Reasonable Decisions Research Articles

SPECIFIC FEATURES OF THE RENEWAL OF PROCESS IN CIVIL AND ADMINISTRATIVE PROCEEDINGS

Court decisions are acts of justice and protection of human rights, which, once they have entered into force, must be complied with by all persons, institutions, organizations and public authorities. However, in order to maximize the protection of personal rights and minimize possible errors in court procedural decisions, the legislation regulating court proceedings provides for a number of forms of verification of the legality and reasonableness of court procedural decisions. In applying the renewal of process, as an exceptional stage of court proceedings, it is important to ensure the protection of legal stability, legal certainty, the protection of the rights and fundamental freedoms of persons acquired by final judgments, and the stability of the substantive legal relations established. Convention for the Protection of Human Rights and Fundamental Freedoms the right to a fair trial, guaranteed by Article 6(1) of the Convention, emphasizes one of the essential elements of the principle of the rule of law: the principle of legal certainty, which implies respect for the principle of res judicata (the court's having finally settled the matter, i.e. the prohibition of an identical action). This principle requires that, once the courts have finally settled a dispute, their decision must not be called into question, thus ensuring the stability of relations. The grounds for reopening proceedings as an exceptional stage must therefore be applied informally and in accordance with the principle of legal certainty, so that reopening of proceedings is possible only for the correction of fundamental errors in important and compelling circumstances. The article presents and discusses on the institute of reopening of proceedings in civil and administrative court's proceedings from a comparative perspective, the main procedural peculiarities of this type of issues in different jurisdiction courts, and draws certain conclusions on the main topics of the renewal of process in both civil and administrative cases. A comparison of the procedural laws governing civil and administrative proceedings and the case-law developing them shows that the essential provisions of the institute of reopening of proceedings make this stage of the proceedings exceptional and optional. The definiteness and clarity of the legal regulation guarantee that this stage of the proceedings complies with the provisions of the Convention on the guarantee of the right to a fair trial.

Views and opinions of the general public about the reimbursement of expensive medicines in the Netherlands.

Solidarity-based healthcare systems are being challenged by the incremental costs of new and expensive medicines for cancer and rare diseases. To regulate reimbursement of such drugs, the Dutch government introduced a policy instrument known as the Coverage Lock (CL) in 2015. Little is known about the public opinion regarding such policy instruments and their consequences, i.e., reimbursement of some, but not all, expensive medicines. We aimed to identify the preferences of Dutch citizens regarding the reimbursement of expensive medicines, and to investigate the views of the public on the use of the CL as a healthcare policy instrument and their input for improvement. Web-based survey of a representative sample of 1999 Dutch citizens aged 18 years and older (panel of research company Kantar Public). Potential respondents were approached via e-mail. Several policy measures, real-life cases and statements related to the CL were presented in the survey to respondents. Their responses were analysed by tabulating descriptive statistics (proportions and percentages). 1179 individuals (response rate 59%) filled in the questionnaire. Although a majority considered the CL policy unjustified, they preferred it to the alternative policy measures that were presented. In four real-life case descriptions of patients in need of expensive medicines, respondents most often indicated effectiveness, lack of availability of alternative treatment and improved quality of life due to treatment as reasons for a positive reimbursement decision. An unfavourable cost-benefit ratio was their main reason to be against reimbursement. Some argued that withholding reimbursement was a way of informing manufacturers that extremely high prices are unacceptable. There is public support for patients in need of expensive medicine. Many respondents supported the CL as a reimbursement policy. However, there is a wish to optimize the interpretation of the assessment criteria and the weight these are attributed in decision making about reimbursement of expensive innovative medicine for patients.

Early treatment discontinuation in patients with deficient mismatch repair or microsatellite instability high metastatic colorectal cancer receiving immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitors (ICIs) are recommended to treat patients with deficient mismatch repair/microsatellite instability high (dMMR/MSI-H) metastatic colorectal cancer (mCRC). Pivotal trials have fixed a maximum ICI duration of 2...

