Braina is a virtual assistant and speech-to-text dictation application for Microsoft Windows developed by Brainasoft. Braina uses natural language interface, speech synthesis, and speech recognition technology to interact with its users and allows them to use natural language sentences to perform various tasks on a computer. The name Braina is a short form of "Brain Artificial". Braina is marketed as a Microsoft Copilot alternative. It provides a voice interface for several locally run and cloud large language models, including the latest LLMs from providers such as OpenAI, Anthropic, Google, xAI, Meta, Mistral, etc; while improving data privacy. Braina also allows responses from its in-house large language models like Braina Swift and Braina Pinnacle. It has an "Artificial Brain" feature that provides persistent memory support for supported LLMs. == Features == Braina provides is able to carry out various tasks on a computer, including automation. Braina can take commands inputted through typing or through dictation to store reminders, find information online, perform mathematical operations, open files, generate images from text, transcribe speech, and control open windows or programs. Braina adapts to user behavior over time with a goal of better anticipating needs. === Speech-to-text dictation === Braina Pro can type spoken words into an active window at the location of a user's cursor. Its speech recognition technology supports more than 100 languages and dialects and is able to isolate the recognition of a user's voice from disturbing environmental factors such as background noise, other human voices, or external devices. Braina can also be taught to dictate uncommon legal, medical, and scientific terms. Users can also teach Braina uncommon names and vocabulary. Users can edit or correct dictated text without using a keyboard or mouse by giving built-in voice commands. === Text-to-speech === Braina can read aloud selected texts, such as e-books. === Custom commands and automation === Braina can automate computer tasks. It lets users create custom voice commands to perform tasks such as opening files, programs, websites, or emails, as well as executing keyboard or mouse macros. === Transcription === Braina can transcribe media file formats such as WAV, MP3, and MP4 into text. === Notes and reminders === Braina can store and recall notes and reminders. These can include scheduled or unscheduled commands, checklist items, alarms, chat conversations, memos, website snippets, bookmarks, contacts. === Image and Video generation === Braina can generate AI images and videos from text and image inputs using generative cloud AI models. These include Black Forest Labs' FLUX.2, Google's Veo, Imagen, and Nano Banana Pro, Kuaishou's Kling, Alibaba's Wan, ByteDance's Seedance and Seedream, MiniMax's Hailuo, OpenAI's GPT Image, and Tongyi Lab's Z Image Turbo. == Platforms == In addition to the desktop version for Windows operating systems, Braina is also available for the iOS and Android operating systems. The mobile version of Braina has a feature allowing remote management of a Windows PC connected via Wi-Fi. == Distributions == Braina is distributed in multiple modes. These include Braina Lite, a freeware version with limitations, and premium versions Braina Pro, Pro Plus, and Pro Ultra. Some additional features in the Pro version include dictation, custom vocabulary, video transcription, automation, custom voice commands, and persistent LLM memory. == Reception == TechRadar has consistently listed Braina as one of the best dictation and virtual assistant apps between 2015 and 2024.
