Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide.Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners.However, the diagnostic accuracy of general practitioners has been reported to be only 0. 24-0. 70 (compared to 0. 77-0. 96 for dermatologists), resulting in over-and under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 of the most common skin conditions, representing roughly 80% of the volume of skin conditions seen in a primary care setting. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively, indicating the fraction of cases where the DLS's top diagnosis and top 3 diagnoses contains the correct diagnosis. For a stratified random subset of the validation set (n=963 cases), 18 clinicians (of three different training levels) reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs . These results highlight the potential of the DLS to augment the ability of general practitioners who did not have additional specialty training to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

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We develop a model for timed, reactive computation by extending the asynchronous, untimed concurrent constraint programming model in a simple and uniform way. In the spirit of process algebras, we develop some combinators expressible in this model, and reconcile their operational, logical and denotational character. We show how programs may be compiled into finite-state machines with loop-fiee computations at each state, thus guaranteeing bounded response time.

Partial Labeled Markov Chains are simultaneously generalizations of process algebra and of traditional Markov chains. They provide a foundation for interacting discrete probabilistic systems, the interaction being synchronization on labels as in process algebra. Existing notions of process equivalence are too sensitive to the exact probabilities of various transitions. This paper addresses contextual reasoning principles for reasoning about more robust notions of "approximate" equivalence between concurrent interacting probabilistic systems.• We develop a family of metrics between partial labeled Markov chains to formalize the notion of distance between processes.• We show that processes at distance zero are bisimilar.• We describe a decision procedure to compute the distance between two processes.• We show that reasoning about approximate equivalence can be done compositionally by showing that process combinators do not increase distance.• We introduce an asymptotic metric to capture asymptotic properties of Markov chains; and show that parallel composition does not increase asymptotic distance.