Abstract Background Organizational Health Literacy (OHL) refers to the extent to which organizations facilitate equitable access, comprehension, and use of health information and services for informed decision-making. Objective This study aimed to (1) review and map existing OHL frameworks and (2) propose an innovative OHL framework that addresses gaps identified in current models. Methods A systematic search of academic (Web of Science, Scopus, MEDLINE) and grey literature from the past 15 years was conducted to identify OHL frameworks. This scoping review followed the PRISMA-ScR guidelines and the Arksey and O’Malley model. A new OHL intervention framework was developed to address gaps in existing models, based on the principles of preventive medicine and the public health action cycle. Results A total of 19 records were included (10 from academic databases and 9 from grey literature), covering diverse approaches and contexts related to OHL. Four intervention levels were identified: integrating HL into formal education, implementing HL assessments, developing interventions for vulnerable populations, and enhancing accessibility to health resources. The proposed framework emphasizes intersectoral collaboration and communication pathways between education and healthcare sectors, facilitating information exchange to continuously adapt interventions to population needs. Conclusion OHL development requires intersectoral collaboration; however, interoperability between sectors remains unaddressed in existing frameworks. This study proposes an innovative model that fosters sectoral connections toward a shared goal, creating a truly collaborative framework.

The United States is engaged in a strategic competition with China over the nature of the global system, and the Middle East has emerged as a central site of great power competition: The United States, China, and Russia are all active there. At the heart of this competition is technology. Middle Eastern countries have been developing strong technology links with China while maintaining their security and economic relations with the United States. Smart cities present a valuable case study of this competition. A smart city is a city that addresses public issues with solutions based on information and communication technology–enabled use of large-scale data available from the Internet of Things. China is involved in dozens of smart city projects in the Middle East. In that region, the need for improved urban environments is pressing. The region is well above the world average for percentage of population living in urban areas and for urban population growth. Smart city infrastructure can be used to improve services, but it can also be used for population control, to limit public dissent, to violate privacy, and to strengthen authoritarian tendencies. This therefore makes smart cities a positive factor in improved services and greater connectivity but also a potential threat to civil society and personal and political freedom. China’s involvement raises an additional issue: that of data security and the integrity of communications networks, especially those related to U.S. activities in the region. This paper addresses potential U.S. concerns related to these developments.

Human Noroviruses (HuNoVs) are the leading etiologic agents responsible for viral gastroenteritis. Drinking water (DW) serves as a significant vehicle for the transmission of HuNoVs. This study aimed to assess the occurrence of HuNoVs in drinking water sources (DWS) and DW. A systematic search spanning Web of Science, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials was executed up to July 15, 2024. Following rigorous screening, 76 eligible studies underwent meta-analysis with heterogeneity assessment via Stata 14.0 using a random-effects model. The results indicated that the pooled occurrence of HuNoVs was 11 % (95 % CI: 8-14), with occurrence of 15 % (95 % CI: 10-21) in DWS and 6 % (95 % CI: 3-9) in DW. Subgroup meta-analysis demonstrated that genogroup II (GII) of HuNoVs exhibited the highest contamination occurrence of 7 % (95 % CI: 4-10), with GII.4 and GII.17 being the predominant genotypes. The two continents with the highest number of studies were Asia (n = 27) and Europe (n = 19), with HuNoVs occurrence of 14 % (95 % CI: 8-22) and 15 % (95 % CI: 7-26), respectively. Furthermore, the occurrence showed no significant differences across the four seasons: in spring, the occurrence was 11 % (95 % CI: 3-23); in summer, 15 % (95 % CI: 7-25); in autumn, 11 % (95 % CI: 2-24); and in winter, 18 % (95 % CI: 10-27). These findings provided valuable epidemiological insight into the global occurrence, seasonal variation, and genotypic distribution of HuNoVs in DWS and DW, aiding policy development and public health strategies.

