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Background: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included.Methods: An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom.Results: Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations.Conclusions: This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease. [ABSTRACT FROM AUTHOR]

This paper unites the history of Computer Science (CS) Education in Ireland by plotting Ireland's roadmap leading to the implementation of formal Computer Science Education in schools. It first outlines the educational system in Ireland. The history roadmap starts in the 1970s with the first notions of introducing computing in post-primary school, and then continues up to the roll-out the CS curriculum in Ireland at the Senior Cycle level in 2018. The story is chiefly available in disparate publications and reports, so piecing together the entire story is often difficult. This paper collates the available literature, together with the authors' local knowledge of the process, into one paper that may be of interest locally and of value to other jurisdictions beginning their planning of national curricula. The paper describes the development and the current situation of the formal curricula in CS at second level. The current landscape of Computing Education at primary level, which at the time of writing is in the planning stages in Ireland, is described. Additionally, an investigation into the introduction of Computing Education in schools in the international jurisdictions that directly influenced the Irish roll-out takes place, to summarize any lessons learned that might provide insights for Ireland going forward.

The aim of this study is to identify the most prolific countries in the field of special education and to discuss the widespread impact of their papers by taking into account the country's h-index. Through a bibliometric analysis, the data were collected in the Web of Science Core Collection category "Education, Special" in the Social Science Citation Index during 2011-2020. The 25 most prolific countries in the field of special education were determined in terms of paper productivity, and it was seen that the leading country was undisputedly the USA (54.42%). Meanwhile, a strong positive correlation was found between the h-index and the number of papers published by the countries (r=0.864). On the other hand, when the ranking in terms of the number of papers was reconfigured by the h-index, it was relatively changed. The possible reasons for this change for the countries with the most changing rankings were discussed by considering some definitive criteria such as the journal quartiles, the percentage of international and domestic, and the percentage of open access papers. This study reports a positive correlation between the quality and quantity in the field of special education for the publications of countries. It has been shown that where the positive correlation deviates, then especially, the journal quartiles, the percentage of international collaboration and the percentage of open access papers have a significant effect. The bibliometric findings may be useful to enrich the discussion about the widespread impact of papers and debate whether the use of h-index is acceptable for cross-national comparisons.

Milk and beef derived from pasture-based systems have been characterized by higher nutritional values and a lower environmental footprint than their equivalents obtained via indoor systems. However, intensification of pasture-based production can have adverse impacts on biodiversity and the environment. To date, studies on pro-environmental diversification options leading to improvement of environmental performance of pasture-based dairy and beef production have rarely been synthesized. The present study sought to review current on-farm pro-environmental measures with the potential for enhancing biodiversity status and/or reducing the environmental impacts of pasture-based agriculture. Literature on farmer attitudes toward these measures was also reviewed to identify potential obstacles and opportunities for transitioning to pro-environmental agriculture. A systematic search of published research from high-income island countries characterized by oceanic temperate climate with a high dependence on pasture-based agriculture--the Republic of Ireland, the United Kingdom and New Zealand, was conducted. Thirty studies that assessed the impact of pro-environmental measures, eight 'attitudinal' studies of dairy and beef farmers and one study covering both aspects were identified. Inductive thematical analysis was subsequently undertaken. Environmentally sensitive management practices such as hedgerows and field margins management, mixed grazing (where two or more herbivorous animals graze the same land), rare livestock breeds, multispecies swards, organic farming and agroforestry were identified as primary themes studied under the auspices of pro-environmental diversification, while forestry, bioenergy crops and organic farming were the main themes identified within attitudinal research studies. Findings suggest that environmentally sensitive practices have varied effects on biodiversity. Mixed grazing was found to improve livestock production, while studies of organic farming reported multiple positive impacts on biodiversity and animal welfare. Effect of multispecies swards on methane emissions and urinary nitrogen extraction were found to be inconsistent. Attitudinal research suggests that the main barrier to implementing afforestation is its lack of attractiveness compared to 'traditional' farming and that organic farmer decisions regarding agricultural management practices might be less profit-oriented and influenced by ecological beliefs to a greater extent than decisions of conventional farmers. The results of this study confirm that pro-environmental diversification inherently encompasses multiple scientific disciplines; however, previous study designs and outcomes were found to be fragmented and narrowly focused. Considering the urgency and importance of climate and biodiversity crises, pro-environmental diversification of pasture-based dairy and beef production has rarely been holistically approached and remains understudied. The development of practical, sustainable solutions for farming based on circular economy and respect to nature and additional strategies to increase farmer and consumer environmental awareness should be prioritized by policymakers, advisory and scientific bodies. [ABSTRACT FROM AUTHOR]

