Regional Collaboration Research Articles

Water Sharing Geopolitics between India and Bangladesh: Recent Trends

The partnership between India and Bangladesh according to water sharing is complex by traditional, geographical, political, sociological, and economical issues. Understanding the present dynamics in water-sharing geopolitics is necessary for understanding the pathways of their bilateral partnership and the conjugation for regional sustainability and improvement. Both countries share almost 54 rivers for example Teesta, Ganges, Brahmaputra, and Meghna. These rivers are lifelines for Bangladesh and India, providing essential irrigation water, communication, and indigenous consumption. However, the unequal distribution of water and the influence of climate change have increased challenges over water management procedures. While both countries have contracted diverse treaties and agreements to manage shared rivers, implementation hazards and occasional breaches of trust have channeled their partners. Subsequently, the increasing demand for water due to population enrichment and industrialization shapes modern challenges for stable water mechanisms. This research aims to describe the present dynamics in water-sharing geopolitics between India and Bangladesh, examining the evolving trends, key factors, and their conjugations for regional sustainability and collaboration. By extending the complexities of this critical view of their partnership, this study seeks to contribute to a deeper realization of South Asia's geopolitical arena and prosecutorial dynamics for cooperative water distribution strategies.

Regional Collaboration Strategy to Overcome Geopolitical Threats in the ASEAN Maritime Region

The ASEAN maritime region is a strategic area that faces various geopolitical threats, such as piracy, smuggling and territorial disputes. Overcoming this threat requires effective regional collaboration among ASEAN member countries. This research aims to analyze regional collaboration strategies that can be implemented to improve maritime security in ASEAN. The research methods used include qualitative analysis of existing cooperation initiatives, evaluation of the effectiveness of collaboration mechanisms, as well as interviews with experts and stakeholders in the field of maritime security. The research results show that strengthening dialogue mechanisms, increasing the capacity of member countries, developing maritime infrastructure, and collaborating with external partners are key elements in the regional collaboration strategy.

Exploring the role of an initiator in a population health management initiative: insights from action research

PurposeThe purpose of this paper is to present the learnings of a broker organization that started a new Population Health Management initiative in two regions in the Netherlands. The research focusses on the role of the broker organization itself in supporting stakeholders in the region to adopt a new implementation strategy designed by the broker organisation itself. The basis of this model was to organize, finance and monitor differently to improve the overall health of the population.Design/methodology/approachAn action research approach was chosen to support the endeavours of the broker organization and to acquire practical knowledge on the role of a third-party in PHM implementation. Qualitative data were collected from documentary analysis, focus groups, logbooks and observational data from team meetings.FindingsThe main result is that the role of the broker organization to implement PHM was subject to change during the more than two years of the research. Several themes emerged that influenced these role changes, both internal and external, showing the complexity of providing PHM implementation support as a third-party to regional stakeholders.Practical implicationsWe hypothesize that the role of a third-party changes depending on the maturity of the regional collaboration. The complexity of the transition in healthcare calls for constant adaptations, and thus learning and reflection, from all involved. Action research is a strong tool for this.Originality/valueThis paper is one of the first to report on the role of a third-party in PHM implementation. The action research methodology offered the right amount of flexibility to adhere to the complexity of the context and provided rich insights.

Molecular Profiling of KIT/PDGFRA-Mutant and Wild-Type Gastrointestinal Stromal Tumors (GISTs) with Clinicopathological Correlation: An 18-Year Experience at a Tertiary Center in Kuwait.

In gastrointestinal stromal tumors (GISTs), identifying prototypical mutations in the KIT/PDGFRA oncogenes, or in rare alternate genes, is essential for prognostication and predicting response to tyrosine kinase inhibitors. Conversely, wild-type GISTs (WT-GIST), which lack known mutations, have limited treatment options. Data on the mutational landscape of GISTs and their impact on disease progression are very limited in Kuwait. Using a targeted next-generation sequencing panel, we investigated the spectrum and frequency of KIT, PDGFRA, and RAS-pathway-related mutations in 95 out of 200 GISTs diagnosed at Kuwait Cancer Center from 2005 to 2023 and assessed their correlation with clinicopathological parameters. Among the 200 tumors (median age 55 years; 15-91), 54% originated in the stomach, 33% in the small bowel, 7% in the colorectum, 1.5% in the peritoneum, and 4.5% had an unknown primary site. Of the 95 molecularly profiled cases, 88% had a mutation: KIT (61%), PDGFRA (25%), NF1 (2%), and one NTRK1 rearrangement. Ten WT-GISTs were identified (stomach = 6, small bowel = 2, and colorectum = 2). WT-GISTs tended to be smaller (median 4.0 cm; 0.5-8.0) (p = 0.018), with mitosis ≤5/5 mm2, and were of lower risk (p = 0.019). KIT mutations were an adverse indicator of disease progression (p = 0.049), while wild-type status did not significantly impact progression (p = 0.934). The genetic landscape in this cohort mirrors that of global studies, but regional collaborations are needed to correlate outcomes with genetic variants.