Some issues of formation of economic competence of non-economic specialty students

The article presents the experience of formation and development of economic competences of non-economic specialty students. The modern world is quite complex, diverse, and multidimensional, in order to adapt to it, work effectively, it is necessary to have information about market relations, relations in the sphere of production, consumption, exchange, distribution, and also to be able to connect these areas, navigate the laws operating in these areas. It should be noted that the formation and development of a specialist’s economic competence occurs throughout his or her entire professional life. In our study, the process of forming economic competence is considered as its formation at the stage of mastering economic disciplines, relevant special courses and methodical support. Training in higher education should lead to the acquired knowledge being transferred into the activity of combining elements into an interconnected structure, into the skillful distribution of resources, into the activity that brings profit and has the form of capital investment, in other words, the individual, acquiring knowledge for himself, should be able to transform it into a socially significant value. This requires the search for and implementation of new approaches in the content and organization of the educational process at all levels of education. Research devoted to the role of education in the preparation of future non-economists for economic competence focuses on the preparation of an individual for the economic literacy of an entrepreneur. One of the main tasks of the education system should be preparation for successful socialization in the context of involvement in entrepreneurial relations. It is students and young specialists who have advantages in entrepreneurship in the current conditions: they have the opportunity to obtain specialized knowledge and skills in the field of economics; they can start their own business, relying on economic knowledge. Therefore, the role of higher education is increasing, since it helps to meet the needs of society and implement its socially significant goals. This poses new challenges for universities to transfer the necessary economic knowledge, skills and abilities to students, and to develop their economic competence. The development of basic economic competences in a student is a guarantee of his competitiveness in the labor market and the basis for making reasonable economic decisions in the daily life of every person.

Who, if not science, can you trust to guide you through a crisis? The relationship between public trust in science and exposure to established and alternative online sources in times of crisis

In light of global crises such as COVID-19, we argue that people’s trust in science drives their media choices in the digital sphere. The results from a German online survey show that individuals who perceive scientists as trustworthy in terms of ability, benevolence, and integrity, confidently expect science to provide accurate knowledge and guide reasonable decision-making in times of crisis. In turn, these positive trusting expectations towards science increase the use of established journalistic and scientific online sources for accessing scientific information. In contrast, people with low or no trust in science tend to resort to the messenger Telegram and ‘alternative’ online media outlets. Interestingly, the individual need for orientation does not amplify this association between trust in science and digital media use in a crisis situation.

Retraction notice: Purchase intention of organic foods: are lifestyles of health and sustainability the reason for my purchase decision?

Retraction notice: Purchase intention of organic foods: are lifestyles of health and sustainability the reason for my purchase decision?

The critical thinking approach to tactical development in team sports: a review of the work of Jean Francis Gréhaigne

