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Introduction: The Affordable Care Act (ACA) provided states and Washington D.C. the option to expand Medicaid coverage to beneficiaries with incomes up to 138% of the Federal Poverty Line. Expanded coverage went into effect in Washington D.C. on January 1, 2014. Insurance coverage, however, does not necessarily equate to access. This holds especially true for low-income, public insurance such as Medicaid as fewer providers accept this insurance. Colorectal cancer (CRC) screening is important for detecting precancerous colonic lesions and preventing progression to future disease. This study compares the rate of CRC screening in appropriately aged individuals on public insurance and in their privately insured counterparts. Methods: Individuals attending an August 2015 health exposition sponsored by the Rodham Institute completed an anonymous health survey. The exposition was hosted at a community center in an urban location with a historically African American predominant population. The survey included questions on demographic information, insurance information, access to primary care, and CRC screening. Data from the survey was analyzed in a Microsoft Excel database. Insurance types were classified as public insurance (Medicaid and other District government sponsored programs) or private insurance (Blue Cross, Aetna, etc.). Surveys were excluded if specific questions of interest were left unanswered. Statistical analysis was performed using Fisher's exact test, with significance set at P<0.05. The study was approved by the university's institutional review board. Results: There were 102 participants with an average age of 42.4. Ninety-three (91.2%) identified as African American. Fifty-six (54.9%) respondents had public insurance and 28 (27.4%) had private insurance. Twenty-nine (51.8%) of those with public insurance enrolled within the past 18 months, 25 (44.6%) enrolled earlier, and 2 participants did not respond. Given the predominantly African American population and the recent CRC screening ...

In the post-9/11 period a common belief emerged that fragile states are launching pads for unprecedented and unconventional transnational threats. The rise of state fragility or state failure as a paradigm surfaced after the end of the Cold War, but their high risk factor was noticed only later. This is because increased interconnectedness allows information to spread faster and intensifies threat perceptions. This study recognizes that the idea of weak states, small states, and political decay existed before, and that the notion of state fragility has been widely used in recent years. The conventional wisdom about political decay refers to the ineffectiveness of institutions and corrupt governance structures which enfeeble the state, and which is similar to the current literature focused on domestic factors. To understand the fragility of statehood, the study answers the following research question: "Under what conditions do weak and fragile states continue to fail?" The analysis explores two core factors: endogenous and exogenous. The academic literature primarily focuses on endogenous factors, mainly political, security, economic, and social performance of states, to determine state capacity and capabilities. However, this study adds geography, or geopolitics, as an exogenous factor causing state fragility in many cases. Therefore, the study suggests a new category, "weak pivot states" in which fragility is not only the outcome of domestic factors but is also due to its geography and position as a "pivot." The evidence suggests that the impact factor of "weak pivot states" is higher than other weak and fragile states, as they are more susceptible to great power struggles. As "weak pivot states" sit at the crossroads of major and regional powers' interests, one of the findings of this dissertation demonstrates that major powers have often supported undemocratic forces, with centralized authoritarian regimes benefiting the interests of a hegemon. The reduction of the threat level requires the provision of stability and the implementation of an effective political order. The findings suggest that fragile states need to reorient their constitutions and laws so as to create opportunity of equality and inclusiveness to its populations. In addition, the dissertation recommends the creation of "spheres of socialization" at intra-state and inter-state level that will allow education for democracy towards state building and establishing accountable political systems instead of interventions in weak and fragile states; and also facilitate an integration process at sub-regional, regional and then global level to tackle the burden of geography respectively.

Abstract Background The Government of Pakistan identified 4 medical Colleges for introduction of COME, one from each province. Curriculum was prepared by the faculty of these colleges and launched in 2001 and despite concerted efforts could not be implemented. The purpose of this research was to identify the reasons for delay in implementation of the COME curriculum and to assess the understanding of the stakeholders about COME. Methods Mixed methods study design was used for data collection. In-depth interviews, mail-in survey questionnaire, and focus group discussions were held with the representatives of federal and provincial governments, Principals of medical colleges, faculty and students of the designated colleges. Rigor was ensured through independent coding and triangulation of data. Results The reasons for delay in implementation differed amongst the policy makers and faculty and included thematic issues at the institutional, programmatic and curricular level. Majority (92% of the faculty) felt that COME curriculum couldn't be implemented without adequate infrastructure. The administrators were willing to provide financial assistance, political support and better coordination and felt that COME could improve the overall health system of the country whereas the faculty did not agree to it. Conclusion The paper discusses the reasons of delay based on findings and identifies the strategies for curriculum change in established institutions. The key issues identified in our study included frequent transfer of faculty of the designated colleges and perceived lack of: · Continuation at the policy making level · Communication between the stakeholders · Effective leadership

Purpose
This study aims to explore the strategies corporations use in engaging stakeholders to sustain healthy corporate partnerships and create value for the corporate entity and the society in which they operate and their influence on the corporate manager's cognitive abilities and decision-making.


