Ethical challenges in argumentation and dialogue in a healthcare context.

As the average age of the population increases, so too do the number of people living with chronic illnesses. With limited resources available, the development of dialogue-based e-health systems that provide justified general health advice offers a cost-effective solution to the management of chronic conditions. It is however imperative that such systems are responsible in their approach. We present in this paper two main challenges for the deployment of e-health systems, that have a particular relevance to dialogue and argumentation: collecting and handling health data, and trust. For both challenges, we look at specific issues therein, outlining their importance in general, and describing their relevance to dialogue and argumentation. Finally, we go on to propose six recommendations for handling these issues, towards addressing the main challenges themselves, that act both as general advice for dialogue and argumentation research in the e-health domain, and as a foundation for future work on this topic

EQRbot: A chatbot delivering EQR argument-based explanations

Data availability statement: The provided link: https://github.com/FCast07/EQRbot refers to the GitHub repository that stores the chatbot programming code.Recent years have witnessed the rise of several new argumentation-based support systems, especially in the healthcare industry. In the medical sector, it is imperative that the exchange of information occurs in a clear and accurate way, and this has to be reflected in any employed virtual systems. Argument Schemes and their critical questions represent well-suited formal tools for modeling such information and exchanges since they provide detailed templates for explanations to be delivered. This paper details the EQR argument scheme and deploys it to generate explanations for patients' treatment advice using a chatbot (EQRbot). The EQR scheme (devised as a pattern of Explanation-Question-Response interactions between agents) comprises multiple premises that can be interrogated to disclose additional data. The resulting explanations, obtained as instances of the employed argumentation reasoning engine and the EQR template, will then feed the conversational agent that will exhaustively convey the requested information and answers to follow-on users' queries as personalized Telegram messages. Comparisons with a previous baseline and existing argumentation-based chatbots illustrate the improvements yielded by EQRbot against similar conversational agents.This research was partially funded by the UK Engineering & Physical Sciences Research Council (EPSRC) under Grant #EP/P010105/1

EQRbot: A chatbot delivering EQR argument-based explanations

Recent years have witnessed the rise of several new argumentation-based support systems, especially in the healthcare industry. In the medical sector, it is imperative that the exchange of information occurs in a clear and accurate way, and this has to be reflected in any employed virtual systems. Argument Schemes and their critical questions represent well-suited formal tools for modeling such information and exchanges since they provide detailed templates for explanations to be delivered. This paper details the EQR argument scheme and deploys it to generate explanations for patients' treatment advice using a chatbot (EQRbot). The EQR scheme (devised as a pattern of Explanation-Question-Response interactions between agents) comprises multiple premises that can be interrogated to disclose additional data. The resulting explanations, obtained as instances of the employed argumentation reasoning engine and the EQR template, will then feed the conversational agent that will exhaustively convey the requested information and answers to follow-on users' queries as personalized Telegram messages. Comparisons with a previous baseline and existing argumentation-based chatbots illustrate the improvements yielded by EQRbot against similar conversational agents

An Empirical Evaluation of the Inferential Capacity of Defeasible Argumentation, Non-monotonic Fuzzy Reasoning and Expert Systems

Several non-monotonic formalisms exist in the field of Artificial Intelligence for reasoning under uncertainty. Many of these are deductive and knowledge-driven, and also employ procedural and semi-declarative techniques for inferential purposes. Nonetheless, limited work exist for the comparison across distinct techniques and in particular the examination of their inferential capacity. Thus, this paper focuses on a comparison of three knowledge-driven approaches employed for non-monotonic reasoning, namely expert systems, fuzzy reasoning and defeasible argumentation. A knowledge-representation and reasoning problem has been selected: modelling and assessing mental workload. This is an ill-defined construct, and its formalisation can be seen as a reasoning activity under uncertainty. An experimental work was performed by exploiting three deductive knowledge bases produced with the aid of experts in the field. These were coded into models by employing the selected techniques and were subsequently elicited with data gathered from humans. The inferences produced by these models were in turn analysed according to common metrics of evaluation in the field of mental workload, in specific validity and sensitivity. Findings suggest that the variance of the inferences of expert systems and fuzzy reasoning models was higher, highlighting poor stability. Contrarily, that of argument-based models was lower, showing a superior stability of its inferences across knowledge bases and under different system configurations. The originality of this research lies in the quantification of the impact of defeasible argumentation. It contributes to the field of logic and non-monotonic reasoning by situating defeasible argumentation among similar approaches of non-monotonic reasoning under uncertainty through a novel empirical comparison