This specially themed ""Getting of Wisdom," Learning in Later Life" Edition of the "Australian Journal of Adult Learning" ("AJAL") is not so much concerned with the issue of ageing itself, but more about quality of life regardless of age. It is about taking, but also giving back as best as possible at any age. This special issue is a result of the one week "The Getting of Wisdom Exchange", a collaboration between around 100 adult education practitioners and researchers from ten countries from Australia, New Zealand, Asia and Europe. In this issue, papers are presented from Sweden, Ireland, Aotearoa/New Zealand, Australia, Slovenia, Poland, Germany, Portugal and the United Kingdom. Papers cover different topics and open questions about various issues in older people's learning.

While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

Simple Summary: An animal's genetic merit can govern its production potential and performance. This study used a bio-economic model informed by a large dataset of records from a commercial sheep-production-flock study to investigate the effects of selecting breeding females based on their maternal genetic merit for productivity, feed demand and gross margin. The results showed that selecting and using breeding females of high genetic merit will increase the gross margin of the flock, thus improving the profitability of the production system for the farmer. Our results provide insight for sheep-meat-production industries into the cumulative economic returns of using animals of high genetic merit. Our results also indicate potential outcomes from improving flock genetic merit, an important key performance indicator for the industry, and inform decision-making around production priorities of producers. The objective of this study was to simulate and assess the profitability of sheep production systems that varied in maternal genetic merit (high or low) and country of origin (New Zealand (NZ) or Ireland), using the Teagasc Lamb Production Model (TLPM). A production system study performed at Teagasc Athenry, Co. Galway, Ireland, from 2016 to 2019, inclusive, provided key animal performance input parameters, which were compared across three scenarios: high maternal genetic merit NZ (NZ), high maternal genetic merit Irish (High Irish) and low maternal genetic merit Irish (Low Irish). Prior to the beginning of the study ewes and rams were imported from New Zealand to Ireland in order to compare animals within the same management system. Ewes were selected based on the respective national maternal genetic indexes; i.e., either the New Zealand Maternal Worth (NZ group) or the €uro-star Replacement index (Irish groups). The TLPM was designed to simulate the impact of changes in physical and technical outputs (such as number of lambs, drafting rates and replacement rates) on a range of economic parameters including variable costs, fixed costs, gross margin and net profit. Results showed that total farm costs (variable and fixed) were similar across the three scenarios, driven by the similar number of ewes in each scenario. The number of lambs produced and the cost of production per lamb was 14.05 lambs per hectare for the NZ scenario at a cost of EUR 82.35 per lamb, 11.40 lambs per hectare for the High Irish scenario at a cost of EUR 101.42 per lamb and 11.00 lambs per hectare for the Low Irish scenario at a cost of EUR 105.72 per lamb. The net profit of the three scenarios was EUR 514, EUR 299, and EUR 258 per hectare, for the NZ, High Irish and Low Irish scenarios, respectively. Overall, the NZ scenario had a lower cost of production in comparison to either Irish group, while the High Irish scenario had a 14% greater net profit than the Low Irish scenario, equating to an additional EUR 41 per hectare net profit. Output from this simulation model reiterates the importance, for overall farm profitability, of maximising the number of lambs weaned per hectare, particularly through maximising income and diluting the total farm costs. To conclude, the use of high-maternal-genetic-merit animals, regardless of their country of origin impacts farm profitability. [ABSTRACT FROM AUTHOR]

Our paper focuses on delineating and scoping international Women's Sheds, a movement that has emerged within the past decade, mainly in Australia, Ireland and the UK. It addresses two main research questions. Firstly, what is the origin, distribution, nature and intent of Women's Sheds internationally to March 2021? Secondly, how might Women's Sheds be located within a typology inclusive of Men's Sheds and a range of community development models? We employed a systematic search via the internet in 2020-21, followed up by attempted email or phone contact to publicly reported Women's Sheds and like organisations internationally. In the process, we created a publicly shareable blog including a database of 122 existing, previously active, developing or planned Women's Sheds and like organisations to 13 March 2021. We identify four nations where self-identified Women's Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice. Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice.

