Microsoft is adding Copilot recommendations to Windows 11’s Start menu.
The company is trying to push Copilot as its next big subscription service.
Microsoft is heavily promoting Copilot across its Windows user base.
When Microsoft first started rolling out Copilot, it felt like the AI assistant was everywhere. However, as time goes on, the Redmond giant finds new and inventive ways to show us Copilot in the hopes that we’ll use it. For a while, the Start menu was a safe haven away from Microsoft’s LLM; unfortunately, it seems that an upcoming update will change that.
PhantomOfEarth made this discovery on X, who has been rifling through the recent insider builds for Windows 11 and showing us what Microsoft is cooking under the hood. Some of it is good; for instance, Phantom spotted an update to the Snipping Tool and additions to File Explorer’s Home page.
But it’s not all good news. Phantom came to us with the grave news that the Start menu has finally fallen to the encroaching, unstoppable tide of Copilot. Microsoft is working on an update where it will subtly ask you to use Copilot in the Start menu:
In the screenshots PhantomOfEarth provides, the Start menu asks you to try out Copilot to write a first draft, explore a topic, ask a work-related question, and…write a first draft again. Yes, it seems the recommendation asks you if you want to write a first draft in two different ways, which is pretty odd.
Microsoft’s Copilot is the company’s next big thing, and it wants you to subscribe to it
Unfortunately, it’s not exactly surprising to see this, given that Microsoft has gone all-in on Copilot. The company has recently seen a ton of layoffs despite boasting about billions in profit, and one person claims the layoffs are due to the company’s fixation with AI. However, Microsoft has sunk a ton of time and money into its venture, so it’s eyeing its Windows user base as potential Copilot Pro subscribers to help it spread out the costs.
From a purely anecdotal point of view, I haven’t seen many people praise Copilot; it’s usually ChatGPT that gets all the glory. However, that’s likely not going to deter Microsoft. If you’re going to stick with Windows for the time being, be ready for Copilot ads, recommendations, and tools coming your way in the future as the company tries to prove its worth to you in the hopes you’ll subscribe for more features. As for me, I’m ducking out of this one.
In the study, published in the Journal of Experimental Psychology: Learning, Memory, and Cognition, participants were shown a series of photographs alongside AI-generated images. Later, these same images reappeared, mixed in with new ones, and participants were asked to judge whether each depicted a real object or event.
The results were clear: images that people had already seen were rated as more credible than those shown for the first time, regardless of whether they were authentic or fabricated.
Lead author Guy Grinfeld, a doctoral candidate at the School of Psychological Sciences in the Gershon H. Gordon Faculty of Social Sciences, explained that the findings are rooted in a well-known psychological phenomenon known as the mere exposure effect.
This effect suggests that information encountered multiple times is perceived as more credible. Until now, it had only been documented for text; this is the first study to confirm it also applies to images.
“As we like to summarize it, if until now the proverb went, ‘A lie told often enough becomes the truth.’ Our study shows that an image seen often enough becomes reality,” added Grinfeld.
Interestingly, the effect was even stronger among participants who were generally more skeptical and less inclined to trust images. This suggests that cautious individuals may rely more heavily on repetition as a signal of truth.
The researchers note that in an age of visual overload and easily manipulated content, the challenge for society is to maintain critical thinking and the ability to distinguish fact from fabrication.
Earlier, Kazinform News Agency reported that Kazakhstan launched Center for Combating Disinformation.
Empathy in the clinical practice can provide several benefits for patients with Parkinson disease (PD) and health care providers. Prior research has shown that traditional training techniques have focused on the health condition instead of the individual living with the disease. This condition-centric approach can be ineffective in generating the ability to understand and accurately acknowledge the feelings of another person. Since technology has advanced over the last few decades, a more effective way to draw out empathy in the clinic could be through using a digital device to simulate the patient’s actual experience such as their symptoms.
In a previously published study, findings demonstrated that those who used the digital tele-emphathy device to simulate PD symptoms had significantly higher empathy scale scores compared with a control group that did not.1 These results suggest that the use of such technology could have practical and clinical implications for providing effective training to health care providers in the movement disorder field. Experiences such as these, whether through a digital device or a simulation, place greater emphasis on the patient’s perspective, helping clinicians better understand the challenges of living with PD.
At the 4th Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 27-30, 2025, a session covered the importance of empathy, offering different perspectives from clinicians and patients living with PD.2 Prior to the session, Anissa Mitchell, LCSW, chief program officer at PMD Alliance, spoke with NeurologyLive®, giving insights on how ATMRD integrates experiential learning to enhance clinicians’ understanding of patient perspectives. Mitchell noted additional sessions that highlighted dance and large amplitude training, cognitive behavioral therapy for neuropsychiatric symptoms, and neuropalliative care approaches that address quality of life.
NeurologyLive: How would participating in a simulation potentially change the way clinicians approach conversations with their patients about their symptom burden?
Anissa Mitchell, LCSW: The reason we put this together was to give health care providers a glimpse into what it might feel like to be the person living with the diagnosis—having to overcome some of the symptoms, obstacles, frustrations, and maybe even fears to discuss what’s happening or things that are prescribed to them. For example, what it might be like to experience something like dysphagia and be prescribed thickened liquids to help them swallow safely. That sounds great in theory, but if you’ve never actually tasted and swallowed it, especially for someone who might be more sensitive to textures, it can be really challenging.
We wanted to give them an opportunity to step into that world. They obviously understand it from the expert side of things, but besides teaching people about therapeutics, we also try to infuse the patient voice into ATMRD and give that experiential opportunity. Something like this can help build empathy. I think most clinicians care very much and are very compassionate, but to step in and experience some of these things makes a difference.
