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Abstract: International policies regulating clinical ethics committees'' (CEC) roles are non-existent. Nonetheless, CECs have established themselves in several countries and there exist striking differences in the way these work. This international practice variation stems from the ways CECs developed, within particular legal, political, social and professional contexts. National guidelines and normative documents have been published in many countries regarding CECs. To better understand CECs'' evolution and differences in various countries, we reviewed guidelines, position statements and normative papers which describe and frame the development of CECs in the United States, the United Kingdom, Canada and France. Systematic content analysis addressed guideline development, CECs'' roles, consultation methods and CEC members'' education requirements. Differing contexts informed the ways in which guidelines were developed. American CECs, established within a strongly litigious context are perceived to play strong decision-making roles, whereas British CECs, encouraged by clinicians, endorse a more supportive model. Canadian guidelines focus on the role of the ethicist, while the French model is interested in a theoretical interdisciplinary approach. This analysis shows important challenges facing the implementation of accountable CECs in different contexts and can help inform future policy development. [Copyright &y& Elsevier]

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]