Physicians have developed a number of implicit and explicit approaches to complex medical decisions. Decision analysis is an explicit, quantitative method of clinical decision making that involves the separation of the probabilities of events from their relative values, or utilities. Its use can help physicians make difficult choices in a manner that promotes true patient participation. Decision analysis also provides a framework for the incorporation of data from multiple sources and for the assessment of the impact of uncertain data on (...) the final decision. Although this approach is imperfect, it represents a significant advance in clinical decision making. (shrink)

Today, the risk management of budget challenges throughout the budget process is greater than ever. The process of change has been driven by new information and communication technologies, resulting in e-government. The purpose of this scientific paper is to see whether budgetary challenges have an effect on the performance of e-government in complex financial systems based on factors F1, F2, F3, F4, and F5: lack of information, lack of cooperation, lack of resources and reduction of focus, lack of budget experts (...) and financial stability, and shortcomings and inconsistencies during the budget process. Therefore, this study aims to advance the understanding of how to manage risks from budgetary challenges by focusing on a novel approach to improve e-government performance in complex financial systems. Empirical research was based on three key issues: an approach to e-government, analyzing which variables need more attention to risk, and learning how to meet budgetary challenges to improve performance during governance. For this study, the data were conducted by Kosovo’s public institutions, more specifically at the central level and at the local level. A total of 38 questionnaires were analyzed and divided into three sessions, which were analyzed through three analyses, such as factor analysis, data reliability analysis, and multiple regression analysis, using SPSS version 23.0 for Windows. The research was conducted over the years 2017, 2018, 2019, and 2020, while the analysis involved several processes, where some of the factors were removed in order to make the model acceptable. In this case, 21 variables were tested and divided into 5 factors. The results showed that special attention should be paid to these factors to reduce budgetary challenges and increase the performance of e-government in complex financial systems, such as lack of resources, increasing the focus on risk management even after the transfer of funds from the ministry to the municipality, the selection of programs based on priorities and not on the basis of wishes and policies, having political stability, rule of law, and more control, and having regulations and guidelines from the practices of developed countries as well as taking into account the opinions of budget experts. The implications of this paper have to do with only a considerable number of variables, which were taken in the study as well as only in the municipalities of Kosovo. In this case, for other analyses by other researchers, other variables can be analyzed in other countries by making comparisons. (shrink)

Background Ethical and scientific principles require that clinical trials address an important question and have the resources needed to complete the study. However, there are no clear standards for review that would ensure that these principles are upheld.Methods We conducted semi-structured interviews with a convenience sample of nineteen experts in clinical trial design, conduct, and/or oversight to elucidate current practice and identify areas of need with respect to ensuring the scientific value and feasibility of clinical trials prior to initiation and (...) while ongoing. We used a priori and grounded theory to analyze the data and constant comparative method to induce higher order themes.Results Interviewees perceived determination of scientific value as the responsibility of the investigator and, secondarily, other parties who review or oversee research. Interviewees reported that ongoing trials are rarely reevaluated due to emerging evidence from external sources, evaluation is complex, and there would be value in the development of standards for monitoring and evaluating evidence systematically. Investigators, IRBs, and/or data monitoring committees (DMCs) could undertake these responsibilities. Feasibility assessments are performed but are typically inadequate; potential solutions are unclear.Conclusions There are three domains where current approaches are suboptimal and in which further guidance is needed. First, who has the responsibility for conducting scientific review, whether it be the investigator, IRB, and/or DMC is often unclear. Second, the standards for scientific review (e.g., appropriate search terms, data sources, and analytic plan) should be defined. Third, guidance is needed on the evaluation of ongoing studies in light of potentially new and evolving evidence, with particular reference to evidence from outside the trial itself. (shrink)

Neuroimaging is critical in the diagnosis and treatment of brain cancers; however, the first detection of tumors is a challenge. Detection techniques like image segmentation are heavily reliant on the segmented image’s resolution. Magnetic resonance imaging tumor segmentation has emerged as a new study area in the medical imaging field. This spongy and delicate mass of tissue is the brain. Stable conditions allow for patterns to enter and interact with each other. To put it simply, a tumor is a mass (...) of tissue that has grown unchecked by the natural mechanisms that keep it under control. When cells divide uncontrollably, they create a cancerous tumor. Brain tumors can be detected and segmented using a variety of methods. A new method for detecting brain tumors using MRI images is presented in this research. An innovative Woelfel filter is used for enhancement, and morphological segmentation approaches combined with anisotropic diffusion are used for segmentation. Segmentation of brain tumors can be accomplished using thresholding and morphological techniques, which are both effective. The tumor will be located and identified using morphological image processing. Image denoising refers to the process of removing artefacts such as noise and aliasing from digital images. Here MATLAB programming language is utilised as it incorporates all the toolboxes required for the application involved in the work. (shrink)