South Korea, Japan, and the United States' trilateral partnership has expanded to include collaboration on economic security, including on critical minerals supply chains (CMSCs). This report offers analysis, tools, and recommendations to strengthen South Korea's CMSCs and economic security through trilateral cooperation and collaboration among South Korea, the United States, and Japan. Included in the report are (1) analysis of the trio's CMSC vulnerabilities and four industry case studies on cobalt, gallium, molybdenum, and tungsten; (2) summaries of the key organizations and governance leading critical minerals efforts, national legislation, policy tactics and tasks, and available financial mechanisms in each country, along with a supply chain net assessment tool and analysis to evaluate supply chain securitization efforts; (3) case studies on trilateral engagement with India and Mongolia and political alignment metrics to evaluate potential partnerships with mineral-rich countries; and (4) opportunities for and barriers to trilateral cooperation. Although barriers exist, opportunities to secure South Korea's supply chains through trilateral cooperation include trade policy and sectoral trade agreements, steering the Minerals Security Partnership (MSP) into new directions, and joint stockpiling initiatives, such as mineral swap agreements. South Korea can improve its supply chain vulnerabilities by expanding its concepts of economic security to include securing raw material inputs for its defense industrial base. This report should be of interest to South Korean, Japanese, and U.S. policymakers; to researchers of Indo-Pacific and East Asian security, economic security, techno-economic competition, supply chain resilience, and related policy; and to the private sector.

National security leaders rarely get to choose what to care about and how much to care about it. They are more often subjects of circumstances beyond their control. The September 11 attacks reversed the George W. Bush administration's plan to reduce the United States' global commitments and responsibilities. Revolutions across the Arab world pushed President Barack Obama back into the Middle East just as he was trying to pull the United States out. And Russia's invasion of Ukraine upended the Biden administration's goal of establishing "stable and predictable" relations with Moscow so that it could focus on strategic competition with China. Policymakers could foresee many of the underlying forces and trends driving these agenda-shaping events. Yet for the most part, they failed to plan for the most challenging manifestations of where these forces would lead. They had to scramble to reconceptualize and recalibrate their strategies to respond to unfolding events. The rapid advance of artificial intelligence—and the possible emergence of artificial general intelligence—promises to present policymakers with even greater disruption. Indicators of a coming powerful change are everywhere. Beijing and Washington have made global AI leadership a strategic imperative, and leading U.S. and Chinese companies are racing to achieve AGI. News coverage features near-daily announcements of technical breakthroughs, discussions of AI-driven job loss, and fears of catastrophic global risks such as the AI-enabled engineering of a deadly pandemic. There is no way of knowing with certainty the exact trajectory along which AI will develop or precisely how it will transform national security. Policymakers should therefore assess and debate the merits of competing AI strategies with humility and caution. Whether one is bullish or bearish about AI's prospects, though, national security leaders need to be ready to adapt their strategic plans to respond to events that could impose themselves on decision-makers this decade, if not during this presidential term. Washington must prepare for potential policy tradeoffs and geopolitical shifts, and identify practical steps it can take today to mitigate risks and turbocharge U.S. competitiveness. Some ideas and initiatives that today may seem infeasible or unnecessary will seem urgent and self-evident with the benefit of hindsight.

Climate models project that the Central Arctic Ocean (CAO) may soon become ice-free in summer for a limited window of time, opening a seasonally navigable route that connects Asia to Europe by crossing over the North Pole. This Transpolar Sea Route (TSR) and its surrounding waters in the CAO have seen little activity and would be available for seasonal commercial and surface military activity, particularly from the surrounding exclusive economic zones (EEZs) of Canada, Denmark (through Greenland and the Faroe Islands), Norway, Russia, and the United States. In this report, the authors explore how global actors may leverage new maritime access in the CAO for economic, political, and military gain. Drawing on insights from climate models, literature, and expert interviews, they examine current and potential future maritime uses of the ocean and the TSR by Arctic states and other actors. They then present a scenario in four phases of how these activities could plausibly develop in the CAO over time. The authors find that the most plausible scenario for maritime use of the CAO in the next 25 years is one of limited activity, though numerous factors could lead to expanded commercial and military presence by global actors.