1.58-bit large language model
A 1.58-bit large language model (also known as a ternary LLM) is a type of large language model (LLM) designed to be computationally efficient. It achieves this by using weights that are restricted to only three values: -1, 0, and +1. This restriction significantly reduces the model's memory footprint and allows for faster processing, as computationally expensive multiplication operations can be replaced with lower-cost additions. This contrasts with traditional models that use 16-bit floating-point numbers (FP16 or BF16) for their weights. Studies have shown that for models up to several billion parameters, the performance of 1.58-bit LLMs on various tasks is comparable to their full-precision counterparts. This approach could enable powerful AI to run on less specialized and lower-power hardware. The name "1.58-bit" comes from the fact that a system with three states contains log 2 3 ≈ 1.58 {\displaystyle \log _{2}3\approx 1.58} bits of information. These models are sometimes also referred to as 1-bit LLMs in research papers, although this term can also refer to true binary models (with weights of -1 and +1). == BitNet == In 2024, Ma et al., researchers at Microsoft, declared that their 1.58-bit model, BitNet b1.58 is comparable in performance to the 16-bit Llama 2 and opens the era of 1-bit LLM. BitNet creators did not use the post-training quantization of weights but instead relied on the new BitLinear transform that replaced the nn.Linear layer of the traditional transformer design. In 2025, Microsoft researchers had released an open-weights and open inference code model BitNet b1.58 2B4T demonstrating performance competitive with the full precision models at 2B parameters and 4T training tokens. == Post-training quantization == BitNet derives its performance from being trained natively in 1.58 bit instead of being quantized from a full-precision model after training. Still, training is an expensive process and it would be desirable to be able to somehow convert an existing model to 1.58 bits. In 2024, HuggingFace reported a way to gradually ramp up the 1.58-bit quantization in fine-tuning an existing model down to 1.58 bits. == Critique == Some researchers point out that the scaling laws of large language models favor the low-bit weights only in case of undertrained models. As the number of training tokens increases, the deficiencies of low-bit quantization surface.
Generative AI pornography
Generative AI pornography or simply AI pornography is a digitally created pornography produced through generative artificial intelligence (AI) technologies. Unlike traditional pornography, which involves real actors and cameras, this content is synthesized entirely by AI algorithms. These algorithms, including generative adversarial networks (GANs) and text-to-image models, generate lifelike images, videos, or animations from textual descriptions or datasets. == Functions and production strategies == AI pornography platforms, beyond account creation and social media linking, primarily enable users to generate sexual images through feature selection or text prompting. Users can customize bodies, clothing, and sociodemographic traits, and browse categorized galleries of user‑generated content. Several sites also support short pornographic videos or GIFs and modification tools such as nudifiers, deepfakes, and facemorphing. Platforms often allow fine‑tuning of parameters such as settings, style, or theme, and provide prompt enhancers or suggestions to improve outputs. Users may edit generated images, refine prior prompts, modify others’ work, or upload personal material as a basis, with iterative and collaborative content creation. Some websites additionally host interactive “erobots,” customizable in real time for appearance, personality, memories, speech, and profession, enabling tailored sexual and non‑sexual interactions. Less common features include VR integration, AI porn games, audio or doodle prompts, and consensual replication of individuals with verification. == History == The use of generative AI in the adult industry began in the late 2010s, initially focusing on AI-generated art, music, and visual content. This trend accelerated in 2022 with Stability AI's release of Stable Diffusion (SD), an open-source text-to-image model that enables users to generate images, including NSFW content, from text prompts using the LAION-Aesthetics subset of the LAION-5B dataset. Despite Stability AI's warnings against sexual imagery, SD's public release led to dedicated communities exploring both artistic and explicit content, sparking ethical debates over open-access AI and its use in adult media. By 2020, AI tools had advanced to generate highly realistic adult content, amplifying calls for regulation. === AI-generated influencers === One application of generative AI technology is the creation of AI-generated influencers on platforms such as OnlyFans and Instagram. These AI personas interact with users in ways that can mimic real human engagement, offering an entirely synthetic but convincing experience. While popular among niche audiences, these virtual influencers have prompted discussions about authenticity, consent, and the blurring line between human and AI-generated content, especially in adult entertainment. === The growth of AI porn sites === By 2023, websites dedicated to AI-generated adult content had gained traction, catering