Water stress is not a unique or new challenge to China, but the scale at which China must manage finite water resources to maintain economic and social stability creates trade-offs and challenges with potentially broader implications. Water supplies are limited in the northern region of China compared with supplies in the southern region. China has invested in large-scale infrastructure projects that move water between regions. However, China has initiated a wave of governmental changes in the past decade that have shifted policy focus to reduce demand, therefore increasing water conservation and efficiency while supporting economic growth and national security aims. Water supply infrastructure projects likely cannot rectify the regional water disparities, particularly as the effects from climate change worsen and China continues investing in water-intensive industries. Water is tied to many of China’s policy initiatives and economic investments, and at some point the total sum of water demand may be significantly more than supply, particularly in northern China. There are disconnects in China’s water policy that will exacerbate water stress in the future and require China to make hard decisions about water, food, and economic security. The authors of this report analyzed China’s water stress and recent water resource policy decisions to identify the current and future implications of water resource constraints for China’s strategic planning. The authors also conducted a workshop with China experts to identify the interaction of water resource constraints with other societal trends, such as economic, geopolitical, and environmental trends.

This paper examines China's evolving strategy of economic deterrence, arguing that while it lacks a formal doctrine, it has developed a coherent and effective system that discourages economic coercion from third parties. The authors identify five core elements underpinning China's strategy: enhancing resilience in critical sectors, fostering strategic interdependencies, maintaining a ready-to-deploy economic retaliation toolbox, building credibility through consistent coercive actions, and preparing the domestic population to absorb economic shocks. These elements are not part of an official economic deterrence strategy, but they are embedded in broader national security and economic policies and are operationalised through mechanisms such as the dual circulation strategy, long-term resource contracts, industrial subsidies, and retaliatory legal instruments like the Export Control Law. The paper distinguishes between deterrence by denial, entanglement, and punishment, noting China's shift toward deterrence by dependence — leveraging asymmetric interdependencies to discourage adversarial actions. It also highlights the importance of credibility and communication in sustaining deterrence, supported by China's track record of economic retaliation. Finally, the paper assesses the applicability of lessons from China's approach to Europe, emphasising the EU and UK's current limitations in strategic coherence, collaboration, and credibility. It calls for a more structured and collective European approach to economic deterrence, leveraging regulatory power, innovation, and strategic interdependence to safeguard sovereignty in an increasingly weaponised global economy.

Background: With the continuous advancement of science and technology, the demand for health knowledge about pediatric orthopedics is also gradually growing. The traditional paper-based and multimedia health education models can no longer fully meet the needs of society. Fortunately, the emergence of social media has mitigated the problem of insufficient medical education resources. However, there is currently relatively little published evidence on the use of social media in pediatric orthopedics. Objective: This study aimed to examine the current applications of social media in pediatric orthopedics and to evaluate the quality and readability of related online health information. Its purpose is to provide relevant evidence to promote the understanding and development of the field. Methods: This review followed the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute reviewer manual. First, a literature search was performed in the PubMed, Embase, CINAHL, Web of Science, and Cochrane databases. The search time range was from the establishment of the databases to September 21, 2023. We endeavored to include research articles related to social media and involving pediatric orthopedics in the review. The literature was reviewed at the title, abstract, and full-text levels. Results: We included 35 of 3400 (1.03%) studies retrieved. Most of the articles used social media to help with medical staff and patient education and training (23/35, 66%) and to disseminate information (21/35, 60%), followed by helping medical staff collect data (8/35, 23%). Medical institutions and staff also used social media to increase attention (6/35, 17%), enhance social support (5/35, 14%), facilitate the recruitment of research participants (3/35, 9%), support professional development (3/35, 9%) and implement health intervention (2/35, 6%). Five general quality of information (QOI) tools, 7 specific QOI tools, and 6 readability tools were used in 12 studies analyzed for quality and readability, with overall quality being fair and readability exceeding the recommended level. According to the research data, people are increasingly interested in pediatric orthopedics on social media platforms and eager to obtain and learn relevant knowledge. Conclusions: This scoping review found that social media has a growing body of literature on pediatric orthopedic conditions and is playing an increasingly important role in knowledge dissemination and education. A variety of tools are being used for assessing the QOI, but little attention has been paid to the readability of the information. The QOI was largely fair, with readability above the recommended level. Future research should further explore the role of social media in pediatric orthopedics and continue to optimize QOI and information readability.

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.