We had different activities throughout this “Empathy in Action” session. We started in the morning with breakfast, and there were things they did while eating to simulate what it might be like to have certain symptoms. After breakfast, we had different stations—experiences related to rigidity and motor changes, swallowing (which I already mentioned), and articulation.
We had some of our patient ambassadors from our PMD Ambassador Program running role-play scenarios. The attendee plays the patient, and the ambassador acts as the health care provider. They’re given a brief scenario: “You are a 68-year-old woman diagnosed with this condition. You came in today feeling these symptoms. Go.” They got prompts, and they had to experience trying to tell their physician or health care provider what’s wrong.
Then, they’ll got 2 responses: 1 that’s less compassionate or empathic—maybe, “Okay, just do this, here’s a prescription”—and 1 that’s very caring and compassionate, with more open-ended, probing questions. We then ask them what it’s like to hear both types of responses, and they get to see how the way someone frames a question or responds might impact what the patient is willing to disclose.
Last year at ATMRD, we did a survey and had a session called “Lips Sealed: What Patients Aren’t Telling Their Providers.” This built on that. Sometimes patients don’t share symptoms because they’re embarrassed or fearful. The top reasons were that they didn’t know it was a symptom, they were embarrassed, they feared appearing weak, or they worried about how it might affect their disease trajectory or lead to more treatments.
This year, we took it a step further. We know people aren’t disclosing certain symptoms. We know they’re struggling. Now, we’re giving providers the chance to step into their world, experience it through these stations, and help open that dialogue. It’s something we’re very passionate about.
Are there any other major highlights from this year’s Congress you’d like to call out?
We’ve infused a couple of different experiences. In one session, José Cabassa, MD, talked about dance and movement classes from a research perspective, and then we had people actually experience a dance class. It was motivating, fun, and energizing—especially for a session that started at 7 a.m.
We also ran another experiential session on large amplitude training. We’re focusing on big voice and big movements. A lot of clinicians recommend or prescribe physical therapy, speech therapy, or occupational therapy, but we want them to see what’s actually happening in those sessions and the “why” behind it.
We also had a session on nonmotor symptoms and will have breakouts on both pharmacologic and nonpharmacologic treatments for these symptoms. One important session was with Marcia Pasqualini, PhD, a neuropsychology expert, on nonpharmacologic treatment of neuropsychiatric issues in Parkinson. She discussed cognitive behavioral therapy (CBT) for depression and anxiety, and how it can be integrated with prescribed treatments. She co-authored a book for mental health providers to better understand Parkinson so they can provide evidence-based CBT.
Another session I was excited about was on the neuropalliative role, led by Jennifer Corcoran, MD. She’s been researching the patient experience in palliative care—some starting early in their movement disorders treatment, some later—and how it impacts quality of life. This session touched on the whole person, including spiritual aspects, quality-of-life goals, advanced care planning, and what those mean from the patient’s perspective. These aren’t necessarily “treated” in the traditional sense but are vital to the treatment plan.
For those who may be interested in a future meeting, can you share the benefit of clinicians attending this Congress?
I’m a little biased, but I love that this Congress brings together so many different perspectives. We have APPs, fellows, and participants in our Mentorship Campfire Fellowship Program. We’re doing hands-on sessions, like botulinum toxin injections and deep brain stimulation deep dives. Sunday is our cognitive day, with deep dives into Alzheimer, Parkinson, and Huntington disease.
There’s something for everyone—early career to seasoned experts—and we encourage that cross-interaction. We want clinicians to engage with partners offering advanced therapies and to hear directly from patients about how treatments are going, what barriers exist, and what’s working.
My favorite part is patient involvement. We have a Conversation Corner, and on Saturday, social workers will be available to share how they support patients—navigating levels of care, offering resources, and adding to the care patients receive. We’ll also hear from 2 young-onset patients with Parkinson—1 discussing what she wants prescribed, the other a husband-and-wife team talking about engaging the Black community and other underrepresented groups in research.
Transcript edited for clarity. Click here for more coverage of ATMRD 2025.
REFERENCES 1. Palanica A, Thommandram A, Fossat Y. Eliciting clinical empathy via transmission of patient-specific symptoms of Parkinson’s disease. Cogent Psychol. 2018;5(1):1526459. doi:10.1080/23311908.2018.1526459 2. Papesh K, Mitchell A, Labib-Kiyarash E, et al. Empathy in Action Breakfast: Multi-Sensory Experiential Hands-On Session. Presented at: ATMRD; June 27-30, 2025; Washington, DC.
LONDON, Aug. 16 (Xinhua) — Richarlison’s double, including a spectacular scissor kick, gave Thomas Frank a winning start as Tottenham manager in a comfortable 3-0 victory over newly promoted Burnley on Saturday.
The Brazilian forward, who managed just four league goals last season, looked rejuvenated as he rediscovered the form that prompted Spurs to pay 60 million pounds (about 81 million US dollars) for him back in 2022.
Richarlison struck early in the Frank era, spinning to fire home on the turn after just 10 minutes, following excellent wing play from debutant Mohammed Kudus, who joined Tottenham in a 55 million-pound (about 75 million US dollars) deal from West Ham this summer.
The pair combined again for Spurs’ second, Kudus lifting a cross to the far post and Richarlison finishing with an acrobatic volley that had the home crowd on their feet and the replays looping on the big screens.
