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The 29th Asia-Pacific Regional Space Agency Forum (APRSAF) meeting reconfirmed the forum’s vital role in regional space initiatives that can further help global coordination in space activities. This report presents such perspective from an intra-region participant’s point of view. It highlights key discussions from the 2023 plenary session, emphasizing the Space Policy and Law Working Group’s contributions. The importance of the APRSAF’s National Space Legislation Initiative (NSLI) in harmonizing space laws and the involvement of young scholars in policy shaping are underscored. The report obeserves the opportunities and challenges in regional space cooperation in the Asia-Pacific region.

Context The emergence of pan-resistant bacteria requires the development of new antibiotics and antibiotic potentiators.Objective This review identifies antibacterial phenolic compounds that have been identified in Asian and Pacific Angiosperms from 1945 to 2023 and analyzes their strengths and spectra of activity, distributions, molecular masses, solubilities, modes of action, structures-activities, as well as their synergistic effects with antibiotics, toxicities, and clinical potential.Methods All data in this review was compiled from Google Scholar, PubMed, Science Direct, Web of Science, and library search; other sources were excluded. We used the following combination of keywords: ‘Phenolic compound’, ‘Plants’, and ‘Antibacterial’. This produced 736 results. Each result was examined and articles that did not contain information relevant to the topic or coming from non-peer-reviewed journals were excluded. Each of the remaining 467 selected articles was read critically for the information that it contained.Results Out of ∼350 antibacterial phenolic compounds identified, 44 were very strongly active, mainly targeting the cytoplasmic membrane of Gram-positive bacteria, and with a molecular mass between 200 and 400 g/mol. 2-Methoxy-7-methyljuglone, [6]-gingerol, anacardic acid, baicalin, vitexin, and malabaricone A and B have the potential to be developed as antibacterial leads.Conclusions Angiosperms from Asia and the Pacific provide a rich source of natural products with the potential to be developed as leads for treating bacterial infections.

Theoretical research indicates that foreign interference, and even allegations thereof, cause long-term negative effects: they erode trust, damaging the bilateral relationship, and lead to a greater polarization of the political system and society due to the securitization of the relationship with the presumed interferer. The article examines the case of how the Australian government and society have reacted to the perceived attempts of interference by the People’s Republic of China (PRC). It tests theoretical hypotheses by answering the question of what are the implications of the above-mentioned issue for Australia - China relations and Australia’s politics. The study has identified that the rhetoric about foreign interference by the PRC into Australia’s internal affairs has been publicly attributed to a complex of attempts at unwanted influence not only in politics but also in other domains such as society, economics, education and mass media. This issue served as a critical juncture in initiating a downward trend in bilateral relations by significantly eroding Australia’s trust in China and public opinion about it as well as by prompting the Australian government to reassess its policy vis-à-vis the PRC against the background of challenging geopolitical landscape of the Asia-Pacific. The securitization of cross-border links with China has become a notable phenomenon. As a result of these events as well as other foreign policy factors, Australia - China relations deteriorated significantly. The Australian government promptly took a hard stance against the perceived foreign interference, becoming the first to adopt a special legislation to combat it. This issue was instrumentalized in political competition, especially by the Liberal Party of Australia. However, there has been no polarization of the Australian political system and society. The result has been a broad public and bipartisan consensus on the need for a greater transparency and public scrutiny over the links with China, as well as the establishment of an effective system to counter foreign interference. The Australian case demonstrates that the instrumentalization of the interference issue may lead not to a polarization but, on the contrary, to a domestic consensus over standing up to a perceived threat.

Abstract Background The Asia-Pacific (APAC) region includes a significant proportion of the global population currently living with overweight and obesity. This modelling analysis was conducted to quantify the incidence of obesity-related comorbidities and change in obesity-related costs over 10 years with a hypothetical 10% weight loss in Australia, South Korea, Thailand, and India. Methods An epidemiological-economic model was used to describe current prevalence and direct medical costs of ten obesity-related comorbidities, including type 2 diabetes and hypertension, in adults aged 20–69 years living with obesity, and estimate incidence and costs over 10 years. Incidence reduction and the associated savings by 2032 were then estimated for a 10% weight-loss scenario. Results The total estimated medical costs for the ten obesity-related comorbidities in 2022 were 2.9, 7.5, 10.2, and 23.3 billion USD in Australia, South Korea, Thailand, and India, respectively. Costs increase to 6.9, 18.4, 23.5, and 44.3 billion USD in 2032, if insufficient action is taken. A 10% weight reduction would result in estimated savings of 0.3, 1.2, 2.2, and 3.0 billion USD in Australia, South Korea, Thailand, and India, respectively, in 2032, with cumulative savings over the 10-year period of 1.8, 7.0, 13.0, and 17.4 billion USD. Incidence of comorbidities were estimated to rise less in the weight-loss scenario. Conclusions The financial, societal, and health benefits of a substantial but achievable 10% weight loss in adults living with obesity, and the consequences of insufficient action, are pronounced in the APAC region. To achieve sustained weight loss in the real world, policy actions for addressing barriers to obesity management are required.

Purpose – The aim of this study was to investigate the role of immersive gaming on brand coolness and brand equity, with particular emphasis on fashion gaming collaborations. We used game theory as a theoretical framework to analyse immersive branding strategies and gain a deeper understanding of fashion consumers’ decision-making process in gaming environments. Gender, as a significant factor affecting gamers, has been studied as a moderator that impacts the overall proposed framework. Design/methodology/approach – A quantitative method was used to assess the significance of relationships within the proposed model empirically. The partial least squares structural equation modelling technique was implemented to assess the relationships of the framework with a sample size of 160 active Malaysian gamers. Findings – The findings indicate that brand equity is positively associated with perceived brand coolness. Furthermore, of the three core values of online games, perceived enjoyment is most strongly associated with perceived brand coolness, ahead of the values of self-expression and perceived emotional challenge. The results of the multigroup analysis further suggest that in the fashion industry, building brand equity through online games is strongly related to perceived brand coolness among female respondents, the role of perceived brand coolness being weaker among male respondents. Originality/value – The study contributes to the existing literature by providing a deeper understanding of the impact of immersive gaming branding practices on the overall equity of the fashion brand. The results provide insight for fashion brand managers into the significant effect on consumer behaviour outcomes of fashion-gaming collaborations. 研究目的 – 本研究擬探討身歷其境的遊戲體驗在品牌酷感和品牌資產上所扮演的角色; 研究特別強調裝扮遊戲的合作。研究人員以博弈論作為研究的理論框架,來分析沉浸品牌策略、和對時裝消費者在遊戲的環境中如何作出決策取得更深入的瞭解。研究人員探討了性別作為影響遊戲參與者的重要因素,這因素被視為為整個被提出的框架帶來調節的影響和作用。 研究設計/方法/理念 – 研究人員採用定量方法進行研究,目的為於被提出的模型內之各種關聯的意義進行以經驗為依據的評估。研究人員採用了基於偏最小平方法的結構方程模型研究法,來對一個包含160名活躍的馬來西亞遊戲參與者的樣本進行框架的各個聯繫的評估研究。 研究結果 – 研究結果顯示,品牌資產與品牌酷感成正相關; 而且,在網絡遊戲的三個核心價值中,感知享受與品牌酷感之間的聯繫最為強烈和密切,超過自我表現和感知情感挑戰兩者的價值; 多群組的分析結果更暗示了在時裝產業裡,透過網絡遊戲去建立品牌資產在女性回應者中是與品牌酷感有強烈密切的關係; 而在男性回應者中,品牌酷感所扮演的角色則較弱。 研究的原創性/價值 – 本研究使我們能更深入認識沉浸遊戲品牌的慣常做法如何影響時裝品牌的整體資產。研究結果為時裝品牌經理提供了啟示,使他們明瞭時裝遊戲的合作會給消費者行為產生重要的影響。

