James' World 2

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While pregnant with her third child last year, Alison Carroll pondered options that hadn’t been available during her first two pregnancies: not one but two ways to help prevent her newborn from ending up in the hospital, fighting for breath because of a severe infection with respiratory syncytial virus (RSV).

A pediatric hospitalist herself, she already had for years witnessed and treated the worst of RSV’s ravages in children, including a scary situation that landed her own daughter, Stella, in the same wing of Vanderbilt Children’s Hospital in Nashville, where Carroll works.

So Carroll didn’t need to think long before saying yes to one of the new preventative options that have revolutionized the medical world’s ability to prevent the most severe symptoms of RSV, especially in infants, who are particularly vulnerable. Since they debuted in 2023, the preventatives—a vaccine for pregnant people and an antibody shot for newborns—have reduced hospitalizations of the youngest babies by up to half.

“That’s amazing,” says Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “It actually caused a slight decrease in the infant mortality rate in this country,” a figure that wasn’t more dramatic, mainly because RSV is responsible for a small proportion of infant deaths relative to other causes.

Although the infant mortality rate is low, respiratory syncytial virus is the leading cause of hospitalization among infants in the U.S., with newborns up to the age of two months being at the highest risk, according to the U.S. Centers for Disease Control and Prevention. Roughly 60,000 to 80,000 children under age five are hospitalized with RSV every year in the U.S., and an estimated 100 to 300 children in that age group die annually.

In some babies, RSV progresses beyond cold-like symptoms, spreading from the upper respiratory tract (primarily the nose and throat) to the lower, where it affects their lungs and ultimately causes severe breathing difficulties, low oxygen levels and other serious complications.

That’s why pediatricians and infectious disease specialists have reacted with such enthusiasm to the development of the preventative measures, which, in both clinical trials and early real-world results, have produced dramatic reductions in RSV infections that require medical attention or hospitalization among babies. A CDC analysis of data from two different groups of children in the U.S. found that RSV-related hospitalization rates among infants seven months and younger decreased by about 28 and 43 percent, respectively, during the peak of the 2024–2025 RSV season, when both preventatives were available, compared with pre-COVID-pandemic RSV seasons from 2018 to 2020.

Looking at the data more narrowly, the researchers saw an even larger effect: for infants aged zero to two months, the decreases were 45 percent and 52 percent for the two groups, respectively. That 45 percent reduction jumped to 71 percent when the Houston, Tex., region was excluded because of its early-onset RSV season, which began before the new drugs were available.

Offit says the CDC data were not limited to babies who received antibodies through the maternal vaccine or monoclonal antibody injections but rather included all RSV-related infant hospitalizations. “This wasn’t an efficacy study,” he says. “They were looking from 30,000 feet, saying, ‘Has there been a decrease [in hospitalizations]?’”

“And there has,” he adds, “which is remarkable.”

Offit isn’t the only expert offering superlatives.

“I think the results have been stunning, actually,” says Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine and a former member of the federal Advisory Committee on Immunization Practices. “Those two treatments, or preventive measures, have resulted in massive reductions in infections and, among infected kids, massive reductions in hospitalizations.”

The protective measures work in different ways. With an injection of the Pfizer vaccine Abrysvo at 32 to 36 weeks of gestation, a pregnant person develops antibodies against RSV that are conferred to the fetus through the placenta, giving babies crucial protection that lasts for the first six to nine months of life.

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Chiara Vercesi

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From Panama’s jungles to Vietnam’s buzzing cities, these five countries offer expats the best mix of affordability, friendliness, and quality of life.

More people than ever are living outside of their country of origin: according to the World Migration Report, 3.6% of the global population are considered international migrants. Moving abroad brings both challenges and rewards, but one recent survey suggests a single factor is shaping expat happiness more than ever right now: money.

Internations, a global community for people living and working overseas, surveyed more than 10,000 expats across 172 nationalities. This year, the countries that scored highest for overall happiness also ranked near the top in the survey’s Personal Finance index, alongside strong results for quality of life and ease of settling in.

We spoke to expats in each of the top five destinations to understand the best parts about living there – and their advice for others considering an international move.

1. Panama

Ranking 1st out of 46 countries overall, Panama placed in the top three across all five of the survey’s major indexes – including first in Working Abroad, second in Ease of Settling in and Expat Essentials (like digital life and housing), and third in Quality of Life and Personal Finance. Popular with freelancers, digital nomads, and retirees, Panama attracts people who appreciate its natural beauty and outdoor activities.”I love beyond words being surrounded by this lush jungle landscape where we see toucans, monkeys, iguanas, agoutis, birds, butterflies every day,” says Cari Mackey, an American who owns and operates Morrillo Beach Eco Resort. “Our area is so remote that we rarely see anyone else on our beach other than our own guests of the resort, so, the waves are never crowded and the vibes are always nice.”

