A public computer (or public access computer) is any of various computers available in public areas. Some places where public computers may be available are libraries, schools, or dedicated facilities run by government. Public computers share similar hardware and software components to personal computers, however, the role and function of a public access computer is entirely different. A public access computer is used by many different untrusted individuals throughout the course of the day. The computer must be locked down and secure against both intentional and unintentional abuse. Users typically do not have authority to install software or change settings. A personal computer, in contrast, is typically used by a single responsible user, who can customize the machine's behavior to their preferences. Public access computers are often provided with tools such as a PC reservation system to regulate access. The world's first public access computer center was the Marin Computer Center in California, co-founded by David and Annie Fox in 1977. == Kiosks == A kiosk is a special type of public computer using software and hardware modifications to provide services only about the place the kiosk is in. For example, a movie ticket kiosk can be found at a movie theater. These kiosks are usually in a secure browser with zero access to the desktop. Many of these kiosks may run Linux, however, ATMs, a kiosk designed for depositing money, often run Windows XP. == Public computers in the United States == === Library computers === In the United States and Canada, almost all public libraries have computers available for the use of patrons, though some libraries will impose a time limit on users to ensure others will get a turn and keep the library less busy. Users are often allowed to print documents that they have created using these computers, though sometimes for a small fee. ==== Privacy ==== Privacy is an important part of the public library institution, since the libraries entitle the public to intellectual freedom. Use of any computer or network may create records of users' activities that can jeopardize their privacy. It is possible for a patron to jeopardize their privacy if they do not delete cache, clear cookies, or documents from the public computer. In order for a member of the public to remain private on a computer, the American Library Association (ALA) has guidelines. These give patrons an idea of the right way to keep using public library computers. In their provision of services to library users, librarians have an ethical responsibility, expressed in the ALA Code of Ethics, to preserve users' right to privacy. A librarian is also responsible for giving users an understanding of private patron use and access. Libraries must ensure that users have the following rights when browsing on public computers: the computer automatically will clear a users history; libraries should display privacy screens so users do not see another patron's screen; updating software for effective safety measures; restoration data software to clear documents that users may have left on their computers and to combat possible malware; security practices; and making users aware of any possible monitoring of their browsing activities. Users can also view the Library Privacy Checklist for Public Access Computers and Networks to better understand what libraries strive for when protecting privacy. === School computers === The U.S. government has given money to many school boards to purchase computers for educational applications. Schools may have multiple computer labs, which contain these computers for students to use. There is usually Internet access on these machines, but some schools will put up a blocking service to limit the websites that students are able to access to only include educational resources, such as Google. In addition to controlling the content students are viewing, putting up these blocks can also help to keep the computers safe by preventing students from downloading malware and other threats. However, the effectiveness of such content filtering systems is questionable since it can easily be circumvented by using proxy websites, Virtual Private Networks, and for some weak security systems, merely knowing the IP address of the intended website is enough to bypass the filter. School computers often have advanced operating system security to prevent tech-savvy students from inflicting damage (i.e. the Windows Registry Editor and Task Manager, etc.) are disabled on Microsoft Windows machines. Schools with very advanced tech services may also install a locked down BIOS/firmware or make kernel-level changes to the operating system, precluding the possibility of unauthorized activity.
