In this article, we survey the applications of Three-way decision theory (TWD) in machine learning (ML), focusing in particular on four tasks: weakly supervised learning and multi-source data management, missing data management, uncertainty quantification in classification, and uncertainty quantification in clustering. For each of these four tasks we present the results of a systematic review of the literature, by which we report on the main characteristics of the current state of the art, as well as on the quality of reporting and reproducibility level of the works found in the literature. To this aim, we discuss the main benefits, limitations and issues found in the reviewed articles, and we give clear indications and directions for quality improvement that are informed by validation, reporting, and reproducibility standards, guidelines and best practice that have recently emerged in the ML field. Finally, we discuss about the more promising and relevant directions for future research in regard to TWD.

The rise of personalized medicine and its remarkable advancements have revealed new requirements for the availability of appropriate medical decision-making models. Computer science is an area that plays an essential role in the field of personalized medicine, where one of the goals is to provide algorithms and tools to extrapolate knowledge and improve the decision-support process. The minimum clinically important difference (MCID) is the smallest change in PROM scores that patients perceive as meaningful. Treatment that does not achieve the minimum level of improvement is considered inappropriate as well as a potential waste of resources. Using the MCID threshold to identify patients who fail to achieve the minimum change in PROM that results in a meaningful outcome may aid in pre-surgical shared decision-making. The decision tree algorithm is a method for extracting valuable information and providing further meaningful information to the domain expert that supports the decision-making. In the present study, different tools based on machine learning were developed. On the one hand, we compared three XGBoost models to predict the non-achievement of the MCID at six months post-operation in the SF-12 physical score. The prediction score threshold was set to 0.75 to provide three decision-making areas on the basis of the high confidence (HC) intervals; the minority class was re-balanced by weighting the positive class to penalize the loss function (XGBoost cost-sensitive), oversampling the minority class (XGBoost with SMOTE), and re-sampling the negative class (XGBoost with undersampling). On the other hand, we modeled the data through a decision tree (assessment tree), based on different complexity levels, to identify the hidden pattern and to provide a new way to understand possible relationships between the gathered features and the several outcomes. The results showed that all the proposed models were effective as binary classifiers, as they showed moderate predictive performance both regarding the minority or positive class (i.e., our targeted patients, those who will not benefit from surgery) and the negative class. The decision tree visualization can be exploited during the patient assessment status to better understand if those patients will benefit or not from the medical intervention. Both of these tools can come in handy for increasing knowledge about the patient’s psychophysical state and for creating an increasingly specialized assessment of the individual patient.

Due to aging demographics, prolonged life expectancy, and chronic diseases, European societies' increasing need for care services has led to a shift towards informal care supplied by family members, friends, or neighbors. However, the progressive decrease in the caregiver-to-patient ratio will result in a significant augmentation in incorporating intelligent aid within general care. This study aimed to build upon the authors' previous systematic literature review on technologies for informal caregivers. Specifically, it focused on analyzing AI-based solutions to understand the advantages and challenges of using AI in decision-making support for informal caregivers in elderly care. Three databases (Scopus, IEEE Xplore, ACM Digital Libraries) were searched. The search yielded 1002 articles, with 24 that met the inclusion and exclusion criteria. Within the scope of this study, we will exclusively concentrate on a subset of 11 papers on AI technologies. The study reveals that AI-based solutions have great potential for real-time analysis advancement, explainable AI enhancement, and meta-information semantic refinement. While digital assistants can personalize information for caregivers, security and privacy are key concerns. The rise of more integrated and complicated solutions reveals that these technologies suit aging monitoring and informal care coordination in emergencies or deviations from usual activities. Informal caregiver decision assistance can be improved in this scenario.

