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Model-based Digital Twin Engineering: Insights, Challenges, and Future Directions
Get PDFThis article presents a systematic literature survey on model-based digital twin engineering (MBDTE). We introduce a novel taxonomy for categorizing MBDTE approaches and provide definitions of both MBDTE and the models it employs. Model-based engineering (MBE) leverages models as essential pillars of the development process, enabling teams to clarify requirements, streamline design, specify behavior, and perform rigorous verification and validation across the entire system life cycle. Digital twins (DTs) are software systems that mirror cyber-physical, socio-economic, or biological entities, systems, or processes. Built from models and data, DTs support high-impact applications including planning, monitoring, control, and optimization of their physical counterparts. The model-centric nature of DTs has naturally sparked exploration into harnessing MBE for DT engineering and operation. However, this exploration for now has created a fragmented landscape of partial solutions. To address this challenge, our survey analyzes 47 peer-reviewed publications across four dimensions, viz.,model characteristics, data integration, implementation technologies, and empirical evidence, to map the current state of practice, identify critical research gaps, and avenues for further exploration
Co-producing an online platform for people with long-term physical health conditions:A development and usability study
Get PDFBackground: There is relatively limited psychological support dedicated to people living with long-term physical health conditions and subthreshold depressive disorder. Online peer support may be an appropriate intervention to help bolster patients’ mental wellbeing to prevent progression of their symptoms to Major Depressive Disorder. For interventions to be successfully integrated into the self-management routines of people with long-term physical health conditions, they should be co-designed to ensure they align with the wants and needs of the target audience. Objective: To co-produce an online peer support intervention with people with lived experience, software experts, clinicians, and academics through an iterative process of co-design and subsequent co-validation through usability testing. Methods: We followed a four-stage co-production process: co-assess, co-design, co-validate, and co-deliver. Our Research Advisory Group were actively involved in all stages, consisting of one co-investigator and six people with lived experience of long-term physical and/or mental health co-morbidities. The co-assess and co-design stages involved our Participatory Design Panel, which included 10 members living with various long-term conditions. The Participatory Design Panel participated in online focus groups to assess their unmet psychosocial needs and then co-designed the intervention prototype through online workshops with software developers. The co-validation stage involved an additional group of participants (n=12) with long-term physical health conditions. During co-validation, the prototype underwent usability testing, including think-aloud exercises and semi-structured interviews. Content analysis identified the priorities for the iterative development that formed the basis of further Research Advisory Group co-design workshops. The next stage, co-delivery, involved co-producing the protocol of a feasibility and acceptability randomised controlled trial. Results: Participants highlighted that a platform must feel safe and trustworthy for the space to support the mental wellbeing of those living with long-term health conditions. A Participatory Design Panel co-designed a platform prototype to meet this need. During the co-validation stage, the think-aloud exercises identified common issues related to navigation challenges and feature glitches. Content analysis of the semi-structured interviews confirmed that the community forum, resources, and other platform pages were appropriate and acceptable, but revealed usability concerns. Participants stressed the need for intuitive navigation and suggested new features that would enhance user experience. Facilitators and barriers to engagement were also noted, including the importance of fostering trust in the platform’s ethos and branding to create a safe space. Through iterative development and subsequent usability testing, the final prototype was approved. Conclusions: We have provided a worked example of a comprehensive, co-production process where we worked alongside people with lived experience to successfully design an online peer support platform with embedded psychoeducation. The platform, called CommonGround, is ready to be evaluated in a feasibility randomised controlled trial.<br/
Effect of lixisenatide on arterial stiffness in people with type 2 diabetes and kidney disease:Results of a randomised controlled trial