Introduction: In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand. Methods: The study applied a case study methodology with the focus on the implementation strategies in each country. Principal investigators gathered relevant information from multiple sources and summarised it according to specific aspects of the implementation process, comparing them across countries. The main implementation aspects are described, as well as the main advantages and barriers perceived by the users. Results: The seven case studies showed that adequate staffing, appropriate information technology, availability of hardware, professional collaboration and continuous training are perceived as important factors which can contribute to the implementation of the interRAI instruments. In addition, the use of electronic standardised assessment instruments such as the interRAI Suite provided evidence to improve decision-making and quality of care, enabling resource planning and benchmarking. Conclusion: In practice, the implementation of health information systems is a process that requires a cultural shift of policymakers and professional caregivers at all levels of health policy and service delivery. Information about the implementation process of the interRAI Suite in different countries can help investigators and policymakers to better plan this implementation. This research sheds light on the advantages and pitfalls of the implementation of the interRAI Suite of instruments and proposes approaches to overcome difficulties [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has exposed the disproportionate effects of pandemics on frontline workers and the ethical imperative to provide effective prophylaxis. We present a model for a pragmatic randomised controlled trial (RCT) that utilises Bayesian methods to rapidly determine the efficacy or futility of a prophylactic agent. Methods: We initially planned to undertake a multicentre, phase III, parallel-group, open-label RCT, to determine if hydroxychloroquine (HCQ) taken once a week was effective in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in healthcare workers (HCW) aged ≥ 18 years in New Zealand (NZ) and Ireland. Participants were to be randomised 2:1 to either HCQ (800 mg stat then 400 mg weekly) or no prophylaxis. The primary endpoint was time to Nucleic Acid Amplification Test-proven SARS-CoV-2 infection. Secondary outcome variables included mortality, hospitalisation, intensive care unit admissions and length of mechanical ventilation. The trial had no fixed sample size or duration of intervention. Bayesian adaptive analyses were planned to occur fortnightly, commencing with a weakly informative prior for the no prophylaxis group hazard rate and a moderately informative prior on the intervention log hazard ratio centred on 'no effect'. Stopping for expected success would be executed if the intervention had a greater than 0.975 posterior probability of reducing the risk of SARS-CoV-2 infection by more than 10%. Final success would be declared if, after completion of 8 weeks of follow-up (reflecting the long half-life of HCQ), the prophylaxis had at least a 0.95 posterior probability of reducing the risk of SARS-CoV-2 infection by more than 10%. Futility would be declared if HCQ was shown to have less than a 0.10 posterior probability of reducing acquisition of SARS-CoV-2 infection by more than 20%. Discussion: This study did not begin recruitment due to the marked reduction in COVID-19 cases in NZ and concerns regarding the efficacy and risks of HCQ treatment in COVID-19. Nonetheless, the model presented can be easily adapted for other potential prophylactic agents and pathogens, and pre-established collaborative models like this should be shared and incorporated into future pandemic preparedness planning. Trial registration: The decision not to proceed with the study was made before trial registration occurred. [ABSTRACT FROM AUTHOR]

Education is the core of the factors that improved people for a better lifestyle and increases the level of society' development. Quality education is one of the most vital goals of Sustainable Development Goals (SDGs) due to actualizing these factors. Using relational network data envelopment analysis (DEA), which have three interrelated substages, this current paper computes the educational economy efficiency of the Organisation for Economic Co-operation and Development (OECD) countries bearing in mind the characteristics related to SDGs. The contribution of our study is the use of a novel approach to computing the educational economy efficiency using relational network DEA with GAMS. Even though some interesting differences reveal in the efficiency of the countries, the findings show that countries with high-efficiency scores are clustered around countries like Latvia, Slovenia, and Korea.

