Convergent encryption, also known as content hash keying, is a cryptosystem that produces identical ciphertext from identical plaintext files. This has applications in cloud computing to remove duplicate files from storage without the provider having access to the encryption keys. The combination of deduplication and convergent encryption was described in a backup system patent filed by Stac Electronics in 1995. This combination has been used by Farsite, Permabit, Freenet, MojoNation, GNUnet, flud, and the Tahoe Least-Authority File Store. The system gained additional visibility in 2011 when cloud storage provider Bitcasa announced they were using convergent encryption to enable de-duplication of data in their cloud storage service. == Overview == The system computes a cryptographic hash of the plaintext in question. The system then encrypts the plaintext by using the hash as a key. Finally, the hash itself is stored, encrypted with a key chosen by the user. == Known Attacks == Convergent encryption is open to a "confirmation of a file attack" in which an attacker can effectively confirm whether a target possesses a certain file by encrypting an unencrypted, or plain-text, version and then simply comparing the output with files possessed by the target. This attack poses a problem for a user storing information that is non-unique, i.e. also either publicly available or already held by the adversary - for example: banned books or files that cause copyright infringement. An argument could be made that a confirmation of a file attack is rendered less effective by adding a unique piece of data such as a few random characters to the plain text before encryption; this causes the uploaded file to be unique and therefore results in a unique encrypted file. However, some implementations of convergent encryption where the plain-text is broken down into blocks based on file content, and each block then independently convergently encrypted may inadvertently defeat attempts at making the file unique by adding bytes at the beginning or end. Even more alarming than the confirmation attack is the "learn the remaining information attack" described by Drew Perttula in 2008. This type of attack applies to the encryption of files that are only slight variations of a public document. For example, if the defender encrypts a bank form including a ten digit bank account number, an attacker that is aware of generic bank form format may extract defender's bank account number by producing bank forms for all possible bank account numbers, encrypt them and then by comparing those encryptions with defender's encrypted file deduce the bank account number. Note that this attack can be extended to attack a large number of targets at once (all spelling variations of a target bank customer in the example above, or even all potential bank customers), and the presence of this problem extends to any type of form document: tax returns, financial documents, healthcare forms, employment forms, etc. Also note that there is no known method for decreasing the severity of this attack -- adding a few random bytes to files as they are stored does not help, since those bytes can likewise be attacked with the "learn the remaining information" approach. The only effective approach to mitigating this attack is to encrypt the contents of files with a non-convergent secret before storing (negating any benefit from convergent encryption), or to simply not use convergent encryption in the first place.
WeChat or Weixin in Chinese (Chinese: 微信; pinyin: Wēixìn ; lit. 'micro-message') is an instant messaging, social media, and mobile payment app developed by Tencent. First released in 2011, it became the world's largest standalone mobile app in 2018 with over 1 billion monthly active users. The Chinese version of WeChat, Weixin, has been described as China's "app for everything" and a super-app because of its wide range of functions. WeChat provides text messaging, hold-to-talk voice messaging, broadcast (one-to-many) messaging, video conferencing, video games, mobile payment, sharing of photographs and videos and location sharing. It has been described as having "an almost indispensable part of life in China". Accounts registered using Chinese phone numbers are managed under the Weixin brand, and their data is stored in mainland China and subject to Weixin's terms of service and privacy policy. Non-Chinese numbers are registered under WeChat, and WeChat users are subject to a more liberal terms of service and better privacy policy, and their data is stored in the Netherlands for users in the European Union, and in Singapore for other users. User activity on Weixin, the