Discussions in Washington about artificial intelligence increasingly turn to how the United States can win the AI race with China. One of President Donald Trump's first acts on returning to office was to sign an executive order declaring the need to "sustain and enhance America's global AI dominance." At the Paris AI Action Summit in February, Vice President JD Vance emphasized the administration's commitment to ensuring that "American AI technology continues to be the gold standard worldwide." And in May, David Sacks, Trump's AI and crypto czar, cited the need "to win the AI race" to justify exporting advanced AI chips to the United Arab Emirates and Saudi Arabia. Given the prospect that AI could transform the power and prosperity of nations in the decades to come, it is better to win the race than lose it. But determining who is ahead depends on what it means to win. A common definition is being the first to cross the threshold of artificial general intelligence, which in basic terms is an AI model that is as smart or smarter than the top human experts across a wide range of cognitive tasks. AGI could unlock extraordinary breakthroughs in science, technology, and economic productivity—and the first country to develop it could reap disproportionate benefits.

China’s increased military threats and intimidation activities against Taiwan and Russia’s full-scale invasion of Ukraine in 2022 have prompted Taiwan’s government and civil society to strengthen the country’s resilience. Although Taiwan has a rich history of volunteerism and ample experience with disaster response, the efforts to build the nation’s civilian resilience against a potential wartime scenario are still in their initial stages. In this report, the authors consider aspects of Taiwan’s civilian resilience preparedness efforts that are particularly pertinent to building resilience against potential acts of war, which could range from a military blockade to kinetic strikes and even invasion. The authors define civilian resilience as civilian society’s ability to anticipate, prepare for, mitigate, and survive an act of war and rebuild following the end of hostilities. They apply an analytical framework based on seven thematic resilience areas (psychological resilience and societal cohesion, health and welfare, critical infrastructure and vital services, continuity of government and governance, transportation and mobility, food and water, and external networks) to evaluate Taiwan’s civilian resilience, its strengths and vulnerabilities, and how Taiwan could improve its civilian resilience capabilities. Drawing on their review of open-source primary and secondary sources and more than 40 interviews with government officials, subject-matter experts, civic leaders, and others from Taiwan, the United States, and Europe, the authors identify key areas in which the United States and the international community could further assist Taiwan’s civilian resilience preparations.

The authors of this report present a brief historical overview of the relationship between African countries and the People’s Republic of China (PRC) since its inception in the middle of the 20th century. In this overview, the authors cover economic, humanitarian, and political aspects; highlight trade and investment flows; and summarize Chinese medical and military aid to Africa. The authors also cover Chinese interests in Africa and African countries’ concerns about Chinese engagement on the continent. In addition, three country case studies are presented to highlight how Chinese engagement differs from country to country on the continent. The authors conclude with recommendations for policymakers and propose areas for further research. A decline in relations between the West and Africa at the end of the Cold War and the drop in Western approval because of undemocratic practices and human rights abuses in African countries have created an avenue for China to expand its relationships with African countries. While the West attached conditions to loans and assistance offered to African countries, China presented a no-strings-attached alternative, which only required African nations to respect China’s core sovereignty interests. China has also taken advantage of disinvestment by Western companies in Africa to increase its investments. Chinese economic engagement declined in the second half of the 2010s but is now enjoying a revitalization. This economic engagement has paved the way for greater political and security engagements with African countries.

Purpose: Low- and middle-income countries (LMICs) experience the highest rates of injury-related deaths globally, exacerbated by a lack of robust emergency medical services (EMS). Though fractures contribute substantially to global injury, little is known about prehospital management of extremity fractures in LMICs. Methods: This review included literature published between January 2000 and January 2024. Inclusion criteria pertained to prehospital settings, defined as care rendered prior to hospital presentation, including care provided by lay first responders (LFRs), professional EMS personnel, and traditional bonesetters (TBS). Multiple authors used the Newcastle-Ottawa scale to assess texts meeting inclusion criteria, extracting relevant details for analysis. Results: Of 1251 articles identified, 25 met inclusion criteria. Studies spanned 9 countries across 4 continents, with 14 articles studying care by TBS, 9 by LFRs, and 2 by other prehospital providers. LFR training courses report a combined weighted average pre-/post-course difference of 29.16 percentage points. A total of 67% of included studies report adverse outcomes associated with TBS-managed fractures in the prehospital setting. TBS care is often sought prior to hospital presentation due to sociocultural beliefs, accessibility, and cheaper costs. Few training courses for TBS have been performed, though one course reports a 20.4% increase in fracture management knowledge. Conclusion: In certain resource-limited settings, TBS provide most initial fracture management, which may adversely impact outcomes. Knowledge transfer has been demonstrated during prehospital fracture management courses for LFRs and TBS. Early evidence suggests TBS training and integration into healthcare systems may reduce complication rates, improving long-term outcomes.