Tottenham added a third midway through the second half, with Richarlison initiating the move before Pape Matar Sarr slipped a pass through for Brennan Johnson to sprint clear and finish clinically.
Richarlison departed to a standing ovation in the 71st minute, making way for Dominic Solanke, who came close to adding a fourth.
For Frank, it was a dream debut in the Spurs dugout. The former Brentford boss was appointed in June to replace Ange Postecoglou, who was dismissed just 16 days after guiding Tottenham to the Europa League title – their first trophy in 17 years. ■
With the home international summer officially underway following the pulsating BKT Tyres T20 series, South Africa’s tour rolls on into a three-match one-day international series against Australia.
Cairns’ Cazalys Stadium will host the first match before the series concludes with two games at Mackay’s recently refurbished Great Barrier Reef Arena.
While there’s still two years until the next ODI World Cup, which will be jointly hosted by South Africa alongside Zimbabwe and Namibia, both the Proteas and the Aussies are in the middle of transition of personnel and will be hoping to see some promising signs from their newer players in these 50-over contests.
BKT Tyres ODI Series – Australia v South Africa
August 19: First ODI, Cazalys Stadium, Cairns, 2:30pm AEST
August 22: Second ODI, Great Barrier Reef Arena, Mackay, 2:30pm AEST
August 24: Third ODI, Great Barrier Reef Arena, Mackay, 2:30pm AEST
How to watch?
Every ball of the T20I and ODI series will be broadcast live and exclusive on Kayo Sports and Foxtel.
For those on the go or perhaps those who prefer the wireless, ABC Sport and SEN will cover the series on radio.
How else can I follow?
Cricket.com.au and the CA Live app is the place to go for all the news, highlights and reactions following each of the T20 matches. The Unplayable Podcast will also be tracking the series, with interviews and updates from on the ground in Far North Queensland.
Listen and subscribe below, or find the show on all podcast platforms:
The squads
Australia ODI squad: Mitchell Marsh (c), Xavier Bartlett, Alex Carey, Cooper Connolly, Ben Dwarshuis, Nathan Ellis, Cameron Green, Aaron Hardie, Josh Hazlewood, Travis Head, Josh Inglis, Matthew Kuhnemann, Marnus Labuschagne, Adam Zampa
There’s been no shortage of changes to the Australian squad since their most recent ODI, the Champions Trophy semi-final loss to India in early March.
Steve Smith and Glenn Maxwell have retired from the format, Spencer Johnson and Matt Short are injured and Jake Fraser-McGurk, Sean Abbott and Tanveer Sangha have been omitted.
Re-live the final over of a thrilling third T20I
In come Mitch Marsh, Josh Hazlewood and Cameron Green, who were all unavailable for that tournament in Pakistan, plus Xavier Bartlett and late inclusion Matt Kuhnemann.
Kuhnemann has been drafted into the squad as a replacement for the injured Short, Mitch Owen and Lance Morris, alongside WA pair Aaron Hardie and Cooper Connolly.
Bartlett and Marnus Labuschagne joined the Aussie camp on Saturday in Cairns after they weren’t included in the T20 squad.
South Africa ODI squad: Temba Bavuma (c), Corbin Bosch, Matthew Breetzke, Dewald Brevis, Nandre Burger, Tony de Zorzi, Aiden Markram, Senuran Muthusamy, Keshav Maharaj, Wiaan Mulder, Lungi Ngidi, Lhuan-dre Pretorius, Kagiso Rabada, Ryan Rickelton, Tristan Stubbs, Prenelan Subrayen
A very inexperienced South African squad showed plenty of promising signs in the T20 series and they regain some older heads for the 50-over stuff.
Captain Temba Bavuma is in alongside veteran spinner Keshav Maharaj in addition to Test triple-centurion Wiaan Mulder and top-order batters Matthew Breetzke and Tony de Zorzi.
Spin duo George Linde and Nqaba Peter have been omitted from the ODI squad as well as 19-year-old quick Kwena Maphaka and the vastly experienced Rassie van der Dussen.
South Africa’s T20 players were urged to “entertain” and “play with freedom” and you can expect their ODI side to approach the game in a similar vein.
Local knowledge
It’s a perfect record in Cairns for Australia, clean-sweeping New Zealand 3-0 when the entire 2022 Chappell-Hadlee Trophy was played in the Far North Queensland city.
Prior to that, Australia easily disposed of Bangladesh in two ODIs here in 2003, winning by eight wickets and nine wickets in the one-sided affairs.
In Mackay however, neither Australia nor South Africa have ever played at the venue.
There was a 1992 World Cup match between India and Sri Lanka in the city, but it was washed out after only two balls were bowled.
Australia’s women have a 2-1 win-loss record at the venue after they faced India there in 2021. The numbers below are from that series.
Head-to-head
The two sides haven’t played one another in 50-over cricket since the 2023 World Cup. At that tournament, South Africa won the pool match in Lucknow but Australia had the last laugh with a three-wicket win in a pulsating semi-final in Kolkata.
The teams were supposed to face off at the Champions Trophy in Pakistan this year, but heavy rains in Rawalpindi saw the match abandoned without a ball bowled.
The most recent ODI series between the two was a 3-2 victory to South Africa in September 2023, winning the final three matches to complete a stunning comeback.
South Africa are the only side to hold a positive win-loss record against Australia, with 55 wins to the Aussies’ 51 (with one tie and three no results).
