National Population Health Data Center(NPHDC)is one of China's 20 national-level science data centers,jointly designated by the Ministry of Science and Technology and the Ministry of Finance.Operated by the Chines...National Population Health Data Center(NPHDC)is one of China's 20 national-level science data centers,jointly designated by the Ministry of Science and Technology and the Ministry of Finance.Operated by the Chinese Academy of Medical Sciences under the oversight of the National Health Commission,NPHDC adheres to national regulations including the Scientific Data Management Measures and the National Science and Technology Infrastructure Service Platform Management Measures,and is committed to collecting,integrating,managing,and sharing biomedical and health data through openaccess platform,fostering open sharing and engaging in international cooperation.展开更多
In the rapidly evolving landscape of digital health,the integration of data analytics and Internet healthserviceshasbecome a pivotal area of exploration.To meet keen social needs,Prof.Shan Liu(Xi'an Jiaotong Unive...In the rapidly evolving landscape of digital health,the integration of data analytics and Internet healthserviceshasbecome a pivotal area of exploration.To meet keen social needs,Prof.Shan Liu(Xi'an Jiaotong University)and Prof.Xing Zhang(Wuhan Textile University)have published the timely book Datadriven Internet Health Platform Service Value Co-creation through China Science Press.The book focuses on the provision of medical and health services from doctors to patients through Internet health platforms,where the service value is co-created by three parties.展开更多
Data space,as an innovative data management and sharing model,is emerging in the medical and health sectors.This study expounds on the conceptual connotation of data space and delineates its key technologies,including...Data space,as an innovative data management and sharing model,is emerging in the medical and health sectors.This study expounds on the conceptual connotation of data space and delineates its key technologies,including distributed data storage,standardization and interoperability of data sharing,data security and privacy protection,data analysis and mining,and data space assessment.By analyzing the real-world cases of data spaces within medicine and health,this study compares the similarities and differences across various dimensions such as purpose,architecture,data interoperability,and privacy protection.Meanwhile,data spaces in these fields are challenged by the limited computing resources,the complexities of data integration,and the need for optimized algorithms.Additionally,legal and ethical issues such as unclear data ownership,undefined usage rights,risks associated with privacy protection need to be addressed.The study notes organizational and management difficulties,calling for enhancements in governance framework,data sharing mechanisms,and value assessment systems.In the future,technological innovation,sound regulations,and optimized management will help the development of the medical and health data space.These developments will enable the secure and efficient utilization of data,propelling the medical industry into an era characterized by precision,intelligence,and personalization.展开更多
Dear Editor,Health management is essential to ensure battery performance and safety, while data-driven learning system is a promising solution to enable efficient state of health(SoH) estimation of lithium-ion(Liion) ...Dear Editor,Health management is essential to ensure battery performance and safety, while data-driven learning system is a promising solution to enable efficient state of health(SoH) estimation of lithium-ion(Liion) batteries. However, the time-consuming signal data acquisition and the lack of interpretability of model still hinder its efficient deployment. Motivated by this, this letter proposes a novel and interpretable data-driven learning strategy through combining the benefits of explainable AI and non-destructive ultrasonic detection for battery SoH estimation. Specifically, after equipping battery with advanced ultrasonic sensor to promise fast real-time ultrasonic signal measurement, an interpretable data-driven learning strategy named generalized additive neural decision ensemble(GANDE) is designed to rapidly estimate battery SoH and explain the effects of the involved ultrasonic features of interest.展开更多
Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific hea...Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific health conditions(e.g.,diabetes or sepsis)for statistical analyses.However,there has been substantial variation in the algorithm development and validation,leading to frequently suboptimal performance and posing a significant threat to the validity of study findings.Unfortunately,these issues are often overlooked.Methods:We systematically developed guidance for the development,validation,and evaluation of algorithms designed to identify health status(DEVELOP-RCD).Our initial efforts involved conducting both a narrative review and a systematic review of published studies on the concepts and methodological issues related to algorithm development,validation,and evaluation.Subsequently,we conducted an empirical study on an algorithm for identifying sepsis.Based on these findings,we formulated specific workflow and recommendations for algorithm development,validation,and evaluation within the