ABSTRACT Background: Critical thinking underlies tactical ability, and in the sporting context, it is known as reflective thinking that is used to make reasonable and defensible decisions in movement tasks. Critical thinking and sports tactics can then be described as analytical processes that involve solving situations in a reflective way. It is through experiences and discussions around experiences that more meaningful learning is generated (Godbout and Gréhaigne 2022). If we want to develop the tactical ability of players and, therefore, their decision-making ability, we should try to improve their critical thinking skills. Purpose: The purpose of this study was to review French Professor Jean Francis (J.F.) Gréhaigne's research on tactical development in team sports from a critical thinking perspective to enhance player decision-making. Gréhaigne, a professor in the Department of Sports Science and Physical Activity at the Institute for Teacher Education of Franche-Comté in Besancon, France, has dedicated his research career to identifying the elements associated with the teaching and pedagogy of team sports. His work is particularly noteworthy in that it proposes that critical thinking underlies tactical ability; it means that before a motor action, there must be an analysis of the situation, and this analysis must be explicit for the current moment. Method: A reflexive thematic analysis was conducted using electronic databases of research articles published before September 2021. The databases utilized were SCOPUS and Google Scholar. The search did not target any exclusive journal but focused on articles where Professor J.F. Gréhaigne was the lead or co-author, specifically related to tactical development and critical thinking in team sports. Although the search was primarily conducted in English, French works were also considered due to the author’s linguistic capabilities and the relevance of Professor Gréhaigne's contributions. A total of twenty articles were included in the documentary analysis. Results: According to the contributions of Professor J.F. Gréhaigne, it is possible to recognize that the proposals based on tactical development in team sports arose from the need, mainly, to identify a pedagogical didactic process that sought to develop analytical abilities in line with the reality of the game. Recognizing the game as a dynamic, chaotic, and uncertain system reveals that the way in which its development should be approached should be far from rigid pedagogical structures. Conclusions: Critical thinking is always essential for team sports players during the game. Pedagogical proposals should focus on developing players’ critical awareness and analytical capacity so that they can solve spontaneous situations on their own. This study is the first reflexive thematic analysis of the work developed by Professor J.F. Gréhaigne related to critical thinking and tactics in team sports. The findings of this study provide significant information and directions for the future development of tactical skills in team sports.

Analysis of JD Logistics Acquisition of Deppon Express

With the rapid development of the Internet economy, logistics has fully penetrated all aspects of human beings’ lives, and many logistics companies occupy the logistics market. To cope with market changes and for other reasons, many companies choose the way of acquisition. Since 2014, China's logistics enterprises have mushroomed, forcing enterprises to restructure and acquire. The policy environment created by the government also encourages enterprises to make acquisitions to achieve the optimal allocation of market resources. This study will take the acquisition of Deppon Express by JD Logistics as an example, describe the entire acquisition event, and analyze whether the acquisition is successful by combining the existing triple risks and corporate performance. Based on the research content, it is found that the acquisition is beneficial and brings broad development prospects to the logistics market, but the acquisition also brings risks, and JD Logistics faces the pressure of accounts receivable in the performance of the company. Therefore, enterprises should evaluate the risks in advance and make reasonable decisions.

Preferences of melanoma patients to accept adjuvant therapy and toxicity – a qualitative substudy of the GerMelaTox-A project

PurposeTargeted treatment and immunotherapy, both adjuvant treatment options, come with a certain toxicity and can cause severe side effects. To date, data about the underlying reasons for patients to accept or reject specific types of adjuvant therapy is scarce. Therefore, this study investigates the motives of melanoma patients for tolerating or rejecting adjuvant therapy and its side effects.MethodsWe conducted semi-structured interviews with a subsample of patients to investigate the underlying reasons for treatment decisions in a quantitative treatment-trade off study. Categorisation was conducted using qualitative content analysis.ResultsThe 17 participants had a mean age of 55.5 years and 12 were female. The final category system covered three clusters. The cluster “type of therapy and therapy process” described therapy-related aspects that affect acceptability of adjuvant treatments. Prospect of treatment benefit and side effects were important aspects. Route of administration and physician visits should be convenient. The cluster “way of living” described the influence that activities and circumstances of life organisation have on acceptability. Participants wished treatment to affect everyday life as little as possible. Maintaining sufficient quality of life was mentioned to be crucial. The cluster “emotions and feelings” described optimism and hope but also mental strain originating from possible treatment options.ConclusionPatients in our study indicate high willingness to undergo adjuvant therapy, even when facing toxicity. The evaluation of potential side effects and prospects of treatment benefit is highly individual. Therefore, it is important to consider personal patient preferences to make appropriate and shared decision-making.