Mackey warns, however, that deforestation is an issue and urges expats to respect the environment. “A lot of people move to Panama and before getting to know the land, [they] start cutting down trees or the understory of the forest and then [we] lose that eco system forever,” she said.

The top 10 countries for expats, according to Internations:

1. Panama

2. Colombia

3. Mexico

4. Thailand

5. Vietnam

6. China

7. UAE

8. Indonesia

9. Spain

10. Malaysia

Bureaucracy can also be a challenge, she says, and hiring professional help like lawyers can go a long way when navigating the systems; even renewing vehicle license plates can require complex paperwork.  To appreciate Panama’s beauty, Mackey recommends visiting Cerro Hoyas National Park. “The park is home to endemic species of plants and animals that I didn’t know existed,” she said. “It is a dream for birders, a challenge for hikers, and an all-round inspiring place to explore with waterfalls everywhere!”

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President Donald Trump’s abrupt change in rhetoric on Ukraine, in which he declared it could retake all its territory with help from NATO, was warmly welcomed by Kyiv and quickly dismissed Wednesday by Moscow, particularly his calling the Russian military “a paper tiger” that had been “fighting aimlessly for three and a half years.”

The few early reactions trickling out of Moscow on Wednesday demonstrated how deeply Trump’s unexpectedly friendly appearance in New York alongside Ukrainian President Volodymyr Zelensky on the sidelines of the U.N. General Assembly vexed the Kremlin, which just weeks ago was gloating over Russian President Vladimir Putin’s warm reception in Alaska.

“Russia is in no way a tiger. Still, Russia is more compared with a bear. There are no paper bears,” Kremlin spokesman Dmitry Peskov said to local radio on Wednesday.

Peskov also suggested the motivation behind Trump’s push to halt European purchases of Russian oil and gas — which are helping fund Russia’s war machine — is tied to his desire to boost American sales.

At a later briefing with reporters, Peskov pushed back on Trump’s comments that the war is “aimless,” while still thanking Trump for his willingness to promote peace — and warning that Ukraine was in a dire position.

Kyiv is “trying to demonstrate to their sponsors in Europe and their handlers that they can fight, but they should not forget that with each passing day when the Ukrainian side refuses to negotiate, the negotiating position of the Ukrainian side will only worsen,” he said.

The outspoken former Russian president Dmitry Medvedev mocked Trump’s new position, saying he had been given a dose of “alternative reality,” and noted his often-changing views of the conflict.

“I have no doubt — he will come back. He always comes back,” Medvedev wrote about Trump on X. “The main thing is to radically change your point of view on various issues more often. And everything will be fine. That’s the essence of successful government through social media.”

Margarita Simonyan, who heads the Russian English-language state news channel RT, dismissed the U.S. president’s support for Zelensky as that of a carnival huckster.

“Trump debuts as the tarot card reader telling the thrice-divorced lady that she is going to meet that billionaire prince after all, as long as she buys the magic crystals,” she wrote on X.

European leaders, however, seized on Trump’s about-face, which matches their long-stated support for Ukraine’s struggle against the 2022 full-scale Russian invasion. Trump’s statements Wednesday acknowledged Russia’s inability to make significant ground advances. He praised Ukraine’s military for holding off the much larger Russian army for so long.

“I think Ukraine, with the support of the European Union, is in a position to fight and WIN all of Ukraine back in its original form,” Trump said on Truth Social. “With time, patience, and the financial support of Europe and, in particular, NATO, the original Borders from where this War started, is very much an option,” he said.

Olof Gill, a European Union spokesman, said Wednesday that the bloc welcomed Trump’s engagement, describing it as “now so strong and meaningful as regards coordinated efforts to try to end Russia’s aggression.”

Although Russia has made some small gains in recent months, the results of the summer offensive were limited. Russia has still failed to take the eastern city of Pokrovsk, after its more than year-long quest to seize it.

When asked on Fox News if he thought Trump’s position on the war had changed, Zelensky replied he believed it had — and that Trump appeared to understand that the two countries could not “swap territory.”

“God bless, I really count on this,” he said. In the past, Trump had talked about the need for territorial swaps in any peace agreement.

Zelensky has touted in recent days a small Ukrainian counteroffensive in the eastern Donetsk region. At the same time, Ukraine has lost some territory in other regions, including in Zaporizhzhia and Dnipropetrovsk. Ukrainian commander in chief Oleksandr Syrsky dismissed two commanders responsible for defending those areas.