Appropriateness of Imaging for Low-Risk Prostate Cancer-Real World Data from the Pennsylvania Urologic Regional Collaboration (PURC).

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.

Accelerating carbon neutral power systems through innovation-driven cost reduction and regional collaboration

Accelerating carbon neutral power systems through innovation-driven cost reduction and regional collaboration

Advancing Leukemia Care and Research in East Africa:Current Challenges and Future Directions

leukemia, encompassing a range of hematological malignancies, presents a significant health challenge in East Africa with distinct epidemiological patterns influenced by age, gender, and geography. Acute Lymphoblastic Leukemia (ALL) predominates in children, while Acute Myeloid Leukemia (AML) is more common in adults, especially the elderly. Chronic Lymphocytic Leukemia (CLL) and Chronic Myeloid Leukemia (CML) exhibit varied prevalence, with CLL being more common in older adults and CML showing lower incidence overall. Despite advancements, leukemia care in East Africa is impeded by limited diagnostic and treatment resources, socio-economic barriers, and inadequate healthcare infrastructure, resulting in lower survival rates compared to high-income countries. Challenges include delayed diagnoses, limited access to advanced treatments, and poor awareness of the disease. Emerging technologies such as targeted therapies and immunotherapy, alongside improved diagnostic tools and public awareness campaigns, offer hope for transforming leukemia care. This review explores the current state of leukemia care and research in East Africa, examining the genetic and environmental risk factors, healthcare infrastructure, survival rates, and socioeconomic impacts. It also highlights the role of public awareness and education, the challenges in pediatric leukemia care, and the importance of research and policy development. Future directions include strengthening healthcare systems, enhancing regional and international collaborations, and integrating advanced technologies to improve outcomes for leukemia patients in the region. Addressing these challenges with a comprehensive approach could significantly enhance leukemia care and research, ultimately improving survival rates and quality of life for patients in East Africa. Keywords: Leukemia Care, East Africa, Current, Challenges, Future Directions

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries.

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

Saudi Arabia's Middle East respiratory syndrome Coronavirus (MERS-CoV) outbreak: consequences, reactions, and takeaways.

Middle East respiratory syndrome (MERS) is a viral illness caused by the MERS-Coronavirus (MERS-CoV) that was first identified in Saudi Arabia in 2012. Saudi Arabia has reported most global MERS-CoV cases and deaths, with periodic outbreaks in other countries. This review aims to provide a comprehensive overview of the 2023 MERS-CoV outbreak in Saudi Arabia, including its epidemiology, public health response, impact, and lessons learned. This study utilized a narrative review approach, drawing on published literature and data from sources such as the WHO and the Centers for Disease Control and Prevention. The 2023 outbreak was centered in the Riyadh region, with 312 confirmed cases and 97 deaths reported. MERS-CoV primarily spreads from dromedary camels to humans, with human-to-human transmission, especially in healthcare settings. The outbreak exhibited seasonal and spatial trends, with most cases during camel calving season and in rural areas with high camel populations. The Saudi Ministry of Health implemented a multi-faceted response, including enhancing surveillance, improving infection prevention, providing clinical support, and conducting risk communication. Over time, the response showed a decline in the number of cases and deaths, indicating its effectiveness. The outbreak has significant public health, economic, and social impacts, underscoring the ongoing threat of emerging zoonotic diseases. Key lessons include early case detection, efficient infection control, vaccine and treatment development, public engagement, and strengthening of regional and global collaboration to mitigate future outbreaks and safeguard public health.

From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region.

Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.

