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    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Multidimensional Risk Analysis and Digital Twins: An Effective and</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Alfredo Cuzzocrea</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Ismail Benlaredj</string-name>
          <xref ref-type="aff" rid="aff1">1</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Dept. of Computer Science, University of Paris City</institution>
          ,
          <addr-line>Paris</addr-line>
          ,
          <country country="FR">France</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>iDEA Lab, University of Calabria</institution>
          ,
          <addr-line>Rende</addr-line>
          ,
          <country country="IT">Italy</country>
        </aff>
      </contrib-group>
      <pub-date>
        <year>2026</year>
      </pub-date>
      <abstract>
        <p>The emergence of Digital Twin technology, coupled with Big Data paradigms, has enabled advanced analytics for real-time monitoring, simulation, and decision-making across multiple domains. In this paper, we address the emerging challenge of multidimensional risk analysis and prediction in Digital Twin environments, by proposing an innovative Multidimensional Big Data Analytics framework that integrates Digital Twin modeling, Cloud-based infrastructures, and OLAP-driven multidimensional analysis to assess and predict risks effectively. Our approach is designed to support complex risk scenarios, such as those in healthcare, by leveraging distributed data processing, real-time analytics, and predictive modeling. Through extensive experimental evaluations over real-life healthcare datasets, we demonstrate the efficiency and scalability of our framework in performing multidimensional risk analytics and prediction.</p>
      </abstract>
      <kwd-group>
        <kwd>1 Digital Twins</kwd>
        <kwd>Big Data</kwd>
        <kwd>Multidimensional Risk Analysis</kwd>
        <kwd>Multidimensional Risk Prediction</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. Introduction</title>
      <p>
        Digital twins (e.g., [
        <xref ref-type="bibr" rid="ref1 ref2 ref3">1-3</xref>
        ]) have emerged as a transformative technology in the era of big data (e.g.,
[46]). By integrating real-time data from sensors and historical information, digital twins enable the
simulation, monitoring, and optimization of physical assets across various domains. The convergence
of digital twin technology with big data applications has opened new avenues for research, focusing
on several key aspects. Firstly, the data integration and management aspect is crucial. Digital twins
rely on vast amounts of data from diverse sources, necessitating advanced data management
techniques to ensure data quality, consistency, and accessibility. Researchers are exploring innovative
methods to handle the volume, velocity, and variety of big data, including the use of cloud computing
and edge computing to enhance data processing capabilities. Secondly, the modeling and simulation
aspect involves creating accurate and dynamic models of physical assets. This requires sophisticated
algorithms and Machine Learning (ML) techniques to predict and replicate the behavior of these assets
under various conditions (e.g., [7,8]). Research in this area aims to improve the fidelity of simulations
and the ability to perform real-time updates based on incoming data. Thirdly, the real-time analytics
and decision-making aspect is pivotal. Digital twins enable real-time monitoring and predictive
maintenance by analyzing data streams to detect anomalies and predict failures before they occur
(e.g., [9]). This aspect of research focuses on developing robust analytics frameworks and
decisionsupport systems that can provide actionable insights in real-time. Lastly, the interoperability and
standardization aspect addresses the need for standardized protocols and frameworks to ensure
seamless integration and communication between digital twins and other systems (e.g., [10,11]).
Researchers are working on establishing common standards and best practices to facilitate the
widespread adoption and scalability of digital twin technology.
1SEDB 2025: 33rd Symposium on Advanced Database Systems, June 16-19, 2025, Ischia, Italy
* This research has been made in the context of the Excellence Chair in Big Data Management and Analytics at University of Paris City,
Paris, France
∗ Corresponding author.
