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Improving Rehabilitation Outcome Prediction Using Hybrid Density-Based and Statistical Anomaly Detection
Recently, significant efforts have been dedicated to enhancing anomaly detection methods, especially concerning high-dimensional and distributed clinical datasets. The analysis of patient information in clinical environments highlights a strong emphasis on improving diagnostic precision, tailoring treatment strategies, and maximizing resource efficiency to boost health outcomes. However, this field encounters distinct difficulties, including sporadic data gathering, variable data quality, and structural differences unique to individual patients. To overcome these obstacles, this paper introduces an innovative hybrid framework that merges stochastic and heuristic techniques for detecting anomalies in clinical patient data. This approach leverages an HPO-optimized Density-Based Spatial Clustering of Applications with Noise to group patient exercise data, thereby streamlining the detection of abnormalities. Following this, an Interquartile Range-based stochastic technique filters out untrustworthy data points, guaranteeing that healthcare practitioners and diagnostic systems are supplied with only highly relevant and precise data. The main goal of this research is to provide medical experts and scholars with a reliable instrument for handling vast, high-dimensional clinical datasets, allowing for the successful separation and elimination of deviant data observations. Additionally, an advanced regression model was constructed utilizing Automated Machine Learning (AutoML) to evaluate the effectiveness of the ensemble technique for detecting abnormal patterns. Multiple statistical error evaluation methods are employed to verify the success of this hybrid strategy in conjunction with AutoML. Empirical findings indicate that applying this cutting-edge hybrid framework to patient rehabilitation data significantly boosts AutoML performance, yielding an average improvement of 0.041 in the score, thereby outperforming conventional regression models.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 March 2022 | Article: 6

Advancing Trustworthy Multi-Modal Motion Prediction for Autonomous Vehicles through Holistic Evaluation and Interpretable Outputs
Anticipating the movement of nearby traffic participants allows automated vehicles to formulate safe and efficient navigation strategies. This undertaking is highly intricate, given that the conduct of road users is shaped by numerous variables, resulting in a substantial variety of potential future paths (multi-modality). The majority of previous methodologies designed to tackle multi-modal trajectory forecasting rely on intricate machine learning architectures that offer minimal interpretability. Furthermore, the performance measures utilized in contemporary benchmarks fail to assess every dimension of the issue, particularly regarding the variety and validity of the generated paths.The authors intend to progress the creation of dependable trajectory forecasting systems by aligning with specific tenets established for Trustworthy Artificial Intelligence. The primary emphasis is directed toward assessment benchmarks, structural resilience, and the explainability of model outputs. Initially, existing appraisal metrics undergo a detailed examination to pinpoint the major deficiencies in current benchmarks, leading to the introduction of a new, comprehensive assessment framework. Following this, a methodology to evaluate spatial and temporal resilience is developed by replicating sensor noise within the perception pipeline. To improve output interpretability and produce more equitable outcomes across the proposed evaluation metrics, an intention forecasting layer is introduced that can be integrated into existing multi-modal trajectory models. The utility of this configuration is analyzed via a user study that investigates distinct graphical representations of multi-modal paths and driver intents. The introduced methodology and subsequent insights offer a meaningful advancement toward constructing dependable trajectory forecasting frameworks for automated vehicles, shifting the discipline toward elevated levels of safety and operational dependability.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 September 2023 | Article: 36

Explainable Machine Learning for Early Prediction of Unscheduled Hospital Readmissions: Integrating Global and Local Interpretability
At present, the majority of healthcare spending is driven by chronic patients who experience multiple readmissions due to their underlying conditions. Implementing individualized prevention frameworks could optimize the clinical management of this demographic. This study aimed to generate localized predictive models utilizing interpretable machine learning approaches to provide early identification of individual unscheduled hospital readmissions. To achieve this, a retrospective case-control investigation was performed, utilizing patient readmission data spanning 2018–2019. Following the cleaning and curation of the initial data repository (n = 76,210), the final sample size comprised n = 29,026 participants. A machine learning analysis evaluated multiple algorithms, employing unscheduled hospital readmission as the dependent variable, alongside local model-agnostic interpretability techniques.The results demonstrated a 13% rate of unscheduled hospital readmissions. Statistically significant variations were identified regarding patient age and length of hospital stay (p < 0.001 in both instances). A logistic regression framework highlighted chronic therapy (odds ratio: 3.75), a history of diabetes mellitus (odds ratio: 1.14), and length of stay (odds ratio: 1.02) as statistically meaningful predictors. Machine learning algorithms demonstrated superior performance concerning sensitivity and complementary evaluation metrics. Within this analytical framework, length of stay and patient age emerged as the primary determinants for forecasting unscheduled readmissions. Notably, other clinical indicators, such as documented allergies and histories of adverse drug reactions, also demonstrated predictive relevance. Individualized prognostic models exhibited high sensitivity. In conclusion, this investigation identified critical determinants governing unscheduled hospital readmissions, highlighting the prominence of age and hospitalization duration. A personalized risk assessment framework capable of predicting readmissions with high accuracy was established. Future investigations should incorporate a broader array of clinical parameters to further optimize the predictive capacity of this model.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 March 2024 | Article: 49