to audiences seeking customizable experiences. These platforms allow users to create or view AI-generated pornography tailored to their preferences. These platforms enable users to create or view AI-generated adult content appealing to different preferences through prompts and tags, customizing body type, facial features, and art styles. Tags further refine the output, creating niche and diverse content. Many sites feature extensive image libraries and continuous content feeds, combining personalization with discovery and enhancing user engagement. AI porn sites, therefore, attract those seeking unique or niche experiences, sparking debates on creativity and the ethical boundaries of AI in adult media. == Ethical concerns and misuse == The growth of generative AI pornography has also attracted some cause for criticism. AI technology can be exploited to create non-consensual pornographic material, posing risks similar to those seen with deepfake revenge porn and AI-generated NCII (Non-Consensual Intimate Image). A 2023 analysis found that 98% of deepfake videos online are pornographic, with 99% of the victims being women. Some famous celebrities victims of deepfake include Scarlett Johansson, Taylor Swift, and Maisie Williams. OpenAI is exploring whether NSFW content, such as erotica, can be responsibly generated in age-appropriate contexts while maintaining its ban on deepfakes. This proposal has attracted criticism from child safety campaigners who argue it undermines OpenAI's mission to develop "safe and beneficial" AI. Additionally, the Internet Watch Foundation has raised concerns about AI being used to generate sexual abuse content involving children. === AI-generated non-consensual intimate imagery (AI Undress) === Generative AI have extensively been used to produce pornography images and videos of non-consenting individuals. 404 Media reported a particular AI generated porn bot on Telegram has more than 100,000 monthly users. Alibaba, the Chinese tech company, released an AI video generation model in 2025 called Wan 2.1, which was modified to produce non-consensual pornography. Several US states are taking actions against using deepfake apps and sharing them on the internet. In 2024, San Francisco filed a landmark lawsuit to shut down "undress" apps that allow users to generate non-consensual AI nude images, citing violations of state laws. The case aligns with California's recent legislation—SB 926, SB 942, and SB 981—championed by Senators Aisha Wahab and Josh Becker and signed by Governor Gavin Newsom. These bills aim to protect individuals from AI-generated explicit images by criminalizing non-consensual distribution, mandating disclosures, and empowering victims to report and remove harmful content from platforms. === Differences from deepfake pornography === While both generative AI pornography and deepfake pornography rely on synthetic media, they differ in their methods and ethical considerations. Deepfake pornography typically involves altering existing footage of real individuals, often without their consent, using AI to superimpose faces, undress said persons, or modify scenes. In contrast, generative AI pornography is created using algorithms, producing hyper-realistic content without the need to upload real pictures of people. Hany Farid, digital image analysis expert, also described the difference between "AI porn" and "deepfake porn." == Legality == The legality of generative AI pornography varies widely by jurisdiction and remains an evolving issue. In some countries, laws addressing digital impersonation, obscenity, or deepfake technologies may indirectly apply, particularly when AI-generated content involves the likeness of real individuals without consent. The absence of a physical performer further complicates traditional regulatory frameworks, which are often grounded in performer protection and distribution laws. In the United States, legal responses have primarily focused on non-consensual deepfakes and impersonation. Some states, such as Virginia, California, and Texas, have enacted legislation criminalising the creation or distribution of non-consensual explicit deepfake content. However, there is no comprehensive federal law addressing AI-generated pornography, leaving a patchwork of legal interpretations and enforcement standards across different jurisdictions. According to a 2023 report, South Korea accounts for approximately 53% of global deepfake pornography production. In September 2024, South Korea's National Assembly amended the Act on Special Cases Concerning the Punishment of Sexual Crimes, introducing two significant reforms related to deepfake content. The first criminalises the possession, viewing, purchase, and storage of non-consensual deepfake material, with penalties of up to three years in prison or fines of up to 30 million won (approximately USD 20,000). The second reform specifically addresses the exploitation of minors, establishing that individuals who use deepfakes to threaten or blackmail minors face a minimum of three years' imprisonment, and at least five years if they coerce minors into unwanted acts. In England and Wales the Data (Use and Access) Act 2025 has legislated against the creation, or the request for creation, of intimate images by nudifying software or websites of another person who has not consented to this. However as of January 2026 this has not yet been brought into force.