Background: Post-traumatic stress disorder (PTSD) affects mental health in the long term and is often associated with past psychological trauma. This systematic review was conducted with a purpose to investigate the correlation between adverse childhood experiences (ACE), experiences of child maltreatment, and the occurrence of PTSD in adults over 18 years to optimize treatment guidelines accordingly. Method: The review utilized articles searched on PubMed, Google Scholar, Scopus, and Cochrane. Inclusion criteria include original studies (RCTs, cross-sectional, and cohorts) involving adults over 18 years with PTSD with a history of ACE published during the last decade (2014 and 2025). This study was conducted according to preferred reported items in systematic reviews and meta-analysis (PRISMA) guidelines. A quality assessment of the included studies was conducted using Newcastle Ottawa scale for cohort studies and the axis scale for cross-sectional studies. Results: Out of 356 articles, 169 were screened, of which 26 studies were included in this review. These studies discussed various forms of childhood maltreatment, including sexual abuse, physical abuse, traumatic events, and neglect from parents. Most of these studies indicate a direct correlation between childhood maltreatment and Adulthood PTSD. Conclusion: A robust association exists between ACE and childhood maltreatment and the development of PTSD in adulthood. There is a need for more literature to study the effects of maltreatment and comorbid mental health conditions for policymaking to protect child mental health.

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.

Background There is a growing body of evidence from discrete choice experiments related to telehealth. Discrete choice experiments offer valuable insights in informing the design and evaluation of telehealth services and supporting the telehealth implementation and policy. Objective This review aims to examine studies assessing consumer preferences for telehealth using discrete choice experiments. Methods A systematic review was conducted, searching five health and multidisciplinary databases from inception until 4 April 2024. Grey literature searches, hand-searching, and reference list checks were also performed. Results Of 2,832 studies screened, 52 met the inclusion criteria. Most studies were conducted from the patient perspective (n=47/52, 90%) and covered a wide range of populations and settings. Of the included studies eligible for quality assessment, 68% (n=23/34) received high-quality ratings, while others were assessed as moderate. Studies comparing face-to-face consultations with telehealth generally found a preference for face-to-face appointments. Telehealth is viewed more favourably if it can be offered at a lower cost, reduces wait times, and is part of a comprehensive care plan. Telehealth tends to be preferred by younger patients and clinicians, those digitally literate, and those with less severe or more private and stigmatised health conditions. Conclusion While face-to-face consultations are generally preferred, telehealth is viewed as advantageous if it reduces costs, shortens wait times, and is integrated into comprehensive care. The findings highlight the importance of considering these attributes when designing telehealth preference studies and informing the adoption and design of telehealth services.

Background: Guidelines recommend that adults with peripheral artery disease (PAD) take antiplatelets, statins, and antihypertensives. However, it is unclear how frequently clinicians do not prescribe these medications (ie, underprescription), how often patients fail to fill/refill their prescriptions (ie, nonadherence), which factors increase underprescription/nonadherence risk, and whether underprescription/nonadherence are associated with outcomes. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (January 1, 2006-to-February 18th, 2025) for studies reporting cumulative incidences/point prevalences of clinician underprescription and/or patient nonadherence to antiplatelets, statins, and/or antihypertensives; adjusted-risk factors for underprescription/nonadherence; and adjusted-outcomes associated with underprescription/nonadherence among adults with PAD. Two investigators independently screened citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Estimate certainty was communicated using GRADE. The study was registered on PROSPERO (CRD42022362801). Findings: Among 4206 citations identified, 125 studies (n = 14,681,801 participants; 37% female) were included. The pooled cumulative incidence of antiplatelet, statin, and antihypertensive (among those with PAD and hypertension) underprescription was 28% (95% confidence interval [CI] = 21-36%; moderate-certainty), 34% (95% CI = 31-38%; high-certainty), and 43% (95% CI = 33-53%; moderate-certainty), respectively. The cumulative incidence of antiplatelet, statin, and antihypertensive nonadherence was 27% (95% CI = 20-35%; moderate-certainty), 28% (95% CI = 24-33%; high-certainty), and 23% (95% CI = 22-24%; low-certainty), respectively. Underprescription was more common in population-based studies and those enrolling more females and past/current smokers while nonadherence was more common in studies enrolling more patients with diabetes. Underprescription risk factors included female sex, advanced age, malignancy history, and chronic limb-threatening ischemia (all moderate-certainty). Nonadherence risk factors included advanced age, comorbidity burden, and receiving specialist mental health care (all moderate-certainty). Underprescription was associated with increased major adverse cardiac events, all-cause mortality, and decreased amputation-free time (all moderate-certainty). Interpretation: One-quarter-to-one-half of adults with PAD are not prescribed antiplatelets, statins, and antihypertensives. Further, approximately one-quarter of these patients do not adhere to these medications after prescription. Funding: This research was supported by a 2024 Vanier Canada Graduate Scholarship (awarded to AMK and supervised by DJR), a Graham Farquharson Physician Services Incorporated Knowledge Translation Fellowship (awarded to DJR), and a Research Program Award, University of OttawaDepartment of Surgery Annual Competition (awarded to DJR).

