In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, depending on state requirements, other potentially abusable prescription drugs. PMPs are meant to help prevent adverse drug-related events such as opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing, and by identifying those patients who are obtaining prescriptions from multiple providers (i.e., "doctor shopping") or those physicians overprescribing opioids. Most US health care workers support the idea of PMPs, which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments. The database, whose use is required by State law, typically requires prescribers and pharmacies dispensing controlled substances to register with their respective state PMPs and (for pharmacies and providers who dispense from their offices) to report the dispensation of such prescriptions to an electronic online database. The majority of PMPs are authorized to notify law enforcement agencies or licensing boards or physicians when a prescriber, or patients receiving prescriptions, exceed thresholds established by the state or prescription recipient exceeds thresholds established by the State. All states have implemented PDMPs, although evidence for the effectiveness of these programs is mixed. While prescription of opioids has decreased with PMP use, overdose deaths in many states have actually increased, with those states sharing data with neighboring jurisdictions or requiring reporting of more drugs experiencing highest increases in deaths. This may be because those declined opioid prescriptions turn to street drugs, whose potency and contaminants carry greater overdose risk. == History == Prescription drug monitoring programs, or PDMPs, are an example of one initiative proposed to alleviate effects of the opioid crisis. The programs are designed to restrict prescription drug abuse by limiting a patient's ability to obtain similar prescriptions from multiple providers (i.e. “doctor shopping”) and reducing diversion of controlled substances. This is meant to reduce risk of fatal overdose caused by high doses of opioids or interactions between opioids and benzodiazepenes, and to enable better decision making on the part of healthcare providers who may be unaware of a patient's prescription drug use, history or other prescriptions. PDMPs have been implemented in state legislations since 1939 in California, a time before electronic medical records, though implementation rose alongside increased awareness of overprescribing of opioids and overdose. A later New York state program was struck down by the U.S. Supreme Court in Whalen v. Roe. But, by 2019, 49 states, the District of Columbia, and Guam had enacted PDMP legislation. In 2021 Missouri, the last State to not use a PMP, adopted legislation to create one. PMPs are constantly being updated to increase speed of data collection, sharing of data across States, and ease of interpretation. This is being done by integrating PDMP reports with other health information technologies such as health information exchanges (HIE), electronic health record (EHR) systems, and/ or pharmacy dispensing software systems. One program that has been implemented in nine states is called the PDMP Electronic Health Records Integration and Interoperability Expansion, also known as PEHRIIE. Another software, marketed by Bamboo Health and integrated with PMPs in 43 states, uses an algorithm to track factors thought to increase risk of diversion, abuse or overdose, and assigns patients a three digit score based on presumed indicators of risk. While some studies have suggested that PDMP-HIT integration and sharing of interstate data brings benefits such as reduced opioid-related inpatient morbidity, others have found no or negative impact on mortality compared to states without PMP data sharing. Patient and media reports suggest need for testing and evaluation of algorithmic software used to score risk, with some patients reporting denial of prescriptions without c explanation or clarity of data. == Goals == Most health care workers support PMPs which intend to assist physicians, physician assistants, nurse practitioners, dentists and other prescribers, the pharmacists, chemists and support staff of dispensing establishments, as well as law-enforcement agencies. The collaboration supports the legitimate medical use of controlled substances while limiting their abuse and diversion. Pharmacies dispensing controlled substances and prescribers typically must register with their respective state PMPs and (for pharmacies and providers who dispense controlled substances from their offices) report the dispensation to an electronic online database. Some pharmacy software can submit these reports automatically to multiple states. == Usage == === List of programs by state === === Software systems === NarxCare is a prescription drug monitoring program (PDMP) run by Bamboo Health. Bamboo Health was formerly known as Appriss. It is widely used across the United States by pharmacies including Rite Aid as well as those at Walmart and Sam’s Club. The NarxCare software allows doctors to view data about a patient, combining data from the prescription registries of various U.S. states to make the registries interoperable nationally. It also uses machine learning to generate an "Overdose Risk Score" that potentially includes EMS and criminal justice data; these scores have been criticized by researchers and patient advocates for the lack of transparency in the process as well as the potential for disparate treatment of women and minority groups. Advertised as an "analytics tool and care management platform", the NarxCare software allows doctors to view data about a patient including how many pharmacies they have visited and the combinations of medication they are prescribed. It combines data from the prescription registries of various U.S. states, making