List of artificial intelligence journals
This is a list of notable peer-reviewed academic journals that publish research in the field of artificial intelligence (AI), including areas such as machine learning, computer vision, natural language processing, robotics, and intelligent systems. == General artificial intelligence == Artificial Intelligence (journal) – Elsevier Journal of Artificial Intelligence Research (JAIR) – AI Access Foundation Knowledge-Based Systems – Elsevier == Machine learning == Data Mining and Knowledge Discovery – Springer Machine Learning (journal) – Springer Journal of Machine Learning Research – Microtome Pattern Recognition (journal) – Elsevier Neural Networks (journal) – Elsevier Neural Computation (journal) – MIT Press Neurocomputing (journal) - Elsevier == Deep learning and neural computation == IEEE Transactions on Evolutionary Computation – IEEE IEEE Transactions on Neural Networks and Learning Systems – IEEE Nature Machine Intelligence – Springer Nature == Computer vision == International Journal of Computer Vision – Springer IEEE Transactions on Pattern Analysis and Machine Intelligence – IEEE Machine Vision and Applications – Springer == Natural language processing == Computational Linguistics (journal) – MIT Press Natural Language Processing Transactions of the Association for Computational Linguistics – ACL == Robotics and intelligent systems == IEEE Transactions on Robotics – IEEE Autonomous Robots – Springer Journal of Intelligent & Robotic Systems – Springer == Interdisciplinary and ethics in AI == AI & Society – Springer Artificial Life – MIT Press Philosophy & Technology – Springer Minds and Machines – Springer
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
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
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
Framebuffer
A framebuffer (frame buffer, or sometimes framestore) is a portion of random-access memory (RAM) containing a bitmap that drives a video display. It is a memory buffer containing data representing all the pixels in a complete video frame. Modern video cards contain framebuffer circuitry in their cores. This circuitry converts an in-memory bitmap into a video signal that can be displayed on a computer monitor. In computing, a screen buffer is a part of computer memory used by a computer application for the representation of the content to be shown on the computer display. The screen buffer may also be called the video buffer, the regeneration buffer, or regen buffer for short. The phrase "screen buffer” refers to a logical function, while video memory refers to a hardware storage location. In particular, the screen buffer may be placed in the main RAM, the video memory, or some other hardware location. To reduce latency and avoid screen tearing, multiple frames can be buffered, and this technique is called multiple buffering. When this is so, at any time, only one frame would be visible, and the others would not be. The currently invisible frames are located in the off-screen buffer. The information in the buffer typically consists of color values for every pixel to be shown on the display. Color values are commonly stored in 1-bit binary (monochrome), 4-bit palettized, 8-bit palettized, 16-bit high color and 24-bit true color formats. An additional alpha channel is sometimes used to retain information about pixel transparency. The total amount of memory required for the framebuffer depends on the resolution of the output signal, and on the color depth or palette size. == History == Computer researchers had long discussed the theoretical advantages of a framebuffer but were unable to produce a machine with sufficient memory at an economically practicable cost. In 1947, the Manchester Baby computer used a Williams tube, later the Williams-Kilburn tube, to store 1024 bits on a cathode-ray tube (CRT) memory and displayed on a second CRT. Other research labs were exploring these techniques with MIT Lincoln Laboratory achieving a 4096 display in 1950. A color-scanned display was implemented in the late 1960s, called the Brookhaven RAster Display (BRAD), which used a drum memory and a television monitor. In 1969, A. Michael Noll of Bell Telephone Laboratories, Inc. implemented a scanned display with a frame buffer, using magnetic-core memory. A year or so later, the Bell Labs system was expanded to display an image with a color depth of three bits on a standard color TV monitor. The vector graphics used in the computer had to be converted for the scanned graphics of a TV display. In the early 1970s, the development of MOS memory (metal–oxide–semiconductor memory) integrated-circuit chips, particularly high-density DRAM (dynamic random-access memory) chips with at least 1 kb memory, made it practical to create, for the first time, a digital memory system with framebuffers capable of holding a standard video image. This led to the development of the SuperPaint system by Richard Shoup at Xerox PARC in 1972. Shoup was able to use the SuperPaint framebuffer to create an early digital video-capture system. By synchronizing the output signal to the input signal, Shoup was able to overwrite each pixel of data as it shifted in. Shoup also experimented with modifying the output signal using color tables. These color tables allowed the SuperPaint system to produce a wide variety of colors outside the range of the limited 8-bit data it contained. This