Chinese version of the app, is analyzed, tracked and shared with Chinese authorities upon request as part of the mass surveillance network in China. Chinese-registered Weixin accounts censor politically sensitive topics, and the software license agreement for Weixin (but not WeChat) explicitly forbids content which "[en]danger[s] national security, divulge[s] state secrets, subvert[s] state power and undermine[s] national unity", as well as other types of content such as content that "[u]ndermine[s] national religious policies" and content that is "[i]nciting illegal assembly, association, procession, demonstrations and gatherings disrupting the social order". Due to its central part of Chinese life, a Chinese person having their WeChat account banned can cause a significant disruption to their life. Any interactions between Weixin and WeChat users are subject to the terms of service and privacy policies of both services. == History == By 2010, Tencent had already attained a massive user base with their desktop messenger app QQ. Recognizing smart phones were likely to disrupt this status quo, CEO Pony Ma sought to proactively invest in alternatives to their own QQ messenger app. WeChat began as a project at Tencent Guangzhou Research and Project center in October 2010. The original version of the app was created by Allen Zhang, named "Weixin" (微信) by Pony Ma, and launched in 2011. The user adoption of WeChat was initially very slow, with users wondering why key features were missing; however, after the release of the Walkie-talkie-like voice messaging feature in May of that year, growth surged. By 2012, when the number of users reached 100 million, Weixin was re-branded "WeChat" by President Martin Lau for the international market. During a period of government support of e-commerce development—for example in the 12th five-year plan (2011–2015)—WeChat also saw new features enabling payments and commerce in 2013, which saw massive adoption after their virtual Red envelope promotion for Chinese New Year 2014. WeChat had over 889 million monthly active users by 2016, and as of 2019 WeChat's monthly active users had risen to an estimate of one billion. As of January 2022, it was reported that WeChat has more than 1.2 billion users. After the launch of WeChat payment in 2013, its users reached 400 million the next year, 90 percent of whom were in China. By comparison, Facebook Messenger and WhatsApp had about one billion monthly active users in 2016 but did not offer most of the other services available on WeChat. For example, in Q2 2017, WeChat's revenues from social media advertising were about US$0.9 billion (RMB6 billion) compared with Facebook's total revenues of US$9.3 billion, 98% of which were from social media advertising. WeChat's revenues from its value-added services were US$5.5 billion. By 2018, WeChat had been used by 93.5% of Chinese internet users. In that year, it became the world's largest standalone mobile app in 2018 with over 1 billion monthly active users. In response to a border dispute between India and China, WeChat was banned in India in June 2020 along with several other Chinese apps, including TikTok. U.S. president Donald Trump sought to ban U.S. "transactions" with WeChat through an executive order but was blocked by a preliminary injunction issued in the United States District Court for the Northern District of California in September 2020. Joe Biden officially dropped Trump's efforts to ban WeChat in the U.S. in June 2021. == Features == WeChat, has been described as China's "app for everything" and a super-app because of its wide range of functions. WeChat provides text messaging, hold-to-talk voice messaging, broadcast (one-to-many) messaging, video conferencing, video games, mobile payment, sharing of photographs and videos and location sharing. It has been described as having "an almost indispensable part of life in China". Due to its central part of Chinese life, a Chinese person having their WeChat account banned can cause a significant disruption to their life. === Messaging === WeChat provides a variety of features including text messaging, hold-to-talk voice messaging, broadcast (one-to-many) messaging, video calls and conferencing, video games, photograph and video sharing, as well as location sharing. WeChat also allows users to exchange contacts with people nearby via Bluetooth, as well as providing various features for contacting people at random if desired (if people are open to it). It can also integrate with other social networking services such as Facebook and Tencent QQ. Photographs may also be embellished with filters and captions, and automatic translation service is available