Exploring the Potential of the Blue Economy: A Systematic Review of Strategies for Enhancing International Business in Bangladesh in the context of Indo-Pacific Region

This systematic review aims to provide a methodical analysis of the Blue Economy in the Indo-Pacific region, particularly from the perspective of Bangladesh, focusing on its growth trajectory, key stakeholders, policy frameworks, technological advancements, trade and investment trends, as well as challenges and opportunities for international business expansion. The methods employed a comprehensive search of electronic databases, and inclusion and exclusion criteria were applied to identify relevant studies for analysis. The results revealed that from 2000 to 2020, the Blue Economy sectors of the country, such as fisheries, aquaculture, maritime transportation, and tourism, saw notable development. International development agencies, corporations, academic institutions, governments, and civil society organizations are some of the major players in Blue Economy projects. The policy frameworks that facilitate the development of the Blue Economy include integrated ocean management, blue growth initiatives, maritime security and governance, and resilience and adaptation to climate change. Innovation and expansion in the Blue Economy sectors have been fueled by technological breakthroughs, such as autonomous underwater vehicles, renewable energy projects, remote sensing technologies, and marine biotechnology. Rising demand for sustainable goods and services, technical advancement, and regional collaboration have all contributed to an increase in trade and investment in Blue Economy industries internationally. The study concludes that there is significant potential for the Blue Economy in the Indo-Pacific region to drive economic growth, promote social progress, and ensure environmental sustainability. However, challenges such as regulatory complexity, access to finance, inadequate infrastructure, and environmental degradation need to be addressed to fully realize this potential. Addressing these challenges requires coordinated efforts from governments, businesses, academia, civil society organizations, and international development agencies, along with a focus on sustainable and inclusive development practices.

Impact of mitochondrial damage on tumor microenvironment and immune response: a comprehensive bibliometric analysis.

Mitochondrial damage contributes to apoptosis, oxidative stress, and inflammation, which collectively impact the immune system's function and the tumor microenvironment (TME). These processes, in turn, influence tumor cell growth, migration, and response to treatment. We conducted a bibliometric analysis to elucidate the complex interactions between mitochondrial damage, the immune system, and the TME. Data were sourced from the Science Citation Index Core Collection (WoSCC) and analyzed using advanced tools like VOSviewer and Citespace. Our focus was on literature published between 1999 and 2023 concerning the interactions between mitochondrial damage and the TME, as well as immune responses to tumors. The analysis included regional contributions, journal influence, institutional collaborations, authorship, co-cited authors, and keyword citation bursts. Our research encompassed 2,039 publications, revealing an increasing trend in annual output exploring the relationship between mitochondrial damage, TME dynamics, and immune responses. China, the United States, and South Korea emerged as the leading contributors. Prominent institutions included Institut National de la Santé et de la Recherche Médicale, University of Texas System, China Medical University, and Sun Yat-sen University. Key journals in this field are the International Journal of Molecular Sciences, Mitochondrion, and the European Journal of Pharmacology. Liang H and Wallace DC were identified as the most productive and co-cited authors, respectively. Keyword analysis highlighted the critical roles of inflammatory responses, oxidative stress, and the immune system in recent research. This bibliometric analysis provides a comprehensive overview of historical and current research trends, underscoring the pivotal role of mitochondrial damage in the TME and immune system.

Study on the evolution of multi-level collaborative innovation networks in China’s cloud manufacturing industry

ABSTRACT CMfg is a new service-oriented manufacturing mode integrating new-generation information technologies, and its development promotes the digital transformation of China’s manufacturing industry. Exploring the evolution trend of CMfg's co-innovation networks is essential to the development of manufacturing digitalisation. The research is carried out from three levels: The evolutionary characteristics of the organisational co-innovation network in the CMfg industry are identified through SNA and THA; the evolution of technological co-innovation network is analysed by using FP-Growth and the textual analysis, to recognise the technology convergence trends; the evolution of the factors affecting regional collaborations are discovered by using QAP model to analyse the regional co-innovation network. Following conclusions are achieved: CMfg co-innovation is centred on state-owned enterprises in the power and telecommunication industries, with University–Industry collaboration as the main form; the current hot spots of CMfg technologies are the Resource Perception-and-Access, the Resource Virtualisation-and-Service; the regional collaboration in China's CMfg industry tends to be partnership-led and multi-polar. It suggests that: In the CMfg industry, more enterprises-supporting policy should be made, while the Virtualisation-and-Service technologies need more attention, and the partnerships among regions should be further enhanced.