guidance.Finally,the guidance underwent independent review by a panel of 20 external experts who then convened a consensus meeting to finalize it.Results:A standardized workflow for algorithm development,validation,and evaluation was established.Guided by specific health status considerations,the workflow comprises four integrated steps:assessing an existing algorithm’s suitability for the target health status;developing a new algorithm using recommended methods;validating the algorithm using prescribed performance measures;and evaluating the impact of the algorithm on study results.Additionally,13 good practice recommendations were formulated with detailed explanations.Furthermore,a practical study on sepsis identification was included to demonstrate the application of this guidance.Conclusions:The establishment of guidance is intended to aid researchers and clinicians in the appropriate and accurate development and application of algorithms for identifying health status from RCD.This guidance has the potential to enhance the credibility of findings from observational studies involving RCD.展开更多
The growing demand for international travel has highlighted the critical need for reliable tools to verify travelers’healthcare status and meet entry requirements.Personal health passports,while essential,face signif...The growing demand for international travel has highlighted the critical need for reliable tools to verify travelers’healthcare status and meet entry requirements.Personal health passports,while essential,face significant challenges related to data silos,privacy protection,and forgery risks in global sharing.To address these issues,this study proposes a blockchain-based solution designed for the secure storage,sharing,and verification of personal health passports.This innovative approach combines on-chain and off-chain storage,leveraging searchable encryption to enhance data security and optimize blockchain storage efficiency.By reducing the storage burden on the blockchain,the system ensures both the secure handling and reliable sharing of sensitive personal health data.An optimized consensus mechanism streamlines the process into two stages,minimizing communication complexity among nodes and significantly improving the throughput of the blockchain system.Additionally,the introduction of advanced aggregate signature technology accommodates multi-user scenarios,reducing computational overhead for signature verification and enabling swift identification ofmalicious forgers.Comprehensive security analyses validate the system’s robustness and reliability.Simulation results demonstrate notable performance improvements over existing solutions,with reductions in computational overhead of up to 49.89%and communication overhead of up to 25.81%inmulti-user scenarios.Furthermore,the optimized consensus mechanism shows substantial efficiency gains across varying node configurations.This solution represents a significant step toward addressing the pressing challenges of health passport management in a secure,scalable,and efficient manner.展开更多
In the production processes of modern industry,accurate assessment of the system’s health state and traceability non-optimal factors are key to ensuring“safe,stable,long-term,full load and optimal”operation of the ...In the production processes of modern industry,accurate assessment of the system’s health state and traceability non-optimal factors are key to ensuring“safe,stable,long-term,full load and optimal”operation of the production process.The benzene-to-ethylene ratio control system is a complex system based on anMPC-PID doublelayer architecture.Taking into consideration the interaction between levels,coupling between loops and conditions of incomplete operation data,this paper proposes a health assessment method for the dual-layer control system by comprehensively utilizing deep learning technology.Firstly,according to the results of the pre-assessment of the system layers and loops bymultivariate statisticalmethods,seven characteristic parameters that have a significant impact on the health state of the system are identified.Next,aiming at the problem of incomplete assessment data set due to the uneven distribution of actual system operating health state,the original unbalanced dataset is augmented using aWasserstein generative adversarial network with gradient penalty term,and a complete dataset is obtained to characterise all the health states of the system.On this basis,a new deep learning-based health assessment framework for the benzeneto-ethylene ratio control system is constructed based on traditionalmultivariate statistical assessment.This framework can overcome the shortcomings of the linear weighted fusion related to the coupling and nonlinearity of the subsystem health state at different layers,and reduce the dependence of the prior knowledge.Furthermore,by introducing a dynamic attention mechanism(AM)into the convolutional neural network(CNN),the assessment model integrating both assessment and traceability is constructed,which can achieve the health assessment and trace the non-optimal factors of the complex control systems with the double-layer architecture.Finally,the effectiveness and superiority of the proposed method have been verified by the benzene-ethylene ratio control system of the alkylation process unit in a styrene plant.展开更多
