Development of a digital twin operational platform using Python Flask

The digital twin concept has developed as a method for extracting value from data, and is being developed as a new technique for the design and asset management of high-value engineering systems such as aircraft, energy generating plant, and wind turbines. In terms of implementation, many proprietary digital twin software solutions have been marketed in this domain. In contrast, this paper describes a recently released open-source software framework for digital twins, which provides a browser-based operational platform using Python and Flask. The new platform is intended to maximize connectivity between users and data obtained from the physical twin. This paper describes how this type of digital twin operational platform (DTOP) can be used to connect the physical twin and other Internet-of-Things devices to both users and cloud computing services. The current release of the software—DTOP-Cristallo—uses the example of a three-storey structure as the engineering asset to be managed. Within DTOP-Cristallo, specific engineering software tools have been developed for use in the digital twin, and these are used to demonstrate the concept. At this stage, the framework presented is a prototype. However, the potential for open-source digital twin software using network connectivity is a very large area for future research and development

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

The use of open source electronic medical records in an urban ED in Kumasi-Ghana

In a busy emergency department (ED), missing patient medical records is a common complaint to contend with. Electronic medical records (EMR) may be one useful way of ensuring patient record integrity and confidentiality. KATH ED sees 28,000 patients a year and integrity of patient records is a major challenge. This study sought to improve the integrity of medical records within the ED and efficiency of patient flow within the ED Methods: Regular panel meetings of emergency physicians, IT specialists and biostatisticians were held from February, 2012 to February, 2013. Open source software, Openemr was adapted in the creation of electronic medical records for the ED of KATH in February, 2012. Changes were made to the software included registration and patient search, triage board, doctor’s notes whiteboard to reflect the pattern of practice in KATH ED. Results: The EMR allows registration, triage and the entire medical records to be stored on patients. 12,000 Patient demographics have been migrated on to the EMR. Emergency physicians and charge nurses are able to monitor patient flow in the ED. Conclusion: Open source medical records may be the most appropriate and cost-effective software to adapt for keeping patient records electronically in a low resource setting. Further studies need to be conducted to demonstrate how EMR may affect the pace of work in the ED

Experimental Assessment of the Influence of Interface Geometries on Structural Dynamic Response

Jointed interfaces are sources of the greatest amount of uncertainty in the dynamics of a structural assembly. In practice, jointed connections introduce nonlinearity into a system, which is often manifested as a softening response in frequency response, exhibiting amplitude dependent damping and stiffness. Additionally, standard joints are highly susceptible to unrepeatability and variability that make meaningful prediction of the performance of a system prohibitively difficult. This high degree of uncertainty in joint structure predictions is partly due to the physical design of the interface. This paper experimentally assesses the influence of the interface geometry on both the nonlinear and uncertain aspects of jointed connections. The considered structure is the Brake-Reuß beam, which possesses a lap joint with three bolted connections, and can exhibit several different interface configurations. Five configurations with different contact areas are tested, identified, and compared, namely joints with complete contact in the interface, contact only under the pressure cones, contact under an area twice that of the pressure cones, contact only away from the pressure cones and Hertzian contact. The contact only under the pressure cone and Hertzian contact are found to behave linearly in the range of excitation used in this work. The contact area twice that of the pressure cone behaves between the complete contact and contact only under the pressure cone cases.Nonlinear Mechanics and Dynamics Research Institut