Ensemble averaging (machine learning)
In machine learning, ensemble averaging is the process of creating multiple models (typically artificial neural networks) and combining them to produce a desired output, as opposed to creating just one model. Ensembles of models often outperform individual models, as the various errors of the ensemble constituents "average out". == Overview == Ensemble averaging is one of the simplest types of committee machines. Along with boosting, it is one of the two major types of static committee machines. In contrast to standard neural network design, in which many networks are generated but only one is kept, ensemble averaging keeps the less satisfactory networks, but with less weight assigned to their outputs. The theory of ensemble averaging relies on two properties of artificial neural networks: In any network, the bias can be reduced at the cost of increased variance In a group of networks, the variance can be reduced at no cost to the bias. This is known as the bias–variance tradeoff. Ensemble averaging creates a group of networks, each with low bias and high variance, and combines them to form a new network which should theoretically exhibit low bias and low variance. Hence, this can be thought of as a resolution of the bias–variance tradeoff. The idea of combining experts can be traced back to Pierre-Simon Laplace. == Method == The theory mentioned above gives an obvious strategy: create a set of experts with low bias and high variance, and average them. Generally, what this means is to create a set of experts with varying parameters; frequently, these are the initial synaptic weights of a neural network, although other factors (such as learning rate, momentum, etc.) may also be varied. Some authors recommend against varying weight decay and early stopping. The steps are therefore: Generate N experts, each with their own initial parameters (these values are usually sampled randomly from a distribution) Train each expert separately Combine the experts and average their values. Alternatively, domain knowledge may be used to generate several classes of experts. An expert from each class is trained, and then combined. A more complex version of ensemble average views the final result not as a mere average of all the experts, but rather as a weighted sum. If each expert is y i {\displaystyle y_{i}} , then the overall result y ~ {\displaystyle {\tilde {y}}} can be defined as: y ~ ( x ; α ) = ∑ j = 1 p α j y j ( x ) {\displaystyle {\tilde {y}}(\mathbf {x} ;\mathbf {\alpha } )=\sum _{j=1}^{p}\alpha _{j}y_{j}(\mathbf {x} )} where α {\displaystyle \mathbf {\alpha } } is a set of weights. The optimization problem of finding alpha is readily solved through neural networks, hence a "meta-network" where each "neuron" is in fact an entire neural network can be trained, and the synaptic weights of the final network is the weight applied to each expert. This is known as a linear combination of experts. It can be seen that most forms of neural network are some subset of a linear combination: the standard neural net (where only one expert is used) is simply a linear combination with all α j = 0 {\displaystyle \alpha _{j}=0} and one α k = 1 {\displaystyle \alpha _{k}=1} . A raw average is where all α j {\displaystyle \alpha _{j}} are equal to some constant value, namely one over the total number of experts. A more recent ensemble averaging method is negative correlation learning, proposed by Y. Liu and X. Yao. This method has been widely used in evolutionary computing. == Benefits == The resulting committee is almost always less complex than a single network that would achieve the same level of performance The resulting committee can be trained more easily on smaller datasets The resulting committee often has improved performance over any single model The risk of overfitting is lessened, as there are fewer parameters (e.g. neural network weights) which need to be set.
