Data-Driven Open-Loop Simulation for Digital-Twin Operator Decision Support in Wastewater Treatment

Operators of safety-critical industrial processes increasingly rely on digital twins to screen control interventions, but such simulators rarely carry certified safety guarantees. Wastewater treatment plants exemplify the gap: operators face a daily safety-efficiency trade-off where aerating too little risks effluent violations and nitrous-oxide (N2O) spikes, and aerating too much wastes energy. We develop an explainable digital twin for aeration and dosing setpoints. CCSS-IX, the simulator, is a bank of interpretable locally linear state-space "experts" adaptively mixed by a context-aware gating network, building on a continuous-time regime-switching scaffold. A runtime decision layer applies conformal risk control to abstain, reopen, or return a falsifying temporal witness for any operator-proposed action that cannot be statistically certified. The artificial-intelligence contribution is twofold: an identifiable, context-conditioned structured surrogate that retains operator-readable dynamics, and a self-falsifying decision rule with finite-sample coverage guarantees. The engineering contribution is a validated, end-to-end decision-support pipeline, tested on a 1000-step slice of the Avedøre full-scale plant (42.6% sensor missingness, 2-minute sampling), the Agtrup/BlueKolding full-scale plant in Denmark, and the Benchmark Simulation Model No. 2 (BSM2) international benchmark, under a matched ten-seed protocol. The static structured ensemble lies within 0.78% root-mean-square error of an unconstrained black-box reference, and the adaptive variant within 1.08%. The calibrated reopen rule cuts aggregate two-plant regret by 43.6% at an unsafe-action cost weight of 4 and eliminates unsafe chosen actions on the BSM2 main slice. Event-aligned temporal witnesses prevent 93 of 187 false-safe N2O approvals, about 4.65x the dyadic baseline (paired McNemar p < 1e-21).

Clinical decision support AI systems (CDSASs) must adapt to evolving patient conditions in real-time while adhering to strict safety constraints. We present an online adaptive framework that integrates Treatment Effect (TE) estimation to quantify clinical benefits, a patient Digital Twin (DT) to simulate treatment trajectories, and Reinforcement Learning (RL) for sequential decision-making. The AI system is initially trained on historical medical records and operates in a continuous learning loop. To ensure safety, a rule-based module monitors vital signs and blocks contraindicated treatments. Cases with strong internal model disagreement are flagged for clinician review, simulated in our experiments via a pre-trained outcome model. We validate our framework using both a synthetic clinical simulator and a real-world ovarian cancer dataset from The Cancer Genome Atlas (TCGA). In both simulated and clinical settings, our method demonstrated superior effectiveness and stability in recommending treatments compared to standard computational baselines. Furthermore, the AI system maintains low latency and requires expert consultation for only a minority of cases in our experimental validation, demonstrating its potential as a safe, clinician-supervised tool for personalized medicine that continuously improves through practical use.

This paper presents a proof-of-concept digital twin framework for simulation-driven diabetes modeling using benchmark clinical data, synthetic temporal augmentation, and illustrative continuous glucose monitoring (CGM) analysis. Unlike traditional predictive models, the framework focuses on generating interpretable simulated trajectories rather than clinically validated outcomes. Evaluation is conducted using a public dataset combined with controlled synthetic scenarios to illustrate temporal behavior and intervention effects. Results illustrate the feasibility of integrating prediction with counterfactual simulation for decision-aware analysis. This work does not claim clinical readiness but provides a foundation for future research on simulation-driven digital twin systems in healthcare.