Background: A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. Method: We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. Findings: One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. Conclusion: This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care. Plain Language Summary: High-quality health care for women and girls should be provided by health workers who are respectful and caring. Health workers should also work with others as a team and help women and girls make their own decisions about their health care. This approach is called patient-centred care. Female genital mutilation (FGM) is a cultural practice associated with poor health outcomes. Women who have experienced FGM have not always received quality health care. We studied the guidance and tools to help health workers provide care to women and girls with or at risk of FGM. This study aimed to understand how health workers are supported to provide woman and girl-centred health care in these documents. We searched for these documents on the websites of health professional associations, government health departments and organisations working in FGM in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The documents were analysed using a tool that described all the important areas needed to provide patient-centred health care. Of the 124 documents, we found that only 12% contained information about all aspects of patient-centred care. Only one document had details about all the areas that are part of patient-centred care. This study shows that we need to improve the FGM-related guidance provided to health workers to care for and protect women and girls. There is a need for health workers to involve women and girls with or at risk of FGM in designing guidelines and tools and evaluating them to these documents best fit their needs. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.Design: Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.Setting: PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).Participants: None.Intervention(s): None.Main Outcome Measure(s): None.Results: PET-CT service provision has grown over the period 2006-2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.Conclusions: Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to benchmark roles that veterinary librarians at universities and colleges play in systematic reviews (SRs) and scoping reviews that are conducted by faculty and students at their institutions, to benchmark the level of training that veterinary librarians have in conducting SRs, to identify barriers to their participation in SRs, and to identify other types of literature reviews that veterinary librarians participate in. Methods: Sixty veterinary librarians in universities and colleges in Canada, the United States, England, Scotland, Ireland, Australia, and New Zealand were surveyed online about their roles and training in conducting SRs, barriers to participation in SRs, and participation in other types of literature reviews. Results: Veterinary librarians' highest participation was at an advising level in traditional librarian roles as question formulator, database selector, search strategy developer, and reference manager. Most respondents reported pretty good to extensive training in traditional roles and no or some training in less traditional roles. Sixty percent of respondents received few or no requests to participate in SRs, and only half of respondents had participated in SRs as a review team member. Sixty percent of respondents stated that their libraries had no policies regarding librarian roles and participation in SRs. Conclusions: The surveyed veterinary librarians participated in SRs to a lesser degree than human health sciences librarians, experienced low demand from veterinary faculty and students to participate in SRs, and participated as review team members at significantly lower rates than human health sciences librarians. The main barriers to participation in SRs were lack of library policies, insufficient training, and lack of time. [ABSTRACT FROM AUTHOR]

Statistical literacy is complex and multifaceted. In every country, education and numeracy are a function of a multitude of factors including culture, history, and societal norms. Nevertheless, since the launch of the International Statistical Poster Competition (ISLP) in 1994, a number of patterns have emerged to suggest there are some common or universal success factors in running statistical literacy competitions involving schools, universities, statistical offices, and many other institutions. This paper outlines some of those factors, such as institutional cooperation, celebrating participation and success, improvement of statistical literacy in the local schools, support for teachers, the involvement of national statistics institutes, and use of technology. These factors have been identified from our own experience running the competition and from articles submitted to the ISLP newsletters. Statistical literacy is a complex phenomenon, and so this is neither an exhaustive list of key factors nor a formula for success, but rather an overview of recurring themes across countries participating in the competition around the world.

Ample evidence indicates that a person's human capital is important for success on the labor market in terms of both wages and employment prospects. However, unlike the efforts to identify the impact of school attainment on labor-market outcomes, the literature on returns to cognitive skills has not yet provided convincing evidence that the estimated returns can be causally interpreted. Using the PIAAC Survey of Adult Skills, this paper explores several approaches that aim to address potential threats to causal identification of returns to skills, in terms of both higher wages and better employment chances. We address measurement error by exploiting the fact that PIAAC measures skills in several domains. Furthermore, we estimate instrumental-variable models that use skill variation stemming from school attainment and parental education to circumvent reverse causation. Results show a strikingly similar pattern across the diverse set of countries in our sample. In fact, the instrumental-variable estimates are consistently larger than those found in standard least-squares estimations. The same is true in two "natural experiments," one of which exploits variation in skills from changes in compulsory-schooling laws across U.S. states. The other one identifies technologically induced variation in broadband Internet availability that gives rise to variation in ICT skills across German municipalities. Together, the results suggest that least-squares estimates may provide a lower bound of the true returns to skills in the labor market.

This paper discusses the emergence of assessment for learning (AfL) across the globe with particular attention given to Western educational jurisdictions. Authors from Australia, Canada, Ireland, Israel, New Zealand, Norway, and the USA explain the genesis of AfL, its evolution and impact on school systems, and discuss current trends in policy directions for AfL within their respective countries. The authors also discuss the implications of these various shifts and the ongoing tensions that exist between AfL and summative forms of assessment within national policy initiatives.