Recent Australia-South Africa ODI encounters
25 Feb 2025, Rawalpindi: Match abandoned without a ball bowled
16 Nov 2023, Kolkata: Australia won by three wickets
12 Oct 2023, Lucknow: South Africa won by 134 runs
Rapid stats
South Africa have won nine of the past 12 completed ODIs between the two sides, dating back to November 2018
Australia’s squad contains six players from their most recent ODI against South Africa, while the Proteas have just the four
Marnus Labuschagne’s batting average of 55.11 against South Africa is the best of all the Aussies
Since the 2023 World Cup, no Australian has more Powerplay wickets than Aaron Hardie, who has claimed eight wickets inside the first 10 overs.
With the retirement of Steve Smith, Heinrich Klaasen and Glenn Maxwell from ODIs, the sides have lost a collective 379 games worth of experience, in which they scored 11,931 runs.
Warner, Labuschagne make huge statements with twin centuries
Players to watch
Marnus Labuschagne: The Queenslander is back in the Australian side for the first time since being dropped from the Test side following the loss to South Africa in the Test final in June. Labuschagne loves playing against the country of his birth, with an average of 55.11 and both his ODI centuries coming against the Proteas.
Dewald Brevis: The 22-year-old is yet to make his ODI debut but after his showing in the T20 series it would be hard to leave Brevis on the bench for the 50-over games. He averages 48.40 with the bat from 25 List A matches with a strike rate of 112.
Dewald Brevis announces himself with blazing 125no
Form guide
Past 10 matches, most recent first. W: win, L: loss, N: no result
Australia: LNWLLLLWWL
Only three wins from their past 11 ODIs doesn’t make for the best reading for Aussie fans. They defeated England in a classic at the Champions Trophy and progressed to the semis with a no result against Afghanistan and an abandoned match against South Africa. Their recent losses have come to India in that semi-final, to Sri Lanka 0-2 following the Test series in February and to Pakistan 1-2 during the last home summer.
South Africa: LWWLLLLLLW
South Africa’s record isn’t any better, losing six in a row leading into the Champions Trophy which included a 0-3 loss at home to Pakistan. A couple of wins at the Champions Trophy (over Afghanistan and England) boosted the confidence but a 50-run loss to New Zealand in the semi-final brought them back down to earth and prompted a change coach.
BKT Tyres ODI Series – Australia v South Africa
August 19: First ODI, Cazalys Stadium, Cairns, 2:30pm AEST
August 22: Second ODI, Great Barrier Reef Arena, Mackay, 2:30pm AEST
August 24: Third ODI, Great Barrier Reef Arena, Mackay, 2:30pm AEST
Australia ODI squad: Mitchell Marsh (c), Xavier Bartlett, Alex Carey, Ben Dwarshuis, Nathan Ellis, Cameron Green, Josh Hazlewood, Travis Head, Josh Inglis, Marnus Labuschagne, Lance Morris, Mitchell Owen, Matthew Short, Adam Zampa
South Africa ODI squad: Temba Bavuma (c), Corbin Bosch, Matthew Breetzke, Dewald Brevis, Nandre Burger, Tony de Zorzi, Aiden Markram, Senuran Muthusamy, Keshav Maharaj, Wiaan Mulder, Lungi Ngidi, Lhuan-dre Pretorius, Kagiso Rabada, Ryan Rickelton, Tristan Stubbs, Prenelan Subrayen
Mila Kunis recalls intense prep for role as ballerina in ‘Black Swan’
Mila Kunis had to undergo a major diet restriction to prepare for her role as a professional ballerina in Black Swan.
The actress, 42, sat with Vogue for an interview marking the 2010 film’s 15th anniversary.
During the interview, Kunis got candid about her intense preparation for the role, which included “a lot of dancing and very little eating.”
“I know you’re not supposed to say, but it’s the truth. I drank a lot of broth and danced for 12 hours a day,” she told the outlet.
“We were only supposed to have three months of prep before filming started, but we lost some financing, so that got extended to six months while Darren tried to find money,” Kunis continued.
“It sucked for Darren, but Nat and I were so happy because we had three extra months to dance,” she said of her costar Natalie Portman, who played the lead in the psychological horror film.
Kunis also admitted to sustaining painful injuries while filming the dance sequences, including bruised ribs from repeated lifts and even a dislocated shoulder.
“I thought I was completely screwed, but Darren sent me to an acupuncturist and I somehow came out totally fine.”
During the same interview, Portman, 44, reflected on how Kunis landed the role of Lily, the seductive rival of Portman’s character, Nina.
She revealed that a casual conversation at a flea market led to her convincing the director to cast Kunis, noting that she over-exaggerated her longtime friend’s ballet background when Kunis admitted that she had danced only once.
“I may have exaggerated on your behalf!” Portman replied.
IT remains to be seen whether the recent surge in Pakistan-US relations is a reflection of Islamabad’s strategy to reduce the trust deficit between the two countries or Washington’s move, driven by broader geopolitical considerations.
This deficit was caused mainly by the two countries’ differing approaches to Afghanistan, as well as Pakistan’s enthusiasm for CPEC and its projection that China could serve as an alternative to the US. Recently, Pakistan has opened new avenues for cooperation by quietly enhancing its counterterrorism support to Washington. The latest CT dialogue held recently in Islamabad was an expression of both sides’ willingness to expand cooperation.
A day before the dialogue, the US State Department designated the proscribed Balochistan Liberation Army’s military wing, the Majeed Brigade, as a foreign terrorist organisation. The move was notable because only a couple of months earlier, Washington had added the Resistance Front, considered to be an offshoot of the proscribed Pakistan-based Lashkar-e-Taiba, to the same list.