The emergence of Covid-19 in late 2019 rapidly shattered the Asia-Pacific region (APR), a bastion of economic dynamism, and it became the epicenter of the global health crisis. This unprecedented pandemic not only triggered a public health catastrophe but also unleashed a financial storm, exposing vulnerability within the region's interconnected economies. This study identifies the factors driving volatility spillovers within Asian-Pacific financial markets during the initial wave of the Covid-19 pandemic (January 2020–February 2021). We analyze the interplay of pandemic transmission dynamics, government interventions, central bank policies, and socioeconomic variables. Our findings reveal a robust and persistent association between the rising number of Covid-19 cases per million and volatility spillovers. We introduce three novel determinants—the number of intensive care unit beds, population density, and the proportion of the elderly population—which significantly impact volatility transmission in response to new cases. Stringent government measures, such as travel bans and lockdowns, mitigate volatility spillovers. Conversely, central bank policies increase volatility spillovers. These insights contribute to a deeper understanding of financial market dynamics in the context of global health emergencies. This knowledge equips policy makers in the APR with valuable tools for navigating future crises.

Summary: Background: There are few studies comparing health status trends among middle-aged and older adults in countries currently experiencing a rapid demographic and economic transition in the Asia-Pacific, relative to their high-income regional counterparts. This study investigates trends in functional limitations among individuals aged 45 years and above in six major Asia-Pacific countries, ranging from middle- to high-income, from 2001 to 2019 and examines disparities across socioeconomic and demographic sub-groups. Methods: Data on 778,507 individuals from seven surveys in three high-income countries (Australia, Japan, South Korea) and three middle-income countries (China, Indonesia, and India) were used. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility measures served as indicators of functional limitations. Age-standardized prevalence was used to assess prevalence trends in functional limitations and their distribution across sex and age. Multivariate linear probability models were used to examine whether the patterns still hold when controlling for birth cohorts and socioeconomic and demographic factors. Findings: People aged 45 years and above in Australia, Japan, and South Korea experienced declines in functional limitations, whereas increases were observed in India and Indonesia. The findings for China were unclear and varied depending on the indicator. Changes in prevalence of functional limitations over time were more pronounced among people aged over 60 years. Higher prevalence of functional limitations was observed for respondents with lower education and among those are not currently married across countries. Interpretation: Study findings highlight the potential for cross-national learning to address functional limitations among older populations in low- and middle-income countries. Funding: Not applicable.

Conservation is necessary to achieve sustainable development, and building capacity of youth and having them participate in conservation is an urgent imperative. The SATO-YAMA-UMI Project was a conservation project operated in six countries in the Asia-Pacific region. The project conducted an internship program for Japanese youth in fiscal year 2018–2019, whose impacts were assessed by members of implementing organizations and former interns in 2024 through online questionnaire and a focus group discussion. The assessment sought answers to: What are the benefits of on-site internship, as opposed to classroom learning? What effects have the on-site internship had in the career of the participants? What program elements would facilitate youth participation in conservation? We found that the field internship provides participants with opportunities to see the environmental issues in their totality without screening, and to gain perspectives that will be difficult to obtain once in the corporate system. Results supported the theory of change that direct experiences lead to enhanced engagement in conservation, such that the participants would play stronger roles as agents of change in the society. Non-governmental organizations organizing and presenting field internship program can significantly lower the barriers that impede many youth members to take the critical step, and they can play a significant role in inter-sectoral collaboration in human resource development. We discuss the role of conservation organizations in mobilizing youth as agents of change for sustainable futures, both through their own activities and in collaborations with private sector and academia.

ABSTRACTHerpes zoster (HZ) is a painful rash which typically affects older adults. This is of concern in Asia-Pacific given its aging population. As HZ epidemiology and burden are evolving, this systematic literature review aimed to update the current understanding of HZ burden and associated costs for selected Asia-Pacific locales. MEDLINE and Embase were searched for English articles of HZ studies conducted in Australia, China, Hong Kong, Japan, Korea, New Zealand, Singapore, and Taiwan. Eligible outcomes included HZ incidence and prevalence, occurrence of HZ-related complications, healthcare resource utilization, costs, and HZ-associated quality of life outcomes. This paper focused on HZ data in the general adult population (N = 90 articles). Substantial HZ-related disease and economic burden were observed in these locales, consistent with global trends. These findings reinforce the increasing burden of HZ and need for preventive strategies, which may include raising awareness and encouraging timely vaccination.

ABSTRACTIn Singapore, population aging and rising life expectancy are increasing herpes zoster (HZ) burden, which may be reduced by vaccination. The present study modeled the public health impact of HZ vaccination in Singapore using ZOster ecoNomic Analysis (ZONA) model adapted with Singapore-specific key model inputs, where available. Base case analysis was conducted in adults ≥ 50 years of age (YOA), exploring three vaccination strategies (no vaccination, recombinant zoster vaccine [RZV], zoster vaccine live [ZVL]) under mass vaccination setting (30% coverage). Scenario and sensitivity analyses were performed. Out of 1.51 million adults in 2021 (base case population), 406,513 (27.0%) cases of HZ, 68,264 (4.5%) cases of post-herpetic neuralgia (PHN), and 54,949 (3.6%) cases of other complications were projected without vaccination. RZV was estimated to avoid 73,129 cases of HZ, 11,094 cases of PHN, and 9,205 cases of other complications over the subjects’ remaining lifetime; ZVL would avoid 17,565 cases of HZ, 2,781 cases of PHN, and 1,834 cases of other complications. The number needed to vaccinate to prevent one case of HZ/PHN was lower for RZV (7/41) than ZVL (26/163). Among all five age-stratified cohorts (50–59/60–64/65–69/70–79/≥80 YOA), RZV (versus no vaccination/ZVL) avoided the largest number of cases in the youngest cohort, 50–59 YOA. Results were robust under scenario and sensitivity analyses. Mass vaccination with RZV is expected to greatly reduce the public health burden of HZ among Singapore individuals ≥ 50 YOA. Findings support value assessment and decision-making regarding public health vaccination strategies for HZ prevention in Singapore.