      </p>
      <p>alfredo.cuzzocrea@unical.it (A. Cuzzocrea); ismail.benlaredj@unical.it (I. Benlaredj)
: 0000-0002-7104-6415 (A. Cuzzocrea); 0009-0003-1138-8039 (I. Benlaredj)</p>
      <p>© 2025 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).</p>
      <p>In summary, the research on digital twins for big data applications is multifaceted, encompassing
data management, modeling and simulation, real-time analytics, and interoperability. These efforts
are driving the evolution of digital twins from conceptual models to practical tools that enhance
efficiency, reliability, and decision-making across various industries.</p>
      <p>In this paper, we focus on a specific, innovative research challenge:risk analysis over digital twins
(e.g., [12,13]). The final goal of this new idea is to design and develop data analytics methodologies
for characterizing, analyzing and, moreover, making predictions about the risk of organizations (e.g.,
healthcare systems) by inspecting the data and knowledge kept in digital twins. Without any loss of
generality, big data technologies have largely been used for risk management activities, in various
organizations (e.g., [14,15]). Given the strict interaction with data analytics methodologies and ML,
several methodologies have been applied for analyzing organizational risk using digital twin data,
particularly in sectors like healthcare. For instance, techniques such as regression analysis, decision
trees, and neural networks are used to predict potential risks by analyzing historical and real-time data
from digital twins [14]. For instance, in healthcare, predictive analytics can forecast patient
deterioration or equipment failure. Similarly, time series analysis analyzes data points collected or
recorded at specific time intervals to identify trends, seasonal patterns, and potential anomalies that
could indicate risks [15]. Tools like dashboards and heat maps help in visualizing complex data from
digital twins, making it easier to identify patterns and outliers that could signify risks [16]. Descriptive
statistics such as mean, median, and standard deviation are used as well to summarize and describe
the main features of a dataset, providing insights into the normal operating conditions and deviations
that might indicate risks [17]. Indeed, leveraging digital twin data through various data analytics
methodologies allows organizations to proactively identify, assess, and mitigate risks. These
methodologies enhance decision-making, improve operational efficiency, and ultimately contribute
to better risk management practices.</p>
      <p>In line with this relevant research trend, this paper proposes the application of the innovative
multidimensional big data analytics paradigm [18-20] to the specific case of risk analysis, via proposing
an innovative model, and the related framework, for supporting multidimensional risk analysis and
prediction over digital twins.</p>
      <p>The remaining of this paper is structured as follows. Section 2 offers a comprehensive overview
of state-of-the-art proposals related to the context of multidimensional risk analysis and prediction
over digital twins. Section 3 summarizes our proposed multidimensional big data analytics paradigm
as applied to the specific research context. Section 4 describes the framework that implements our
methodology for multidimensional risk analysis and prediction. In Section 5, we introduce and
describe the real-life datasets used in our experimental assessment. Section 6 presents the first part
of our experimental campaign, which consists of multidimensional risk analytics. Similarly, Section
7 presents the second part, which consists of the multidimensional risk prediction. Finally, Section
8 provides conclusions and possible future work.</p>
    </sec>
    <sec id="sec-2">
      <title>2. Related Work</title>
      <p>In this Section, we provide a comprehensive overview of state-of-the-art proposals in the context of
multidimensional risk analysis and prediction over digital twins.</p>
      <p>[21] contributes significantly to the intersection of computational intelligence, data privacy and
Digital Twins (DT) technology for Cyber-Physical Systems (CPS) in smart cities. The approach centers
on using Differential Privacy Frequent Subgraph-Big Multigraph (DPFS-BM) for preserving data
privacy in DT, which maps the complex physical spaces of CPS into virtual environments. Authors
propose a novel Differential Privacy-AlexNet (DP-AlexNet) model for analyzing and predicting Big
Graphic Data (BGD) in DT, solving the gradient dispersion problem typically encountered in deep
networks. Through comparative analysis with various neural networks (e.g., CNN, RNN, etc.), the
model demonstrates superior performance in terms of error rates, training, and testing time.</p>
      <p>
        In the field of precision medicine forCardio-Vascular Disease (CVD), the concept of digital twins
has gained attention for its potential to improve patient-specific diagnosis and treatment. By creating
a virtual representation of a patient that integrates real-time updates from various clinical, imaging,
molecular and so forth, the DT can optimize treatment decisions and predict disease progression. In
[
        <xref ref-type="bibr" rid="ref4">22</xref>
        ], authors conduct a mapping review of DT research in CVD. The review also highlighted the
growing commercial interest in DT technology, with several companies that focus on CVD-related
digital twin models, including simulation models that act as precursors to real-time cyber-physical
systems. Despite the promising interdisciplinary and global nature of this research, authors identified
several challenges, such as ethical concerns and clinical barriers to the adoption of AI-driven decision
tools in healthcare.
      </p>
      <p>
        [
        <xref ref-type="bibr" rid="ref5">23</xref>
        ] presents a comprehensive review of the application of ML techniques in healthcare,
particularly focusing on health prediction systems using Electronic Health Record (EHR) datasets.
Authors emphasize the importance of ML in automating healthcare processes and improving disease
prediction accuracy. By leveraging ML methods, this review highlights the potential for intelligent
systems to learn from past experiences, by enabling more accurate and proactive healthcare solutions.
Authors argue that ML can extract valuable insights from EHRs, ultimately contributing to better
health risk prediction. This work serves as a foundational resource for researchers looking to explore
the intersection of ML and healthcare prediction.
      </p>
      <p>
        In [
        <xref ref-type="bibr" rid="ref6">24</xref>
        ] authors explore the application of a Fuzzy Control System (FCS) in healthcare for diagnosing
human health risks related to blood pressure, and blood glucose across different age groups. The FCS
is recognized for its ability to handle uncertainty in clinical decision-making and treatment, which
makes it suitable for addressing the variability in medical diagnoses. This research predicts health
risks by employing FCS and compares the results with previous studies. The system supports reliable
decision-making, by enabling immediate treatment recommendations and lifestyle adjustments to
mitigate future health risks. Authors also suggest that this FCS approach can be extended to predict
additional health risks, including mental and physical conditions, providing a versatile tool for
healthcare diagnostics.