Many observers saw the addition of the Majeed Brigade as a balancing act between India and Pakistan, given that India had hailed the Resistance Front listing as a diplomatic victory and evidence of America’s acknowledgment that the militant group, which India alleges is backed by Pakistan, was involved in the Pahalgam attack.
By sanctioning the Majeed Brigade, which is linked to the Jaffar Express terrorist attack, Washington appears to be signalling that both the Resistance Front and Majeed Brigade were designated per its internal procedures rather than as a concession to any side. The parallel drawn between the Pahalgam and Jaffar Express incidents reinforces this perception. It is also worth noting that Pakistan had previously asked for the international designation of Majeed Brigade as a terrorist entity, but the request was not entertained at the time.
Restoration of confidence between the US and Pakistan has not come without a price for the latter.
The US and Pakistan have a long history of CT cooperation, dating back to 2001 when both countries formally engaged in a joint effort against the global threat of terrorism in the aftermath of 9/11. This engagement, however, has always been overshadowed by constraints arising from mutual mistrust and conflicting geopolitical interests. Despite these challenges, the CT dialogue remained intact, except for a few disruptions after the Taliban’s takeover of Afghanistan.
Even before the Taliban’s return to power, Pakistan had been struggling to maintain cordial relations with Washington. After August 2021, the trust deficit widened into a deep gulf. Under these circumstances, the CT dialogue faced disillusionment as both sides struggled to identify common interests to sustain cooperation.
With Al Qaeda significantly weakened following the killing of Ayman al-Zawahiri, American interest declined. For Washington, the TTP was primarily viewed as Pakistan’s internal problem, despite acknowledging in joint statements that it posed a threat. The group seen by both as a genuine global security concern was the Islamic State-Khorasan, which also had implications for US homeland security.
Pakistan concentrated its CT efforts on IS-K and eventually delivered results on that front, helping to restore America’s confidence in bilateral CT cooperation. Not only did the recently retired Centcom chief, Gen Michael Kurilla, praise Pakistan as a “phenomenal partner in the world of counterterrorism”, but President Donald Trump himself acknowledged Pakistan’s support in handing over an IS-K terrorist to the US.
The progress achieved last year also brought tangible US support for enhancing Pakistan’s investigative and prosecutorial capabilities, developing border security infrastructure and delivering training to more than 300 police officers and front-line responders.
The underlying objective has been to keep the CT dialogue as a continuous and reliable channel of engagement between the two countries.
A comparison of two joint statements, one issued in May 2024 during the Joe Biden administration and the other released last week, clearly illustrates how the CT dialogue has regained its lost momentum. The May 2024 statement was worded cautiously, noting that “Pakistan and the United States recognise that a partnership to counter [IS-K], TTP and other terrorist organisations will advance security in the region and serve as a model of bilateral and regional cooperation to address transnational terrorism threats”.
By contrast, last week’s joint statement not only acknowledged Pakistan’s sacrifices in the fight against terrorism but also expanded the scope of cooperation to include “the threats posed by the Balochistan Liberation Army”, a long-standing demand of Pakistan.
Equally significant, Pakistan has long sought advanced technological support for its CT efforts. The latest statement reflects an agreement to strengthen institutional frameworks, enhance capabilities to respond to security challenges and counter the use of emerging technologies for terrorist purposes. This effectively acknowledges the threat posed by the militant use of drones, and signals that cooperation in this domain is likely to materialise in the coming weeks.
The restoration of confidence between the two countries and the enhancement of CT cooperation have not come without a price for Pakistan. Islamabad has drastically altered its Afghanistan policy, going so far as to treat the ruling Taliban as an adversary. Afghanistan’s Foreign Minister Amir Khan Muttaqi’s visit was cancelled on US advice, reportedly due to the Taliban’s growing ties with Russia and their increasing assertiveness.
Second, it has sought to balance its relations with China, operating under the belief that Beijing, as a pragmatic actor, will not view Pakistan’s growing ties with Washington with suspicion. The thinking in Islamabad is that China might welcome such developments, seeing them as an opportunity to elevate Pakistan’s geopolitical and economic stature, which could benefit Beijing at the right time.
However, Afghanistan has re-emerged as a critical factor in Pakistan’s internal security landscape and its ambitions to connect both geopolitically and geo-economically with Central Asia. The concern is that Pakistan’s national security planners often fail to adopt long-term, strategic perspectives, focusing instead on short-term gains. They seem content celebrating India’s current diplomatic and geopolitical discomfort, without anticipating the challenges that may arise once New Delhi absorbs these shocks and recalibrates its approach.
IF the Gaza genocide does not serve as a strong enough daily reminder of how bereft of principles Western politics is, images of Russia’s President Vladimir Putin and his US counterpart Donald Trump beamed live from Alaska this weekend reinforced the point quite unequivocally.
President Trump makes no bones about how he deserves the Nobel Peace Prize. In his no-holds barred quest for being acknowledged as a peacemaker, not only did he bring in from the cold the Russian leader who has been a pariah in the eyes of the West, since his invasion of Ukraine in 2022, but also gifted his guest a great optics win.
From the arrival at an airbase near Anchorage where the two landed within minutes of each other and then alighted from their respective planes and walked on their respective red carpet strips to where they converged, it was a carefully choreographed move that seemed more designed by the guest than the host.
As Trump waited for Putin to walk the final few steps he brought his two hands together to applaud the Russian leader and then the two met and smiled before a handshake, patting each other in a gesture of warmth, even affection. It isn’t clear what the US TV networks were saying but the BBC seemed to struggle with the live broadcast.
Till he arrived in Alaska, Putin did not appear prepared to return any part of eastern Ukraine.