Argumentation-logic for creating and explaining medical hypotheses

<p>Objective: While EIRA has proved to be successful in the detection of anomalous patient responses to treatments in the Intensive Care Unit, it could not describe to clinicians the rationales behind the anomalous detections. The aim of this paper is to address this problem.</p> <p>Methods: Few attempts have been made in the past to build knowledge-based medical systems that possess both argumentation and explanation capabilities. Here we propose an approach based on Dung's seminal calculus of opposition.</p> <p>Results: We have developed a new tool, arguEIRA, which is an extension of the existing EIRA system. In this paper we extend EIRA by providing it with an argumentation-based justification system that formalizes and communicates to the clinicians the reasons why a patient response is anomalous.</p> <p>Conclusion: Our comparative evaluation of the EIRA system against the newly developed tool highlights the multiple benefits that the use of argumentation-logic can bring to the field of medical decision support and explanation.</p&gt

Evaluating the Impact of Defeasible Argumentation as a Modelling Technique for Reasoning under Uncertainty

Limited work exists for the comparison across distinct knowledge-based approaches in Artificial Intelligence (AI) for non-monotonic reasoning, and in particular for the examination of their inferential and explanatory capacity. Non-monotonicity, or defeasibility, allows the retraction of a conclusion in the light of new information. It is a similar pattern to human reasoning, which draws conclusions in the absence of information, but allows them to be corrected once new pieces of evidence arise. Thus, this thesis focuses on a comparison of three approaches in AI for implementation of non-monotonic reasoning models of inference, namely: expert systems, fuzzy reasoning and defeasible argumentation. Three applications from the fields of decision-making in healthcare and knowledge representation and reasoning were selected from real-world contexts for evaluation: human mental workload modelling, computational trust modelling, and mortality occurrence modelling with biomarkers. The link between these applications comes from their presumptively non-monotonic nature. They present incomplete, ambiguous and retractable pieces of evidence. Hence, reasoning applied to them is likely suitable for being modelled by non-monotonic reasoning systems. An experiment was performed by exploiting six deductive knowledge bases produced with the aid of domain experts. These were coded into models built upon the selected reasoning approaches and were subsequently elicited with real-world data. The numerical inferences produced by these models were analysed according to common metrics of evaluation for each field of application. For the examination of explanatory capacity, properties such as understandability, extensibility, and post-hoc interpretability were meticulously described and qualitatively compared. Findings suggest that the variance of the inferences produced by expert systems and fuzzy reasoning models was higher, highlighting poor stability. In contrast, the variance of argument-based models was lower, showing a superior stability of its inferences across different system configurations. In addition, when compared in a context with large amounts of conflicting information, defeasible argumentation exhibited a stronger potential for conflict resolution, while presenting robust inferences. An in-depth discussion of the explanatory capacity showed how defeasible argumentation can lead to the construction of non-monotonic models with appealing properties of explainability, compared to those built with expert systems and fuzzy reasoning. The originality of this research lies in the quantification of the impact of defeasible argumentation. It illustrates the construction of an extensive number of non-monotonic reasoning models through a modular design. In addition, it exemplifies how these models can be exploited for performing non-monotonic reasoning and producing quantitative inferences in real-world applications. It contributes to the field of non-monotonic reasoning by situating defeasible argumentation among similar approaches through a novel empirical comparison