      </p>
      <p>
        [
        <xref ref-type="bibr" rid="ref7">25</xref>
        ] explores the challenges and opportunities of leveraging Electronic Health Records for
datadriven healthcare. Given the inherent difficulties in working with EHR data, such as temporality,
sparsity, and noise, authors propose a Deep Learning-based approach for phenotyping from patient
EHRs. Their method represents each patient’s EHR as a temporal matrix, where time and medical
events form the two dimensions. A four-layer convolutional neural network model is then applied. To
account for temporal dynamics, the study investigates three fusion techniques: early, late, and slow
fusion. Moreover, the proposed model is validated over a real-life EHR dataset, particularly in the
context of predictive modeling for chronic diseases. This evaluation demonstrates its effectiveness in
phenotype extraction and disease prediction.
      </p>
      <p>
        In [
        <xref ref-type="bibr" rid="ref8">26</xref>
        ], authors explore the impact of Digital Twin technology on healthcare, by emphasizing its
transformative potential in diagnostics, drug delivery, and treatment optimization as part of digital
transformation adopted by Industry 4.0. Digital Twin technology has broad applications in healthcare,
from hospital operations and public health processes and so forth. Motivated by the COVID-19
pandemic, authors focus on applying DT technology for virus containment in workplaces through
social distancing measures. Their contributions consist of introducing a generalized DT architecture
to identify key functional components of DT systems and then presenting “CanTwin” an innovative
case study that utilizes DT technology in a canteen service for monitoring social distancing. This study
provides valuable insights into how DT technology can be applied for real-time monitoring and
optimization in healthcare.
      </p>
      <p>
        [
        <xref ref-type="bibr" rid="ref9">27</xref>
        ] highlights the promising role of digital twin technology in healthcare, which focuses on its
applications in monitoring, diagnosis, treatment development and drug discovery. Digital twins, acting
as virtual counterparts of real human patients, leverage various data sources such as blood glucose
levels, heart imaging, cardiac electrophysiology, and multi-omics data. The article explores the
challenges of standardizing, integrating, and interpreting these diverse datasets and highlights how
different methods help to overcome these issues in order to create effective digital twins. Despite the
significant progress in DT technology, authors note that further advancements innon-invasive data
collection, as a result, modeling techniques and computational power are needed to achieve fully
comprehensive patient digital twins.
      </p>
      <p>
        [
        <xref ref-type="bibr" rid="ref10">28</xref>
        ] presents a literature review on the use of digital twin technology in safety analysis, risk
assessment and emergency management. While digital twins are emerging as powerful tools for
monitoring complex systems, autonomous control, and real-time assistance during emergencies,
authors emphasize that key issues such as safety, cybersecurity, and reliability remain unresolved.
These concerns are crucial for evaluating the risks and benefits associated with DT implementation.
This research has two main objectives, (i) it reviews the latest advancements in DT technology, by
offering a catalog of expected functions and enabling technologies across various application
domains; (ii) it highlights the limitations and challenges that still need to be addressed for effective
digital twin integration in safety and risk management scenarios. This study underscores the
importance of further research to enhance the safety and reliability of DT, particularly in critical and
high-risk environments.
      </p>
      <p>
        [
        <xref ref-type="bibr" rid="ref11">29</xref>
        ] provides a review of digital twin technology, focusing on its role in smart manufacturing and
Industry 4.0. DT facilitates unified integration between the cyber and physical spaces, and their
significance is increasingly recognized in bothacademic and industrial literature. Despite the concept
being introduced nearly 15 years ago and its successful application in various industries (e.g., product
design, production, and health management). This paper addresses those concerns by reviewing the
key components, current developments, and major applications of DT in industry. Additionally, it
discusses ongoing challenges and proposes future research directions to advance DT implementation
in industrial environments.
      </p>
      <p>
        Finally, [
        <xref ref-type="bibr" rid="ref12">30</xref>
        ] presents a novel approach that combines reduced-order models with ML to create
physics-informed digital twins for nuclear reactor core simulations. The digital twin predicts complex
outputs like neutron flux and power distribution by solving forward and inverse problems. Proper
orthogonal decomposition is used offline to build accurate computational models, while ML techniques,
such as k-Nearest-Neighbors (KNN) and decision trees, handle input-parameter-dependent coefficients.