European Conference on Artificial Intelligence
The European Conference on Artificial Intelligence (ECAI) is the leading conference in the field of Artificial Intelligence in Europe, and is commonly listed together with IJCAI and AAAI as one of the three major general AI conferences worldwide. The conference series has been held without interruption since 1974, originally under the name AISB. The conference was originally held biennially, but has been organized annually since ECAI 2022. The conferences are held under the auspices of the European Coordinating Committee for Artificial Intelligence (ECCAI) and organized by one of the member societies. The journal AI Communications, sponsored by the same society, regularly publishes special issues in which conference attendees report on the conference. Publication of a paper in ECAI is considered by some journals to be archival: the paper should be considered equivalent to a journal publication and that the contents of ECAI papers cannot be reformulated as separate journal submissions unless a significant amount of new material is added. == List of ECAI conferences == ECAI-1992 took place in Vienna, Austria. ECAI-1996 took place in Budapest, Hungary. ECAI-1998 tool place in Brighton, United Kingdom. ECAI-2000 took place in Berlin, Germany. ECAI-2004 took place in Valencia, Spain. ECAI-2006 took place in Riva del Garda, Italy. ECAI-2008 took place in Patras, Greece. ECAI-2010 took place in Lisbon, Portugal. ECAI-2012 took place in Montpellier, France. ECAI-2014 took place in Prague, Czech Republic. ECAI-2016 took place in The Hague, Netherlands. ECAI-2018 took place in Stockholm, Sweden. ECAI-2020 took place in Santiago de Compostela, Spain. ECAI-2022 took place in Vienna, Austria. ECAI-2023 took place in Kraków, Poland. ECAI-2024 took place in Santiago de Compostela, Spain. ECAI-2025 took place in Bologna, Italy.
Graph cuts in computer vision and artificial intelligence
As applied in the field of computer vision, graph cut optimization can be employed to efficiently solve a wide variety of low-level computer vision problems (early vision), such as image smoothing, the stereo correspondence problem, image segmentation, object co-segmentation, numerous military applications (eg Automatic target recognition) and many other problems that can be formulated in terms of energy minimization (eg Climate Science and Environmental modelling). Graph cut techniques are now increasingly being used in combination with more general spatial Artificial intelligence techniques (eg to enforce structure in Large language model output to sharpen tumour boundaries and similarly for various Augmented reality, Self-driving car, Robotics, Google Maps applications etc). Many of these energy minimization problems can be approximated by solving a maximum flow problem in a graph (and thus, by the max-flow min-cut theorem, define a minimal cut of the graph). Under most formulations of such problems in computer vision, the minimum energy solution corresponds to the maximum a posteriori estimate of a solution. Although many computer vision algorithms involve cutting a graph (e.g. normalized cuts), the term "graph cuts" is applied specifically to those models which employ a max-flow/min-cut optimization (other graph cutting algorithms may be considered as graph partitioning algorithms). "Binary" problems (such as denoising a binary image) can be solved exactly using this approach; problems where pixels can be labeled with more than two different labels (such as stereo correspondence, or denoising of a grayscale image) cannot be solved exactly, but solutions produced are usually near the global optimum. == History == The foundational theory of graph cuts in computer vision was first developed by Margaret Greig, Bruce Porteous and Allan Seheult (GPS) of Durham University in a now legendary discussion contribution to Julian Besag's 1986 paper and a more detailed follow on paper in 1989. In the Bayesian statistical context of smoothing noisy images, using a Markov random field as the image prior distribution, they showed with a mathematically beautiful proof how the maximum a posteriori estimate of a binary image can be obtained exactly by maximizing the flow through an associated image network, or graph, involving the introduction of a source and sink and Log-likelihood ratios. The problem was shown to be efficiently solvable exactly, an unexpected result as the problem was believed to be computationally intractable (NP hard). GPS also addressed the computational cost of the max-flow algorithm on large graphs, a significant concern at the time. They proposed a partitioning algorithm (see Section 4 of GPS) involving the recursive amalgamation of non-overlapping blocks, or tiles, which gave a 12X increase in speed. This approach recursively solved and amalgamated independent sub-graphs until the whole graph was solved. While contemporaries like Geman and Geman had advocated Parallel computing in