Get PDFOBJECTIVE: People with chronic kidney disease (CKD) and diabetes are at high risk of cardiovascular disease (CVD). Aortic pulse wave velocity (Ao-PWV) is an independent predictor of CVD. Cardiovascular outcome trials (CVOTs) with glucagon like peptide-1 receptor agonist (GLP-1 RA) class demonstrate notable differences, with lixisenatide having neutral effects as compared to longer acting GLP-1 RA. It is unknown if shorter acting GLP-1 RA have an impact on Ao-PWV and if this may explain the discordance observed in GLP-1RA CVOTs.MATERIALS AND METHODS: We studied people with type 2 diabetes and CKD in a proof-of-concept single centre, randomised, double-blind parallel-group placebo-controlled study that evaluated 24 weeks' treatment with lixisenatide as compared to placebo on the primary endpoint of Ao-PWV.RESULTS: In total, 101 participants (male 66%) were randomised of whom 90 were eligible for analyses (lixisenatide [n = 47] and placebo [n = 43]). Ao-PWV did not change significantly from baseline after 24 weeks of treatment with final mean (95% confidence intervals) of 9.65 (9.17, 10.13) m/s with lixisenatide and 9.96 (9.45, 10.46) m/s with placebo, p = 0.38. Similarly, no significant changes were observed in cardio-renal risk biomarkers including albuminuria and Klotho levels. HbA1c decreased with lixisenatide as compared to placebo.CONCLUSIONS: In people with CKD and type 2 diabetes the use of short-acting GLP-1 RA lixisenatide did not significantly influence Ao-PWV. Further studies are needed to understand mechanisms that may explain discordance in CVOTs results observed with GLP-1 RA.CLINICAL TRIAL REGISTRATION: ISRCTN: ISRCTN97699312; EudraCT/CTIS number: 2016-001758-17.</p
Prevalence of clinical and pre-clinical obesity at six months postpartum following gestational diabetes mellitus
Get PDFBackground/Objectives: A number of initiatives have refocused attention from obesity to adiposity-related organ dysfunction. In this prospective observational study, we examined this paradigm postpartum. Methods: At King’s College Hospital, London, UK, we invited for review by six months postpartum, consecutive women with GDM (N = 1442, September 2023–August 2025) and without GDM (N = 646, January 2025–August 2025). Those with excess adiposity (BMI ≥ 30 kg/m2 and waist-to-height ratio > 0.5) were assessed for organ dysfunction, using criteria from a recent Commission: anovulation, metabolism or renal clusters, raised blood pressure, or elevated end-diastolic left ventricular filling pressure. Multiple regression determined predictors of adiposity-related organ dysfunction, the prevalence of which was calculated as a range (highest estimate: absolute organ dysfunction prevalence; lowest estimate: adiposity-adjusted, as highest estimate minus prevalence of organ dysfunction in women without excess adiposity). Results: Of those invited for review, 1086/1442 (75.3%) GDM and 562/646 (87.0%) non-GDM women attended, at median 5.8 months after birth (interquartile range 4.8–6.7). Excess adiposity was observed in 385/1086 (35.5%) GDM and 117/562 (20.8%) non-GDM women, among whom organ dysfunction was seen in 61.0% GDM (235/385), 51.3% non-GDM (60/117). 35.9% (408/1137) of women without excess adiposity. Organ dysfunction attributable to excess adiposity was estimated to be 22.9% (58.8% minus 35.9%), and was poorly predicted by the multivariable model (AUC 0.64, 95%CI 0.60–0.69). Conclusions: Among women with prior GDM, organ dysfunction attributable to excess adiposity affects at least 20% of those with excess adiposity postpartum, and is not currently predictable
Key performance indicators in elite women’s blind football based on technical-tactical and match performance metrics
Get PDFFemale footballers with any level of vision impairment (VI) that meet the sport’s minimum impairment criteria (the point at which impairment impacts performance in the un-adapted form of the sport) wear eyeshades and compete together in blind football. The women’s sport has only recently held its first World Championships. Key performance indicators (KPIs) for women’s blind football have yet to be identified in scientific research. Therefore, the study aimed to determine the KPIs for women’s blind football. Video match analysis provided notational data of 8 international women’s blind teams who competed in a total of 15 world championship matches. Team and hybrid variables (offensive, defensive and ball possession index) were used to identify predictors of win ratio (total games won divided by total games played). Offensive zone entries (β = 0.0229), total shots (β = 0.0049) and the number of VI players (β = 0.1411) were significant predictors of win ratio (p <0.05). Of the indices assessed, the offensive index (β = 7.5791) had the most profound effect on win ratio. Coaches may consider a direct style of play to optimise and prioritise offensive performance. By identifying key components of football performance, the findings will help coaches develop evidence-based approaches to training and competition.</p
Translating Latent State World Model Representations into Natural Language
Get PDFRecent successes in model-based reinforcement learning have stem\-med from models that learn a latent representation of the world. However, these latent representations are unintelligible, meaning that we cannot interpret the agent's internal world representation, nor any plans made in this latent space. In this work we present Somniloquy, an algorithm that learns to translate latent state plans into a natural language description that captures what the plan means in terms of the agent's expected interaction with the world. We demonstrate that latent plan translations can be learned in tandem with the latent representations, whilst giving the latent representations an additional learning signal to be translatable, and that Somniloquy enables a deep model-based reinforcement learning agent to verbalise its latent plan in natural language prior to acting. In addition to interpretability, we show that Somniloquy enables defining desired behaviour in language by rewarding latent states whose translation matches the requested behaviour. Importantly, this requires no reward signal at any point from the environment. We demonstrate experimentally that, in deterministic environments, Somniloquy's plan translation accurately describes the plan's execution, and that in the stochastic setting the translations of multiple latent plan rollouts can approximate the true environment dynamics. Finally, we demonstrate that our translation reward function approach successfully trains policies to achieve goals specified in natural language, and achieves on-par performance with training an agent that has access to each natural language goal's unobservable extrinsic reward function