Abstract Primary liver cancer is the third leading cause of cancer-related mortality. The increasing prevalence of metabolic syndrome and alcohol consumption, along with the existing burden of viral hepatitis, could significantly heighten the impact of primary liver cancer. However, the specific effects of these factors in the Asia–Pacific region, which comprises more than half of the global population, remain largely unexplored. This study aims to analyze the epidemiology of primary liver cancer in the Asia–Pacific region. We evaluated regional and national data from the Global Burden of Disease study spanning 2010 to 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years associated with primary liver cancer in the Asia–Pacific region. During the study period, there were an estimated 364,700 new cases of primary liver cancer and 324,100 deaths, accounting for 68 and 67% of the global totals, respectively. Upward trends were observed in the age-standardized incidence rates of primary liver cancer due to metabolic dysfunction-associated fatty liver disease (MASLD) and alcohol-associated liver disease (ALD) in the Asia–Pacific region, as well as an increase in primary liver cancer from Hepatitis B virus infection in the Western Pacific region. Notably, approximately 17% of new cases occurred in individuals aged 15–49 years. Despite an overall decline in the burden of primary liver cancer in the Asia–Pacific region over the past decade, increases in incidence were noted for several etiologies, including MASLD and ALD. However, viral hepatitis remains the leading cause, responsible for over 60% of the total burden. These findings underscore the urgent need for comprehensive strategies to address the rising burden of primary liver cancer in the Asia–Pacific region.

Introduction: Atezolizumab plus bevacizumab is a commonly used first-line regimen for advanced hepatocellular carcinoma (HCC) treatment owing to its superior outcomes compared to sorafenib. However, optimal subsequent treatment options for patients with HCC who progressed on first-line atezolizumab plus bevacizumab remain unclear. Methods: This multinational, multi-institutional, retrospective study included patients with HCC from 22 centers in five Asia-Pacific countries who were treated with first-line atezolizumab plus bevacizumab, which was discontinued for any reason. The endpoints included progression-free survival (PFS) and overall survival (OS) according to patient characteristics and second-line regimens. Results: Between June 2016 and May 2023, 1,141 patients were treated with first-line atezolizumab plus bevacizumab, of whom 629 (55.1%) received subsequent treatment. Sorafenib and lenvatinib were the most commonly administered second-line regimens (53.9% and 25.6%, respectively). Overall, the median PFS and OS were 2.9 and 8.0 months, respectively. Lenvatinib had longer PFS (4.0 vs. 2.3 months) and OS (8.0 vs. 6.3 months) than sorafenib. Patients treated with tyrosine kinase inhibitor (TKI) plus immune checkpoint inhibitor (ICI) (n = 50, 8.3%) showed PFS and OS of 5.4 and 12.6 months, respectively. Lower tumor burden and lenvatinib or TKI plus ICI use were associated with longer second-line PFS. Preserved liver function was associated with improved OS. Conclusions: In patients with HCC who progressed on first-line atezolizumab plus bevacizumab, sorafenib and lenvatinib were the most commonly used second-line regimens in Asia-Pacific countries, with lenvatinib resulting in longer OS than sorafenib. The second-line TKI plus ICI combination exhibited promising efficacy, suggesting the potential role of continuing ICIs beyond disease progression.

IntroductionBrucellosis is a zoonotic disease of mammals caused by bacterial species of the Brucella genus. The reservoir for disease is typically mammals, with species of Brucella found infecting amphibians, bats, and marine mammals. Brucella spp. can pass directly to humans through contact with infected animals or their products. Brucella spp. can cause chronic debilitating infections in mammals, including humans, and is associated with spontaneous abortions in infected animals, causing reduced fecundity. In Hawai‘i, terrestrial species that could harbor Brucella spp. include swine, cattle, horses, and axis deer among others. The numerous feral swine in Hawai‘i are known to carry Brucella suis, with evidence supporting infections in cattle. Brucella suis also poses infection risk to humans, dogs, and potentially horses across the state.MethodsIn this study, 3,274 feral swine serum samples collected from 5 of the 8 main islands over a 15-year span were analyzed for exposure to B. suis. Of the 558 watersheds in the state, 77 were sampled as part of this effort. Spatial analysis was used to identify watersheds of concern. MLVA and whole genome SNP analysis was used for molecular epidemiological analysis.ResultsStatewide seropositivity rates were triple that of feral swine found in the conterminous United States. Smoothed positivity rates were highest on Maui, followed by O‘ahu, and the island of Hawai‘i. Island-by-island analysis found high brucellosis positivity levels associated with specific watersheds and agricultural areas. Local spatial autocorrelation identified hot spots on O‘ahu and Hawai‘i. MLVA analysis of available B. suis from Hawai‘i found molecular epidemiological connections with B. suis found in French Polynesia and the mainland US while differing from those in Tonga, Western Polynesia. Strains from Hawai‘i are phylogenetically closest to strains from the United States. MLVA and SNP analysis found B. suis strains from Hawai‘i fell into the genetic group that contains biovar 1 B. suis.DiscussionThis work identified islands and watersheds of high brucellosis seropositivity in feral swine of Hawai‘i, highlighting the magnitude of the zoonotic risk. Introduction of strains in recent history is unlikely due to modern animal trade and disease control practices. Genomic analysis of strains in Hawai‘i and the Pacific area can provide hidden historical and local clues to brucellosis epidemiology in the state.

The Regional Comprehensive Economic Partnership, better known as the RCEP, is a free trade agreement signed by 15 countries from the Asia-Pacific region in November 2020. It took effect in January 2022. After presenting an overview of the agreement, this paper looks at the negotiations and the current state of the RCEP. It then focuses on its basic content, particularly from a legal standpoint, as it analyses the institutional framework, the decision rule, its legal sources and the dispute settlement system, without omitting to look at the agreement from an economic perspective.

Migration at international level is a global phenomenon. In recent years the world experienced the highest number of people who migrated abroad. For example, in 2020 approximately 3.6% of global population were international migrants. This was the highest proportion of the global population registered in the last thirty years. The paper analyses some general aspects of international migration. There are detailed migration patterns in various regions such as America, Europe, the Asia-Pacific region, and Africa. Based on the data provided can be drawn some policy implications. Countries of destination should apply policies in order to facilitate the integration of migrants and should provide labour market regulations.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition. The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and antiresorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to antiresorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for individuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions: This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

The experience of development banks has led to the conclusion that they directly affect economic growth: projects implementation ensures production of goods and services, creates new workplaces. The growth of gross domestic product is not always inclusive and does not guarantee equal accessibility of all segments of the population to economic opportunities, education, health care, etc. on a constant basis. The Asian Development Bank (hereinafter referred to as the Bank) purposefully influences inclusive economic growth (hereinafter referred to as IEG) in the countries of the Asia-Pacific (hereinafter referred to as APAC) with the help of its own IEG model and allows assessing public administration, economic growth, social support, using 35 indicators, which contributes to reduction of poverty and inequality. For each country the Bank develops its own strategy of cooperation. The authors conducted a hier-archical clustering of the APAC countries based on the values of 24 IEG indicators of the Bank (for two datasets). The APAC countries in each cluster are characterised by approximately the same general level of IEG. The clustering model provides an opportunity to plan projects and assess their influence on IEG, excludes disadvantages of the so-called composite indices that could describe the IEG of a country or region with one value, compensates potential inaccuracies of the basic data.