“We agree. Ukraine is indeed in a position to fight and WIN all of Ukraine back in its original form,” Jonatan Vseviov, secretary general of Estonia’s Foreign Ministry, wrote on X in response to Trump’s assertion that Ukraine could win the war.

Estonian lawmaker Marko Mihkelson, who chairs his Parliament’s foreign affairs committee, shared a post from the White House that quoted Trump describing Zelensky as “a brave man” who is “putting up one hell of a fight.” The post included an image of Zelensky laughing next to Trump on Tuesday — a stunning contrast to Trump and Vice President JD Vance’s dressing down of Zelensky in the Oval Office in February.

“Incredible turnaround. Now actions should follow,” Mihkelson wrote.

Zelensky’s chief of staff, Andriy Yermak, tweeted a bicep emoji in response to the White House post.

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I have a patient named “Alex.” He is 15. He feels alone, down almost every day. He tells me he’s having trouble with schoolwork. He worries about his future. He struggles to make friends and keep the ones he has. He says it’s hard to get out of bed, to shower, and brush his teeth. He doesn’t find joy in things he used to love, like painting. I met him in our emergency department; he was in the middle of a crisis and came to us for help.

Alex has depression and anxiety, and these feelings had been going on for about one year. Recently, he told me he’d been thinking about hurting himself or overdosing on medication. These thoughts were becoming more frequent. He talked a lot about wanting to die.

The teenage years are difficult. Our kids carry huge emotional burdens, and more youths than ever face anxiety, depression or have trouble regulating their emotions. Unfortunately, suicide is now the second leading cause of death in youth ages 10 to 24. Among this age group, suicide rates have risen more than 60 percent in the last 20 years. Chronic physical health issues, abuse or other traumatic events, substance use, bullying or negative experiences with social media, family history or past history of contemplating or attempting suicide are huge risk factors.

I’ve sat beside far too many children who’ve told me they don’t want to live anymore. Some whisper it. Others say it with tears streaming down their cheeks. It doesn’t have to come to this. And parents are key to prevention.

So why was I, a child psychiatrist, particularly concerned about Alex? He initially had a hard time opening up and minimized concerns his family had about him. His parents knew something was off but attributed it to teenage angst until the changes became more pronounced. His struggles and the progression of his symptoms were seriously concerning. We needed to act.

There are many things that I and others think has led to the rise in suicide risk. Our teens constantly question their self-worth, struggle to cope with distressing situations, or feel disconnected and unvalidated. Family, school, and community can make these feelings worse, and the risks worsen alongside other mental or physical health problems.

Getting Alex treatment, establishing a clear safety plan, limiting access to things that could pose harm (like medications or firearms), finding friends and family to build a support network, and making sure he was getting support at school, home and within the community would be important in reducing his risk. But this goes for all children at increased risk of suicide.

Having a child at risk can be scary and uncertain. Even if everything looks okay on the outside, it may not be. It’s the last thing any parent ever expects to hear. But you’re in a powerful position. You can protect your child by knowing what leads to suicide, picking up on warning signs, and getting help.

You are not alone in this. There is hope. Your child can get through it. Here’s how:

Warning signs vary, and some are less obvious than others. Alex complained that he was tired on school days, that he had a stomachache,e and didn’t want to eat. Of course, these can be symptoms of physical health concerns or, if brief and transient, they may be related to typical teenage behavior. When it’s vague, persistent, impairing, however, and there is no clear medical cause, it could very well be a symptom of anxiety, depression, chronic stress or general emotional distress.

Recognizing when your child is acting differently and uncharacteristically may be a subtle sign that there is something wrong. For you, here’s the opportunity to be curious and check in. “I noticed you have been having more bellyaches before school. I wonder if there is something about school or something else that is bothering you. I am here to listen and want to understand how I can help.” Acting early can help reduce overall risk.

But there are some warning signs that are more obvious: Making statements about wanting to die or not be around, expressing intense guilt or shame, saying things like they feel like a constant burden to family or others, are all red flags. Others include talking about feeling empty, trapped, or hopeless; or isolating themselves, or, like Alex, no longer doing activities they enjoyed. Mood matters too. Some children are irritable, sad, or constantly worried. Others talk about unbearable emotional or physical pain. You might see significant changes in eating or sleep patterns, and involvement in risky and uncharacteristic behaviors, including substance use.

Alex told his primary care doctor and his family how high his risk had gotten; he told his family how trapped he felt. A mental health screen affirmed concerns about worsening depression, anxiety, and more frequent thoughts about hurting himself. The emergency visit confirmed he was in crisis.

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