RANK REVERSAL IN ECONOMIC DECISION MAKING

Economic decision making is often based on a sequence of ranking alternatives to ensure reasonable decisions. Cases of rank reversals, in which the order of preference of choices is altered by the introduction or removal of options, present important issues. This study examines the occurrence of degree of change characterized by uncertainty in economic parameters in environment Z. The study examines the causes of rate fluctuations and their implications for economic theory and practice using advanced decision-making models and simulations The findings show that rank change in environment Z is not only a theoretical irregularity, but also a real concern that can lead to bad economic outcomes. This study presents a relatively low-complexity, theoretically driven, and comprehensive method to decision-making under bimodal uncertainty, as represented by Z-numbers. The suggested technique for making decisions is based on the consistency-driven preferences creation method, and the eigenvector determination method of Z-number valued matrixes. The study concludes with recommendations to avoid rate-shifting in economic decision-making, emphasizing the need for vigorous modeling approaches and sensitivity analysis. The recommended method's correctness and viability are demonstrated with an numerical example using Z-lab tool created for calculation of Z-numbers and sets. Keywords: Z-number, economic decision making, consistent preferences.

The Reasoning of Judicial Decisions as Principle for a Due Process of Law

One of the main principles of the civil procedural law is to reason the court decisions. This principle comes as an obligation of the court and as a right to be familiar with a reasoned decision. The good reasoning of decisions secures transparency and accountability. It addresses to the parties and aims to show them why someone won and why the other part lost, supporting the standard of a due process of law. The reasoning of the court decisions limits the arbitrariness and ensures correctness in making it. A reasoned court decision clearly presents the legal issue relevant to the resolution of the dispute. The judge summarizes the most important facts of the case and explains the legal principles that are aplayed to the specific case. He makes a detailed analysis of the application of legal principles in relation to the facts of the case, where the type of decision-making clearly emerges. But what does a reasoned decision means? Is the provision of the first paragraph of the Article 142 of the Constitution in the Republic of Albania absolute? Received: 2 August 2024 / Accepted: 10 November 2024 / Published: 3 December 2024

Multi-vehicle dynamic interaction in autonomous driving: integrating game theory and the potential field method

Lane-changing behaviour is more complex and riskier than lane-keeping, posing challenges for autonomous vehicle decision-making. To address this issue, this study modelled the decision-making process of lane-changing behaviour by combining Stackelberg game theory with the potential field method. The potential field method analyzes dynamic interactions between multiple vehicles, while game theory quantifies the efficiency and safety benefits of lane-changing. Subsequently, a decision-making model for multi-vehicle interaction was established by integrating game theory and the potential field method. Finally, the lane-changing trajectory was optimised for maximum driving benefit. A simulation of lane-changing behaviour was used to validate the performance of the proposed model. The results indicated that the proposed method leads to a higher average velocity (20.07 m/s), faster lane changing (3.14 s) and lower computational costs (0.075 s) than the rule-based method (19.21 m/s, 4.04 and 0.17 s, respectively). This finding can provide a reference for reasonable decision-making for autonomous vehicles.

Evaluation of Tolerance Selection Strategies and Multifidelity Techniques in ABC Methods

Approximate Bayesian Computation (ABC) methods provides a flexible and robust framework for solve model fitting problems, particularly pertinent to complex models with intractable likelihood functions. This methodology is based on approximating a simulated parameter values through auxiliary data and evaluating the distance of this data with the true dataset. Effective implementation of these methods require reasonable decisions to be made about the selection of ABC techniques and how to implement the algorithm to ensure computational efficiency. A comprehensive understanding of these factors facilitates a more accurate inference about the model. This study aims to explore the impact of the tolerance selection and the integration of Multifidelity techniques to the convergence and cost of the method. In the initial approach, three methods of choosing tolerances are employed: a predefined vector, a percentile calculation, and a percentage calculation based on the distance vector obtained from model simulations, in order to verify the most effective strategy for the improvement of the inference process. Subsequently, the optimal approach of tolerances selection is combined with Multifidelity techniques to reduce the computational cost. This methodology is applied in the examination of infectious disease models of differential equations. This study aims to highlight the importance of careful decision-making when using ABC methods, through the evaluation of some approaches for choosing tolerance in combination with techniques that aim to reduce the computational cost in constructing samples in ABC methods. Through this analysis, we focus our efforts on trying to demonstrate insights about gains in computational efficiency and accuracy in results.