the registries interoperable nationally. It additionally uses machine learning to generate various three-digit "risk scores" and an overall "Overdose Risk Score", collectively referred to as Narx Scores, in a process that potentially includes EMS and criminal justice data as well as court records. == Controversy == Many doctors and researchers support the idea of PDMPs as a tool in combatting the opioid epidemic. Opioid prescribing, opioid diversion and supply, opioid misuse, and opioid-related morbidity and mortality are common elements in data entered into PDMPs. Prescription Monitoring Programs are purported to offer economic benefits for the states who implement them by decreasing overall health care costs, lost productivity, and investigation times. However, there are many studies that conclude the impact of PDMPs is unclear. While use of PMPs has been accompanied by decrease in opioid prescribing, few analyses consider corresponding use of street opioids, extramedical use, or diversion, which might provide a more holistic method for evaluation of PMP intent and efficacy. Evidence for PDMP impact on fatal overdoses is decidedly mixed, with multiple studies finding increased overdose rates in some states, decreases in others, or no clear impact. Interestingly, an increase in heroin overdoses after PDMP implementation has been commonly reported, presumably as denial of prescription opioids sends patients in search of street drugs. Narx Scores have been criticized by researchers and patient advocates for the lack of transparency in the generation process as well as the potential for disparate treatment of women and minority groups. Writing in Duke Law Journal, Jennifer Oliva stated that "black-box algorithms" are used to generate the scores.
Multimedia database
A Multimedia database (MMDB) is a collection of related for multimedia data. The multimedia data include one or more primary media data types such as text, images, graphic objects (including drawings, sketches and illustrations) animation sequences, audio and video. A Multimedia Database Management System (MMDBMS) is a framework that manages different types of data potentially represented in a wide diversity of formats on a wide array of media sources. It provides support for multimedia data types, and facilitate for creation, storage, access, query and control of a multimedia database. == Contents of MMDB == A Multimedia Database (MMDB) hosts one or more multimedia data types (i.e. text, images, graphic objects, audio, video, animation sequences). These data types are broadly categorized into three classes: Static media (time-independent: image and graphic object). Dynamic media (time-dependent: audio, video and animation). Dimensional media(3D game and computer aided drafting programs). === Comparison of multimedia data types === Additionally, a Multimedia Database (MMDB) needs to manage additional information pertaining to the actual multimedia data. The information is about the following: Media data: the actual data representing an object. Media format data: information about the format of the media data after it goes through the acquisition, processing, and encoding phases. Media keyword data: the keyword descriptions, usually relating to the generation of the media data. Media feature data: content dependent data such as contain information about the distribution of colours, the kinds of textures and the different shapes present in an image. The last three types are called metadata as they describe several different aspects of the media data. The media keyword data and media feature data are used as indices for searching purpose. The media format data is used to present the retrieved information. == Requirements of Multimedia databases == Like the traditional databases, Multimedia databases should address the following requirements: Integration Data items do not need to be duplicated for different programs invocations Data independence Separate the database and the management from the application programs Concurrency control Allows concurrent transactions Persistence Data objects can be saved and re-used by different transactions and program invocations Privacy Access and authorization control Integrity control Ensures database consistency between transactions Recovery Failures of transactions should not affect the persistent data storage Query support Allows easy querying of multimedia data Multimedia databases should have the ability to uniformly query data (media data, textual data) represented in different formats and have the ability to simultaneously query different media sources and conduct classical database operations across them. (Query support) They should have the ability to retrieve media objects from a local storage device in a good manner. (Storage support) They should have the ability to take the response generated by a query and develop a presentation of that response in terms of audio-visual media and have the ability to deliver this presentation. (Presentation and delivery support) == Issues and challenges == Multimedia data consists of a variety of media formats or file representations including TIFF, BMP, PPT, IVUE, FPX, JPEG, MPEG, AVI, MID, WAV, DOC, GIF, EPS, PNG, etc. Because of restrictions on the conversion from one format to the other, the use of the data in a specific format has been limited as well. Usually, the data size of multimedia is large such as video; therefore, multimedia data often require a large storage. Multimedia database consume a lot of processing time, as well as bandwidth. Some multimedia data types such as video, audio, and animation sequences have temporal requirements that have implications on their storage, manipulation and presentation, but images, video and graphics data have special constraints in terms of their content. == Application areas == Examples of multimedia database application areas: Digital Libraries News-on-Demand Video-on-Demand Music database Geographic Information Systems (GIS) Telemedicine