The geopolitics of Asia-Pacific are witnessing a transition. The regional powers calculate their bets as China rises as a key player and challenges the traditional dominance of the United States. The region hosts various flashpoints – in the wake of rising tensions, the US and China may redefine the power equilibrium, resulting in increased militarization and altering the region’s security environment. The evolving geopolitical dynamics thus characterize a power rivalry between these two powers. In pursuit of influence and supremacy, the US generates far-reaching consequences for regional stability. The involvement of the US in the region and the interests of regional stakeholders are closely connected with the US-China competition. This research paper analyzes this environment in a comprehensive manner, taking into account the multifaceted drivers shaping regional security dynamics. In addition, it highlights the complex network of alliances and military modernization efforts that are exacerbating the strategic equilibrium within the region. It also explores the complex maritime disputes in the South and East China Seas, highlighting the direct territorial and strategic stakes for both the US and China.

This paper draws on a comparative study of seven jurisdictions in the Asia-Pacific region to examine current challenges to progressing inclusive education for students with special educational needs (SEN) in mainstream schools. The study used a qualitative approach to collect data from each jurisdiction through a purposive sampling of knowledgeable, university-associated informants. Content analysis was used to identify and quantify specific challenges reported in the data. Subsequently, these items were coded as themes to form a matrix of challenges within and across jurisdictions. Findings revealed that challenges were broadly consistent with recent global trends and shared many commonalities, despite occurring in diverse societal, political and education systems. These challenges are: lack of adequate initial teacher education and ongoing professional development for practicing teachers; lack of resources and support to meet the needs of students with SEN; inconsistent policy guidelines and implementation action plans; restricted stakeholder engagement and collaboration across all levels of education; and limited local inclusion research to inform practice in schools. The findings underscore the need for government and institutional commitment and oversight to bridge the policy-to-practice gap, and an urgent need for local research to identify and disseminate successful approaches for including students with SEN throughout the region.

The international landscape, particularly in Northeast Asia, is portrayed as volatile due to the presence of nuclear-armed states, territorial disputes, and escalating geopolitical tensions. Considering this reality, this paper delves into the political ramifications of potential nuclear use in the Northeast Asia. It scrutinizes conceivable power shifts, the evolving role of anti-nuclear groups, and the broader impact on security policies. The exploration extends to scenarios post-nuclear use, encompassing positive, negative, and complex outcomes. The paper concludes by offering recommendations to policymakers, underscoring the imperative of substantive dialogues on arms control and conflict resolution to avert catastrophic nuclear events. Overall, the paper provides a comprehensive analysis of the multifaceted challenges posed by nuclear weapons in Northeast Asia and offers valuable insights for crafting a more secure global environment. Recent developments point towards a disconcerting unraveling of arms control structures and a growing threat to the nonproliferation regime. The paper underscores the dynamic evolution of nuclear deterrence, highlighting the strategic use of emerging technologies by states to reshape the balance of vulnerabilities.

The East Asian region is a major global economic player, given its economic size and potential. As such, regional economic integration of East Asia could be considered as an important building bloc towards integration of the Asia Pacific region. East Asia has made significant progress in creating institutions for closer cooperation and integration. East Asian regional production networks are the most integrated in the world, and regional financial initiatives have taken off. Gripped by this wave of regionalism, the East Asian economies have expedited further liberalization process and have started unmarked trade liberalization strategies, enhanced economic cooperation, and negotiating on currency un-ion. Since 1997, East Asian regionalism seems to have progressed and an East Asian Community is just around the corner. This paper is a study which presents the realities that East Asian regionalism is still lap-sided: economic regionalism is highly developed, while other key components (regional financial integration, education collaboration, and a regional political framework) are developing at a slower rate, stagnating, and/or regressing. It aims to present the reality of East Asian regionalism, provoke awareness of false perspectives, and present a recommendation towards a balanced and more sustainable East Asian integration.

Nowadays, the Korean Peninsula is a long-term source of tension in the Asia-Pacific region. The international community is particularly concerned about the DPRK ’s nuclear missile program and Pyongyang’s tests, which a number of countries view as a serious threat to the regional security. Therefore, many international actors became involved in the situation around the Korean Peninsula. For several decades, certain countries have been making intensive efforts to solve this problem. Apart from China and Russia, Japan, the United States, and South Korea play a significant role in this process. The author analyzes the current situation on the Korean Peninsula, examines the degree of influence of the DPRK problem on the situation in the region and possible consequences for regional security. The article examines Japan’s policy towards North Korea, to counter which Tokyo is pursuing a course of strengthening the Japan–US alliance and increasing sanctions pressure. The North Korean factor is highlighted in the Japan –US–South Korea triangle. The author analyzes the role of trilateral defense cooperation, which has seen a significant expansion. The article describes various approaches to resolving the situation on the Korean Peninsula and identifies the most optimal scenario.

Background: Experiential learning activities help students prepare for their future careers by providing opportunities for hands‑on practice experiencing real‑world scenarios. Innovations in technology can facilitate experiential learning and cross‑cultural connections for large groups of students in multiple global settings through a virtual platform. However, designing these opportunities with diverse groups of students for a virtual environment can be challenging. Objective: The purpose of this paper is to highlight three examples of innovative virtual experiential learning initiatives that were developed and implemented by the Global Health Program of the Association of Pacific Rim Universities (APRU), a non‑profit network of 60+ leading research universities in the Asia‑Pacific. Findings: We have leveraged the expertise of our wide network to enhance student learning through the purposeful design of virtual educational experiences centered around pedagogical approaches that emphasize active learning, self‑reflection, and knowledge exchange with people from other cultures and disciplines. The annual global health joint virtual courses, the annual APRU Virtual Global Health Case Competition, and the APRU Mini Certificate foster meaningful engagement with other students and experts in the field, expanding the lens of students to foster an increased awareness and appreciation of the diversity of perspectives represented in an international network such as APRU. These allow students to practice real‑world application of knowledge gained in a traditional didactic classroom setting. Conclusions: The benefits of virtual experiential learning to students greatly outweigh the challenges in the design and implementation of such programs. While relatively short‑term, these virtual initiatives have had a demonstrable impact on student participants. Such programs can enhance student learning and provide cost‑effective ways to allow large international cohorts to experience global experiential learning.

Since the discovery of hepatitis C virus (HCV) in 1989, we now have curative treatment options with direct-acting antiviral therapies. By increasing the rate of treatment and reducing transmission, the eradication of HCV is potentially achievable. Nonetheless, the feasibility and implementation of this goal remains challenging. This article sums up the approach to managing children with HCV in the Asia–Pacific region and lists some of the difficulties and complexities surrounding this issue.