and could also translate the conversation during messaging. WeChat supports different instant messaging methods, including text messages, voice messages, walkie talkie, and stickers. Users can send previously saved or live pictures and videos, profiles of other users, coupons, lucky money packages, or current GPS locations with friends either individually or in a group chat. WeChat also provides a message recall feature to allow users to recall and withdraw information (e.g. images, documents) that are sent within 2 minutes in a conversation. WeChat also provides a voice-to-text feature that brings convenience when it is not convenient to listen to voice messages, as well as the basic ability to recognize emojis based on different tones of voice. A distance sensing feature is implemented in WeChat. It has the ability to activate the receivers' hold-to-talk function when the phone was brought in close proximity to the ear. After the receiver was held at a certain distance from the ear, the sensor would then proceed to automatically disable the phone speakers. This feature eliminates the risk of the user's voice messages being inadvertently broadcast to the general public. === Public accounts === WeChat users can register as a public account (公众号), which enables them to push feeds to subscribers, interact with subscribers, and provide subscribers with services. Users can also create an official account, which fall under service, subscription, or enterprise accounts. Once users as individuals or organizations set up a type of account, they cannot change it to another type. By the end of 2014, the number of WeChat official accounts had reached 8 million. Official accounts of organizations can apply to be verified (cost 300 RMB or about US$45). Official accounts can be used as a platform for services such as hospital pre-registrations, or credit card service. To create an official account, the applicant must register with Chinese authorities, which discourages "foreign companies". In April 2022, WeChat announced that it will start displaying the location of users in China every time they post on a public account. Meanwhile, overseas users on public accounts will also display the country based on their IP address. === Moments === "Moments" (朋友圈) is WeChat's brand name for its social feed of friends' updates. "Moments" is an interactive platform that allows users to post images, text, and short videos taken by users. It also allows users to share articles and music (associated with QQ Music or other web-based music services). Friends in the contact list can like the content and leave comments, functioning similarly to a private social network. In 2017 WeChat had a policy of a maximum of two advertisements per day per Moments user. Privacy in WeChat works by groups of friends: only the friends from the user's contact are able to view their Moments' contents and comments. The friends of the user will only be able to see the likes and comments from other users only if they are in a mutual friend group. For example, friends from high school are not able to
Dominic Harris
Dominic Harris (born 16 November 1976) is a British artist known for integrating modern technology and classical design in his interactive artworks. == Background == Dominic Harris was born in London on 16 November 1976, and grew up in London, Brussels, and Michigan before returning to London in 1995. Harris attended the Cranbrook Kingswood Upper School, and then trained as an architect at the Bartlett School of Architecture, and has been ARB registered since 2011. Harris designs and fabricates his artworks at Dominic Harris Studio, a multi-disciplinary practice he founded in 2007. This studio consists of 25 people with diverse backgrounds including architecture, product design, electronics, programming, graphic design, and workshop skills. Harris uses the resources of his studio for the ongoing development, prototyping and production of his artworks. Harris also oversees the studio's international projects where his fascinations are translated into larger scale projects that span residential, retail, and public art projects. In 2015, Harris was granted permission by the Walt Disney Company to use their Intellectual Property for the purpose of making new interactive artworks. Harris is the only artist to gain permission to use Disney's back catalogue of characters, and led him to creating his interactive versions of "Snow White and the Seven Dwarfs" and "Mickey and Minnie: An Interactive Diptych". Harris is fascinated by the idea of using data streams, algorithms, and computer code to generate dynamic and ever-changing artworks. He sees data as a raw