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Distributional–relational database
A distributional–relational database, or word-vector database, is a database management system (DBMS) that uses distributional word-vector representations to enrich the semantics of structured data. As distributional word-vectors can be built automatically from large-scale corpora, this enrichment supports the construction of databases which can embed large-scale commonsense background knowledge into their operations. Distributional-Relational models can be applied to the construction of schema-agnostic databases (databases in which users can query the data without being aware of its schema), semantic search, schema-integration and inductive and abductive reasoning as well as different applications in which a semantically flexible knowledge representation model is needed. The main advantage of distributional–relational models over purely logical or semantic web models is the fact that the core semantic associations can be automatically captured from corpora, in contrast to the definition of manually curated ontologies and rule knowledge bases. == Distributional–relational models == Distributional–relational models were first formalized as a mechanism to cope with the vocabulary/semantic gap between users and the schema behind the data. In this scenario, distributional semantic relatedness measures, combined with semantic pivoting heuristics can support the approximation between user queries (expressed in their own vocabulary), and data (expressed in the vocabulary of the designer). In this model, the database symbols (entities and relations) are embedded into a distributional semantic space and have a geometric interpretation under a latent or explicit semantic space. The geometric aspect supports the semantic approximation between entities from different databases, or between a query term and a database entity. The distributional relational model then becomes a double layered model where the semantics of the structured data provides the fine-grained semantics intended by the database designer, which is extended by the distributional semantic model which contains the semantic associations expressed at a broader use. These models support the generalization from a closed communication scenario (in which database designers and users live in the same context, e.g. the same organization) to an open communication scenario (e.g. different organizations, the Web), creating an abstraction layer between users and the specific representation of the conceptual model.
Chatbot
A chatbot (originally chatterbot) is a software application or web interface designed to converse through text or speech. Modern chatbots are typically online and use generative artificial intelligence systems that are capable of maintaining a conversation with a user in natural language and simulating the way a human would behave as a conversational partner. Such chatbots often use deep learning and natural language processing. Simpler chatbots have existed for decades. Chatbots have gained popularity during the AI boom of the 2020s, with the releases of generative AI chatbots such as ChatGPT, Gemini, Claude, and Grok. These chatbots typically use fine-tuned large language models to generate text. A major area where chatbots have long been used is customer service and support, with various sorts of virtual assistants. == History == === Turing test === In 1950, Alan Turing published an article entitled "Computing Machinery and Intelligence" in which he proposed what is now called the Turing test as a criterion of intelligence. This criterion depends on the ability of a computer program to impersonate a human in a real-time written conversation with a human judge, to the extent that the judge is incapable of reliably distinguishing, on the basis of the conversational content alone, between the program and a real human. === Early chatbots === Joseph Weizenbaum's program ELIZA was first published in 1966. Weizenbaum did not claim that ELIZA was genuinely intelligent, and the introduction to his paper presented it more as a debunking exercise:In artificial intelligence, machines are made to behave in wondrous ways, often sufficient to dazzle even the most experienced observer. But once a particular program is unmasked, once its inner workings are explained, its magic crumbles away; it stands revealed as a mere collection of procedures. The observer says to himself "I could have written that". With that thought, he moves the program in question from the shelf marked "intelligent", to that reserved for curios. The object of this paper is to cause just such a re-evaluation of the program about to be "explained". Few programs ever needed it more. ELIZA's key method of operation involves the recognition of clue words or phrases in the input, and the output of the corresponding pre-prepared or pre-programmed responses that can move the conversation forward in an apparently meaningful way (e.g. by responding to any input that contains the word 'MOTHER' with 'TELL ME MORE ABOUT YOUR FAMILY'). Thus an illusion of understanding is generated, even though the processing involved has been merely superficial. ELIZA showed that such an illusion is surprisingly easy to generate because human judges are ready to give the benefit of the doubt when conversational responses are capable of being interpreted as "intelligent". Following ELIZA, psychiatrist Kenneth Colby developed PARRY in 1972. From 1978 to some time after 1983, the CYRUS project led by Janet Kolodner constructed a chatbot simulating Cyrus Vance (57th United States Secretary of State). It used case-based reasoning, and updated its database daily by parsing wire