The article examines the political potential of Latin American countries in bolstering their influence within the Indo-Pacific region (IP). It delves into the Indo-Pacific concept, championed internationally by India and Japan, as an alternative viewpoint in contrast to the predominant orientation towards China as the regional leader in the Asia-Pacific region. Carlos Exudé's "Peripheral Realism" provides the theoretical framework for the study, although Latin American states strive to move beyond their peripheral status.The focus is on four Pacific coastal countries in Latin America: Colombia, Mexico, Peru, and Chile. It identifies key areas of cooperation between these nations and major players in the IP such as India, Japan, South Korea, and Australia. Chile and Peru have established a more robust transpacific partnership compared to their neighbors. However, Mexico possesses a significant advantage due to its unique geographical position intersecting the Atlantic and Pacific routes.Colombia, along with Mexico, Chile, and Peru, formed the Pacific Alliance, an integration association that emphasizes closer ties with Asian countries. Over its decade-long existence, this Alliance has significantly increased in both economic and political significance. The article highlights the pivotal role of this alliance in fostering Asian-Latin American trade and entrepreneurship.The study also delves into the prospects of integrating the two regions by extending the reach of Pacific economic megablocks (Regional Comprehensive Economic Partnership, Trans-Pacific Partnership) to Latin America. After the ratification of the TPP by Mexico, Peru, and Chile, an agreement that unites all four Pacific Ocean continents for the first time emerged. The advent of the RCEP, which includes powerful economies such as China, South Korea, and Japan, demonstrates a clear global shift from the Atlantic to the Pacific and from West to East. The inclusion of Latin American countries in these processes is poised to advance their regional and global interests on the international stage.

Breda Cushen,1,* Mariko Siyue Koh,2,* Trung N Tran,3 Neil Martin,3,4 Ruth Murray,5 Thendral Uthaman,6 Celine Yun Yi Goh,5,6 Rebecca Vella,7 Neva Eleangovan,5,6 Lakmini Bulathsinhala,5,6 Jorge F Maspero,8,9 Matthew J Peters,10 Florence Schleich,11 Paulo Pitrez,12 George Christoff,13 Mohsen Sadatsafavi,14 Carlos A Torres-Duque,15,16 Celeste Porsbjerg,17 Alan Altraja,18 Lauri Lehtimäki,19 Arnaud Bourdin,20 Christian Taube,21 Nikolaos G Papadopoulos,22,23 Csoma Zsuzsanna,24 Unnur Björnsdóttir,25 Sundeep Salvi,26 Enrico Heffler,27 Takashi Iwanaga,28 Mona al-Ahmad,29 Désirée Larenas-Linnemann,30 Job FM van Boven,31 Bernt Bøgvald Aarli,32,33 Piotr Kuna,34 Cláudia Chaves Loureiro,35,36 Riyad Al-lehebi,37 Jae Ha Lee,38 Nuria Marina,39 Leif Bjermer,40 Chau-Chyun Sheu,41,42 Bassam Mahboub,43 John Busby,44 Andrew Menzies-Gow,45 Eileen Wang,46 David B Price5,6,47 On behalf of ISAR Inventory Study Group1Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland; 2Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore; 3AstraZeneca, Gaithersburg, MD, USA; 4Department of Respiratory Medicine, University of Leicester, Leicester, UK; 5Optimum Patient Care Global, Cambridge, UK; 6Observational Pragmatic Research Institute, Singapore, Singapore; 7Optimum Patient Care, Brisbane, Queensland, Australia; 8Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; 9University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina; 10Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; 11CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium; 12Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil; 13Faculty of Public Health, Medical University, Sofia, Bulgaria; 14Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada; 15CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; 16Universidad de La Sabana, Chia, Colombia; 17Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark; 18Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia; 19Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; 20PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France; 21Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany; 22Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK; 23Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; 24Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary; 25Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland; 26Pulmocare Research and Education Foundation, Pune, India; 27Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 28Kindai University Hospital, Osakasayama, Japan; 29Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait; 30Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico; 31University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands; 32Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; 33Department of Clinical Science, University of Bergen, Bergen, Norway; 34Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland; 35Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; 36Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; 37Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia; 38Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea; 39Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain; 40Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden; 41Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 42Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 43Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates; 44Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK; 45Lung Division, Royal Brompton & Harefield Hospital, London, UK; 46Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA; 47Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK*These authors contributed equally to this workCorrespondence: David B Price, Observational and Pragmatic Research Institute (OPRI) Pte Ltd, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore, Tel +65 3105 1489, Email dprice@opri.sgAim: The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests.Methods: Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR’s Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised.Results: Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting > 90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases.Conclusion: Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.Keywords: Asia-Pacific, biologics, COVID-19, Europe, ISAR, International Severe Asthma Registry, oral corticosteroids, Registry, Middle East, Severe Asthma, Latin America, USA

Chia-Hung Tsai,1,* Yu-Chin Chen,2,* Po-Yu Chen,3 Chih-Cheng Lai,4,5 Hung-Jen Tang,1 Yin-Ching Chuang,6 Chi-Chung Chen,6,7 Chung-Han Ho,6,8 Wei-Yun Hsu,9,* Tu-Hsuan Chang9,* 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Pediatrics, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 3Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan; 4Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 5School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 6Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Food Science, National Chiayi University, Chiayi, Taiwan; 8Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 9Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Tu-Hsuan Chang; Wei-Yun Hsu, Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, Tel +886-2-281-2811 Ext 57109, Fax +886-6-220-3706, Email a755115@yahoo.com.tw; wyhsu17@gmail.comPurpose: To investigate the antibiotic susceptibility of Escherichia coli isolates in patients diagnosed with intra-abdominal infections (IAIs) in the Asia-Pacific region.Patients and Methods: This study was conducted at 50 medical hospitals across 9 countries/regions as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program from 2014 to 2018. Nonduplicate isolates of aerobic and facultative gram-negative bacilli were collected and processed for further antimicrobial susceptibility testing.Results: A total of 10,709 isolates were collected, with E. coli (n=4737, 44.2%) being the leading pathogen causing IAIs, followed by Klebsiella pneumoniae (n=2429, 22.7%) and Pseudomonas aeruginosa (n=931, 8.7%). Community-associated (CA) E. coli isolates generally exhibited higher susceptibility rates for most antibiotics than hospital-associated (HA) isolates. In countries/regions other than Hong Kong, South Korea, and Singapore, HA isolates displayed lower susceptibility rates for multiple classes (≥ 4) of antibiotics. Among the commonly used antibiotics in IAIs, the overall susceptibility rate for ciprofloxacin was low, with an average of 41.3%. Ceftriaxone susceptibility rates in all selected countries were below 80% starting in 2018, ranging from 23.3% to 75.8%. The cefepime susceptibility rates varied across regions, with consistently reduced susceptibility ranging from 45.5% to 57.8% in India, Thailand, and Vietnam. Piperacillin/tazobactam demonstrated effectiveness against E. coli isolates in almost all countries except India, with a downward trend observed in the Philippines and Taiwan. Carbapenems remained effective against more than 90% of E. coli isolates, except in India.Conclusion: Prudent use of fluoroquinolones and ceftriaxone is advised when treating both CA and HA IAIs in the Asia-Pacific region. The low susceptibility rate of cefepime in India, Thailand, and Vietnam needs careful consideration in its administration. Moreover, the increase in nonsusceptibility to piperacillin/tazobactam in the Philippines and Taiwan poses a potential risk that should be closely monitored.Keywords: intra-abdominal infection, E. coli, antibiotic susceptibility, Asia-Pacific