scheme would later become commonplace in computer framebuffers. In 1974, Evans & Sutherland released the first commercial framebuffer, the Picture System, costing about $15,000. It was capable of producing resolutions of up to 512 by 512 pixels in 8-bit grayscale, and became a boon for graphics researchers who did not have the resources to build their own framebuffer. The New York Institute of Technology would later create the first 24-bit color system using three of the Evans & Sutherland framebuffers. Each framebuffer was connected to an RGB color output (one for red, one for green and one for blue), with a Digital Equipment Corporation PDP 11/04 minicomputer controlling the three devices as one. In 1975, the UK company Quantel produced the first commercial full-color broadcast framebuffer, the Quantel DFS 3000. It was first used in TV coverage of the 1976 Montreal Olympics to generate a picture-in-picture inset of the Olympic flaming torch while the rest of the picture featured the runner entering the stadium. The rapid improvement of integrated-circuit technology made it possible for many of the home computers of the late 1970s to contain low-color-depth framebuffers. Today, nearly all computers with graphical capabilities utilize a framebuffer for generating the video signal. Amiga computers, created in the 1980s, featured special design attention to graphics performance and included a unique Hold-And-Modify framebuffer capable of displaying 4096 colors. Framebuffers also became popular in high-end workstations and arcade system boards throughout the 1980s. SGI, Sun Microsystems, HP, DEC and IBM all released framebuffers for their workstation computers in this period. These framebuffers were usually of a much higher quality than could be found in most home computers, and were regularly used in television, printing, computer modeling and 3D graphics. Framebuffers were also used by Sega for its high-end arcade boards, which were also of a higher quality than on home computers. == Display modes == Framebuffers used in personal and home computing often had sets of defined modes under which the framebuffer can operate. These modes reconfigure the hardware to output different resolutions, color depths, memory layouts and refresh rate timings. In the world of Unix machines and operating systems, such conveniences were usually eschewed in favor of directly manipulating the hardware settings. This manipulation was far more flexible in that any resolution, color depth and refresh rate was attainable – limited only by the memory available to the framebuffer. An unfortunate side-effect of this method was that the display device could be driven beyond its capabilities. In some cases, this resulted in hardware damage to the display. More commonly, it simply produced garbled and unusable output. Modern CRT monitors fix this problem through the introduction of protection circuitry. When the display mode is changed, the monitor attempts to obtain a signal lock on the new refresh frequency. If the monitor is unable to obtain a signal lock or if the signal is outside the range of its design limitations, the monitor will ignore the framebuffer signal and possibly present the user with an error message. LCD monitors tend to contain similar protection circuitry, but for different reasons. Since the LCD must digitally sample the display signal (thereby emulating an electron beam), any signal that is out of range cannot be physically displayed on the monitor. == Color palette == Framebuffers have traditionally supported a wide variety of color modes. Due to the expense of memory, most early framebuffers used 1-bit (2 colors per pixel), 2-bit (4 colors), 4-bit (16 colors) or 8-bit (256 colors) color depths. The problem with such small color depths is that a full range of colors cannot be produced. The solution to this problem was indexed color, which adds a lookup table to the framebuffer. Each color stored in framebuffer memory acts as a color index. The lookup table serves as a palette with a limited number of different colors, while the rest is used as an index table. Here is a typical indexed 256-color image and its own palette (shown as a rectangle of swatches): In some designs, it was also possible to write data to the lookup table (or switch between existing palettes) on the fly, allowing dividing the picture into horizontal bars with their own palette and thus rendering an image that had a far wider palette. For example, viewing an outdoor shot photograph, the picture could be divided into four bars: the top one with emphasis on sky tones, the next with foliage tones, the next with skin and clothing tones, and the bottom one with ground colors. This required each palette to have overlapping colors, but, carefully done, allowed great flexibility. == Memory access == While framebuffers are commonly accessed via a memory mapping directly to the CPU memory space, this is not the only method by which they may be accessed. Framebuffers have varied widely in the methods used to access memory. Some of the most common are: Mapping the entire framebuffer to a given memory range. Port commands to set each pixel, range of pixels or palette entry. Mapping a memory range smaller than the framebuffer memory, then bank switching as necessary. The framebuffer organization may be packed pixel or planar. The framebuffer may be all
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