Design/methodology/approach
The authors used an interpretive research approach leveraging the strengths of qualitative method of content analysis and comparative and critical analyses to report the results. Interpretive methods incorporate social theories and standpoints that view reality as the social construction of understandable events in the context of organizational communication.


Findings
The findings of this study suggest that corporations are assumed to follow and execute the principles of engaging stakeholders to achieve corporate social responsibility (CSR) claiming to manage a sustainable and responsible business practices that recognize local cultures, human rights and protect the environment. However, little attention has been paid to the cognitive reasoning of the individuals responsible for CSR and corporate sustainability (CS) as opposed to the growing concerns about strategies corporations use in engaging stakeholders to sustain healthy corporate partnerships and create value – especially the processes that take place during engagement and decision-making including cognitive offloading.


Practical implications
Stakeholder engagement requires practical approaches that enable corporations and individuals charged with decision-making responsibilities to understand, respond and fulfill their CSRs. To achieve CSRs, corporations and managers responsible for relevant decision-making would need to involve stakeholders in social performance planning, as social reporting/auditing has long been advocating for preventing managerial biasness, groupthink and increased information dissemination via detailed reporting practices toward more collaborative stakeholder relationships. Thus, it is crucial for corporations to implement enhanced stakeholder and managerial decision-making strategies such as integrative approaches to achieve balance in the trio elements of sustainability as well as the growing use of paradox perspective to understand the nature of the tensions being sought to balance and, in the process, provide opportunity for a better evaluation of complex sustainability issues for innovative approach to resolving them. While cognitive decision-making is at play, in practice, managers tasked with making decisions must ensure the most effective stakeholder engagement strategies that are transparent and inclusive are used.


Originality/value
The main contribution of this study is its argument regarding the tools corporations use in engaging key stakeholders and the cognitive reasoning of the individuals responsible for CSR and CS. The study further contributes to interpreting the integrative approach to achieving balance in the trio elements of sustainability as well as the growing use of paradox perspective to understand the nature of the tensions being sought to balance and, in the process, provide an opportunity for a better evaluation of complex sustainability issues for an innovative approach to resolving them.

Several trends show that the efforts to alter South Asian strategic landscape have increased, which primarily includes unprecedented proliferation of technology to India. This has exacerbated Pakistan's security dilemma and is a matter of significant concern for South Asian security environment. Militaries worldwide are preparing for a new warfare trend in emerging technologies that include artificial intelligence and machine learning-based autonomous weapon systems, robotics, hypersonic weapons, and quantum technologies. These technologies are expected to change the character of war besides affecting geopolitical competitions and rivalries. It is pertinent to analyse the impact of these new technologies on regional rivalries to identify and implement effective solutions, thus mitigating potential risks and preventing the occurrence of a catastrophe. As several states are developing AI-based Lethal Autonomous Weapon Systems, capable of targeting without human supervision, possible exploitation of these technologies by nuclear-armed states may increase the risk of war leading to more aggressive nuclear postures. Such a risk would be higher in South Asia as the ballistic missile flight time would be less than ten minutes, and conventional military interactions of rival states could occur near a long border. The integration of autonomy into conventional weapons and nuclear systems has the potential to undermine strategic stability and will be a quick recipe for accidents and miscalculations. This study explores the region's threat perceptions and analyses the potential use of LAWS and how it can impact nuclear deterrence and strategic stability of South Asia. This study hypothesizes that LAWS will lower the nuclear threshold in the region and undermine deterrence stability.

Bibliography Entry
Masood, Maryyum and Muhammad Ali Baig. 2023. "Potential Impact of Lethal Autonomous Weapon Systems on Strategic Stability and Nuclear Deterrence in South Asia." Margalla Papers 27 (2): 27-43.

AbstractFlipped learning has garnered substantial attention as a potential means to enhance student engagement, improve learning outcomes, and adapt to the evolving educational landscape. However, despite the growing interest and potential benefits of flipped learning, several challenges and areas of concern persist. This systematic literature review critically examines the implementation of the flipped classroom in higher education by focusing on the role of technologies and tools, pedagogical activities and courses, and existing challenges. Using a systematic approach, a total of 30 research articles published between 2014 and 2023 were chosen for the review. This study identified video creation tools, learning management systems (LMS), content repositories, collaborative platforms, podcasts, and online assessment tools as technologies that play a central role in the flipped classroom. Moreover, this study identifies specific pedagogical activities within different courses that contribute to the effectiveness of flipped learning in higher education. The implementation challenges that teachers and students may face in the flipped classroom were presented, and potential strategies to alleviate these challenges were provided. This study will contribute to a more comprehensive understanding of flipped learning's benefits, technologies and tools, challenges, and potential to improve higher education.