      </p>
      <p>From the analysis of the active literature, the strident interest for our investigated topic clearly
emerges.</p>
    </sec>
    <sec id="sec-3">
      <title>3. Multidimensional Big Data Analytics Applied</title>
    </sec>
    <sec id="sec-4">
      <title>Multidimensional Risk Analysis and Prediction Problem to the</title>
      <p>In this Section, we propose a brief summary about the multidimensional big data analytics paradigm
we proposed recently [18-20], and how it is applied to the multidimensional risk analysis and
prediction problem.</p>
      <p>
        Basically, the proposed methodology aims at applying the well-known multidimensional and
OLAP analysis paradigm [
        <xref ref-type="bibr" rid="ref13">31</xref>
        ] to the core of emerging big data analytics procedures (e.g., [
        <xref ref-type="bibr" rid="ref14">32</xref>
        ]), even
within the applicative context of state-of-the-art big data processing platforms, such as Apache
Hadoop and Apache Spark. The methodology relies on the following main steps:
      </p>
      <p> designing and implementing a proper big multidimensional analysis model over the target
heterogeneous data sources, driven by specific analysis goals;</p>
      <p> designing and implementing a proper (distributed) MapReduce-based big multidimensional
data storage model, based on a reference big data platform (e.g., Apache Hadoop);
 designing and implementing a proper collection of (distributed) functional-based
multidimensional big data analytics procedures, driven by specific analytics goals;
 designing and implementing a proper collection of (distributed) multidimensional big data
visualization tools, driven by the target knowledge fruition .</p>
      <p>
        It should be noticed here that, as regards research challenges, the most annoying problem is
represented by the issue of creating and developing ad-hoc big data management and processing
algorithms, which support the analytics and prediction phases, by strictly taking into account
performance aspects, which play a relevant role in emerging big data research (e.g., [
        <xref ref-type="bibr" rid="ref15 ref16">33,34</xref>
        ]). Indeed,
computational overheads are a challenging aspect of these issues, when applied to real-life big data
settings, so that appropriate solutions must be taken.
      </p>
      <p>When applied to the big data scenarios represented by digital twins, the most significant aspect
for the methodology we propose is represented by the issue of appropriately capturing the streaming
and pervasive nature of such kind of data sources, by integrating a proper functional component. In
addition, another important aspect for the case of digital twins is represented by the need for big data
prediction tools, due to specific operational settings of these environments.</p>
      <p>Finally, still in the specific context we investigate, the core multidimensional model is “shaped” as
a multidimensional risk model, meaning that the measures to analyze are connected to the evaluation
of the risk in the specific setting (e.g., healthcare) and the core multidimensional predictive model is
“shaped” as a multidimensional risk prediction model, both tailored to digital twins.</p>
    </sec>
    <sec id="sec-5">
      <title>4. An Innovative Framework for Supporting Multidimensional Risk</title>
    </sec>
    <sec id="sec-6">
      <title>Analysis and Prediction over Digital Twins</title>
      <p>In this Section, we introduce our proposed innovative framework designed to support
multidimensional risk analysis and prediction over digital twins, particularly in the healthcare
domain. Notably, this framework is distinguished by its integration of digital twin modeling,
Cloudbased infrastructure, and advanced analytics, which enable risk assessment and prediction. Figure 1
shows a comprehensive overview of this reference framework.</p>
      <p>As shown in Figure 1, the framework is composed of several key layers, each playing a crucial role
in the overall functioning of the framework. These layers are described below and will be discussed
in detail in the following.</p>
      <p> Cyberphysical World: this layer focuses on gathering data from various sensors, such as heart
sensors, which provide critical information about heart disease analysis;</p>
      <p> Cloud-Based Infrastructure: this infrastructure consists of two core components: first,Digital
Twin Modeling component, which involves interconnected Cloud nodes with Apache Kafka instances
that handle streaming data produced by digital twins; second, Multidimensional Risk Modeling
component is responsible for creating data cubes in each Cloud node in order to be efficiently
processed and analyzed;</p>
      <p> Multidimensional Risk Analysis: this layer performs Cloud-based OLAP-shaped
multidimensional risk analysis, enabling the exploration of heart disease risks from multiple
dimensions;</p>
      <p> Multidimensional Risk Analytics: this layer focuses on supporting multidimensional risk
analytics derived from the analysis, making it easier to interpret and understand the multidimensional
risk data;</p>
      <p> Multidimensional Risk Prediction: this final layer is responsible for providing predictive
insights based on multidimensional risk analysis.</p>
      <p>
        In the following, we examine these layers and components with greater detail, by highlighting
their specific roles within the proposed framework. While our proposed framework is general enough
to capture any innovative big data setting scenario, here we specialize our description for the very
relevant case represented by the digital twin healthcare scenario (e.g., [
        <xref ref-type="bibr" rid="ref17">35</xref>
        ]).