Abstract Surgical, obstetric, and anaesthesia care saves lives, prevents disability, promotes economic prosperity, and is a fundamental human right. Session two of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia–Pacific Region discussed financing strategies for surgical care. During this session, participants made a robust case for investing in surgical care given its cost-effectiveness, macroeconomic benefits, and contribution to health security and pandemic preparedness. Funding for surgical system strengthening could arise from both domestic and international sources. Numerous strategies are available for mobilising funding for surgical care, including conducive macroeconomic growth, reprioritisation of health within government budgets, sector-specific domestic revenue, international financing, improving the effectiveness and efficiency of health budgets, and innovative financing. A wide range of funders recognised the importance of investing in surgical care and shared their currently funded projects in surgical, obstetric, anaesthesia, and trauma care as well as their funding priorities. Advocacy efforts to mobilise funding for surgical care to align with the existing funder priorities, such as primary health care, maternal and child health, health security, and the COVID-19 pandemic. Although the COVID-19 pandemic has constricted the fiscal space for surgical care, it has also brought unprecedented attention to health. Short-term investment in critical care, medical oxygen, and infection prevention and control as a part of the COVID-19 response must be leveraged to generate sustained strengthening of surgical systems beyond the pandemic.

Abstract Surgical, obstetric, and anaesthesia care are required to treat one-third of the global disease burden. They have been recognised as an integral component of universal health coverage. However, five billion people lack access to safe and affordable surgical care when required. Countries in the Asia–Pacific region are currently developing strategies to strengthen their surgical care systems. The Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia–Pacific Region meeting is a three-part virtual meeting series that brought together Ministries of Health, intergovernmental organisers, funders, professional associations, academic institutions, and nongovernmental organisations in the Asia–Pacific region. The meeting series took place over three virtual sessions in February and March 2021. Each session featured framing talks, panel presentations, and open discussions. Participants shared lessons about the challenges and solutions in surgical system strengthening, discussed funding opportunities, and forged strategic partnerships. Participants discussed strategies to build ongoing political momentum and mobilise funding, the implications of the COVID-19 pandemic and climate change on surgical care, the need to build a broad-based, inclusive movement, and leveraging remote technologies for workforce development and service delivery. This virtual meeting series is only the beginning of an ongoing community for knowledge sharing and strategic collaboration towards surgical system strengthening in the Asia–Pacific region.

Abstract Emergency and essential surgery is a critical component of universal health coverage. Session three of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia–Pacific Region focused on strategic partnerships. During this session, a range of partner organisations, including intergovernmental organisations, professional associations, academic and research institutions, non-governmental organisations, and the private sector provided an update on their work in surgical system strengthening in the Asia–Pacific region. Partner organisations could provide technical and implementation support for National Surgical, Obstetric, and Anaesthesia Planning (NSOAP) in a number of areas, including workforce strengthening, capacity building, guideline development, monitoring and evaluation, and service delivery. Participants emphasised the importance of several forms of strategic collaboration: 1) collaboration across the spectrum of care between emergency, critical, and surgical care, which share many common underlying health system requirements; 2) interprofessional collaboration between surgery, obstetrics, anaesthesia, diagnostics, nursing, midwifery among other professions; 3) regional collaboration, particularly between Pacific Island Countries, and 4) South-South collaboration between low- and middle-income countries (LMICs) in mutual knowledge sharing. Partnerships between high-income countries (HIC) and LMIC organisations must include LMIC participants at a governance level for shared decision-making. Areas for joint action that emerged in the discussion included coordinated advocacy efforts to generate political view, developing common monitoring and evaluation frameworks, and utilising remote technology for workforce development and service delivery.

Abstract The World Health Assembly resolution 68.15 recognised emergency and essential surgery as a critical component of universal health coverage. The first session of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia–Pacific Region focused on the current status of surgical care and opportunities for improvement. During this session, Ministries of Health and World Health Organization (WHO) Regional Directors shared country- and regional-level progress in surgical system strengthening. The WHO Western Pacific Regional Office (WPRO) has developed an Action Framework for Safe and Affordable Surgery, whilst the WHO South-East Asia Regional Office (SEARO) highlighted their efforts in emergency obstetric care, workforce strengthening, and blood safety. Numerous countries have begun developing and implementing National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs). Participants agreed surgical system strengthening is an integral component of universal health coverage, pandemic preparedness, and overall health system resilience. Participants discussed common challenges, such as the COVID-19 pandemic, climate change, workforce capacity building, and improving access for hard-to-reach populations. They generated and shared common solutions, including strengthening surgical care capacity in first-level hospitals, anaesthesia task-shifting, remote training, and integrating surgical care with public health, preventive care, and emergency preparedness. Moving forward, participants committed to developing and implementing NSOAPs and agreed on the need to raise political awareness, build a broad-based movement, and form intersectoral collaborations.

The import demand for energy resources, including liquefied natural gas (LNG), has been steadily increasing in the Asia-Pacific region. Australia, the Middle East (Qatar), the Russian Federation, and the U.S. are the major players who compete strategically to capture this ever-growing market for LNG. The objective of this paper is to examine the potential for Canada’s entry into this market as another LNG exporter and what impact that can have on the existing suppliers. Using a game-theoretic LNG export competition model, we explore the conditions under which Canada can make a profitable entry. We also investigate the effect of Canada’s entry on the profitability of the four incumbent exporters. Employing a multi-leader Stackelberg model, we found that Canada’s entry could be a Pareto superior outcome under certain conditions because it benefits all competing firms and consumers. Further, Canada’s entry into the LNG export market always helps the low-cost incumbent firms by increasing their output and profit. However, the high-cost incumbent firms’ output falls, while their profit may increase or decrease depending on the unit cost and market size parameters. With differential export costs between Canada and the U.S., the latter has an incentive to act strategically to affect the entrance of the former.

IntroductionThe COVID-19 pandemic has had a significant impact on mental health globally. To understand the impact of the pandemic on mental health in Fiji, this study aimed to investigate the prevalence of anxiety disorder and depression among the young adults.MethodAn online survey was conducted to assess the prevalence of anxiety disorder and depression among the general population in Suva, Fiji during the COVID-19 pandemic. A total of 1,119 Fiji adults participated in the study. The study was conducted between May 20 to June 30, 2022, using a snowball sampling via social media platforms. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales were used to measure anxiety and depression, respectively. The COVID-19 related stressors was evaluated using the adapted SARS stressors assessment. Univariate and multivariate logistic regression analysis was performed to determine the factors influencing mental health among respondents.ResultsThe result shows that a significant portion of individuals experienced each of the stressors, with the highest prevalence seen for hearing information about the severity of COVID-19. The prevalence of anxiety and depression was found to be 45% and 49%, respectively. Being female, having pre-existing illness and COVID-19 stressors were a risk factor to develop anxiety and depression. On the other hand, employed individuals and having high BMI was a protective factor against developing depression during COVID-19 lockdown.ConclusionThese findings highlight the importance of addressing the mental health needs of the Fijian population during the COVID-19 pandemic and beyond.