Background: The paucity of actionable data on the epidemiological profile of dental caries among adolescents in Nigeria poses significant challenges to policy formulation and implementation. This study aimed to estimate the prevalence of dental caries among adolescents in Nigeria and identify dental caries preventive behaviours associated with dental caries experience among adolescents in Nigeria over 10 years. Methods: A systematic review and meta-analysis of studies on dental caries among adolescents was undertaken in September 2023. Literature searches were conducted across Academic Info, Cochrane Library, Refseek, and PubMed databases and Google Scholar, to identify studies on dental caries prevalence and dental caries preventive behaviour among adolescents in Nigeria that were published between January 2013 and December 2022. Eligible studies included cross-sectional, cohort, and case-control studies. Studies were also included if they presented data for at least one of the primary outcomes. Excluded were studies without information on the sample size, those with incomplete or overlapping samples, case reports, case series, editorials, or reviews without primary data. Heterogeneity was assessed using I2 percentages, and a funnel plot evaluated publication bias. A random effects model was used to determine the prevalence of dental caries with subgroup analysis by sex. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist to assess the quality and integrity of the included studies. The systematic review was registered on PROSPERO (CRD42024458849). Results: Sixteen studies met the eligibility criteria. The pooled prevalence of dental caries among adolescents in Nigeria was 23.0% (95% CI: 16-30). The pooled prevalence for males was 16.0% (95% CI: 9-23) and that for females was 22.0% (95% CI: 11-32). The commonest dental caries preventive practices reported were daily tooth brushing, use of fluoride-containing toothpastes, and dental service utilization. Factors associated with dental caries included a history of dental service utilization, poor oral hygiene practices, and consumption of refined carbohydrates in-between-meals. Conclusion: The high prevalence of dental caries among adolescents in Nigeria warrants programmatic attention with an emphasis on improving oral hygiene practices and controlling the consumption of refined carbohydrates in-between-meals. Dental service utilization for dental caries preventive needs to be encouraged.

Background: Health inequalities are differences in health status or in the distribution of resources and opportunities between different population groups. Bayesian models are well-suited to address the special features and uncertainties in inequality analyses, making them useful for informing policymaking. This research reviewed the use of Bayesian models in racial health equity studies focused on non-communicable diseases. Methodology: A systematic review was conducted to assess the applications and utility of Bayesian inference in racial health equity studies for non-communicable diseases (PROSPERO Registry No. CRD42024568708). A total of 2274 articles were identified through electronic databases, and 46 studies met inclusion criteria. All but three articles were from high-income countries, and all were published between 2008 and 2024. We summarized the information qualitatively, and each document included was assessed using the Bennett-Manuel checklist tool. Findings: Studies on cancer and cardiovascular diseases were the most frequent. The most frequently used models were Poisson, spatial, and logistic regressions, with Markov-chain Monte Carlo and Integrated nested Laplace approximations being the dominant sampling strategies. The studies found that Black individuals, followed by those of Hispanic ethnicity, are the racial/ethnic groups most affected by health inequities. Data on other racial groups (e.g., Indigenous populations, people of Asian heritage) was insufficient for drawing definitive conclusions. The main factor contributing to these disparities lies within the health system, particularly in terms of access and quality, which can be understood in the context of each disease. Interpretation: The integration of Bayesian modeling into health equity studies holds promise for developing methodologies that lead to insights and foster meaningful change.