      </p>
      <p>1. Cyberphysical World: this layer is the initial layer of our framework, where real-time
healthcare data from the physical environment are captured. In the context of cardiovascular
healthcare, it includes patient health metrics such as heart rate, blood pressure,
Electrocardiogram (ECG) readings, and other cardiovascular signals. The aim of this layer is to
ensure that an accurate dataset is available for analysis. The data gathered here serves as input
to the following layers in the framework. This layer is crucial because the accuracy and quality
of data directly impact the effectiveness of the analytical models and predictions of heart
diseases;
2. Cloud-Based Infrastructure: this layer is crucial due to its importance in providing an
environment for processing and managing large amounts of data collected from the cyberphysical
world layer. The infrastructure is composed of two primary components, (i) Digital Twin Modeling
component; (ii) Multidimensional Risk Modeling component, each playing a pivotal role in the data
analysis process.</p>
      <p>
        a. Digital Twin Modeling: this component is composed of several interconnected Cloud nodes,
each equipped with Apache Kafka instances to manage the data streams of the collected
data from heart sensors. Later the collected data is transmitted in CSV format and fed into
these Cloud nodes through Apache Kafka;
b. Multidimensional Risk Modeling: the second critical part of the Cloud-based infrastructure
is the Multidimensional Risk Modeling component, which transforms data into
multidimensional models (OLAP data cubes – e.g., [
        <xref ref-type="bibr" rid="ref13 ref18">31,36</xref>
        ]). Each data cube is created and
maintained in a distributed-Cloud-mode (e.g., [
        <xref ref-type="bibr" rid="ref19 ref20">37,38</xref>
        ]). With this distributed architecture,
the efficiency of data processing is enhanced by enabling parallel operations across nodes.
The multidimensional nature of these cubes allows for OLAP-based querying (e.g., [
        <xref ref-type="bibr" rid="ref21">39</xref>
        ]),
which is essential for extracting and analyzing the relationships and trends of data. The
OLAP cubes generated by the Cloud nodes are then materialized within Apache Hive. This
step allows us to integrate the data into Apache Kylin, which is in charge of supporting
efficient OLAP querying and multidimensional analysis. Then, we use Apache Superset to
visualize the multidimensional data in an intuitive format by connecting to Apache Kylin
and retrieving the multidimensional data. This setup provides a robust platform for
visualizing and exploring healthcare analytics.
3. Multidimensional Risk Analysis: this layer focuses on processing aggregate data from the
Cloud infrastructure and deriving meaningful insights through multidimensional querying and
exploration, thus fully realizing the multidimensional risk analytics phase. This phase involves
organizing data into dimensions and measures, such as cardiovascular metrics (e.g., heart rate, blood
pressure, and so forth) and patient demographics categorized by time, age group, and region for
efficient analysis. The risk analysis algorithms then apply transformations, aggregations and
statistical analyses to identify trends, patterns and correlations within the data. Concurrently, a
continuous flow of data between various fragments of this risk analysis layer enables
multidimensional querying. Users can drill-down into specific data or aggregate data across
various dimensions, providing deeper insights into cardiovascular risk;
4. Multidimensional Risk Analytics: it focuses on translating complex analytical results into
easyto-understand visual representations for healthcare providers to interpret the results and make
informed decisions. By employing a variety of visualization tools such as bar plots, pie plots, 3D
plots, and so forth, the framework allows users to explore and analyze risk effectively. These visual
tools help users gain a deeper understanding of the relationships between different risk factors
and patterns emerging from multidimensional data analysis;
5. Multidimensional Risk Prediction: the final component of the framework focuses on
multidimensional risk prediction, which translates the analyzed data into actionable predictions.
This layer is responsible for generating predictions based on the processed healthcare data, using
ML models and statistical tools. After generating predictions, the next phase consists of presenting
the results in an intuitive manner through the usage of plots and graphs. The 3D plots and bar
plots show trends and relationships between risk factors, while comparison plots illustrate the
likelihood of specific outcomes (e.g.,chest pain prevalence, glucose level predictions, etc.).
      </p>
      <p>Finally, the proposed framework operates in a continuous cycle, starting with real-time data
collection from the cyberphysical world, which is then mirrored virtually via digital twin modeling.
These data flow through Cloud-based infrastructure for risk modeling and culminate in visualized
predictions and risk assessments. The seamless integration of these technological components allows
healthcare providers to monitor patient conditions in real-time, predict future risks, and take
preventive actions accordingly. This comprehensive solution effectively addresses the challenges
faced by modern healthcare systems.</p>
    </sec>
    <sec id="sec-7">
      <title>5. Experimental Assessment and Analysis: Dataset Description</title>
      <p>
        In this Section, we introduce the following three healthcare-related datasets: HeartStudy Dataset [
        <xref ref-type="bibr" rid="ref22">40</xref>
        ],
DiabetesHealthcare Dataset [
        <xref ref-type="bibr" rid="ref23">41</xref>
        ] and LungCancer Dataset [
        <xref ref-type="bibr" rid="ref24">42</xref>
        ]. These datasets have been used in our
experimental campaign. We explore the specific attributes that each dataset contains, and also
examine the structure of these datasets in detail discussing the key variables that contribute to
understanding heart disease, diabetes and lung cancer. As mentioned in Section 4, data contained in
these datasets have been used to feed the Apache Kafka component, like they were produced by the
digital twin layer of the framework. In turn, Apache Kafka aliments the Cloud storage of the
framework, and these Cloud-enabled datasets are finally used to populate the OLAP data cubes that
are built according to the multidimensional big data analytics paradigm [18-20].
