An operational data store (ODS) is used for operational reporting and as a source of data for the enterprise data warehouse (EDW). It is a complementary element to an EDW in a decision support environment, and is used for operational reporting, controls, and decision making, as opposed to the EDW, which is used for tactical and strategic decision support. An ODS is a database designed to integrate data from multiple sources for additional operations on the data, for reporting, controls and operational decision support. Unlike a production master data store, the data is not passed back to operational systems. It may be passed for further operations and to the data warehouse for reporting. An ODS should not be confused with an enterprise data hub (EDH). An operational data store will take transactional data from one or more production systems and loosely integrate it, in some respects it is still subject oriented, integrated and time variant, but without the volatility constraints. This integration is mainly achieved through the use of EDW structures and content. An ODS is not an intrinsic part of an EDH solution, although an EDH may be used to subsume some of the processing performed by an ODS and the EDW. An EDH is a broker of data. An ODS is certainly not. Because the data originates from multiple sources, the integration often involves cleaning, resolving redundancy and checking against business rules for integrity. An ODS is usually designed to contain low-level or atomic (indivisible) data (such as transactions and prices) with limited history that is captured "real time" or "near real time" as opposed to the much greater volumes of data stored in the data warehouse generally on a less-frequent basis. == General use == The general purpose of an ODS is to integrate data from disparate source systems in a single structure, using data integration technologies like data virtualization, data federation, or extract, transform, and load (ETL). This will allow operational access to the data for operational reporting, master data or reference data management. An ODS is not a replacement or substitute for a data warehouse or for a data hub but in turn could become a source.
Gas (app)
Gas (sometimes stylized in all caps), formerly known as Melt as well as Crush, was an American anonymous social media app. Launched in August 2022, the app is oriented towards high schoolers. The app was developed by Nikita Bier, Isaiah Turner, and former Facebook engineer Dave Schatz. Gas was largely based upon the prior tbh app developed by co-founder Nikita Bier, along with Erik Hazzard, Kyle Zaragoza, and Nicolas Ducdodon in September 2017. tbh was acquired by Facebook inc. (now Meta Platforms) on October 16, 2017, and nearly a year later in July 2018 was dissolved, owing to low usage. Gas follows a similar purpose to tbh in being a social media app oriented towards high schoolers. In the app, users participate in anonymous polls regarding pre-written complimentary statements to their peers, such as "I'd say yes if (blank) asked me out on a date," "I think (blank) is the coolest kid in school," or "would make an ugly face and still look pretty." Winners of said polls receive a "flame." The name of the app is derived from this, with "gassing someone up" being Gen Z slang for complimenting someone. Users can pay a $6.99 subscription that enables "God Mode," which shows hints regarding who voted for them in a poll. Gas overtook TikTok and BeReal as the most downloaded app on the Apple App Store in October 2022 (the app is currently not available for Android). The app has over 5.1 million downloads as of early November 2022, over a million active users and 300 thousand daily downloads as of October 2022. Currently, the app is available in Canada and the majority of the United States. On January 17, 2023, Gas was acquired by Discord, however it would remain a standalone app and its developers became Discord staff members. On October 18, 2023, Discord announced that service for Gas would be permanently ending effective November 7, 2023, due to a steep decline in users. Effective November 7, the app became completely unusable. == Controversy regarding human-trafficking == Beginning in October 2022, rumors spread largely throughout TikTok and Snapchat alleged that the app was linked to human trafficking (in particular sex trafficking). According to Bier, the rumor originated with a single user review from China on October 5, and then was disseminated through TikTok accounts with "few to no US teen followers." Although largely dismissed as a hoax by experts, who cite how the app doesn't log user locations and general anonymity, the hoax became pervasive to the extent that various police departments, school systems, and local news outlets began issuing warnings regarding the app. For instance, on October 31, 2022, the police department of Piedmont, Oklahoma issued a warning to parents, encouraging them to check their children's phones, while on November 3, the Oklahoma Oktaha Public School system stated in a Facebook post that "Children are being kidnapped in other towns and this new app is thought to be the source of predators finding their location." (both statements have since been retracted by Police Chief Scott Singer and Superintendent Jerry Needham respectively). Additionally, local medial outlets such as KOCO in Oklahoma City ran stories making similar statements. The rumor had a negative impact on the app, with downloads plateauing for a two-week period in late October and with 3% of users in a single day reportedly uninstalling the app. Revenue and ratings have also reportedly dropped and the company's social media accounts have been bombarded with comments labeling them as sex-traffickers. Additionally, the four-person development team has reportedly been bombarded with various death threats as a result.
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
Gas (app)
Gas (sometimes stylized in all caps), formerly known as Melt as well as Crush, was an American anonymous social media app. Launched in August 2022, the app is oriented towards high schoolers. The app was developed by Nikita Bier, Isaiah Turner, and former Facebook engineer Dave Schatz. Gas was largely based upon the prior tbh app developed by co-founder Nikita Bier, along with Erik Hazzard, Kyle Zaragoza, and Nicolas Ducdodon in September 2017. tbh was acquired by Facebook inc. (now Meta Platforms) on October 16, 2017, and nearly a year later in July 2018 was dissolved, owing to low usage. Gas follows a similar purpose to tbh in being a social media app oriented towards high schoolers. In the app, users participate in anonymous polls regarding pre-written complimentary statements to their peers, such as "I'd say yes if (blank) asked me out on a date," "I think (blank) is the coolest kid in school," or "would make an ugly face and still look pretty." Winners of said polls receive a "flame." The name of the app is derived from this, with "gassing someone up" being Gen Z slang for complimenting someone. Users can pay a $6.99 subscription that enables "God Mode," which shows hints regarding who voted for them in a poll. Gas overtook TikTok and BeReal as the most downloaded app on the Apple App Store in October 2022 (the app is currently not available for Android). The app has over 5.1 million downloads as of early November 2022, over a million active users and 300 thousand daily downloads as of October 2022. Currently, the app is available in Canada and the majority of the United States. On January 17, 2023, Gas was acquired by Discord, however it would remain a standalone app and its developers became Discord staff members. On October 18, 2023, Discord announced that service for Gas would be permanently ending effective November 7, 2023, due to a steep decline in users. Effective November 7, the app became completely unusable. == Controversy regarding human-trafficking == Beginning in October 2022, rumors spread largely throughout TikTok and Snapchat alleged that the app was linked to human trafficking (in particular sex trafficking). According to Bier, the rumor originated with a single user review from China on October 5, and then was disseminated through TikTok accounts with "few to no US teen followers." Although largely dismissed as a hoax by experts, who cite how the app doesn't log user locations and general anonymity, the hoax became pervasive to the extent that various police departments, school systems, and local news outlets began issuing warnings regarding the app. For instance, on October 31, 2022, the police department of Piedmont, Oklahoma issued a warning to parents, encouraging them to check their children's phones, while on November 3, the Oklahoma Oktaha Public School system stated in a Facebook post that "Children are being kidnapped in other towns and this new app is thought to be the source of predators finding their location." (both statements have since been retracted by Police Chief Scott Singer and Superintendent Jerry Needham respectively). Additionally, local medial outlets such as KOCO in Oklahoma City ran stories making similar statements. The rumor had a negative impact on the app, with downloads plateauing for a two-week period in late October and with 3% of users in a single day reportedly uninstalling the app. Revenue and ratings have also reportedly dropped and the company's social media accounts have been bombarded with comments labeling them as sex-traffickers. Additionally, the four-person development team has reportedly been bombarded with various death threats as a result.
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