The BBC North America correspondent saw the presence of F-35 stealth warplanes on the tarmac as a force projection. A flypast by a B2 stealth bomber and four F-35s was also similarly described (with a mention of how the B2s released their bunker buster bombs against Iranian nuclear sites in June).
But to the unbiased observer, Putin appeared amused rather than being awed or fearful at the spectacle. In all likelihood, he saw it as a salute by the USAF just as the soldiers lined up either side of the red carpet to ‘present arms’ salute with their ceremonial rifles.
Such was the Russian leader’s confidence at being welcomed back into acceptance by reputedly the most powerful nation’s president that he set aside protocol and security considerations to ride in the Trump limousine while his own limousine, flown in from Russia earlier, followed.
Again, bizarrely, one of the people commenting on BBC TV said they weren’t sure if Putin spoke or understood English, while the Russian leader was visibly engaged in a continuous conversation with his host and later told the media he greeted Trump with a ‘Good afternoon, neighbour. Good to see you’ when he met him. In Alaska, only the Bering Strait separates the two.
As the motorcade was pulling away from the airport, Putin smiled and waved to the cameras. The significance of all this is clear from the fact that over the past three years, Putin, who has been indicted for war crimes by the International Criminal Court in The Hague, has not been received by any Western country. And here the red carpet had been rolled out for him.
After three hours of talks, the two leaders faced the media but did not answer questions. Putin read from a prepared statement where, after talking about the US-Russia history with specific reference to Alaska, he seemed to flatter Trump, saying that he endorsed the latter’s view that the Ukraine war would not have happened if he had been the US president.
Putin said the meeting, and what was agreed in it, will mark the beginning of peace in Ukraine if what he called the ‘root causes’ were addressed. For his part, Trump spoke briefly and started by saying, “There no deal until there is a deal”. He described the meeting as productive where many points were agreed on but “a few” remain.
Before leaving the podium, he also said he would now call the Ukrainian President Volodymyr Zelensky, European leaders and Nato officials for consultations.
The discussions must have gone well with the late-night White House announcement that the Ukrainian leader is arriving in Washington on Monday and will be received by Trump for talks. The European leaders, too, reacted positively to whatever they were told.
A peace deal will hinge on how far Putin and Zelensky and the latter’s Western European allies are willing to compromise on their ‘no land for peace’ stance. Till he arrived in Alaska, Putin did not appear prepared to return any part of eastern Ukraine his forces have captured. He also wants recognition of his 2014 annexation of Crimea.
For now, the security guarantees for Ukraine that are being discussed exclude any eastward expansion of Nato into Ukraine. Putin will also be averse to Western boots on the ground. It was, inter alia, talk of Nato expansion plans that first spooked Russia because, after the collapse of the Soviet Union, Moscow saw Ukraine as a buffer between Western Europe-Nato and itself.
Trump’s word may not amount to much as has been demonstrated by his support to the Gaza ethnic cleansing by Israel in contrast to his earlier reservations, but in this European conflict, he has moved away a shade from his earlier stance that only Ukraine will have to give up land for peace and it will be Europe and not the US which will offer security guarantees to Kiev.
But for Putin to leave the summit meeting beaming tells one how many compromises he has been forced to agree to, including the amount of land he would swap for peace. For now, he has pushed back by several weeks the likelihood of sterner US sanctions and also charmed his way to having Trump listen to his point of view face to face.
Trump can give himself any prize he wants, like our leaders have done, but hundreds of millions around the world will find any accolade he gets legitimate only if he moves from the end to the war in Ukraine to peace in Gaza and gives up his support for the ethnic cleansing and forced displacement of the Palestinians.
In the overall matched cohort, patients diagnosed with HZ within one year following COVID-19 exhibited a higher all-cause mortality rate of 8.0%, compared to 6.1% in those without HZ. However, Kaplan–Meier survival analysis showed no significant difference in overall survival curves between the two groups over the full three-year follow-up period (log-rank p = 0.260), and the corresponding HR was 1.04 (95% CI: 0.97–1.11) (Fig. 2A).
Fig. 2
Kaplan–Meier survival curves comparing COVID-19 patients with and without herpes zoster (HZ) infection for (A) all-cause mortality, (B) MACE, (C) AKI, and (D) decline in eGFR to less than 60 mL/min/1.73 m² over a three-year follow-up period. The blue line represents patients with HZ development, and the red line represents patients without HZ. The log-rank test was used to compare survival distributions between groups, with p-values provided in each panel. Abbreviation: AKI, acute kidney injury; eGFR, estimated glomerular filtration rate; HZ, herpes zoster; MACE, major adverse cardiovascular events.
Notably, the proportional hazards assumption was violated (global test p < 0.001), suggesting that the effect of post-COVID HZ on mortality varied over time. Time-stratified survival analyses were therefore performed (Supplementary Table S1). During the first 90 days after COVID-19 diagnosis, patients with HZ had a significantly lower mortality risk (HR = 0.30, 95% CI: 0.25–0.36, p < 0.001), potentially reflecting increased medical attention during acute HZ episodes (Supplementary Table S2). From day 91 onward, this early survival advantage reversed. Between day 91 and three years, the mortality risk became significantly higher in the HZ group (HR = 1.33, 95% CI: 1.24–1.44; log-rank p < 0.001), and the proportional hazards assumption was no longer violated (p = 0.897) (Supplementary Figure S1). Further stratified analyses showed that the excess risk emerged most prominently between days 181–270 (HR = 1.45, 95% CI: 1.13–1.87) and 271–360 (HR = 1.55, 95% CI: 1.24–1.94), indicating a delayed but persistent adverse impact of HZ on long-term survival.