the context of Simulated annealing, the GPS blocking strategy offered a deterministic structure amenable to parallelisation and anticipated modern artificial intelligence design across multiple GPUs. However, until recently, this aspect of the paper was largely ignored and subsequent research focused on Serial computer global search trees, such as the Boykov-Kolmogorov algorithm. Although the general k {\displaystyle k} -colour problem is NP hard for k > 2 , {\displaystyle k>2,} the GPS approach has turned out to have very wide applicability in general computer vision problems. This was first demonstrated by Boykov, Veksler and Zabih who, in a seminal paper published more than 10 years after the original GPS paper, and in other important works, lit the blue touch paper for the general adoption of graph cut techniques in computer vision. They showed that, for general problems, the GPS approach can be applied iteratively to sequences of binary problems, using their now ubiquitous alpha-expansion algorithm, yielding near optimal solutions. Prior to these results, approximate local optimisation techniques such as simulated annealing (as proposed by the Geman brothers) or iterated conditional modes (a type of greedy algorithm suggested by Julian Besag) were used to solve such image smoothing problems. Building on these advancements, GPS graph cut optimization was subsequently adapted for interactive image segmentation, most notably through the "GrabCut" algorithm introduced by Carsten Rother, Vladimir Kolmogorov, and Andrew Blake of Microsoft Research, Cambridge. GrabCut extended earlier interactive graph cut methods by replacing monochrome image histograms with Gaussian mixture models to estimate colour distributions, and by employing an iterative GPS energy minimisation scheme. This approach significantly simplified user interaction, requiring only a rough bounding box around the target object rather than detailed user-drawn strokes, and it quickly became a standard tool in both academic research and commercial image editing software. The GPS paper connected and bridged profound ideas from Mathematical statistics (Bayes' theorem, Markov random field), Physics (Ising model), Optimisation (Energy function) and Computer science (Network flow problem) and led the move away from approximate local and slow optimisation approaches (eg simulated annealing) to more powerful exact, or near exact, faster global optimisation techniques. It is now recognised as seminal as it was well ahead of its time and, in particular, was published years before the computing power revolution of Moore's law and GPUs. Significantly, GPS was published in a mathematical statistics (rather than a computer vision) journal, and this led to it being overlooked by the computer vision community for many years. It is unofficially known as "The Velvet Underground" paper of computer vision (ie although very few computer vision people read the paper [bought the record], those that did, most importantly Boykov, Veksler and Zabih, started new and important research [formed a band]). This is confirmed by GPS' very large amplification ratio (2nd order citations/first order citations), estimated at well in excess of 100. Despite the foundational nature of the GPS work, formal recognition from the computer vision community has predominantly gone to the researchers who followed to extend and popularise the graph cut method. For example, Boykov, Veksler and Zabih deservedly received a Helmholtz Prize from the ICCV in 2011. This prize recognises ICCV papers from 10 or more years earlier that have had a significant impact on computer vision research. In 2011, Couprie et al. proposed a general image segmentation framework, called the "Power Watershed", that minimized a real-valued indicator function from [0,1] over a graph, constrained by user seeds (or unary terms) set to 0 or 1, in which the minimization of the indicator function over the graph is optimized with respect to an exponent p {\displaystyle p} . When p = 1 {\displaystyle p=1} , the Power Watershed is optimized by graph cuts, when p = 0 {\displaystyle p=0} the Power Watershed is optimized by shortest paths, p = 2 {\displaystyle p=2} is optimized by the random walker algorithm and p = ∞ {\displaystyle p=\infty } is optimized by the watershed algorithm. In this way, the Power Watershed may be viewed as a generalization of graph cuts that provides a straightforward connection with other energy optimization segmentation/clustering algorithms. == Binary segmentation of images == === Notation === Image: x ∈ { R , G , B } N {\displaystyle x\in \{R,G,B\}^{N}} Output: Segmentation (also called opacity) S ∈ R N {\displaystyle S\in R^{N}} (soft segmentation). For hard segmentation S ∈ { 0 for background , 1 for foreground/object to be detected } N {\displaystyle S\in \{0{\text{ for background}},1{\text{ for foreground/object to be detected}}\}^{N}} Energy function: E ( x , S , C , λ ) {\displaystyle