Informal or unpaid caregivers, commonly known as family caregivers, are responsible for providing the 80% of long-term care in Europe, which constitutes a significant portion of health and social care services offered to elderly or disabled individuals. However, the demand for informal care among the elderly is expected to outnumber available supply by 2060. The increasing decline in the caregiver-to-patient ratio is expected to lead to a substantial expansion in the integration of intelligent assistance within general care. The aim of this systematic review was to thoroughly investigate the most recent advancements in AI-enabled technologies, as well as those encompassed within the broader category of assistive technology (AT), which are designed with the primary or secondary goal to assist informal carers. The review sought to identify the specific needs that these technologies fulfill in the caregiver’s activities related to the care of older individuals, the identification of caregivers’ needs domains that are currently neglected by the existing AI-supporting technologies and ATs, as well as shedding light on the informal caregiver groups that are primarily targeted by those currently available. Three databases (Scopus, IEEE Xplore, ACM Digital Libraries) were searched. The search yielded 1002 articles, with 24 articles that met the inclusion and exclusion criteria. Our results showed that AI-powered technologies significantly facilitate ambient assisted living (AAL) applications, wherein the integration of home sensors serves to improve remote monitoring for informal caregivers. Additionally, AI solutions contribute to improve care coordination between formal and informal caregivers, that could lead to advanced telehealth assistance. However, limited research on assistive technologies like robots and mHealth apps suggests further exploration. Future AI-based solutions and assistive technologies (ATs) may benefit from a more targeted approach to appeasing specific user groups based on their informal care type. Potential areas for future research also include the integration of novel methodological approaches to improve the screening process of conventional systematic reviews through the automation of tasks using AI-powered technologies based on active learning approach.

The increasing integration of artificial intelligence (AI) in decision-making processes has amplified discussions surrounding algorithmic authority—the perceived epistemic legitimacy of AI systems over human judgment. This study investigates how individuals attribute epistemic authority to AI, focusing on psychological, contextual, and sociotechnical factors. Existing research highlights the importance of trust in automation, perceived performance, and moral frameworks in shaping such attributions. Unlike prior conceptual or philosophical accounts of algorithmic authority, our study adopts a relational and empirically grounded perspective by operationalizing algority through psychometric measures and contextual assessments. To address knowledge gaps in the micro-level dynamics of this phenomenon, we conducted an empirical study using psychometric tools and scenario-based assessments. Here, we report key findings from a survey of 610 participants, revealing significant correlations between trust in automation (TiA), perceptions of automated performance (PAS), and the propensity to defer to AI, particularly in high-stakes scenarios like criminal justice and job-matching. Trust in automation emerged as a primary factor, while moral attitudes moderated deference in ethically sensitive contexts. Our findings highlight the practical relevance of transparency and explainability for supporting critical engagement with AI outputs and for informing the design of contextually appropriate decision support. This study contributes to understanding algorithmic authority as a multidimensional construct, offering empirically grounded insights for designing AI systems that are trustworthy and context-sensitive.

Total hip (THA) and total knee (TKA) arthroplasty procedures have steadily increased over the past few decades, and their use is expected to grow further, mainly due to an increasing number of elderly patients. Cost-containment strategies, supporting a rapid recovery with a positive functional outcomes, high patient satisfaction, and enhanced patient reported outcomes, are needed. A Fast Track surgical procedure (FT) is a coordinated perioperative approach aimed at expediting early mobilization and recovery following surgery and, accordingly, shortening the length of hospital stay (LOS), convalescence and costs. In this view, rapid rehabilitation surgery optimizes traditional rehabilitation methods by integrating evidence-based practices into the procedure. The aim of the present study was to compare the effectiveness of Fast Track versus Care-as-Usual surgical procedures and pathways (including rehabilitation) on a mid-term patient-reported outcome (PROs), the SF12 (with regard both to Physical and Mental Scores), 3 months after hip or knee replacement surgery, with the use of Propensity score-matching (PSM) analysis to address the issue of the comparability of the groups in a non-randomized study. We were interested in the evaluation of the entire pathways, including the postoperative rehabilitation stage, therefore, we only used early home discharge as a surrogate to differentiate between the Fast Track and Care-as-Usual rehabilitation pathways. Our study shows that the entire Fast Track pathway, which includes the post-operative rehabilitation stage, has a significantly positive impact on physical health-related status (SF12 Physical Scores), as perceived by patients 3 months after hip or knee replacement surgery, as opposed to the standardized program, both in terms of the PROs score and the relative improvements observed, as compared with the minimum clinically important difference. This result encourages additional research into the effects of Fast Track rehabilitation on the entire process of care for patients undergoing hip or knee arthroplasty, focusing only on patient-reported outcomes.