Assessing the Fitness of Deep Learning for Combined Sewer Overflow Prediction Using a Problem Frames Approach
Unchecked discharges of untreated water from combined sewer systems pose critical hazards to public health and ecosystems. To address this, regional sanitation authorities like the Metropolitan Sewer District of Greater Cincinnati (MSDGC) have begun collecting massive streams of hydrological telemetry, looking toward deep learning (DL) methodologies—specifically recurrent neural networks (RNN)—to forecast these spill events. Crucially, determining whether a DL model is truly suitable for this domain requires a structured analysis of the environment in which it operates. This paper introduces a requirements engineering methodology grounded in problem frames to map out and organize stakeholder concerns. This approach systematically evaluates real-world conditions where standard assumptions of high-quality data break down, translating these insights into actionable software testing benchmarks known as metamorphic relations, which govern both data input adjustments and output validations. Deploying this methodology within MSDGC’s operational context provides a rigorous, standardized baseline to assess how effectively competing RNN designs fulfill core operational mandates.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 September 2024 | Article: 54

Enhancing Transparency in Spatial PM₂.₅ Prediction over Singapore through Explainable Machine Learning
The climate system is heavily influenced by aerosols through direct and indirect pathways, notably the absorption and scattering of radiant energy. Beyond climate impacts, these particles compromise atmospheric visibility and jeopardize public health. Specifically, human populations face exposure to fine particulate matter PM2.5, a major driver of respiratory and cardiovascular pathologies. Long-term modifications in PM levels are generally governed by emission shifts and meteorological patterns, whereas short-term fluctuations are predominantly dictated by immediate weather dynamics. Surface variations in PM2.5 levels are further driven by environmental variables such as temperature, wind velocity, relative humidity, and vegetative coverage.Air quality forecasting has advanced significantly through the application of machine learning. This research explores PM2.5 estimation by utilizing these environmental and meteorological metrics as spatiotemporal inputs. This study evaluates seven years (2014–2021) of in situ PM2.5 measurements gathered from five distinct monitoring stations across Singapore, establishing a baseline dataset for spatial modeling.The primary contribution of this paper is a novel predictive architecture tailored for temporal analysis, utilizing Random Forest (RF), Gradient Boosting (GB) regression, and the Tree-based Pipeline Optimization Tool (TP) Auto ML framework, which optimizes via a meta-heuristic genetic algorithm. The TP model demonstrated strong predictive capabilities, achieving a peak Global Performance Index (GPI) of 7.4 in August 2016 and a minimum value of −0.6 in June 2019. These metrics highlight the robust nature of the TP framework; its negative values remained superior to competing models, indicating less pessimistic errors. Finally, the underlying logic of these machine learning systems is clarified using eXplainable Artificial Intelligence (XAI) methods, which validate the integrity of feature importance and offer deeper insights into the cyclical variations of PM2.5 concentrations.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 March 2025 | Article: 61

From Prediction to Intervention: A Causal Explainability Framework for Counterfactual Reasoning, Mechanism Discovery, Confounding Control, and Decision Validity
Explainable artificial intelligence increasingly supports decisions whose consequences extend beyond prediction, yet many explanations remain grounded in associations, feature contributions, saliency, or local perturbations. Such outputs may clarify model behaviour without establishing what would happen under intervention, why an outcome arose through a particular mechanism, or whether a proposed change is feasible and decision-valid. This article develops a conceptual causal explainability framework for moving from prediction-oriented explanation toward intervention-aware reasoning. The framework begins by separating predictive, associative, and model-behaviour claims from causal questions. It then connects explicit causal assumptions with causal structures, mechanistic reasoning, interventional explanation, counterfactual reasoning, confounding assessment, identifiability, sensitivity, external validity, uncertainty communication, and human interpretation. Particular attention is given to the distinction between model counterfactuals and real-world recourse, the risks created by unmeasured confounding, selection and collider bias, and the need to define decision boundaries before explanations inform action. Human users are treated as active interpreters whose causal literacy, expertise, cognitive constraints, and susceptibility to false causal confidence affect explanation usefulness. The main contribution is an integrated framework that organizes the evidential transition from prediction to intervention while preserving explicit no-guarantee boundaries concerning causal truth, intervention validity, recourse, identifiability, human understanding, decision validity, and deployment readiness. The framework is intended to support disciplined conceptual development and evaluation planning, not to prescribe a universal causal model, intervention procedure, or operational decision system.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 March 2026 | Article: 88

Say What the Model Does Not Know: A Framework for Confidence Calibration, Ambiguity Disclosure, Risk Communication, and Selective Prediction in Explainable Decision Intelligence
Intelligent systems increasingly provide predictions, recommendations, and explanations in decisions where uncertainty can materially affect interpretation and action. Yet many explainable systems foreground predicted outcomes or feature contributions while inadequately communicating what the model does not know. This article proposes a conceptual uncertainty-aware explainable decision-intelligence framework organized around four connected responsibilities: calibrating confidence, disclosing ambiguity, communicating decision-relevant risk, and supporting selective prediction or abstention when available evidence is insufficient. The framework treats uncertainty as a trustworthiness requirement rather than a secondary technical output. It distinguishes aleatoric uncertainty arising from irreducible variability, epistemic uncertainty associated with limited knowledge or evidence, and distributional uncertainty arising when operating conditions depart from those represented during development. It further connects confidence calibration and miscalibration review with prediction qualification, rejection, abstention, deferral, and human review. Ambiguity disclosure and risk communication are positioned as interpretive functions that should clarify scope limitations, competing interpretations, possible consequences, and appropriate next actions without implying that communication alone guarantees understanding. Human decision support is addressed through escalation pathways, oversight, trust calibration, and evaluation of overreliance, underreliance, automation bias, and cognitive burden. The principal contribution is an integrated framework that links uncertainty identification, calibrated interpretation, selective system behavior, human review, monitoring, and feedback updating. The framework supports conceptual development and domain-specific evaluation but does not independently establish correctness, safety, decision validity, ethical sufficiency, legal compliance, or deployment readiness.
Journal of Trustworthy and Explainable Intelligent Systems
Original Research | Open access | 15 March 2026 | Article: 89