A fast-changing global landscape highlights the importance of understanding spatial price dynamics in key international markets such as China, especially in the era of COVID-19 pandemic with international food trade and food system experiencing an unprecedented challenge. Nowadays, New Zealand's dominant position in China's dairy import market is being challenged by European Union (EU) dairy exporters leading to intensified market competition. Using monthly export data of skim milk powder (SMP), we applied threshold cointegration models along with asymmetric error correction models to examine spatial price dynamics and price transmissions of New Zealand and Ireland in Chinese and global markets. We found that New Zealand's export prices retain their leadership position in China, Ireland's export prices are well more aligned with those in international markets. In terms of own-country price transmission, Ireland's relatively symmetric and swift adjustments were found to contrast with New Zealand's SMP export prices, which displayed more asymmetric price transmissions. [ABSTRACT FROM AUTHOR]

Background: As the role of the physician assistant/associate grows globally, one question is: what is the level of patient satisfaction with PAs? Driven by legislative enactments to improve access to care, the PA has emerged as a ready and able medical professional to address workforce shortages. The aim of this study was to review the literature on patient satisfaction of PAs., Objectives: The basis for this review was to clarify working definitions, synthesize the evidence, and establish conceptual boundaries around the topic of patient satisfaction with PAs. The intent was to identify gaps in the literature and offer suggested undertakings for more clarification on the subject., Methods: A scoping review was undertaken. Literature from 1968 to 2019 was searched and filtered for eligibility. Those that met criteria were categorized by date, method, geography, themes, and design., Results: In total, there were 987 papers or reports that were identified through bibliography database searching. Additional articles found through snowball methodology-reviewing references (n = 11). Only English language articles emerged for analysis. From this effort, 25 articles surfaced from the filtering process for final inclusion. Most (72%) of the articles came from the United States of America, three from the United Kingdom, and one each from Ireland, the Netherlands, and New Zealand. Most articles were descriptive in nature. Some variations in methods emerged., Conclusion: PAs are operational in 15 nations; their acceptance appears successful and satisfaction with their care largely indistinguishable from physicians. Findings from this analysis highlight one theory that when patient's needs are met, satisfaction is high regardless of the medical provider. Areas for further research are identified.

Objective: To map key policy documents worldwide and establish how they address the treatment and care needs of children and young people (CYP) who are suicidal., Design: We conducted a scoping review to systematically identify relevant key policy documents following a pre-established published protocol., Data Sources: Four databases (CINAHL; Medline; PsycINFO; The Cochrane Database of Systematic reviews) and the websites of key government, statutory and non-statutory agencies were searched. Google and Google Scholar were used to identify other policy documents and relevant grey literature. Leading experts were consulted by email., Eligibility Criteria for Selected Studies: Policies, policy guidance, strategies, codes of conduct, national service frameworks, national practice guidance, white and green papers, and reviews of policy-concerned with indicated suicide prevention approaches for children up to 18 years old. Limited by English language and published after 2000., Data Extraction and Synthesis: Data were extracted using a predetermined template. Second reviewers independently extracted 25%. Documents were categorised as international guidance, national policy and national guidance, and presented in a table providing a brief description of the policy, alongside how it specifically addresses suicidal CYP. Findings were further expressed using narrative synthesis., Results: 35 policy documents were included in the review. Although many recognise CYP as being a high-risk or priority population, most do not explicitly address suicidal CYP. In general, national guidance documents were found to convey that suicidal children should be assessed by a child and adolescent mental health practitioner but offer no clear recommendations beyond this., Conclusion: The lack of specific reference within policy documents to the treatment and care of needs of children who are suicidal highlights a potential gap in policy that could lead to the needs of suicidal children being overlooked, and varying interpretations of appropriate responses and service provision., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Treatment with new and/or innovative drugs with uncertain safety and efficacy profile is associated with substantial ethical concerns. The main objective of this paper is to present guidance on the use of such drugs contained in: (i) major international codes and guidelines pertaining to medical ethics and biomedical research; (ii) national codes of medical ethics and professional conduct of the USA, Canada, Australia, New Zealand, the UK, Ireland, France and Germany. Out of the four international codes and guidelines analysed, only the Declaration of Helsinki addresses the question of the use of unproven drugs. Among national codes, only two (USA and New Zealand) explicitly allow for use of new or innovative drugs. Moreover, treatment with unproven drugs seems to be permissible under the French code, though this is not stated explicitly. The remaining codes do not contain any articles on the use of new and innovative drugs. An update of existing articles, as well as the addition of new guidelines to the codes, should be considered in view of the rapid pace of development and introduction to clinical practice of new drugs. This work is relevant to innovative off-label applications of approved drugs and expanded access to investigational drugs., (© 2018 The British Pharmacological Society.)