material that can be transformed into visual poetry. Many of his installations and sculptures are interactive, responding to the presence and movement of viewers/participants. This creates an immersive experience where the observer becomes part of the artwork itself. Harris is also the founding partner of a sister studio in London called Cinimod Studio that creates large commissioned installations, interactive events and lighting designs for large brands. == Works == == Exhibitions == The works of Dominic Harris have been exhibited internationally, both through direct and gallery representation. Solo shows: "Feeding Consciousness" at Halcyon Gallery, Mayfair, London, UK – 2023 "US: NOW" at Halcyon Gallery, Mayfair, London, UK – 2020 "Imagine" at Halcyon Gallery, Mayfair, London, UK – 2019 "5 Year Celebration", Priveekollektie Contemporary Art | Design, London, UK – 2016. "Moments of Reflection" at PHOS ART + DESIGN, Mayfair, London, UK – 2015 Recent exhibitions include: In Plain Sight, 2024 Halcyon Gallery Victoria & Albert Museum Dublin Science Museum Design Miami / Basel Design Miami Art Miami Art 14, London PAD Paris PAD London Art Geneva == Gallery Representation == 2010 to 2019: Dominic Harris was represented by Priveekollektie Contemporary Art | Design, a Dutch gallery based in Heusden, the Netherlands, and with a regular presence on the international art and design circuits. 2015: Dominic Harris was shown with PHOS ART + DESIGN Gallery, in Mayfair, London, UK. 2019 – ongoing: Dominic Harris is exclusively represented by the Halcyon Gallery, an established international gallery based in Mayfair, London. == Collections == The majority of Harris's work has been bought by private collectors. Since 2012 Harris's work is also being acquired by several large institutional collections, including the Borusan Contemporary Art Collection in Istanbul. Harris's artworks include some of the biggest and most respected international art collectors and are also displayed in public spaces. == Books == Dominic Harris: Feeding Consciousness. Halcyon Gallery, 2023. Imagine: Dominic Harris (exhibition catalogue). Halcyon Gallery, 2019. A Touch Of Code: Documents the "Beacon" art installation and "Flutter" artwork (ISBN 978-3899553314) Dominic Harris, Artworks, Edition Eight. (ISBN 978-0957306325) Digital Real: Kunst & Nachhaltigkeit Vol 8.
Sinewave synthesis
Sinewave synthesis, or sine wave speech, is a technique for synthesizing speech by replacing the formants (main bands of energy) with pure tone whistles. The first sinewave synthesis program (SWS) for the automatic creation of stimuli for perceptual experiments was developed by Philip Rubin at Haskins Laboratories in the 1970s. This program was subsequently used by Robert Remez, Philip Rubin, David Pisoni, and other colleagues to show that listeners can perceive continuous speech without traditional speech cues, i.e., pitch, stress, and intonation. This work paved the way for a view of speech as a dynamic pattern of trajectories through articulatory-acoustic space.
Amazon Bedrock
Amazon Bedrock is a cloud computing service provided by Amazon Web Services (AWS) for building generative artificial intelligence applications. Launched in 2023, the platform provides a unified API to access foundation models (FMs) from several AI companies, alongside related tools. Bedrock is a serverless computing service which competes with similar enterprise AI platforms such as Microsoft Foundry and Google Cloud Platform. == History == Amazon announced Bedrock on April 13, 2023. The service became generally available on September 28, 2023. Throughout 2024 and 2025, AWS expanded the service to include AI agents, which allow models to interact with external systems. == Features == Knowledge Bases: a managed workflow for Retrieval-Augmented Generation (RAG), which allows models to pull facts from private data stored in Amazon S3. Guardrails: a security feature that allows administrators to set content filters and personally identifiable information redaction across all models in the platform to increase the safety and compliance of AI deployments. == PartyRock == In November 2023, Amazon launched PartyRock, a web-based no-code environment for building generative AI applications. The platform uses a natural language interface to translate user descriptions into software widgets. These widgets enable specific AI behaviors, including text-based prompts, conversational agents, generating images, and the summarization and querying of user-uploaded documents. Although it initially launched with a limited-time free trial, AWS transitioned the service to a recurring free daily usage credit model in early 2025.