E(x,S,C,\lambda )} where C is the color parameter and λ is the coherence parameter. E ( x , S , C , λ ) = E c o l o r + E c o h e r e n c e {\displaystyle E(x,S,C,\lambda )=E_{\rm {color}}+E_{\rm {coherence}}} Optimization: The segmentation can be estimated as a global minimum over S: arg min S E ( x , S , C , λ ) {\displaystyle {\arg \min }_{S}E(x,S,C,\lambda )} === Existing methods === Standard Graph cuts: optimize energy function over the segmentation (unknown S value). Iterated Graph cuts: First step optimizes over the color parameters using K-means. Second step performs the usual graph cuts algorithm. These 2 steps are repeated recursively until convergence Dynamic graph cuts:Allows to re-run the algorithm much faster after modifying the problem (e.g. after new seeds have been added by a user). === Energy function === Pr ( x ∣ S ) = K − E {\displaystyle \Pr(x\mid S)=K^{-E}} where the energy E {\displaystyle E} is composed of two different mod
Clinical decision support system
A clinical decision support system (CDSS) is a form of health information technology that provides clinicians, staff, patients, or other individuals with knowledge and person-specific information to enhance decision-making in clinical workflows. CDSS tools include alerts and reminders, clinical guidelines, condition-specific order sets, patient data summaries, diagnostic support, and context-aware reference information. They often leverage artificial intelligence to analyze clinical data and help improve care quality and safety. CDSSs constitute a major topic in artificial intelligence in medicine. == Characteristics == A clinical decision support system is an active knowledge system that uses variables of patient data to produce advice regarding health care. This implies that a CDSS is simply a decision support system focused on using knowledge management. === Purpose === The main purpose of modern CDSS is to assist clinicians at the point of care. This means that clinicians interact with a CDSS to help to analyze and reach a diagnosis based on patient data for different diseases. In the early days, CDSSs were conceived to make decisions for the clinician in a literal manner. The clinician would input the information and wait for the CDSS to output the "right" choice, and the clinician would simply act on that output. However, the modern methodology of using CDSSs to assist means that the clinician interacts with the CDSS, utilizing both their knowledge and the CDSS's, better to analyse the patient's data than either a human or a CDSS could do on their own. Typically, a CDSS makes suggestions for the clinician to review, and the clinician is expected to pick out useful information from the presented results and discount erroneous CDSS suggestions. The two main types of CDSS are knowledge-based systems and non-knowledge-based (machine learning–based) systems: An example of how a clinician might use a clinical decision support system is a diagnosis decision support system (DDSS). DDSS requests some of the patient's data and, in response, proposes a set of possible diagnoses. The physician then takes the output of the DDSS and determines which diagnoses are likely and which are not, and, if necessary, orders further tests to narrow down the diagnosis. Another example of a CDSS would be a case-based reasoning (CBR) system. A CBR system might use previous case data to help determine the appropriate amount of beams and the optimal beam angles for use in radiotherapy for brain cancer patients; medical physicists and oncologists would then review the recommended treatment plan to determine its viability. Another important classification of a CDSS is based on the timing of its use. Physicians use these systems at the point of care to help them as they are dealing with a patient, with the timing of use being either pre-diagnosis, during diagnosis, or post-diagnosis. Pre-diagnosis CDSS systems help the physician prepare the diagnoses. CDSSs help review and filter the physician's preliminary diagnostic choices to improve outcomes. Post-diagnosis CDSS systems are used to mine data to derive connections between patients and their past medical history and clinical research to predict future events. Early speculation that AI-based decision support would replace clinicians in common tasks has largely given way to a consensus around assistive models, in which AI augments rather than supplants clinical judgment. Contemporary deep learning-based systems, unlike earlier rule-based tools, can be trained directly on clinical data without manual rule authoring and integrated into electronic health record workflows at the point of care. Another approach, used by the National Health Service in England, is to use a CDSS to triage medical conditions out of hours by suggesting a suitable next step to the patient (e.g. call an ambulance, or see a general practitioner on the next working day). The suggestion, which may be disregarded by either the patient or