences between paid users and unpaid users. The streaming services literature has primarily focused on general users (Fernandes and Guerra, 2019), but the services neglect to understand the differences in between paid and unpaid users.

Objectives To generate a prognostic classification method for Amyotrophic Lateral Sclerosis (ALS) from a prognostic model built using clinical variables from a population register. Materials and Methods We carried out a retrospective multivariate analysis of 713 patients with ALS over a 20 year period from the South-East England Amyotrophic Lateral Sclerosis (SEALS) population register. Patients were randomly allocated to ‘discovery’ or ‘test’ cohorts. A prognostic score was calculated using the discovery cohort and then used to predict survival in the test cohort. This score was used as a predictor variable in subsequent survival analyses, either as a raw value for a Cox regression or split into four prognostic categories (good, moderate, average, poor). Results A prognostic score generated from one cohort of patients predicted survival for a second cohort of patients (r2=0.72). Six variables were included in the survival model: age at onset, diagnostic delay, El Escorial category, use of riluzole, gender and site of onset. Cox regression demonstrated a strong relationship between these variables and survival (χ2 80.8, df 1, p<0.0001, n=343) in the test cohort. Kaplan-Meier analysis demonstrated a significant difference in survival between clinical categories (log rank 161.932, df 3, p<0.001). Conclusion It is possible to correctly classify patients into prognostic categories using clinical data easily available at time of diagnosis.

Objectives. Recent work on Supreme Court decision making has argued that different areas of law demonstrate the creation of jurisprudential regimes, which alter the importance of different case facts to the justices, suggesting that the justices do alter their behavior in response to changes in the law. However, the work on jurisprudential regimes has suggested that all justices, or at least all justices who participate in establishing the regime, react similarly to the regime creation. Methods. I separate out the justices who support the establishment of the regime and those who oppose the establishment of the regime to test the hypothesis that majority and dissenting justices react differently to the creation of jurisprudential regimes. Results. Both sets of justices react to the establishment of the regime, but the change in behavior of the dissenters occurs after that of the majority. Conclusions. These results suggest that the impact of jurisprudential regimes may be even more substantial than previously believed.