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The use of the term “treatment resistance” (TR) in psychiatry has blossomed over the last two decades, with 20%–60% of all cases now labeled as such. Remaining effective treatment options, however, can be identified for two‐thirds of these cases. There is no consensus on definition or criteria for TR within any diagnostic category, and literature review supports a broad range of individual causes of treatment failure (TF), rather than an actual entity of TR. Application of the TR label inhibits a practitioner's search for the true cause(s) of TF, a disservice to the trust patients place in us and their hope for recovery. It also threatens to worsen prognosis by unnecessarily extending the length of an index or recurrent episode, and increases the risk of death and burden of disease by prolonging categorical and functional impairments. We must view TF as a stage of treatment, still expecting and seeking eventual remission, rather than applying TR as an endpoint and an unsanctioned pseudo diagnosis. We must always recall that the clinical tasks we face are inherently complex; routine solutions are unlikely to fit and often lead to TF. The actual value we offer our patients is our problem‐solving skill and our willingness to be with them through the difficulties of reaching their goals. We can address so‐called TR, or, rather, TF by confirming our diagnostic validity and accuracy, the thoroughness of our evaluations and monitoring efforts, the clarity of our therapeutic guidance, and the quality of our therapeutic alliances. Highlights 20%–60% of all cases in psychiatry are labeled “treatment resistant.” Effective treatment options remain in 2/3 of these cases. No consensus exists on definition or criteria for “treatment resistance.” A broad range of individual causes leads to treatment failure. Labeling a case “treatment resistant” erodes quality of care and outcome.

The internet holds the potential promise of improved patient outcomes, especially when one is faced with a critical or life-threatening disease or condition. Appropriate and timely access to health information can support informed negotiation of optimal treatments, optimal management, and expedited recovery, and to an improved outcome for a patient. However, there are many human and technical barriers that may prevent the application of the best possible information for both patient and provider alike, making the patient journey complex and potentially dangerous. In this viewpoint paper, the author (who is also a JMIR editor) reflects on a personal patient journey, where use of the internet facilitated a means of reaching a good patient outcome in the face of a variety of informational and organizational limitations and gaps. This journey illustrates the importance of human-related factors affecting access to health information. The application of a range of internet information resources at critical points can result in a positive patient outcome, as this case illustrates. This paper reflects on how the experience highlights several information needs and concerns. It also highlights the need for improved access to appropriate health information along the patient journey that can support patient and provider joint decision-making. This access to information can make the difference between positive clinical outcomes and death, illustrating how health information on the internet can be both critical and life saving.

Exposure notification applications (ENAs) or digital proximity tracing apps were used in several countries during the COVID-19 pandemic. In this viewpoint, we share our experience of implementing and running the Finnish ENA (Koronavilkku), one of the national ENAs with the highest proportion of users during the pandemic. With the aim of strengthening public trust and increasing app uptake, there was a strong prioritization of privacy and data security for the end user throughout the ENA development. This, in turn, limited the use of the app as a tool for health care professionals and deeper insight into its potential effectiveness. The ENA was designed to supplement conventional contact tracing, rather than replace it, and to serve as an early warning system and a trigger for action for the user in case of potential exposure. The predefined target of 40% uptake in the population was achieved within 3 months of the ENA launch. We consider easy-to-understand information produced together with communication experts crucial during the changing pandemic situation. This information educated people about the app as one component in mitigating the pandemic. As the pandemic and its mitigation evolved, the ENA also needed adapting and updating. A few months after its launch, Finland joined European interoperability, which allowed the ENA to share information with ENAs of other countries. We added automatic token issuing to the ENA as of mid-2021. If added earlier and more comprehensively, automatization could have more effectively saved resources in health care services and prevented overburdening contact tracing teams, while also notifying potentially exposed individuals quicker and more reliably. In the spring of 2021, the number of active apps started to gradually decline. Quarantine and testing practices for asymptomatic vaccinated individuals following exposure to the virus were eased and home tests became more common, eventually replacing laboratory testing for much of the population. Taken together, this led to decreased token issuance, which weakened the potential public health usefulness of the app. A self-service option for token issuance would likely have prolonged the lifespan of the app. The ENA was discontinued in mid-2022. Regularly conducted surveys would have helped gain timely knowledge on the use and effectiveness of the app for better responding to the changing needs during the pandemic.

In 2015, Canada, the United States, and Mexico signed a letter of intent to protect the continent’s migratory bats. In charting a path for protecting bats, we look to the century of efforts to protect birds. Despite a barrage of obstacles, millions of migratory birds still cross North America each year. One key reason for their survival has been international cooperation. The past year marks the 100th anniversary of the Migratory Bird Treaty between Canada and the United States, as well as the 80th anniversary of a similar agreement between the United States and Mexico. These treaties were based on the practical benefits from migratory birds—values today known as ecosystem services. Migratory bats also provide significant natural benefits to people; a fully fledged international convention on migratory bats would not only protect these benefits but would also celebrate a century of transborder cooperation to conserve migratory species in North America.

The study and practice of public administration vary in each and every country, yet there are many lessons to be learned internationally. Public Administration Review (PAR) and the American Society for Public Administration (ASPA) have contributed substantially to these lessons over the last 80 years, including for public administration in Australia. That contribution has been particularly in organizational theory and behavioral influence, policy studies, and teaching and research. Australia has tended to emphasize institutions and descriptions of practice. These differences help explain the more limited involvement of practitioners in ASPA and the Institute of Public Administration Australia's too little involvement of scholars. ASPA and PAR have played a leading role in recent years in expanding opportunities for international learning. Such learning requires an appreciation of differences in contexts, including of America's own unique context. Better understanding of Australia's context might lead to a more positive appreciation in the United States of Australia's reform experience. The balancing of scholarly and practitioner perspectives is also required.