the phone operative if common sense or caution suggests otherwise, is based on the known information and an implicit conclusion about what the worst-case diagnosis is likely to be; it is not always revealed to the patient because it might well be incorrect and is not based on a medically-trained person's opinion - it is only used for initial triage purposes. === Knowledge-based === Most CDSSs consist of three parts: the knowledge base, an inference engine, and a mechanism to communicate. The knowledge base contains the rules and associations of compiled data which most often take the form of IF-THEN rules. If this was a system for determining drug interactions, then a rule might be that IF drug X is taken AND drug Y is taken THEN alert the user. Using another interface, an advanced user could edit the knowledge base to keep it up to date with new drugs. The inference engine combines the rules from the knowledge base with the patient's data. The communication mechanism allows the system to show the results to the user as well as have input into the system. An expression language such as GELLO or CQL (Clinical Quality Language) is needed for expressing knowledge artefacts in a computable manner. For example: if a patient has diabetes mellitus, and if the last haemoglobin A1c test result was less than 7%, recommend re-testing if it has been over six months, but if the last test result was greater than or equal to 7%, then recommend re-testing if it has been over three months. The current focus of the HL7 CDS WG is to build on the Clinical Quality Language (CQL). The U.S. Centers for Medicare & Medicaid Services (CMS) has announced that it plans to use CQL for the specification of Electronic Clinical Quality Measures (eCQMs). === Non-knowledge-based === CDSSs which do not use a knowledge base use a form of artificial intelligence called machine learning, which allow computers to learn from past experiences and/or find patterns in clinical data. This eliminates the need for writing rules and expert input. However, since systems based on machine learning cannot explain the reasons for their conclusions, most clinicians do not use them directly for diagnoses, reliability and accountability reasons. Nevertheless, they can be useful as post-diagnostic systems, for suggesting patterns for clinicians to look into in more depth. As of 2012, three types of non-knowledge-based systems are support-vector machines, artificial neural networks and genetic algorithms. Artificial neural networks use nodes and weighted connections between them to analyse the patterns found in patient data to derive associations between symptoms and a diagnosis. Genetic algorithms are based on simplified evolutionary processes using directed selection to achieve optimal CDSS results. The selection algorithms evaluate components of random sets of solutions to a problem. The solutions that come out on top are then recombined and mutated and run through the process again. This happens over and over until the proper solution is discovered. They are functionally similar to neural networks in that they are also "black boxes" that attempt to derive knowledge from patient data. Non-knowledge-based networks often focus on a narrow list of symptoms, such as symptoms for a single disease, as opposed to the knowledge-based approach, which covers the diagnosis of many diseases. An example of a non-knowledge-based CDSS is a web server developed using a support vector machine for the prediction of gestational diabetes in Ireland. == Regulations == === History, United States === The IOM had published a report in 1999, To Err is Human, which focused on the patient safety crisis in the United States, pointing to the incredibly high number of deaths. This statistic attracted great attention to the quality of patient care. The Institute of Medicine (IOM) promoted the usage of health information technology, including clinical decision support systems, to advance the quality of patient care. With the enactment of the American Recovery and Reinvestment Act of 2009 (ARRA), there was a push for widespread adoption of health information technology through the Health Information Technology for Economic and Clinical Health Act (HITECH). Through these initiatives, more hospitals and clinics were integrating electronic medical records (EMRs) and computerized physician order entry (CPOE) within their health information processing and storage. Despite the absence of laws, the CDSS vendors would almost certainly be viewed as having a legal duty of care to both the patients who may adversely be affected due to CDSS usage and the clinicians who may use the technology for patient care. However, duties of care legal regulations are not explicitly defined yet. With the enactment of the HITECH Act included in the ARRA, encouraging the adoption of health IT, more detailed case laws for CDSS and EMRs were still being defined by the Office of National Coordinator for Health Informati