Research on the Driving Paths and Evolution of Digital Innovation in Intelligent Connected Vehicle Enterprises—A Configurational Analysis Based on Dynamic fsQCA

Intelligent connected vehicles (ICVs) are increasingly emerging as a pivotal driving force for promoting sustainable development in global transportation due to their outstanding performance in mitigating carbon emissions, alleviating traffic congestion, and enhancing travel efficiency. Enhancing the digital innovation capability of ICV enterprises is an imperative path to explore high-quality industry development and effectively respond to the latest technological revolution and industrial transformation. Based on the panel data from 20 listed companies in the ICV industry in China from 2019 to 2022, this study utilizes a fixed-base index and fuzzy set qualitative comparative analysis (fsQCA) method within the framework of technology–organization–environment (TOE) theory to investigate the influencing factors, driving paths, and temporal trends of digital innovation in ICV enterprises in China. The results show the following: (1) No single factor can constitute a sufficient condition for achieving a high level of digital innovation. (2) The level of digital innovation of ICV enterprises in China showed a fluctuating growth trend during 2019–2022. Digital infrastructure and market competition are the two critical factors for digital innovation, while technology and organizational conditions have become bottlenecks. (3) There are five driving paths of digital innovation in ICV enterprises in China, including the Entrepreneurial Navigation + Technology Accumulation Driving Path, R&D Advantage + Environment Driving Path, Application Oriented + Environment Driving Path, Knowledge Absorption Driving Path, and Total Factor Driving Path. (4) From 2019 to 2022, the digital innovation of ICV enterprises in China underwent two stages of evolution, namely “Knowledge Absorption + Government Promotion” to “Technology Embedded + Market Driven”. (5) A substitutive relationship exists between digital resource acquisition capabilities and digital infrastructure, which promotes digital innovation through different paths leading to the same goal. The findings of this study have important theoretical and practical implications for ICV enterprises in making scientific and reasonable digital innovation decisions, thereby fostering the sustainable development of the automotive industry.

The “Ought” Involving Requirements of Rationality and the “Ought” Involving Reasons

What we ought to do seems to be influenced by two different elements. One is our beliefs and intentions; the other is the requirement of rationality. There are, correspondingly, two approaches of explaining ‘ought’ statement, one goes the way that ‘ought’ associates an agent with something he has reasons to do, the other goes that ‘ought’ represents the rational requirement that demands agent’ actions to be consistent with her attitude towards propositions. In this paper, I try to analyze the grammatical basis and normative characteristics of the above approaches. I argue that the two approaches can be combined because our attitude to propositions requires us to produce reasons for action, and rationality ensures that we rationally get decisive reasons for our actions through a set of rational principles.