      </p>
      <p>
        HeartStudy [
        <xref ref-type="bibr" rid="ref22">40</xref>
        ] is a dataset about heart disease that includes 4,240 records and 16 columns, with
15 attributes related to patient information. This dataset aims to predict whether a patient has a
10year risk of developing Coronary Heart Disease (CHD). The dataset target attribute named
TenYearCHD is a binary indicator representing the 10-year risk of CHD. It takes the value 1 if the
patient is at risk of developing CHD in the next 10 years, or 0 otherwise.
      </p>
      <p>
        DiabetesHealthcare [
        <xref ref-type="bibr" rid="ref23">41</xref>
        ] is a dataset sourced from the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK) project that focuses on creating knowledge and treatments for chronic,
costly, and consequential diseases. The objective is to predict whether or not a patient has diabetes
based on various diagnostic measurements. The dataset includes 8 medical variables and one target
variable named Outcome indicating whether the patient has diabetes or not (i.e., 1 or 0).
      </p>
      <p>
        LungCancer [
        <xref ref-type="bibr" rid="ref24">42</xref>
        ] is a dataset that focuses on evaluating the effectiveness of a cancer prediction
system by providing information to assess lung cancer risk at a low cost. The data is collected from
an Online Lung Cancer Prediction System. Gender attribute has two values M for Male and F for Female.
All other attributes have two values 1 or 2 (e.g., Smoking attribute the value 1 indicates that the person
is not smoking, and 2 indicates the person is smoking).
      </p>
    </sec>
    <sec id="sec-8">
      <title>6. Experimental Assessment and</title>
    </sec>
    <sec id="sec-9">
      <title>Analytics</title>
    </sec>
    <sec id="sec-10">
      <title>Analysis: Multidimensional Risk</title>
      <p>In this Section, we are going to experiment with three different datasets related to healthcare, with
particular attention to the multidimensional risk analytics supported by our proposed framework.
Accordingly, we create dashboards for each dataset using Apache Superset in order to present key
analytics and visualizations that help uncover critical patterns, trends, and actionable insights,
contributing to data-driven decision-making in healthcare.</p>
      <p>As described in Section 4, the multidimensional risk analytics is generated by our
multidimensional OLAP model embedded in the framework, which adheres to the underlying
multidimensional big data analytics paradigm [18-20].</p>
      <p>First, we consider the HeartStudy dataset. The constructed HeartStudy dashboard showcases a
series of analytical plots related to the target dataset. These visualizations provide insights into
various key metrics and patterns, enabling a deeper understanding of the dataset attributes and
trends. Figure 2 shows the HeartStudy dashboard, which provides an overview of important smoking
and health patterns. The dashboard focuses the attention on the relationship between smoking
cigarettes and CHD risk. It demonstrates 37.9K cigarettes per day in the overall dataset, and the most
represented age in the dataset was from 40 to 50. Males smoke more than females. The cigarette
smoking rate for people aged 40 to late 40s is the highest. Both males and females have roughly the
same average glucose level. At the age of 32, smoking rates reached their peak and remained consistent
thereafter.</p>
      <p>Second, we consider the DiabetesHealthcare dataset. Figure 3 shows the DiabetesHealthcare
dashboard, which is underlined by a few of the following health metric indicators. The AVG(glucose)
maintains its stability in the range between 80 to 160. The histogram of SUM(pregnancies) shows that
women aged 40 to 45 have the highest number of pregnancies. The area plot of AVG( bloodpressure)
shows stability in the range of 50 to 90. The pie plot of AVG(skinthickness) shows similar averages
across all ages. The AVG(insulin) is 178.78. Finally, two line plots represent how the MAX(BMI) will
be in the range of 40 to 65, and MIN(BMI) is in the range of 0 to 30.</p>
      <p>Finally, the LungCancer dataset is considered, being the corresponding LungCancer dashboard
shown in Figure 4. Here are some of the insights derived from this dashboard. Two pie plots reveal
that females have slightly higher average anxiety levels, while the COUNT(lung_cancer) is relatively
the same for both genders. An histogram of COUNT(smoking) shows that males smoke more than
females, with the most smokers in the late 50s to early 60s age group. Another histogram of
AVG(allergy) indicates stability, with males slightly more affected. A line plot of AVG(anxiety) shows
that both genders have similar anxiety levels, and the total COUNT(smoking) is 1.01K.</p>
    </sec>
    <sec id="sec-11">
      <title>7. Experimental Assessment and</title>
    </sec>
    <sec id="sec-12">
      <title>Prediction</title>
    </sec>
    <sec id="sec-13">
      <title>Analysis: Multidimensional Risk</title>
      <p>In this Section, we focus on the second aspect of our experimental assessment and analysis, i.e. the
multidimensional risk prediction. Our model includes all steps from data processing, analysis, and
generating predictions to the final results, and advanced techniques including data aggregation,
multidimensional data analysis, and reporting with suitable plots. The very relevant innovation of
our risk prediction approach is, again, the multidimensionality of the analysis, meaning that our
approach completely captures the multidimensional nature of the surrounding analysis problem, in
order to finally enhance theexpressive power of the overall (analytics) process.</p>
      <p>
        In our experimental campaign, we have developed Credit Scoring [
        <xref ref-type="bibr" rid="ref25">43</xref>
        ], which is normally utilized
by financial institutions as a statistical tool to decide thecreditworthiness of either an individual or an
organization. However, our customized model is used for healthcare-related multidimensional
prediction from digital twin data. Indeed, instead of financial dimensions, our custom model evaluates
variables like medical history, clinical indicators, chronic conditions, lifestyle choices, and various health
measurements to predict the likelihood of future health issues or events. The second prediction model
is the Deep Learning Network [
        <xref ref-type="bibr" rid="ref26">44</xref>
        ] used for estimating the Probability of Default (PD). Basically, this
model trains a credit risk for PD prediction using a Deep Neural Network [45]. The model focuses on
alternative network designs and fits simpler models withoutmacroeconomic variables. Again, like in
the case of Credit Scoring, we customize the model implementation as to support multidimensional
prediction from digital twin data, via proper multidimensional healthcare model.
