Decision support systems based on prediction sets help humans solve multiclass classification tasks by narrowing down the set of potential label values to a subset of them, namely a prediction set, and asking them to always predict label values from the prediction sets. While this type of systems have been proven to be effective at improving the average accuracy of the predictions made by humans, by restricting human agency, they may cause harm---a human who has succeeded at predicting the ground-truth label of an instance on their own may have failed had they used these systems. In this paper, our goal is to control how frequently a decision support system based on prediction sets may cause harm, by design. To this end, we start by characterizing the above notion of harm using the theoretical framework of structural causal models. Then, we show that, under a natural, albeit unverifiable, monotonicity assumption, we can estimate how frequently a system may cause harm using only predictions made by humans on their own. Further, we also show that, under a weaker monotonicity assumption, which can be verified experimentally, we can bound how frequently a system may cause harm again using only predictions made by humans on their own. Building upon these assumptions, we introduce a computational framework to design decision support systems based on prediction sets that are guaranteed to cause harm less frequently than a user-specified value using conformal risk control. We validate our framework using real human predictions from two different human subject studies and show that, in decision support systems based on prediction sets, there is a trade-off between accuracy and counterfactual harm.

Significant effort has been placed on developing decision support tools to improve patient care. However, drivers of real-world clinical decisions in complex medical scenarios are not yet well-understood, resulting in substantial gaps between these tools and practical applications. In light of this, we highlight that more attention on understanding clinical decision-making is required both to elucidate current clinical practices and to enable effective human-machine interactions. This is imperative in high-stakes scenarios with scarce available resources.

Whenever a binary classifier is used to provide decision support, it typically provides both a label prediction and a confidence value. Then, the decision maker is supposed to use the confidence value to calibrate how much to trust the prediction. In this context, it has been often argued that the confidence value should correspond to a well calibrated estimate of the probability that the predicted label matches the ground truth label. However, multiple lines of empirical evidence suggest that decision makers have difficulties at developing a good sense on when to trust a prediction using these confidence values. In this paper, our goal is first to understand why and then investigate how to construct more useful confidence values. We first argue that, for a broad class of utility functions, there exists data distributions for which a rational decision maker is, in general, unlikely to discover the optimal decision policy using the above confidence values--an optimal decision maker would need to sometimes place more (less) trust on predictions with lower (higher) confidence values. However, we then show that, if the confidence values satisfy a natural alignment property with respect to the decision maker's confidence on her own predictions, there always exists an optimal decision policy under which the level of trust the decision maker would need to place on predictions is monotone on the confidence values, facilitating its discoverability. Further, we show that multicalibration with respect to the decision maker's confidence on her own prediction is a sufficient condition for alignment. Experiments on a real AI-assisted decision making scenario where a classifier provides decision support to human decision makers validate our theoretical results and suggest that alignment may lead to better decisions.

Machine learning based decision-support tools in criminal justice systems are subjects of intense discussions and academic research. There are important open questions about the utility and fairness of such tools. Academic researchers often rely on a few small datasets that are not sufficient to empirically study various real-world aspects of these questions. In this paper, we contribute WCLD, a curated large dataset of 1.5 million criminal cases from circuit courts in the U.S. state of Wisconsin. We used reliable public data from 1970 to 2020 to curate attributes like prior criminal counts and recidivism outcomes.

This paper investigates real-time decision support systems that leverage low-latency AI models, bringing together recent progress in holistic AI-driven decision tools, integration with Edge-IoT technologies, and approaches for effective human-AI teamwork. It looks into how large language models can assist decision-making, especially when resources are limited. The research also examines the effects of technical developments such as DeLLMa, methods for compressing models, and improvements for analytics on edge devices, while also addressing issues like limited resources and the need for adaptable frameworks. Through a detailed review, the paper offers practical perspectives on development strategies and areas of application, adding to the field by pointing out opportunities for more efficient and flexible AI-supported systems. The conclusions set the stage for future breakthroughs in this fast-changing area, highlighting how AI can reshape real-time decision support.

Analyzing decision problems under uncertainty commonly relies on idealizing assumptions about the describability of the world, with the most prominent examples being the closed world and the small world assumption. Most assumptions are operationalized by introducing states of the world, conditional on which the decision situation can be analyzed without any remaining uncertainty. Conversely, most classical decision-theoretic approaches are not applicable if the states of the world are inaccessible. We propose a decision model that retains the appeal and simplicity of the original theory, but completely overcomes the need to specify the states of the world explicitly. The main idea of our approach is to address decision problems in a radically empirical way: instead of specifying states and consequences prior to the decision analysis, we only assume a protocol of observed act--consequence pairs as model primitives. We show how optimality in such empirical decision problems can be addressed by using protocol-based empirical choice functions and discuss three approaches for deriving inferential guarantees: (I) consistent statistical estimation of choice sets, (II) consistent statistical testing of choice functions with robustness guarantees, and (III) direct inference for empirical choice functions using credal sets. We illustrate our theory with a proof-of-concept application comparing different prompting strategies in generative AI models.