This paper examines the impact of marine plastic pollution on small-scale fishers in Asia-Pacific countries and how the existing international law accommodates this problem. The research method used is doctrinal legal research with a statute approach and case approach using primary, secondary, and tertiary legal materials analysed with descriptive analytical techniques. The results show that Asia-Pacific is the most significant contributor to marine plastic pollution in the world as a region at the centre of the world's economic growth. The fisheries industry is one of the economic sectors that is the mainstay of countries in the Asia-Pacific, such as Indonesia, Australia, and China, because it contributes to a high Gross Domestic Product and becomes a job for small-scale fishers. However, marine plastic pollution is a problem because it contaminates fish, impacting fishermen's productivity. This has eliminated the rights of fishermen, especially the small-scale fisher, to obtain decent work and the right to an adequate standard of living. Meanwhile, the existing international law has yet to accommodate the plastic waste problem in the Asia-Pacific Ocean explicitly, so there is legal uncertainty that regulates this problem. This research concluded that the issue of marine plastic pollution in the Asia-Pacific must be handled seriously by formulating an agreement between countries in the region that contains more technical and specific arrangements to maintain the rights of small-scale fishers in obtaining decent work and adequate living standards.

One of the possible scenarios in Asia-Pacific is a bipolar order of two great powers, the United States and China. In this situation, alliance commitments will likely remain fixed rather than flexible. This scenario is also known as “a new kind of cold war” because both actors have many social and ideological differences that will often be emphasized in the competition for the geopolitical position. Three main questions are addressed in this study: 1) What are the roles the United States plays as the status quo in the Asia-Pacific?; 2) What approaches does China take to challenge the United States-centred security order?; 3) What are solutions for the United States and China to avoid the Lose-Lose Situation in the New Cold War?. This paper goes into view on the roles of states as either status quo or revisionist and introduces the happening of a New Cold War in the Asia-Pacific. China has made much progress in recent years, but the United States still has relatively significant advantages over a traditional power in economic size, technological capabilities, and military systems. The research will analyze whether the United States could strengthen the existing order by shifting from a strategy of engagement to a confrontation against China. However, the new Cold War, the “real” of new stability and stability derived from the bipolar order is still in significant doubt. Therefore, the United States and China should find solutions to avoid the “Lose-Lose” situation for all of them.

Background: Osteoporosis is common among elderly patients and can result in vertebral fractures requiring surgical treatment. This study assessed clinical outcomes associated with spinal surgery in patients with osteoporosis/osteopenia with an additional focus on Asian patients. Methods: A PRISMA-compliant systematic review and meta-analysis were conducted using the PubMed and ProQuest databases to identify articles published up to May 27, 2021, that included outcomes for patients with osteoporosis or osteopenia undergoing spinal surgery. Statistical analysis was conducted comparing rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF), implant loosening, and revision surgery. A qualitative summary of Asian studies was also conducted. Results: A total of 16 studies comprising 133,086 patients were included; among the 15 studies reporting rates of osteoporosis/osteopenia, 12.1% (16,127/132,302) of patients overall and 38.0% (106/279) of Asian patients (n=4 studies) had osteoporosis/osteopenia. The risks of PJK/PJF (relative risk [RR]=1.89; 95% confidence interval [CI]=1.22-2.92, p=0.004), screw loosening (RR=2.59; 95% CI=1.67-4.01, p

The article explores the ongoing evolution of India's relationship with Russia, using the concept of "uneven multipolarity" and its specific distribution of capabilities. It argues that India's perception of the balance of threats has shifted with respect to China, particularly in the Asia-Pacific and Indian Ocean regions, which are crucial to India's national security and future power projection ambitions. In the current context of uneven multipolarity, the capabilities of the US and China exceed those of weaker major powers, such as India, Russia, and Japan, without tipping the system into explicit bipolarity. This specific nature of current polarity and India's "China challenge" have led to shifting alignments in its foreign policy.When combined with changes in Russia's external relations, particularly the breakdown of its relations with the West and growing closeness with China, these factors have created particular constraints on New Delhi's partnership with Moscow. Multi-alignment for India represents a choice other than the formation of alliances as a balancing response, but it does introduce a hierarchy in its foreign relations. Under prevailing conditions, it emphasizes the importance of the relationship with the US while diminishing the significance of the relationship with Russia, even as the value of the bilateral partnership is retained in specific ways. These observations are instrumental in the assessment of the present and future trajectory of Indo-Russian ties presented in the article.

Abstract In light of the growing global environmental challenges, smart cities need to serve as testing workshops or labs to smartly tackle complex cross-sectional issues like jobs, seamless mobility, safety and security, sustained growth, while responding to the impending climate change too. This necessitates for developing a smart model or tool that integrates such varied but crucial climate concerns of a city into its direct decision-making and long-term planning. In this research, we conduct a literature review to have an overview of the state-of-the-affairs on urban climate planning in Asia-Pacific Cities covering China, Japan, India, Philippines, Singapore and Thailand. This is followed by an intensive theoretical understanding on the need of having a smart tool in urban climate action planning. This includes the study of recent urban climate metrics and tools, their different typologies based on key purpose, method, sectoral and geographical scope, and challenges and gaps in formulating smart urban climate tools. We then introduce the conceptual framework for integrated climate action planning (ICLAP) tool that transects spatial, statistical and bibliometric methods. We establish applicability of ICLAP in case of Indian cities by discerning climate vulnerabilities, GHG trends and relevant urban climate solutions. The paper eventually culminates with major scientific findings and policy recommendations, essentially underscoring more intensive and wider application of ICLAP like smart urban climate tools in local decision making and national urban policies duly supported by international scientific collaborations.