Exploring the Integrated Development of Culture and Tourism in Guangdong, Hong Kong and Macao Greater Bay Area

This study seeks to examine the present status, advantages, and various challenges encountered in the advancement of culture and tourism in the Greater Bay Area of Guangdong, Hong Kong, and Macao, in light of their deep integration. Additionally, the study aims to provide specific strategic recommendations to address these issues. Through a combination of qualitative analyses and case studies, this study provides a comprehensive interpretation of the distribution of cultural and tourism resources, integration mechanisms and policy environment in the Greater Bay Area. The investigation reveals that while the cultural and tourism industry in the Greater Bay Area has exhibited diversification and offers significant opportunities for collaboration, there remain substantial challenges in terms of resource integration and regional coordination. The integration and expansion of the cultural and tourism sectors represent a demanding yet rewarding journey. By fully tapping into their respective cultural characteristics and tourism resources, and strengthening regional collaboration and policy support, the Greater Bay Area is anticipated to evolve into a globally recognized exemplar of integrated cultural and tourism development, exerting a profound and enduring influence on the regional economy.

Tracing the Scientific Legacy: Bibliometric Analysis of LATAM Research in Bariatric Surgery for 33 Years.

Metabolic and bariatric surgery (MBS) has experienced considerable growth, addressing the challenges of obesity and its complications. The lack of a comprehensive bibliometric analysis in Latin America motivates this study, highlighting the need to understand the evolution of research in this area and its impact on clinical decision-making and health policies. A cross-sectional bibliometric study was carried out using the Scopus database. A structured search strategy was designed to identify articles related to bariatric surgery with authors affiliated with Latin American countries. Inclusion and exclusion criteria were applied, followed by a descriptive and bibliometric analysis of the scientific production found. A total of 3553 documents published between 1991 and 2024 were included. There was an annual growth of 11%, with an average age of documents of 7.5years. A concentration was observed in some countries, notably Brazil, Mexico, and Chile. Although scientific output increased, the average number of citations per article showed a downward trend since 2003. Despite the growth in scientific production, the quality and relevance of research is questioned, especially given the decrease in the impact received. It highlights the lack of meaningful regional collaboration, which could limit the sharing of knowledge and resources. Questions are raised about gaps in research capacity and the economic and development implications are discussed. This study provides valuable information to strengthen future research in bariatric surgery in Latin America. It highlights the importance of promoting regional and international collaboration and improving research training in countries with less participation. Clinical intervention strategies can benefit from better understanding research trends and adopting evidence-based practices in a more informed manner.

Climate-Induced Migration: Conflict Resolution and Legal Efforts in Pacific, Africa, and South Asia

Climate-induced migration involves people relocating caused by detrimental climate changes affecting their living environment. Pacific, Africa, and South Asia have experienced climate-induced migration resulting from extreme weather events, sea level rise, drought and desertification, and temperature extremes. The purpose of this research is to find out in terms of conflict resolution, what legal efforts have been made by the government of the affected regions to address climate-induced migration. This study uses descriptive qualitative method and case studies. Based on the results obtained from the data, it was found that the affected governments are pursuing various legal efforts to be able to tackle climate-induced migration. Several efforts made, namely “Migration with Dignity” policy, the Pacific Adaptation to Climate Change (PACC) Project, Great Green Wall initiative, the African Union’s Regional Economic Communities (RECs), Bangladesh’s Climate Change Strategy and Action Plan (BCCSAP), the South Asian Association for Regional Cooperation (SAARC) Disaster Management Centre, and India’s National Action Plan on Climate Change (NAPCC). The regional initiatives mentioned earlier play pivotal roles in implementing these frameworks and fostering collaborative endeavors, whilst the innovative legal frameworks, guided by SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) indicators, ensure that climate-induced migration is addressed effectively. To sum up, dealing with climate-induced migration requires a holistic approach involving regional collaboration and innovative legal frameworks.