news from United Press International. The program was unable to process the news items subsequent to the surprise resignation of Cyrus Vance in April 1980, and the team constructed another chatbot simulating his successor, Edmund Muskie. In 1984, an interactive version of the program Racter was released which acted as a chatbot. A.L.I.C.E. was released in 1995. This uses a markup language called AIML, which is specific to its function as a conversational agent, and has since been adopted by various other developers of, so-called, Alicebots. A.L.I.C.E. is a weak AI without any reasoning capabilities. It is based on a similar pattern matching technique as ELIZA in 1966. This is not strong AI, which would require sapience and logical reasoning abilities. Jabberwacky, released in 1997, learns new responses and context based on real-time user interactions, rather than being driven from a static database. Chatbot competitions focus on the Turing test or more specific goals. Two such annual contests are the Loebner Prize and The Chatterbox Challenge (the latter has been offline since 2015, however, materials can still be found from web archives). Pre-dating the current generation of large language models, Gavagai, a Swedish language technology startup, created a Twitter-based bot in 2015 and DBpedia created a chatbot during the 2017 Google Summer of Code that communicated through Facebook Messenger. === Modern chatbots based on large language models === Modern chatbots like ChatGPT are often based on foundational large language models called generative pre-trained transformers (GPT). They are based on a deep learning architecture called the transformer, which contains artificial neural networks. They generate text after being trained on a large text corpus, and have emergent abilities that they are not specifically trained for. Chatbots integrated into apps and websites can call image-generation models or search the web. Some platforms also enable users to interact with conversational interfaces directly through web-based chat environments, allowing real-time assistance, content generation, and task automation without requiring software installation. == Application == === Messaging apps === Many companies' chatbots run on messaging apps or simply via SMS. They are used for B2C customer service, sales and marketing. In 2016, Facebook Messenger allowed developers to place chatbots on their platform. There were 30,000 bots created for Messenger in the first six months, rising to 100,000 by September 2017. Since September 2017, this has also been as part of a pilot program on WhatsApp. Airlines KLM and Aeroméxico both announced their participation in the testing; both airlines had previously launched customer services on the Facebook Messenger platform. The bots usually appear as one of the user's contacts, but can sometimes act as participants in a group chat. Many banks, insurers, media companies, e-commerce companies, airlines, hotel chains, retailers, health care providers, government entities, and restaurant chains have used chatbots to answer simple questions, increase customer engagement, for promotion, and to offer additional ways to order from them. Chatbots are also used in market research to collect short survey responses. A 2017 study showed 4% of companies used chatbots. In a 2016 study, 80% of businesses said they intended to have one by 2020. ==== As part of company apps and websites ==== Previous generations of chatbots were present on company websites, e.g. Ask Jenn from Alaska Airlines which debuted in 2008 or Expedia's virtual customer service agent which launched in 2011. The newer generation of chatbots includes IBM Watson-powered "Rocky", introduced in February 2017 by the New York City-based e-commerce company Rare Carat to provide information to prospective diamond buyers. ==== Chatbot sequences ==== Used by marketers to script sequences of messages, very similar to an autoresponder sequence. Such sequences can be triggered by user opt-in or the use of keywords within user interactions. After a trigger occurs a sequence of messages is delivered until the next anticipated user response. Each user response is used in the decision tree to help the chatbot navigate the response sequences to deliver the correct response message. === Company internal platforms === Companies have used chatbots for customer support, human resources, or in Internet-of-Things (IoT) projects. Overstock.com, for one, has reportedly launched a chatbot named Mila to attempt to automate certain processes when customer service employees request sick leave. Other large companies such as Lloyds Banking Group, Royal Bank of Scotland, Renault and Citroën are now using chatbots instead of call centres with humans to provide a first point of contact. In large companies, like in hospitals and aviation organizations, chatbots are also used to share information within organizations, and to assist and replace service desks. === Customer service === Chatbots have been proposed as a replacement for customer service departments. In 2026, The Financial Times reported on agentic chatbots that could do shopping for customers once given instructions. In 2016, Russia-based Tochka Bank launched a chatbot on Facebook for a range of financial services, including a possibility of making payments. In July 2016, Barclays Africa also launched a Facebook chatbot. === Healthcare === Chatbots are also appearing in the healthcare industry. A study suggested that physicians in the United States believed that chatbots would be most beneficial for scheduling doctor appointments, locating health clinics, or providing medication information. A 2025 review found that participants often rated chatbot responses as more empathic than those from clinicians. In 2020, WhatsApp worked with th
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