Model-based Digital Twin Engineering: Insights, Challenges, and Future Directions
No full textThis article presents a systematic literature survey on model-based digital twin engineering (MBDTE). We introduce a novel taxonomy for categorizing MBDTE approaches and provide definitions of both MBDTE and the models it employs. Model-based engineering (MBE) leverages models as essential pillars of the development process, enabling teams to clarify requirements, streamline design, specify behavior, and perform rigorous verification and validation across the entire system life cycle. Digital twins (DTs) are software systems that mirror cyber-physical, socio-economic, or biological entities, systems, or processes. Built from models and data, DTs support high-impact applications including planning, monitoring, control, and optimization of their physical counterparts. The model-centric nature of DTs has naturally sparked exploration into harnessing MBE for DT engineering and operation. However, this exploration for now has created a fragmented landscape of partial solutions. To address this challenge, our survey analyzes 47 peer-reviewed publications across four dimensions, viz.,model characteristics, data integration, implementation technologies, and empirical evidence, to map the current state of practice, identify critical research gaps, and avenues for further exploration
The Prognostic Value of Right Ventricle–Pulmonary Artery Coupling in Valve Interventions:Systematic Review and Meta-Analysis
No full textBackground Right ventricle–pulmonary artery (RV-PA) coupling is prognostically important in valvular heart disease. Objectives The authors performed a systematic review and meta-analysis to quantify the association of RV-PA coupling with clinical endpoints after intervention for aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). Methods The primary outcome was all-cause mortality, and the secondary outcome was a composite of major adverse cardiovascular events (MACE). A random-effects model was used to compute pooled effect estimates, and summary receiver-operating characteristic curves identified optimal RV-PA thresholds. Results In total, 30 interventional studies (N = 12,992) met eligibility criteria, including 14 AS (n = 6,100), 12 MR (n = 5,032), and 4 TR (n = 1,860) studies. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) was the most studied RV-PA coupling index. Reduced TAPSE/PASP was independently associated with all-cause mortality (AS adjusted HR: 1.69 [95% CI: 1.30-2.20]; MR adjusted HR: 1.94 [95% CI: 1.40-2.69]; P < 0.001) and the composite MACE (AS adjusted HR: 1.60 [95% CI: 1.29-2.00]; MR adjusted HR: 2.01 [95% CI: 1.54-2.62]; P < 0.001). There were significant nonlinear associations between TAPSE/PASP and adverse outcomes in AS and MR (P < 0.001). There were insufficient data to estimate a pooled effect-size in TR. Optimal TAPSE/PASP thresholds to predict all-cause mortality were ≤0.51 mm/mm Hg for AS interventions, ≤0.33 mm/mm Hg for MR interventions and ≤0.44 mm/mm Hg for TR interventions. Conclusions TAPSE/PASP is an independent predictor of outcomes after interventions for AS and MR. The disease-specific TAPSE/PASP cutoffs could be integrated into risk-stratification models to better predict mortality before valve interventions and improve patient selection.</p
Effect of lixisenatide on arterial stiffness in people with type 2 diabetes and kidney disease:Results of a randomised controlled trial
No full textOBJECTIVE: People with chronic kidney disease (CKD) and diabetes are at high risk of cardiovascular disease (CVD). Aortic pulse wave velocity (Ao-PWV) is an independent predictor of CVD. Cardiovascular outcome trials (CVOTs) with glucagon like peptide-1 receptor agonist (GLP-1 RA) class demonstrate notable differences, with lixisenatide having neutral effects as compared to longer acting GLP-1 RA. It is unknown if shorter acting GLP-1 RA have an impact on Ao-PWV and if this may explain the discordance observed in GLP-1RA CVOTs.MATERIALS AND METHODS: We studied people with type 2 diabetes and CKD in a proof-of-concept single centre, randomised, double-blind parallel-group placebo-controlled study that evaluated 24 weeks' treatment with lixisenatide as compared to placebo on the primary endpoint of Ao-PWV.RESULTS: In total, 101 participants (male 66%) were randomised of whom 90 were eligible for analyses (lixisenatide [n = 47] and placebo [n = 43]). Ao-PWV did not change significantly from baseline after 24 weeks of treatment with final mean (95% confidence intervals) of 9.65 (9.17, 10.13) m/s with lixisenatide and 9.96 (9.45, 10.46) m/s with placebo, p = 0.38. Similarly, no significant changes were observed in cardio-renal risk biomarkers including albuminuria and Klotho levels. HbA1c decreased with lixisenatide as compared to placebo.CONCLUSIONS: In people with CKD and type 2 diabetes the use of short-acting GLP-1 RA lixisenatide did not significantly influence Ao-PWV. Further studies are needed to understand mechanisms that may explain discordance in CVOTs results observed with GLP-1 RA.CLINICAL TRIAL REGISTRATION: ISRCTN: ISRCTN97699312; EudraCT/CTIS number: 2016-001758-17.</p