      </p>
      <p>In the following, due to space limitation, we present our experimental results as restricted to the
multidimensional risk prediction over the HeartStudy dataset only, but we conducted the prediction
accuracy analysis over all the three datasets, with similar results.
7.1.</p>
    </sec>
    <sec id="sec-14">
      <title>Credit Scoring Model</title>
      <p>
        In our Credit Scoring model [
        <xref ref-type="bibr" rid="ref25">43</xref>
        ], we use a credit ScoreCard function to generate predictions based on
specific health metrics. This allows us to predict health risks based on critical patient attributes.
Subsequently, we use a Fitmodel function to fit aLogistic Regression Model to the Weight of Evidence
(WOE) data. Fitmodel internally bins the training data, and transforms it into WOE values,
after that, we compute the probability of default for the credit scorecard model using the Probdefault
function, and we define the threshold for the probability of default as 0.35. Finally, we use custom
functions for the visual reports to plot aggregate results, and we use 3 D plots for more detailed
reports.
      </p>
      <p>Here, we present the results of applying our Credit Scoring model to the first of the three healthcare
datasets previously described (i.e., HeartStudy dataset). By focusing on this initial dataset, we provide
a closer look at the predictions, combining and aggregating various attributes. This approach
uncovered valuable insights and helped identify relationships between key indicators.</p>
      <p>Through the application of our model on the HeartStudy dataset, we generate predictions for the
target variable, which is a 10-year risk of future CHD, we provide detailed analysis and informative
reports. These outputs are visually represented in 3 D plots.</p>
      <p>Figure 5 displays the prediction counts for CHD. In order to capture the multidimensional
modelling, in Figure 5 ( a ) we select three attributes, including the target variable CHD. Numerical
variables, such as heartRate and cigsPerDay, have been grouped into intervals (mostly four intervals).
The first two attributes, heartRate and gender, have been combined resulting in a combination of
intervals, while the third attribute, cigsPerDay, has been presented independently. The results have
been aggregated based on the three selected attributes, with the prediction counts split into two
categories: CHD and No CHD. Overall, this originates a multidimensional prediction model over
digital twin data extracted from the target dataset, according to the three-dimensional range
cigsPerDay, heartRate, gender.</p>
      <p>
        Similarly, Figure 5 ( b ) shows the prediction counts for CHD over the range glucose, diaBP,
sysBP. For this range, we selected the three attributes, glucose, diaBP and sysBP, including the target
variable CHD. All these attributes were grouped into four intervals. The first two attributes,sysBP and
diaBP, have been combined resulting in a combination of bins, while the third attribute, glucose, has
been used independently. It is easy to notice, here, that this approach can easily scale to higher
numbers of dimensions, since multiple dimensions can be easily grouped/projected into different
subgroups of dimensions (e.g., [
        <xref ref-type="bibr" rid="ref26">44</xref>
        ]).
      </p>
      <p>As shown in Figure 5 ( b ), the predictions demonstrate that patients with high values of the three
attributes (glucose &gt; 110, diaBP &gt; 90, and sysBP &gt; 180) have a serious risk of developing
CHD. We observe the risk of having CHD decreases with glucose less than 110; however, we notice
that high diaBP and sysBP values still put some patients at risk of developing CHD even with a low
level of glucose.</p>
      <p>Figure 6 shows the prediction counts for CHD over the range currentSmoker, heartRate,
prevalentHip. In this case, we selected three attributes, including the target variable CHD. All these
attributes were grouped into four intervals. The first two attributes, (i.e., currentSmoker and
prevalentHip), have been combined while the third attribute, heartRate, has been represented
independently.</p>
      <p>As a result, the predictions show that patients who are smokers and who have prevalent
hypertension are at risk of developing CHD, especially patients with irregular heart rates (
heartRate &gt; 90). On the other hand, predictions show that non-smoker patients without prevalent
hypertension have a low risk of CHD.