Ontology driven clinical decision support for early diagnostic recommendations

Diagnostic error is a significant problem in medicine and a major cause of concern for patients and clinicians and is associated with moderate to severe harm to patients. Diagnostic errors are a primary cause of clinical negligence and can result in malpractice claims. Cognitive errors caused by biases such as premature closure and confirmation bias have been identified as major cause of diagnostic error. Researchers have identified several strategies to reduce diagnostic error arising from cognitive factors. This includes considering alternatives, reducing reliance on memory, providing access to clear and well-organized information. Clinical Decision Support Systems (CDSSs) have been shown to reduce diagnostic errors. Clinical guidelines improve consistency of care and can potentially improve healthcare efficiency. They can alert clinicians to diagnostic tests and procedures that have the greatest evidence and provide the greatest benefit. Clinical guidelines can be used to streamline clinical decision making and provide the knowledge base for guideline based CDSSs and clinical alert systems. Clinical guidelines can potentially improve diagnostic decision making by improving information gathering. Argumentation is an emerging area for dealing with unstructured evidence in domains such as healthcare that are characterized by uncertainty. The knowledge needed to support decision making is expressed in the form of arguments. Argumentation has certain advantages over other decision support reasoning methods. This includes the ability to function with incomplete information, the ability to capture domain knowledge in an easy manner, using non-monotonic logic to support defeasible reasoning and providing recommendations in a manner that can be easily explained to clinicians. Argumentation is therefore a suitable method for generating early diagnostic recommendations. Argumentation-based CDSSs have been developed in a wide variety of clinical domains. However, the impact of an argumentation-based diagnostic Clinical Decision Support System (CDSS) has not been evaluated yet. The first part of this thesis evaluates the impact of guideline recommendations and an argumentation-based diagnostic CDSS on clinician information gathering and diagnostic decision making. In addition, the impact of guideline recommendations on management decision making was evaluated. The study found that argumentation is a viable method for generating diagnostic recommendations that can potentially help reduce diagnostic error. The study showed that guideline recommendations do have a positive impact on information gathering of optometrists and can potentially help optometrists in asking the right questions and performing tests as per current standards of care. Guideline recommendations were found to have a positive impact on management decision making. The CDSS is dependent on quality of data that is entered into the system. Faulty interpretation of data can lead the clinician to enter wrong data and cause the CDSS to provide wrong recommendations. Current generation argumentation-based CDSSs and other diagnostic decision support systems have problems with semantic interoperability that prevents them from using data from the web. The clinician and CDSS is limited to information collected during a clinical encounter and cannot access information on the web that could be relevant to a patient. This is due to the distributed nature of medical information and lack of semantic interoperability between healthcare systems. Current argumentation-based decision support applications require specialized tools for modelling and execution and this prevents widespread use and adoption of these tools especially when these tools require additional training and licensing arrangements. Semantic web and linked data technologies have been developed to overcome problems with semantic interoperability on the web. Ontology-based diagnostic CDSS applications have been developed using semantic web technology to overcome problems with semantic interoperability of healthcare data in decision support applications. However, these models have problems with expressiveness, requiring specialized software and algorithms for generating diagnostic recommendations. The second part of this thesis describes the development of an argumentation-based ontology driven diagnostic model and CDSS that can execute this model to generate ranked diagnostic recommendations. This novel model called the Disease-Symptom Model combines strengths of argumentation with strengths of semantic web technology. The model allows the domain expert to model arguments favouring and negating a diagnosis using OWL/RDF language. The model uses a simple weighting scheme that represents the degree of support of each argument within the model. The model uses SPARQL to sum weights and produce a ranked diagnostic recommendation. The model can provide justifications for each recommendation in a manner that clinicians can easily understand. CDSS prototypes that can execute this ontology model to generate diagnostic recommendations were developed. The decision support prototypes demonstrated the ability to use a wide variety of data and access remote data sources using linked data technologies to generate recommendations. The thesis was able to demonstrate the development of an argumentation-based ontology driven diagnostic decision support model and decision support system that can integrate information from a variety of sources to generate diagnostic recommendations. This decision support application was developed without the use of specialized software and tools for modelling and execution, while using a simple modelling method. The third part of this thesis details evaluation of the Disease-Symptom model across all stages of a clinical encounter by comparing the performance of the model with clinicians. The evaluation showed that the Disease-Symptom Model can provide a ranked diagnostic recommendation in early stages of the clinical encounter that is comparable to clinicians. The diagnostic performance can be improved in the early stages using linked data technologies to incorporate more information into the decision making. With limited information, depending on the type of case, the performance of the Disease-Symptom Model will vary. As more information is collected during the clinical encounter the decision support application can provide recommendations that is comparable to clinicians recruited for the study. The evaluation showed that even with a simple weighting and summation method used in the Disease- Symptom Model the diagnostic ranking was comparable to dentists. With limited information in the early stages of the clinical encounter the Disease-Symptom Model was able to provide an accurately ranked diagnostic recommendation validating the model and methods used in this thesis