Change agency during crises: path development in tourism destinations

ABSTRACT The study explores the role that change agency and regional preconditions play in a region’s path development. To address empirically this research question, the study uses the cases of two destinations in Norway during the COVID-19 pandemic. This research uses quantitative and qualitative data to investigate the industry’s capacity for path development in the face of significant external shocks. The findings reveal marked differences regarding industry adaptation and resilience between the two regions. While one destination struggled with coordination, the other, anchored by the popularity of a major zoo and theme park, demonstrated a more cohesive response. This contrast highlights the pivotal role of regional preconditions and change agency in shaping a destination’s ability to navigate crises. Key conclusions suggest that crises can serve as catalysts for industry development; however, the extent of such transformation is constrained by the regional preconditions, place leadership, and collaboration that a destination can mobilize.

Integrated Management of Hazardous Solid Waste in Dental Offices of Talara (Peru) and Machala (Ecuador): A Policy Brief Comparing Two Latin American Countries

Background The improper management of hazardous solid waste in dental care offices poses significant risks to public health and the environment. Dental offices generate hazardous waste, including biological and chemical contaminants, which can lead to infections, pollution, and harm if not managed properly. Effective waste management practices are crucial, yet compliance varies significantly across regions, especially in Latin America, due to limited resources, inadequate training, and insufficient infrastructure. This study compares hazardous waste management practices in dental offices in Talara, Peru, and Machala, Ecuador, to provide actionable recommendations for improvement. Policy and Implications In Peru, hazardous waste management involves critical steps such as conditioning, segregation, transport, storage, treatment, and disposal. Compliance minimizes exposure risks and environmental contamination. Ecuador emphasizes administrative and operational aspects, including policies, records, training, and procedures. Improving practices in both countries can model enhanced waste management across Latin America. Recommendations To address challenges in Talara and similar Latin American cities, it is essential to strengthen administrative systems, increase budget allocations for waste management, and develop comprehensive training programs. Waste management should be prioritized within public policy agendas with clear guidelines and accountability measures. Both cities need improved resource allocation, modern waste treatment facilities, and centralized storage solutions. Continuous education and certification programs are crucial. Implementing integrated policies, regular reviews, and robust compliance mechanisms based on Machala’s practices can benefit other regions. Public awareness campaigns and regional collaboration through workshops and research initiatives are also recommended. Conclusions Significant disparities in hazardous waste management exist between Talara and Machala. Talara requires strengthened systems and improved infrastructure, while Machala’s practices serve as a model. Tailored interventions can enhance public health and environmental outcomes across Latin America. Regular monitoring, evaluation, and collaboration are essential for sustained improvements.

Examining the Impact of Regional Integration on Peace and Security in East African Community

Attempts at regionalization and integration are increasingly viewed as offering chances for guaranteeing peace, stability, and sustained economic growth in the face of Africa’s numerous security concerns. As a result, organizations dedicated to regional integration and cooperation, like EAC, are beginning to take on the role of conflict resolution experts in their particular areas. Therefore, this study’s primary goal was to evaluate how regional integration contributes to African peace and security. In particular, the study was conducted to determine the various missions that EAC members carried out to restore peace and security in member nations, as well as to assess the effects of various policies created by the EAC to address peace and security concerns among member states. Furthermore, this study exclusively used secondary data. From online books, articles, reports, conference papers, magazines other research papers and assess the effects of the various policies that the East Asian Community (EAC) established to address issues of peace and security among its member states. Additionally, the missions that the EAC members carried out to help member states that needed to regain peace and security and were affiliated with the East were reviewed. Furthermore, it was discovered that regional integration had the subsequent implications for security and peace: strengthened domestic peacekeeping forces by means of regional collaboration; provided members with monetary assistance to sustain peace and security; and made it simple to obtain support and assistance from non-member nations in emergency situations. East Africa is now united as a result of the EAC’s formation. But the EAC still has certain obstacles to the advancement of peace and security as well as regional integration. For instance, it was discovered that certain states are not fully dedicated to regional peace and security strategies, and it was also mentioned that a shortage of resources and training is one of the challenges to implementing peace. for these reasons I would recommend that members states pay on time their contribution, members states should be committed to the agenda of the community a finally, states should resolve conflicts between and among themselves.

Assessing the March 2024 Pakistan Airstrikes in Afghanistan

This Essay assesses Pakistan's evolving strategy towards Afghanistan, characterized by increased coercion, stringent border controls, and plans to repatriate one million documented Afghans. Additionally, it explores the potential for regional collaboration, particularly with China, emphasizing China's role in exerting diplomatic pressure on Kabul and mediating with the Afghan Taliban. This analysis highlights the complex geopolitical dynamics and strategic considerations influencing Pakistan's actions.