7.2.</p>
    </sec>
    <sec id="sec-15">
      <title>Deep Learning Network Model</title>
      <p>
        In our Deep Learning Network model [
        <xref ref-type="bibr" rid="ref26">44</xref>
        ], we train a credit risk for the probability of default prediction
using a Deep Neural Network. The model starts by loading and preprocessing the data, all attributes
should be appropriately formatted to fit the input of the model. After preparing the data, we divide it
into training, validation, and testing sets. The training data is used to build the model, the validation
data is utilized to fine-tune and confirm the model parameters, and the testing data is used to check
the overall performance of the models.
      </p>
      <p>With prepared data, we define the network architecture, including the parameters of layers,
functions, and other key components. Afterward, we fine-tune the training parameters, such as
Learning Rate, Batch Size and Epochs Number. Once these steps are completed, we proceed to train the
network using the prepared data. For efficiency, a pre-trained model, named
residualTrainedNetworkMacro, is provided, which allows us to bypass the training process and directly
explore the results with other versions of the dataset. Moreover, the same advanced visualization
techniques are employed for more detailed reports.</p>
      <p>Through the application of our model on the HeartStudy dataset, we generate predictions for the
target variable, which is the 10-year risk of future coronary heart disease CHD, thus furnishing
detailed analyses and informative reports. These outputs are then visually represented in ad-hoc plots.
The prediction model discriminates between the two same categories exploited for the Credit Scoring
model, i.e. CHD and No CHD (see Section 7.1).</p>
      <p>Figure 7 ( a ) displays the prediction counts for CHD over the range
⟨ cigsPerDay , heartRate , gender ⟩. By analyzing the results, the predictions indicate that female
smokers have a higher likelihood of developing CHD compared to males. We observe that smokers
with cigsPerDay &lt; 5 are the biggest group, therefore, we observe that the latter is the group having
the highest chance of getting a CHD, despite males and females having some numbers of getting CHD
across all cigsPerDay interval cases.</p>
      <p>Figure 7 ( b ) shows the prediction counts for CHD over the range ⟨ glucose , diaBP , sysBP ⟩.
The predictions reveal that patients with high levels of all three attributes ( glucose &gt; 110,
diaBP &gt; 90, and sysBP &gt; 180) are at a significantly increased risk of developing CHD. While the
risk decreases when glucose levels fall below 110; however, we observe that patients with high diaBP
and sysBP values remain at risk, even if their glucose levels are low.</p>
      <p>Figure 8 shows the prediction counts for CHD over the range ⟨ age , education , totChol ⟩. The
predictions reveal that patients with lower education levels (degrees 1 and 2), as well as higher
cholesterol levels (totChol &gt; 200), tend to be connected with an increase in developing CHD,
particularly among the older patients (age &gt; 50). Contrarily, for patients under 40, the counts for
CHD are relatively low across all education and cholesterol levels. It should be noticed here that the
latter situation is very close to the real and effective today’s status about health guidelines for large
communities, at various scales such as the province scale and the regional scale.</p>
      <p>(a) (b)
Figure 7: Prediction Counts for ⟨ cigsPerDay , heartRate , gender ⟩ ( a )
⟨ glucose , sysBP , diaBP ⟩ ( b ) (Deep Learning Network Model)
and</p>
    </sec>
    <sec id="sec-16">
      <title>8. Conclusions and Future Work</title>
      <p>This paper has explored the convergence of two innovative and very relevant scientific areas: digital
twins and big data technologies. In particular, we focused on the issue of supporting multidimensional
risk analysis and prediction over digital twin data, by nicely applying an emerging state-of-the-art
analytics paradigm, the so-called multidimensional big data analytics.</p>
      <p>The result is represented by a comprehensive framework, for which we provided anatomy and
main functionalities. In addition to this, we conducted an extensive experimental evaluation and
analysis of the performance of the proposed framework in both the different analytics and prediction
phases, over state-of-the-art datasets populating the target healthcare digital twin scenario.</p>
      <p>Future work is mainly oriented to further extend our contributions with specific aspects of the
emerging big data trend, such as performance optimization and outlier management, and, also, studying
possible integration with emerging flexible security paradigms (e.g., [46,47]).</p>
    </sec>
    <sec id="sec-17">
      <title>Acknowledgements</title>
      <p>This work was partially supported by project SERICS (PE00000014) under the MUR National Recovery
and Resilience Plan funded by the European Union - NextGenerationEU. The authors are grateful to
Ilies Merzouk for his contribution to the experimental analysis of this research.</p>
    </sec>
    <sec id="sec-18">
      <title>Declaration on Generative AI</title>
      <p>The authors have not employed any Generative AI tools.
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