Background: Children with complex communication needs (CCN), particularly those with autism spectrum disorder (ASD), experience significant communication challenges. This scoping review analyses the existing literature on clinical interventions designed to enhance communication in these children. The aim was to describe which intervention models are being evaluated in studies, which treatments have shown positive effects and what the clinical profile of children and adolescents who benefit from these interventions is. Method: The scoping review was conducted following the methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Results: The search strategy identified 797 records; eight records met all eligibility criteria and were included for review. The review found that multimodal interventions combining augmentative and alternative communication (AAC), naturalistic strategies and parent training were the most effective in improving both expressive and receptive communication. Conclusions: Despite the limited existing research, studies suggest that multimodal interventions can effectively enhance communication in children with CCN. This review highlights significant gaps in the literature, including the scarcity of studies with appropriate methodological rigour and the lack of standardised protocols for CCN interventions. There is a critical need for evidence-based guidelines, professional training and policy development to ensure equitable access to effective interventions.

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.

Background: Artificial intelligence (AI) is increasingly integrated into health care, including psychiatry and psychology. In educational contexts, AI offers new possibilities for enhancing clinical reasoning, personalizing content delivery, and supporting professional development. Despite this emerging interest, a comprehensive understanding of how AI is currently used in mental health education, and the challenges associated with its adoption, remains limited. Objective: This scoping review aimed to identify and characterize current applications of AI in the teaching and learning of psychiatry and psychology. It also sought to document reported facilitators of and barriers to the integration of AI within educational contexts. Methods: A systematic search was conducted across 6 electronic databases (MEDLINE, PubMed, Embase, PsycINFO, EBM Reviews, and Google Scholar) from inception to October 2024. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies were included if they focused on psychiatry or psychology, described the use of an AI tool, and discussed at least 1 facilitator of or barrier to its use in education. Data were extracted on study characteristics, population, AI application, educational outcomes, facilitators, and barriers. Study quality was appraised using several design-appropriate tools. Results: From 6219 records, 10 (0.2%) studies met the inclusion criteria. Eight categories of AI applications were identified: clinical decision support, educational content creation, therapeutic tools and mental health monitoring, administrative and research assistance, natural language processing (NLP), program/policy development, students' study aid, and professional development. Key facilitators included the availability of AI tools, positive learner attitudes, digital infrastructure, and time-saving features. Barriers included limited AI training, ethical concerns, lack of digital literacy, algorithmic opacity, and insufficient curricular integration. The overall methodological quality of included studies was moderate to high. Conclusions: AI is being used across a range of educational functions in psychiatry and psychology, from clinical training to assessment and administrative support. Although the potential for enhancing learning outcomes is clear, its successful integration requires addressing ethical, technical, and pedagogical barriers. Future efforts should focus on AI literacy, faculty development, and institutional policies to guide responsible and effective use. This review underscores the importance of interdisciplinary collaboration to ensure the safe, equitable, and meaningful adoption of AI in mental health education.

This systematic review examined trends in the prevalence of type 2 diabetes mellitus (T2DM) and identified its risk factors among adults in Vietnam. PubMed, Web of Science, Wiley Online Library, and Scopus databases were searched to identify relevant literature. The search yielded 10 studies, including 2 national surveys and 8 regional investigations. National prevalence estimates of T2DM were 2.7% in 2002 and 5.4% in 2012. The estimates for the northern region were 1.4% in 1994 and 3.7% in 2012 and those for the southern region were 3.8% in 2004, 7.0% in 2008, and 12.4% in 2010. The major determinants of T2DM included older age, urban residence, high levels of body and abdominal fat, physical inactivity, sedentary lifestyle, genetic factors, and hypertension. The prevalence rate by gender was variable in both national and regional studies. There was insufficient information available on some potentially important risk factors such as smoking, dietary intake, income, and educational level. Our review signifies a rapidly growing prevalence of T2DM in Vietnam and suggests that extra effort is required to prevent and control this disease

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.

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.