Statistical learning theory
Statistical learning theory is a framework for machine learning drawing from the fields of statistics and functional analysis. Statistical learning theory deals with the statistical inference problem of finding a predictive function based on data. Statistical learning theory has led to successful applications in fields such as computer vision, speech recognition, and bioinformatics. == Introduction == The goals of learning are understanding and prediction. Learning falls into many categories, including supervised learning, unsupervised learning, online learning, and reinforcement learning. From the perspective of statistical learning theory, supervised learning is best understood. Supervised learning involves learning from a training set of data. Every point in the training is an input–output pair, where the input maps to an output. The learning problem consists of inferring the function that maps between the input and the output, such that the learned function can be used to predict the output from future input. Depending on the type of output, supervised learning problems are either problems of regression or problems of classification. If the output takes a continuous range of values, it is a regression problem. Using Ohm's law as an example, a regression could be performed with voltage as input and current as an output. The regression would find the functional relationship between voltage and current to be R {\displaystyle R} , such that V = I R {\displaystyle V=IR} Classification problems are those for which the output will be an element from a discrete set of labels. Classification is very common for machine learning applications. In facial recognition, for instance, a picture of a person's face would be the input, and the output label would be that person's name. The input would be represented by a large multidimensional vector whose elements represent pixels in the picture. After learning a function based on the training set data, that function is validated on a test set of data, data that did not appear in the training set. == Formal description == Take X {\displaystyle X} to be the vector space of all possible inputs, and Y {\displaystyle Y} to be the vector space of all possible outputs. Statistical learning theory takes the perspective that there is some unknown probability distribution over the product space Z = X × Y {\displaystyle Z=X\times Y} , i.e. there exists some unknown p ( z ) = p ( x , y ) {\displaystyle p(z)=p(\mathbf {x} ,y)} . The training set is made up of n {\displaystyle n} samples from this probability distribution, and is notated S = { ( x 1 , y 1 ) , … , ( x n , y n ) } = { z 1 , … , z n } {\displaystyle S=\{(\mathbf {x} _{1},y_{1}),\dots ,(\mathbf {x} _{n},y_{n})\}=\{\mathbf {z} _{1},\dots ,\mathbf {z} _{n}\}} Every x i {\displaystyle \mathbf {x} _{i}} is an input vector from the training data, and y i {\displaystyle y_{i}} is the output that corresponds to it. In this formalism, the inference problem consists of finding a function f : X → Y {\displaystyle f:X\to Y} such that f ( x ) ∼ y {\displaystyle f(\mathbf {x} )\sim y} . Let H {\displaystyle {\mathcal {H}}} be a space of functions f : X → Y {\displaystyle f:X\to Y} called the hypothesis space. The hypothesis space is the space of functions the algorithm will search through. Let V ( f ( x ) , y ) {\displaystyle V(f(\mathbf {x} ),y)} be the loss function, a metric for the difference between the predicted value f ( x ) {\displaystyle f(\mathbf {x} )} and the actual value y {\displaystyle y} . The expected risk is defined to be I [ f ] = ∫ X × Y V ( f ( x ) , y ) p ( x , y ) d x d y {\displaystyle I[f]=\int _{X\times Y}V(f(\mathbf {x} ),y)\,p(\mathbf {x} ,y)\,d\mathbf {x} \,dy} The target function, the best possible function f {\displaystyle f} that can be chosen, is given by the f {\displaystyle f} that satisfies f = argmin h ∈ H I [ h ] {\displaystyle f=\mathop {\operatorname {argmin} } _{h\in {\mathcal {H}}}I[h]} Because the probability distribution p ( x , y ) {\displaystyle p(\mathbf {x} ,y)} is unknown, a proxy measure for the expected risk must be used. This measure is based on the training set, a sample from this unknown probability distribution. It is called the empirical risk I S [ f ] = 1 n ∑ i = 1 n V ( f ( x i ) , y i ) {\displaystyle I_{S}[f]={\frac {1}{n}}\sum _{i=1}^{n}V(f(\mathbf {x} _{i}),y_{i})} A learning algorithm that chooses the function f S {\displaystyle f_{S}} that minimizes the empirical risk is called empirical risk