ТЕХНІЧНА КУЛЬТУРА МЕНЕДЖЕРІВ СТРАТЕГІЧНОГО ПЛАНУВАННЯ Й РОЗВИТКУ В ОРГАНІЗАЦІЯХ: ТЕОРЕТИЧНІ ТА МЕТОДИЧНІ АСПЕКТИ

Strategic planning involves defining the organization’s long-term goals and ways to achieve them through the development and implementation of strategies. In the military sphere, strategic planning managers play a key role in ensuring the efficient use of military resources, achieving national defense goals, and responding to possible threats. The article reveals that technical culture is a set of knowledge, skills, values and practices related to the effective use of technologies, technical means and methods in professional activities. It includes not only knowledge of technical aspects, but also the ability to apply them rationally, improve them, and integrate them into work processes. Technical culture reflects the level of technical awareness, innovation and ability to adapt to new technological challenges. The technical culture of strategic planning managers encompasses a set of knowledge, skills, and values that allow effective use of modern technologies and tools to make reasonable decisions in strategic management. Among the components of technical there is the ability to analyze data, innovate, and coordinate resources to achieve the goals of the organization. The aim of the article is to reveal the theoretical and methodological aspects of formation and development of technical culture of strategic planning managers, its essence and content. The methodology of the study is based on an integrated approach that combines several research methods for a comprehensive analysis. The main components of such a methodology involve the analysis of scientific and educational sources related to technical culture, strategic planning and management of organizations; obtaining information about the essence and content of technical culture; identifying traditional and innovative forms and methods of formation and development of technical culture; generalizing the data obtained, making conclusions about the impact of managers’ technical culture on strategic planning. Conclusions. Effective formation of the technical culture of strategic management managers in higher education institutions can be achieved through interactive forms of learning, such as simulation games, project-based learning, and gamification. The use of methods such as flipped learning, adaptive learning, and cross-disciplinary teams helps engage students and develop their analytical and technological skills. Such approaches provide the practical experience needed to successfully integrate technology into strategic management. Key words: technical culture, strategic management managers, higher education institutions, interactive forms of learning, innovative teaching methods, strategic planning.

Seasonal variations in the association between proteinuria, CKD, and kidney failure.

Proteinuria exhibits seasonal fluctuations, decreasing in summer and increasing in winter. It is unknown whether the association between proteinuria and the risk of kidney failure varies by season. The Osaka Consortium for Kidney Disease Research (OCKR) database contained retrospective data from 15 367 patients with estimated glomerular filtration rates of 10-60mL/min/1.73m2, who were referred to the Department of Nephrology at five clinical centers in Japan, between 2010 and 2021. Multivariate Cox models were used to examine the associations of urinary protein-to-creatinine ratio (UPCR) in summer (UPCRsummer) and winter (UPCRwinter) with kidney failure defined as initiation of kidney replacement therapy. LASSO was used to compare the strength of the association between UPCRsummer and UPCRwinter with respect to kidney failure. We also assessed whether seasonal fluctuations in UPCR were associated with kidney failure. The median [interquartile range] UPCRwinter was 0.89 [0.22, 2.69] g/gCre, 46% higher than UPCRsummer (0.61 [0.16, 1.87] g/gCre). During a median follow-up of 3.0 years, 1 585 patients developed kidney failure. In time-dependent Cox models, UPCRwinter showed a higher hazard of kidney failure (1.66 per 1-standard deviation [SD] increase; 95% confidence interval [CI], 1.60-1.73) than UPCRsummer (1.45 per 1-SD increase; 95%CI, 1.41-1.48). LASSO identified that UPCRwinter was more strongly associated with kidney failure than UPCRsummer. Furthermore, higher % changes in UPCRwinter relative to UPCRsummer was associated with a higher hazard of kidney failure. Proteinuria in winter exhibited stronger associations with kidney failure than that in summer. Seasonal fluctuations in UPCR should not be overlooked in the management of CKD to make reasonable clinical decisions.

The Application of GCN Algorithm in Building Construction Knowledge Graph Updating under the Combination of Artificial Intelligence and Knowledge Management

To promote the updating and iteration of the construction field, the construction knowledge graph can expand the professional knowledge system within the field and provide scientific and reasonable management decisions. The research adopts deep learning technology to update the knowledge graph in computer vision. The specific update method is to extract entities and analyze entity relationships in the framework of the knowledge graph, to achieve the application of the knowledge graph in the field of construction. Afterwards, a graph convolutional neural network is used to integrate semantic information and construct a network model of semantic embedding vectors. Finally, zero sample learning technologies are combined to enhance prior information during the construction process, thus demonstrating a better backward process for updating iterations. Through testing and validation of the dataset, it is found that the highest TOP-1 accuracy of the zero sample object detection model is 77%, 30%, and 45%, respectively, under different proportions of the dataset. The TOP-1 accuracy of the zero sample action recognition model increases by 22%, 23%, and 41%, respectively, compared to the former. In addition, the detection model combined with semantic embedding vectors has an average accuracy of 45% for unknown class tasks at a ratio of 8:2. This proves that the performance of the zero sample human object interaction detection model based on semantic embedding vectors is superior, providing a knowledge foundation and theoretical support for the updating of knowledge graphs in the field of construction.