In subgroup analyses (Fig. 3A), several factors were associated with increased all-cause mortality among COVID-19 patients who developed HZ, including older age (HR: 3.83; 95% CI: 3.42–4.29), diabetes mellitus (HR: 1.39; 95% CI: 1.25–1.54), hypertension (HR: 1.34; 95% CI: 1.15–1.54), smoking (HR: 1.45; 95% CI: 1.25–1.69), chronic obstruction pulmonary disease (COPD) (HR: 1.85; 95% CI: 1.63–2.11), reduced eGFR < 60 mL/min/1.73 m² (HR: 2.08; 95% CI: 1.85–2.34), CRP ≥ 10 mg/L (HR: 3.10; 95% CI: 2.68–3.58), and vitamin D deficiency < 30 ng/mL (HR: 1.77; 95% CI: 1.43–2.20). In contrast, female sex (HR: 0.69; 95% CI: 0.62–0.77) and higher body mass index (BMI) (HR: 0.65 for BMI ≥ 30; 95% CI: 0.57–0.74) were associated with lower mortality risk.
Fig. 3
Subgroup analysis of adverse clinical outcomes in COVID-19 patients with herpes zoster (HZ). Hazard ratios (HRs) with 95% confidence intervals (CIs) are shown for key risk factors associated with (A) all-cause mortality, (B) MACE, (C) AKI, and (D) renal function decline (eGFR < 60 mL/min/1.73 m²). Abbreviations: AKI, acute kidney injury; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HTN, hypertension; MACE, major adverse cardiovascular events.
Major adverse cardiovascular events
Patients diagnosed with HZ within one year after COVID-19 exhibited a higher risk of MACE compared to those without HZ. The MACE incidence was 18.1% in the post-COVID HZ group versus 10.6% in the non-HZ group. Kaplan–Meier analysis demonstrated a significantly lower MACE-free survival probability in the HZ group (80.27%) relative to the non-HZ group (84.95%), with a log-rank p < 0.001. The corresponding HR was 1.38 (95% CI: 1.30–1.46), indicating a sustained increase in cardiovascular risk throughout the follow-up period (Fig. 2B).
Subgroup analysis among COVID-19 patients with HZ (Fig. 3B) revealed that several risk factors were significantly associated with elevated MACE risk. These included older age (HR: 2.94; 95% CI: 2.72–3.18), diabetes mellitus (HR: 1.67; 95% CI: 1.53–1.83), hypertension (HR: 2.18; 95% CI: 1.96–2.42), smoking (HR: 1.58; 95% CI: 1.51–1.98), COPD (HR: 2.03; 95% CI: 1.81–2.27), reduced eGFR < 60 mL/min/1.73 m² (HR: 1.70; 95% CI: 1.52–1.89), and elevated CRP ≥ 10 mg/L (HR: 1.41; 95% CI: 1.26–1.59). Conversely, female sex was associated with a lower MACE risk (HR: 0.77; 95% CI: 0.71–0.84). BMI ≥ 30 (HR: 0.95; 95% CI: 0.87–1.05) and vitamin D deficiency < 30 ng/mL (HR: 1.01; 95% CI: 0.86–1.18) were not significantly associated with MACE.
Acute kidney injury
Patients diagnosed with HZ within one year after COVID-19 had a significantly higher risk of AKI compared to those without HZ. The incidence of AKI was 9.5% in the post-COVID HZ group versus 4.6% in the non-HZ group. Kaplan–Meier analysis showed a lower AKI-free survival probability in the HZ group (89.71%) compared to the non-HZ group (93.55%), with a significant difference confirmed by the log-rank test (p < 0.001). The HR for AKI associated with HZ was 1.67 (95% CI: 1.55–1.80), suggesting a sustained increased renal risk following the occurrence of HZ during the post-acute COVID-19 phase (Fig. 2C).
Subgroup analysis (Fig. 3C) demonstrated that the risk of AKI was markedly elevated among patients aged ≥ 65 years (HR: 3.04; 95% CI: 2.75–3.37), those with diabetes mellitus (HR: 2.10; 95% CI: 1.90–2.33), hypertension (HR: 3.02; 95% CI: 2.59–3.53), smoking history (HR: 1.67; 95% CI: 1.43–1.96), and COPD (HR: 1.96; 95% CI: 1.72–2.24). Furthermore, pre-existing eGFR < 60 mL/min/1.73 m² (HR: 4.24; 95% CI: 3.76–4.81) and elevated CRP ≥ 10 mg/L (HR: 2.35; 95% CI: 2.06–2.67) were strongly associated with increased AKI risk. Vitamin D deficiency < 30 ng/mL was also significantly associated (HR: 1.37; 95% CI: 1.14–1.64). In contrast, female sex was protective (HR: 0.63; 95% CI: 0.57–0.70), and BMI ≥ 30 was not significantly associated with AKI (HR: 1.07; 95% CI: 0.95–1.20).
Renal function decline by eGFR < 60 mL/min/1.73 m²
Among patients with a diagnosis of HZ within one year following COVID-19, the incidence of renal function decline (defined as eGFR < 60 mL/min/1.73 m²) was 12.2%, compared to 7.6% in the matched COVID-19 cohort without HZ. Kaplan–Meier survival analysis demonstrated a lower renal function preservation rate in the HZ group, with 86.56% of patients maintaining eGFR ≥ 60 mL/min/1.73 m² at three years, compared to 89.23% in the non-HZ group. The log-rank test indicated a significant difference in renal outcomes between groups (p < 0.001), with a corresponding HR of 1.28 (95% CI: 1.20–1.37) (Fig. 2D).