During U.S. President Donald Trump’s second term, his administration has been signaling the possibility of U.S. retrenchment from Europe (and possibly other regions) to promote allied burden-sharing. Evaluating whether such a change serves U.S. interests involves considering a variety of effects, including the behaviors of U.S. rivals, regional stability, and U.S. defense budgets. RAND researchers analyze one aspect of this broader calculation: how retrenchment affects the behavior of U.S. allies. To do so, they consider lessons from cases of U.S. retrenchment from West Germany, South Korea, Japan, and Taiwan in the 1960s and 1970s. The United States has long viewed itself as a global security leader, so it has not entirely retrenched from key regions. Still, the United States has engaged in limited retrenchment, which means reducing (but not eliminating) U.S. military involvement in a country or region by withdrawing U.S. forces, downgrading U.S. commitments to allies or partners, or providing less military assistance. Contemporary proponents of limited retrenchment argue that it would incentivize U.S. allies to do more for their own defense, moderate their ambitions, and act in ways that promote regional stability. However, these arguments run counter to the central tenets of post–Cold War U.S. grand strategy. To evaluate these competing beliefs, RAND researchers assessed how these historical U.S. force drawdowns and accompanying policies affected the perceptions and behaviors of these four U.S. allies, including effects on nuclear proliferation.

Background: Despite advances in precision medicine, the translation of genetic and genomic technologies into routine practice is hampered by a heterogeneous and limited evidence base and the absence of standardized evaluation methodologies. Health Technology Assessment (HTA) plays a critical role in bridging this gap, yet assessment approaches and comprehensiveness vary widely. This systematic review aims to map the landscape of the assessment reports on genetic and genomics applications, analyze their methodological aspects and identify gaps. Methods: PubMed, Scopus, Web of Science, and the international HTA database, were searched for assessment reports of genetic/genomic technologies. Information on reports general characteristics, assessment domains and their components, consulted sources of evidence and reported gaps was extracted. Findings were synthesized narratively. Results: Out of 27,331 screened records, 41 reports were included, predominantly from Canada, the United Kingdom, and Australia, mainly aimed at informing policy making for single or multiple gene tests for cancer patients. Most reports used a generic HTA methodology and assessment domains varied across reports. Key clinical aspects, such as clinical accuracy and safety, suffered from evidence gaps (39.0% and 22.0%), while personal and societal aspects were the least investigated assessment domain (48.8-78.0%). Overall, lack of evidence and limited generalizability of findings were the most commonly reported gaps across multiple domains. Conclusions: The review highlighted significant fragmentation in current evaluation methodologies of genetic and genomic applications, with underassessment of analytical/clinical accuracy, safety, and non-health outcomes, alongside evidence gaps and limited generalizability. These issues compromise both evaluation and decision-making process, underscoring the urgent need for alternative study designs and standardized, comprehensive assessment frameworks to facilitate the successful implementation of emerging genetic and genomic technologies.

Background: The SARS-CoV-2 pandemic had a major impact on nursing and healthcare as well as on research. The aim of this study was to analyse the characteristics of nursing- and SARS-CoV-2-related research in Germany. Methods: A scoping review was conducted. We systematically searched (06/2023) Medline, CINAHL, the German Register of Clinical Trials, abstract books of conferences and conducted a manual literature search. We included empirical studies addressing aspects of nursing and the pandemic and involving German researchers. Study selection and data extraction were conducted independently by two reviewers. Results were analysed descriptively. Results: We included 131 publications (85 quantitative, 27 qualitative, 6 mixed-/multi-methods studies, 12 systematic reviews, 1 discussion paper); 49 % of the studies were published in 2021. First authors were mostly from medicine, psychology and nursing science, last authors from medicine. Most studies were explorative. Most of the quantitative studies used observational designs, only four were experimental. Nurses and other healthcare professionals were the most common target group; people with care needs or relatives were rarely addressed. The most common topics included health, perceived burden, working conditions, and characteristics of care during the pandemic. A quarter of the studies were not externally funded, 32 % did not provide information on funding. The Federal Ministry of Education and Research (21 %) was the most common funding body. Conclusion: Pandemic-related nursing research was published to a limited extent by nursing scientists; clinical nursing research was particularly underrepresented. Dependable funding and the development of a research infrastructure for nursing research are necessary to ensure evidence-based nursing in times of crisis and to generate findings that are relevant to clinical practice and health policy decision-makers.