Purpose: In this study, we aimed to assess the geographic distribution and molecular characteristics of β-lactamases among Enterobacterales isolates causing intra-abdominal infections (IAIs) from 2015 to 2018 in the Asia–Pacific region. Method: Isolates were investigated for extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and carbapenemases using multiplex PCR assays and full-gene DNA sequencing. Result: A total of 832 Enterobacterales isolates from 8 different countries with β-lactamase genes were analysed. Plasmid-mediated ESBLs and AmpC β-lactamases were encoded in 598 (71.9 %) and 314 (37.7 %) isolates, respectively. In 710 (85.3 %) carbapenemase-negative isolates, positivity for both AmpC β-lactamases and ESBLs was identified in 51 (8.5 %) Escherichia coli and 24 (3.4 %) Klebsiella pneumoniae isolates. The most prevalent countries were Taiwan and Vietnam, and the co-occurrence of CMY/CTX-M in E. coli and DHA-1/ESBLs in K. pneumoniae was predominant. All isolates showed high susceptibility to colistin, but susceptibility to carbapenems varied among different resistance mechanism combinations. Among 122 (14.7 %) isolates encoding carbapenemase, NDM (n = 67, including 64.2 % NDM-1) was the most common, followed by the OXA-48-type (n = 49), KPC (n = 24) and IMP (n = 4). The most prevalent country was Thailand (n = 44), followed by Vietnam (n = 35) and the Philippines (n = 21). Twenty-two isolates were found to encode multiple carbapenemases, 16 of which were collected from Thailand and harbored NDM-1, OXA-232 and CTX-M-15. Despite high susceptibility to amikacin, susceptibility to colistin was only 56 %. Conclusion: The emergence of carbapenem-non-susceptible AmpC/ESBL co-occurring Enterobacterales and colistin non-susceptible carbapenemases co-occurring K. pneumoniae highlights potential therapeutic challenges in the Asia–Pacific region.

Russia began to refocus its attention on the Asia-Pacific region in 1994, but the policy of pivoting toward Asia was implemented dramatically in the second decade of the 21st century. Adjustments made by Russia to its foreign policy and practical activities carried out by Russia in the region have impacted Russia-Vietnam relations generally and their economic ties in particular. Based on a qualitative approach and analysis of secondary data collected from previously conducted research works, this paper focuses on the following issues: (1) Adjustments made by Russia to its foreign policy towards Asia-Pacific over the first two decades of the 21st century; (2) Position of Vietnam in Russia’s foreign policy towards Asia–Pacific; and (3) Impacts of Russia’s new foreign policy on the economic ties between Russia and Vietnam over the first two decades of the 21st century. Based on the results of the analysis and evaluation, Russia's Asia-Pacific policy has been adjusted, particularly in the second decade of the 21stcentury, when the country turned its attention to Southeast Asia. Due to the importance of this region, Russia is implementing a comprehensive Asia policy and promoting Russia's interests in this region. The Russian Federation considers Vietnam an important partner in its "Look to the East" policy and plays a leading role because Vietnam is a country with an important geostrategic position to connect both land and sea between Northeast Asia and Southeast Asia. This is reflected in the Russian Federation's upgrading of its strategic partnership with Vietnam from 2001 to a comprehensive strategic partnership in 2012. The adjustment of the Asia-Pacific policy of the Russian Federation has positively affected the relationship between Vietnam and Russia in the economic fields (trade and investment). Doi: 10.28991/ESJ-2022-06-06-017 Full Text: PDF

Despite clear evidence of the adverse health impacts of unsafe child feces disposal (CFD), there is little evidence of the effectiveness of interventions targeting the improvement of unsafe CFD practices in the Asia-Pacific region. A systematic review of the literature was conducted to identify and evaluate the quality of both behavior change and hardware interventions targeting the improvement of CFD practices in this region. A total of 695 articles were screened, and 15 studies were included. The combined hardware and behavior change interventions reported the highest rates of safe CFD (SCFD) post-intervention; however, these interventions were of lower quality. Four interventions focused specifically on improving SCFD practices, while the remaining seven studies evaluated the impacts of large-scale interventions, such as India's MANTRA and Total Sanitation Campaign programs, on unsafe CFD practices. Large-scale programs and hardware interventions are important for providing communities with the infrastructure necessary to improve unsafe CFD practices, but such interventions may be improved by the addition of a behavioral change component. With little evidence available on the effectiveness of behavioral interventions on reducing unsafe CFD in the Asia-Pacific region, future work should focus on how behavior change models combined with hardware interventions impact unsafe CFD. HIGHLIGHTS The Asia-Pacific region has high rates of unsafe child feces disposal (CFD).; There is little evidence on the effectiveness of sanitation interventions targeting the improvement of unsafe CFD practices.; Hardware interventions may be improved by the addition of a behavioral change component.; Future work should focus on how behavior change models combined with hardware interventions address unsafe CFD practices.;

Background: Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals. Methods: We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries. Results: Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy. Conclusion: While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.

Abstract The provision of equitable healthcare on remote islands is critical in the fight to attain the sustainable development goals (SDGs). Many island countries, particularly the Small Island Developing States (SIDS), are confronted with numerous obstacles to accessing quality healthcare. Many SIDS are located in the Asia‐Pacific region, and they suffer shared challenges such as a lack of infrastructure, logistical concerns, and a shortage of health staff. As a SIDS, the Maldives has made significant progress in the health sector, when compared to its neighbours. Part of this is due to spending a large portion of the national budget on the social sector, and a well‐structured health system. Despite these accomplishments, it continues to struggle to provide equitable health care across the whole nation, especially to the small and underpopulated islands. One contributing factor is the dispersed geography. The pandemic highlighted the importance of telemedicine and its capacity to bridge the barriers to healthcare delivery, and its potential in the Maldives is huge. There is also a need to strengthen integrated health services through primary healthcare, train a larger workforce, and upgrade hospitals to be able to provide comprehensive medical services. This will limit the frequency of travel to the capital and abroad in search of better healthcare.

Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert “Bob” Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.

The effects of climate change are being recognized in all regions of the world and they are predicted to increase in the coming decades. This paper aims to study the impacts of economic growth, energy use, and trade liberalization on CO2 emissions in Asia-Pacific countries. By using panel data to build an Environmental Kuznet Curve (EKC), the empirical result shows that the EKC of Asia-Pacific countries has N-shape. Besides, the energy use is one of the factors that worsen the environment. Finally, trade liberalization is an important factor that improves environmental quality in the region.

The article is devoted to the study of the origins of the colonial struggle of European powers for spheres of influence in the Asia-Pacific region in the late 17th ‒ first half of the 18th century. The international situation around the process of opening and developing the northern Pacific Ocean, the fear of metropolises to lose their spheres of influence stand out as one of the main reasons for the advancement of countries in the region. The reasons for the study of the North Pacific Territories are systematized, economic, political and scientific prerequisites are noted. In the first half of the 18th century, the Pacific Ocean became the arena of geopolitical interests of leading powers. On the one hand, this period was characterized by an Anglo-French colonial confrontation. On the other hand, the interest of these countries in the north of the Pacific Ocean was not so pronounced in comparison with the positions of Russia and Spain in the region. Nevertheless, at the intersection of Asia and America, there was a clash of interests of several countries, expressed in direct and potential expansion. It was in the first half of the 18th century that the formation of international relations on the study of the North of the Pacific Ocean and the emergence of the struggle of powers for spheres of influence in the Asia-Pacific region were traced. The article examines the view of Spain, France, Great Britain and Russia on the course of colonization of North America. The Russian Empire seems to be the main participant in geopolitics in the north of the Asia-Pacific region. The main directions of Russia’s policy in the struggle for spheres of influence in the region are systematized and analyzed. The development of Russian-British, Russian-French and Russian-Spanish relations on the study of these territories in the first half of the 18th century is studied, the interaction of countries on the process of studying the North Pacific region and the further development of the west coast of North America is analyzed.