minimization. == Loss functions == The choice of loss function is a determining factor on the function f S {\displaystyle f_{S}} that will be chosen by the learning algorithm. The loss function also affects the convergence rate for an algorithm. It is important for the loss function to be convex. Different loss functions are used depending on whether the problem is one of regression or one of classification. === Regression === The most common loss function for regression is the square loss function (also known as the L2-norm). This familiar loss function is used in Ordinary Least Squares regression. The form is: V ( f ( x ) , y ) = ( y − f ( x ) ) 2 {\displaystyle V(f(\mathbf {x} ),y)=(y-f(\mathbf {x} ))^{2}} The absolute value loss (also known as the L1-norm) is also sometimes used: V ( f ( x ) , y ) = | y − f ( x ) | {\displaystyle V(f(\mathbf {x} ),y)=|y-f(\mathbf {x} )|} === Classification === In some sense the 0-1 indicator function is the most natural loss function for classification. It takes the value 0 if the predicted output is the same as the actual output, and it takes the value 1 if the predicted output is different from the actual output. For binary classification with Y = { − 1 , 1 } {\displaystyle Y=\{-1,1\}} , this is: V ( f ( x ) , y ) = θ ( − y f ( x ) ) {\displaystyle V(f(\mathbf {x} ),y)=\theta (-yf(\mathbf {x} ))} where θ {\displaystyle \theta } is the Heaviside step function. == Regularization == In machine learning problems, a major problem that arises is that of overfitting. Because learning is a prediction problem, the goal is not to find a function that most closely fits the (previously observed) data, but to find one that will most accurately predict output from future input. Empirical risk minimization runs this risk of overfitting: finding a function that matches the data exactly but does not predict future output well. Overfitting is symptomatic of unstable solutions; a small perturbation in the training set data would cause a large variation in the learned function. It can be shown that if the stability for the solution can be guaranteed, generalization and consistency are guaranteed as well. Regularization can solve the overfitting problem and give the problem stability. Regularization can be accomplished by restricting the hypothesis space H {\displaystyle {\mathcal {H}}} . A common example would be restricting H {\displaystyle {\mathcal {H}}} to linear functions: this can be seen as a reduction to the standard problem of linear regression. H {\displaystyle {\mathcal {H}}} could also be restricted to polynomial of degree p {\displaystyle p} , exponentials, or bounded functions on L1. Restriction of the hypothesis space avoids overfitting because the form of the potential functions are limited, and so does not allow for the choice of a function that gives empirical risk arbitrarily close to zero. One example of regularization is Tikhonov regularization. This consists of minimizing 1 n ∑ i = 1 n V ( f ( x i ) , y i ) + γ ‖ f ‖ H 2 {\displaystyle {\frac {1}{n}}\sum _{i=1}^{n}V(f(\mathbf {x} _{i}),y_{i})+\gamma \left\|f\right\|_{\mathcal {H}}^{2}} where γ {\displaystyle \gamma } is a fixed and positive parameter, the regularization parameter. Tikhonov regularization ensures existence, uniqueness, and stability of the solution. == Bounding empirical risk == Consider a binary classifier f : X → { 0 , 1 } {\displaystyle f:{\mathcal {X}}\to \{0,1\}} . We can apply Hoeffding's inequality to bound the probability that the empirical risk deviates from the true risk to be a Sub-Gaussian distribution. P ( | R ^ ( f ) − R ( f ) | ≥ ϵ ) ≤ 2 e − 2 n ϵ 2 {\displaystyle \mathbb {P} (|{\hat {R}}(f)-R(f)|\geq \epsilon )\leq 2e^{-2n\epsilon ^{2}}} But generally, when we do empirical risk minimization, we are not given a classifier; we must choose it. Therefore, a more useful result is to bound the probability of the supremum of the difference over the whole class. P ( sup f ∈ F | R ^ ( f ) − R ( f ) | ≥ ϵ ) ≤ 2 S ( F , n ) e − n ϵ 2 / 8 ≈ n d e − n ϵ 2 / 8 {\displaystyle \mathbb {P} {\bigg (}\sup _{f\in {\mathcal {F}}}|{\hat {R}}(f)-R(f)|\geq \epsilon {\bigg )}\leq 2S({\mathcal {F}},n)e^{-n\epsilon ^{2}/8}\approx n^{d}e^{-n\epsilon ^{2}/8}} where S ( F , n ) {\displaystyle S({\mathcal {F}},n)} is the shattering number and n {\displaystyle n} is the number of samples in your dataset. The exponential term comes from Hoeffding but there is an extra cost of taking the supremum over the whole cla
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