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IntroductionDigital twins of patients are virtual models that can create a digital patient replica to test clinical interventions in silico without exposing real patients to risk. With the increasing availability of electronic health records and sensor-derived patient data, digital twins offer significant potential for applications in the healthcare sector.MethodsThis article presents a scalable full-stack architecture for a patient simulation application driven by graph-based models. This patient simulation application enables medical practitioners and trainees to simulate the trajectory of critically ill patients with sepsis. Directed acyclic graphs are utilized to model the complex underlying causal pathways that focus on the physiological interactions and medication effects relevant to the first 6 h of critical illness. To realize the sepsis patient simulation at scale, we propose an application architecture with three core components, a cross-platform frontend application that clinicians and trainees use to run the simulation, a simulation engine hosted in the cloud on a serverless function that performs all of the computations, and a graph database that hosts the graph model utilized by the simulation engine to determine the progression of each simulation.ResultsA short case study is presented to demonstrate the viability of the proposed simulation architecture.DiscussionThe proposed patient simulation application could help train future generations of healthcare professionals and could be used to facilitate clinicians’ bedside decision-making.

BackgroundDigital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care.MethodsA mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey.ResultsMedian SUS scores and NASA-TLX were 70 (IQR 62.5–82.5) and 29.2 (IQR 22.5–34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies.ConclusionA digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.

This study investigates effect of addition of ground recycled tyre on ammonium nitrate exposed specimens by performing a significant number of unconfined compressive strength (UCS) tests when cured at different curing periods. The results showed that addition of ground recycled tyre enhanced UCS values of control and exposed specimens for all three curing periods. The microstructural analysis encompasses XRD and SEM analysis conducted on the samples and the results showed that exposure of the specimens to the ammonium nitrate cause formation of a poor connection amongst soil, cement, and ground recycled tyre particles and a reduction on hydration product generation of the cement. The results of this study showed that the ground recycled tyre is an effective replacement for cement and can successfully applied while cement contribution is reduced, and strength of the specimens have not been compromised.

Two strategies for teaching lung and heart-lung transplant subjects to use an electronic spirometer/diary instrument at home to input and transmit daily respiratory, vital sign, and symptom measurements were compared. The first strategy integrated teaching into subjects' postoperative clinic visits, whereas the second strategy involved referral to a Patient Learning Center (PLC) for instruction. Adherence was increased by 30% when the teaching was transferred from the clinic setting to the PLC. These findings suggest that the PLC is an effective resource for preparing patients to manage their care after discharge from a hospital or clinic. [ABSTRACT FROM AUTHOR]