Subgroup analysis (Fig. 3D) showed that renal function decline was more pronounced in patients aged ≥ 65 years (HR: 2.86; 95% CI: 2.62–3.13), those with diabetes mellitus (HR: 1.47; 95% CI: 1.33–1.63), hypertension (HR: 1.80; 95% CI: 1.60–2.04), smoking history (HR: 1.18; 95% CI: 1.03–1.36), COPD (HR: 1.25; 95% CI: 1.10–1.43), and elevated CRP ≥ 10 mg/L (HR: 1.41; 95% CI: 1.24–1.60). Female sex (HR: 0.91; 95% CI: 0.82–1.00) showed a marginal protective effect. Notably, BMI ≥ 30 (HR: 1.05; 95% CI: 0.94–1.17) and vitamin D deficiency (HR: 1.03; 95% CI: 0.87–1.22) were not significantly associated with eGFR decline in this subgroup.
Sensitivity analysis
In the matched cohorts, excluding patients with CKD within one year prior to COVID-19 diagnosis, HZ was significantly associated with increased risks of MACE, AKI, and decreased renal function, but not with all-cause mortality (Supplementary Table S3). When patients with AKI within one year before COVID-19 were excluded, HZ remained significantly associated with increased risks of MACE, AKI, and reduced kidney function, while the association with all-cause mortality remained nonsignificant (Supplementary table S4). In a third sensitivity analysis excluding patients with influenza one year before or after COVID-19, the associations between HZ and both cardiovascular and renal outcomes persisted, whereas the association with all-cause mortality was not statistically significant (Supplementary Table S5).
Furthermore, in analyses using expanded covariate adjustment, HZ remained independently associated with elevated risks of MACE, AKI, and eGFR decline. In the model adjusted for age, sex, race, and major comorbidities (Supplementary Table S6), the HRs for MACE, AKI, and renal impairment ranged from 1.25 to 1.44, with no significant association for all-cause mortality (HR 0.98, p = 0.520). These findings remained consistent when key laboratory parameters (CRP, hemoglobin, and iron) were included in the matching algorithm (Supplementary Table S7), showing robust associations with cardiorenal outcomes and a nonsignificant association with mortality (HR 0.968, p = 0.310).
In an additional sensitivity analysis focused on the early post-COVID period (days 1–90), we assessed whether the observed short-term survival advantage among HZ patients was confounded by baseline renal vulnerability. After excluding individuals with CKD or AKI in the year prior to COVID-19, the early mortality benefit associated with post-COVID HZ remained statistically significant (HR = 0.36, 95% CI: 0.29–0.45, p < 0.001) compared to matched non-HZ controls (Supplementary Table S8).
In a further sensitivity analysis stratified by COVID-19 vaccination status, we evaluated whether vaccination modified the associations between post-COVID HZ and adverse outcomes. Among vaccinated patients, HZ was significantly associated with increased risks of all-cause mortality (HR = 1.25, 95% CI: 1.06–1.47, p < 0.05), MACE (HR = 1.36, 95% CI: 1.21–1.52, p < 0.05), AKI (HR = 1.38, 95% CI: 1.20–1.60, p = 0.07), and eGFR < 60 mL/min/1.73 m² (HR = 1.29, 95% CI: 1.14–1.46, p = 0.08), although the associations for AKI and renal impairment did not reach conventional statistical significance. In contrast, among unvaccinated individuals, HZ was significantly associated with increased risks of MACE (HR = 1.29, 95% CI: 1.22–1.37, p < 0.001), AKI (HR = 1.65, 95% CI: 1.53–1.77, p < 0.001), and renal function decline (HR = 1.20, 95% CI: 1.13–1.28, p < 0.05), while the association with all-cause mortality was not statistically significant (HR = 1.05, 95% CI: 0.98–1.12, p < 0.001) (Supplementary Table S9).
Risk estimates in the overall and age-restricted cohorts
Because the overall cohort included more than one million patients, conducting PSM across the full dataset was computationally infeasible. To provide a representative example of matched baseline characteristics, we selected the 40–50-year-old subgroup for presentation in Table 1. To support the generalizability of our findings, Table 2 presents outcome estimates from both the overall cohort and this age-restricted subgroup. In both groups, HZ was consistently associated with significantly increased risks of MACE, AKI, and renal function decline, while the association with all-cause mortality was not statistically significant. These concordant results support the validity of our matching approach and the robustness of the observed associations.
To further address concerns regarding the temporal alignment of COVID-19 diagnosis dates between groups, we evaluated the distributions of age at index (i.e., date of COVID-19 diagnosis) and current age before and after matching. As shown in Supplementary Table S10, the age at index was perfectly matched between HZ and non-HZ patients after PSM (mean 58.3 ± 15.6 years in both groups), resulting in nearly identical current age distributions (62.8 ± 15.6 years).
COVID-19 reinfection risk and frequency
To explore whether post-COVID HZ was associated with increased vulnerability to SARS-CoV-2 reinfection, we compared reinfection risk and frequency between matched cohorts. As shown in Supplementary Table S11, patients with HZ experienced a significantly higher risk of COVID-19 reinfection than those without HZ (71.0% vs. 53.2%). Moreover, the mean number of reinfection episodes was higher in the HZ group (2.90 ± 5.13) compared to the non-HZ group (1.66 ± 3.65), with a statistically significant difference (p < 0.001).