Assessing Project Resilience Through Reference Class Forecasting and Radial Basis Function Neural Network

A project needs to be able to anticipate potential threats, respond effectively to adverse events, and adapt to environmental changes. This overall capability is known as project resilience. In order to make efficient project decisions when the project is subjected to disruption, such as adjusting the project budget, reformulating the work plan, and rationalizing the allocation of resources, it is necessary to quantitatively understand the level of project resilience. Therefore, this paper develops a novel approach for forecasting project performance, illustrating the changes in performance levels during the disruption and recovery phases of a project and thus quantitatively assessing project resilience. While there are several methods for assessing project resilience in existing research, the majority of assessment approaches originate from within projects and are highly subjective, which makes it difficult to objectively reflect the level of project resilience. Moreover, the availability of project samples is limited, which makes it difficult to forecast the level of project performance. In view of the fact that the Reference Class Forecasting (RCF) technique avoids subjectivity and the Radial Basis Function (RBF) neural network is known to be better at forecasting small sample datasets, this paper therefore combines the RCF technique and the RBF neural network to construct a model that forecasts the project performance of the current project after experiencing a disruption, further assessing the level of the project resilience. Specifically, this paper first presents a conceptual model of project resilience assessment; subsequently, an RBF neural network model that takes into account project budget, duration, risk level of disruption, and performance before disruption based on the RCF technique is developed to forecast project performance after experiencing disruption; and finally, the level of project resilience is assessed through calculating the ratio of recovery to loss of project performance. The model is trained and validated using 64 completed construction projects with disruptions as the datasets. The results show that the average relative errors between the forecast results of schedule performance index (SPI) and the real values are less than 5%, and the R2 of the training set and the testing set is 0.991 and 0.964, respectively, and the discrepancy between the forecasted and real values of project resilience is less than 10%. These illustrate that the model performs well and is feasible for quantifying the level of project resilience, clarifying its impact on project disruption and recovery situations, and facilitating the decision-makers of the project to make reasonable decisions.

Analysis of Clinical Utility of Functional MRI in Neurosurgical Decision-Making in Focal Epilepsy.

Functional MRI (fMRI) has proven valuable in presurgical planning for people with brain tumors. However, it is underutilized for patients with epilepsy, likely due to less data on its added clinical value in this population. We reviewed clinical fMRI referrals at the QEII Health Sciences Center (Halifax, Nova Scotia) to determine the impact of fMRI on surgical planning for patients with epilepsy. We focused on reasons for fMRI referrals, findings and clinical decisions based on fMRI findings, as well as postoperative cognitive outcomes. We conducted a retrospective chart review of patients who underwent fMRI between June 2015 and March 2021. Language lateralization represented the primary indication for fMRI (100%), with 7.7% of patients also referred for motor and sensory mapping. Language dominance on the side of resection was observed in 12.8% of patients; in 20.5%, activation was adjacent to the proposed resection site. In 18% of patients, fMRI provided an indication for further invasive testing due to the risk of significant cognitive morbidity (e.g., anterograde amnesia). Further invasive testing was avoided based on fMRI findings in 69.2% of patients. Cognitive outcomes based on combined neuropsychological findings and fMRI-determined language dominance were variable. fMRI in epilepsy was most often required to identify hemispheric language dominance. Although fMRI-determined language dominance was not directly predictive of cognitive outcomes, it helped identify patients at low risk of catastrophic cognitive morbidity and those at high risk who required additional invasive testing.