Healthcare AI systems have historically faced challenges in merging contextual reasoning, long-term state management, and human-verifiable workflows into a cohesive framework. This paper introduces a completely innovative architecture and concept: combining the Model Context Protocol (MCP) with a specific clinical application, known as MCP-AI. This integration allows intelligent agents to reason over extended periods, collaborate securely, and adhere to authentic clinical logic, representing a significant shift away from traditional Clinical Decision Support Systems (CDSS) and prompt-based Large Language Models (LLMs). As healthcare systems become more complex, the need for autonomous, context-aware clinical reasoning frameworks has become urgent. We present MCP-AI, a novel architecture for explainable medical decision-making built upon the Model Context Protocol (MCP) a modular, executable specification for orchestrating generative and descriptive AI agents in real-time workflows. Each MCP file captures clinical objectives, patient context, reasoning state, and task logic, forming a reusable and auditable memory object. Unlike conventional CDSS or stateless prompt-based AI systems, MCP-AI supports adaptive, longitudinal, and collaborative reasoning across care settings. MCP-AI is validated through two use cases: (1) diagnostic modeling of Fragile X Syndrome with comorbid depression, and (2) remote coordination for Type 2 Diabetes and hypertension. In either scenario, the protocol facilitates physician-in-the-loop validation, streamlines clinical processes, and guarantees secure transitions of AI responsibilities between healthcare providers. The system connects with HL7/FHIR interfaces and adheres to regulatory standards, such as HIPAA and FDA SaMD guidelines. MCP-AI provides a scalable basis for interpretable, composable, and safety-oriented AI within upcoming clinical environments.

This paper develops the foundations of Quantum Granular Computing (QGC), extending classical granular computing including fuzzy, rough, and shadowed granules to the quantum regime. Quantum granules are modeled as effects on a finite dimensional Hilbert space, so granular memberships are given by Born probabilities. This operator theoretic viewpoint provides a common language for sharp (projective) and soft (nonprojective) granules and embeds granulation directly into the standard formalism of quantum information theory. We establish foundational results for effect based quantum granules, including normalization and monotonicity properties, the emergence of Boolean islands from commuting families, granular refinement under Luders updates, and the evolution of granules under quantum channels via the adjoint channel in the Heisenberg picture. We connect QGC with quantum detection and estimation theory by interpreting the effect operators realizing Helstrom minimum error measurement for binary state discrimination as Helstrom type decision granules, i.e., soft quantum counterparts of Bayes optimal decision regions. Building on these results, we introduce Quantum Granular Decision Systems (QGDS) with three reference architectures that specify how quantum granules can be defined, learned, and integrated with classical components while remaining compatible with near term quantum hardware. Case studies on qubit granulation, two qubit parity effects, and Helstrom style soft decisions illustrate how QGC reproduces fuzzy like graded memberships and smooth decision boundaries while exploiting noncommutativity, contextuality, and entanglement. The framework thus provides a unified and mathematically grounded basis for operator valued granules in quantum information processing, granular reasoning, and intelligent systems.

Such models are integral to the development of context-aware surgical training systems and process monitoring platforms [11], [19] as well as for encoding adaptive robotic control policies in teleoperated environments [13], [20], [78]. However, their limited capacity to capture continuous biophysical dynamics can constrain their utility in applications where physiological fidelity is essential. Recognizing the limitations inherent in purely continuous or discrete approaches, hybrid modeling strategies have emerged as a state-of-the-art solution for surgical digital twins. These frameworks integrate continuous dynamic models with discrete state machines, enabling the simultaneous tracking of physiological changes and procedural events [8], [7], [19], [37]. For example, hybrid automata have been deployed to synchronize real-time updates of tissue deformation with the sequencing of surgical tool actions [7], [19]. This integration allows digital twins to provide context-sensitive support, adapting to abrupt workflow transitions and physiological perturbations alike--a critical requirement in both routine and emergent surgical scenarios [8], [11], [7]. B. Mutual Information and Information-Theoretic Approaches With the proliferation of multi-modal surgical data, information-theoretic concepts have become indispensable for quantifying uncertainty, relevance, and redundancy across heterogeneous information streams. Mutual information I(X; Y) has been adopted as a rigorous metric for selecting the most informative sensors, imaging modalities, or clinical parameters, thereby enhancing the efficiency and robustness of digital twin-enabled decision support [2], [3], [13], [34], [11], [51], [48], [26], [29]. This is formally captured as Eq.

Subjective expected utility theory assumes that decision-makers possess unlimited computational resources to reason about their choices; however, virtually all decisions in everyday life are made under resource constraints---i.e.