INTEGRATING DIGITAL TWIN CONCEPTS TO ENHANCE AGILITY OF THE UNITED STATES MARINE CORPS’ DECISION SUPPORT FRAMEWORK

Digital twin (DT) application and related technology has the potential to enhance the accuracy of wargame simulations in order to provide risk-informed decision support recommendations. A DT of the operating environment could theoretically be developed to continuously gather data from the operating forces and create computational models or simulations to test battlespace conditions. Effective implementation of DT can provide commanders with timely updates and adjustments to recommendations, aiding the decision-making process. Real-time updates would then inform commanders if the previously recommended course of action is no longer considered optimal based on the continuously running simulations. This thesis performs a qualitative assessment on the integration of a DT-enabled decision support system into the Marine Corps planning process and as an effective tool for leadership at various levels of command. The researchers determined that the wargaming process can be enhanced by incorporating real-time data into simulated future conflict to facilitate the inclusion of data analysis into time-sensitive decisions and potentially improve the management of uncertainty in the decision-making process. Leaders would benefit from increased awareness and quantitative assistance with resource allocation decisions. Expected challenges will be the digitization process of the operating force as well as acculturating leaders to the new technology.Approved for public release. Distribution is unlimited.Major, United States Marine CorpsCaptain, United States Marine Corp

Functions preserving nonnegativity of matrices

The main goal of this work is to determine which entire functions preserve nonnegativity of matrices of a fixed order $n$ -- i.e., to characterize entire functions $f$ with the property that $f(A)$ is entrywise nonnegative for every entrywise nonnegative matrix $A$ of size $n\times n$. Towards this goal, we present a complete characterization of functions preserving nonnegativity of (block) upper-triangular matrices and those preserving nonnegativity of circulant matrices. We also derive necessary conditions and sufficient conditions for entire functions that preserve nonnegativity of symmetric matrices. We also show that some of these latter conditions characterize the even or odd functions that preserve nonnegativity of symmetric matrices.Comment: 20 pages; expanded and corrected to reflect referees' remarks; to appear in SIAM J. Matrix Anal. App

Comment on ``Two Time Scales and Violation of the Fluctuation-Dissipation Theorem in a Finite Dimensional Model for Structural Glasses''

In cond-mat/0002074 Ricci-Tersenghi et al. find two linear regimes in the fluctuation-dissipation relation between density-density correlations and associated responses of the Frustrated Ising Lattice Gas. Here we show that this result does not seem to correspond to the equilibrium quantities of the model, by measuring the overlap distribution P(q) of the density and comparing the FDR expected on the ground of the P(q) with the one measured in the off-equilibrium experiments.Comment: RevTeX, 1 page, 2 eps figures, Comment on F. Ricci-Tersenghi et al., Phys. Rev. Lett. 84, 4473 (2000

Research in Extracorporeal Life Support: A Call to Action

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Patterns of use of adjunctive therapies in patients with early moderate- severe Acute Respiratory Distress syndrome: Insights from the LUNG SAFE Study

Background: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. Research Question: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (PaO2/FIO2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Study Design and Methods: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). Results: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. Interpretation: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. Trial Registry: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.go

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

BACKGROUND: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). METHODS: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. RESULTS: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. CONCLUSIONS: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. TRIAL REGISTRATION: NCT02010073 . Registered on 12 December 2013

Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction (HARP-2) trial : study protocol for a randomized controlled trial

Acute lung injury (ALI) is a common devastating clinical syndrome characterized by life-threatening respiratory failure requiring mechanical ventilation and multiple organ failure. There are in vitro, animal studies and pre-clinical data suggesting that statins may be beneficial in ALI. The Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial is a multicenter, prospective, randomized, allocation concealed, double-blind, placebo-controlled clinical trial which aims to test the hypothesis that treatment with simvastatin will improve clinical outcomes in patients with ALI