Accurate estimation of battery health status plays a crucial role in battery management systems.However,the lack of operational data still affects the accuracy of battery state of health(SOH)estimation.For this reason...Accurate estimation of battery health status plays a crucial role in battery management systems.However,the lack of operational data still affects the accuracy of battery state of health(SOH)estimation.For this reason,a SOH estimation method is proposed based on charging data reconstruction combined with image processing.The charging voltage data is used to train the least squares generative adversarial network(LSGAN),which is validated under different levels of missing data.From a visual perspective,the Gram angle field method is applied to convert one-dimensional time series data into image data.This method fully preserves the time series characteristics and nonlinear evolution patterns,which avoids the difficulties and limited expressive power associated with manual feature extraction.At the same time,the Swin Transformer model is introduced to extract global structures and local details from images,enabling better capture of sequence change trends.Combined with the long short-term memory network(LSTM),this enables accurate estimation of battery SOH.Two different types of batteries are used to validate the test.The experimental results show that the proposed method has good estimation accuracy under different training proportions.展开更多
Structural health monitoring (SHM) is a multi-discipline field that involves the automatic sensing of structural loads and response by means of a large number of sensors and instruments, followed by a diagnosis of the...Structural health monitoring (SHM) is a multi-discipline field that involves the automatic sensing of structural loads and response by means of a large number of sensors and instruments, followed by a diagnosis of the structural health based on the collected data. Because an SHM system implemented into a structure automatically senses, evaluates, and warns about structural conditions in real time, massive data are a significant feature of SHM. The techniques related to massive data are referred to as data science and engineering, and include acquisition techniques, transition techniques, management techniques, and processing and mining algorithms for massive data. This paper provides a brief review of the state of the art of data science and engineering in SHM as investigated by these authors, and covers the compressive sampling-based data-acquisition algorithm, the anomaly data diagnosis approach using a deep learning algorithm, crack identification approaches using computer vision techniques, and condition assessment approaches for bridges using machine learning algorithms. Future trends are discussed in the conclusion.展开更多
Objective: Challenges remain in current practices of colorectal cancer(CRC) screening, such as low compliance,low specificities and expensive cost. This study aimed to identify high-risk groups for CRC from the genera...Objective: Challenges remain in current practices of colorectal cancer(CRC) screening, such as low compliance,low specificities and expensive cost. This study aimed to identify high-risk groups for CRC from the general population using regular health examination data.Methods: The study population consist of more than 7,000 CRC cases and more than 140,000 controls. Using regular health examination data, a model detecting CRC cases was derived by the classification and regression trees(CART) algorithm. Receiver operating characteristic(ROC) curve was applied to evaluate the performance of models. The robustness and generalization of the CART model were validated by independent datasets. In addition, the effectiveness of CART-based screening was compared with stool-based screening.Results: After data quality control, 4,647 CRC cases and 133,898 controls free of colorectal neoplasms were used for downstream analysis. The final CART model based on four biomarkers(age, albumin, hematocrit and percent lymphocytes) was constructed. In the test set, the area under ROC curve(AUC) of the CART model was 0.88 [95%confidence interval(95% CI), 0.87-0.90] for detecting CRC. At the cutoff yielding 99.0% specificity, this model’s sensitivity was 62.2%(95% CI, 58.1%-66.2%), thereby achieving a 63-fold enrichment of CRC cases. We validated the robustness of the method across subsets of test set with diverse CRC incidences, aging rates, genders ratio, distributions of tumor stages and locations, and data sources. Importantly, CART-based screening had the higher positive predictive value(1.6%) than fecal immunochemical test(0.3%).Conclusions: As an alternative approach for the early detection of CRC, this study provides a low-cost method using regular health examination data to identify high-risk individuals for CRC for further examinations. The approach can promote early detection of CRC especially in developing countries such as China, where annual health examination is popular but regular CRC-specific screening is rare.展开更多
Guangzhou is the capital and largest city（land area：7287 km2）of Guangdong province in South China.The air quality in Guangzhou typically worsens in November due to unfavorable meteorological conditions for pollutan...Guangzhou is the capital and largest city（land area：7287 km2）of Guangdong province in South China.The air quality in Guangzhou typically worsens in November due to unfavorable meteorological conditions for pollutant dispersion.During the Guangzhou Asian Games in November 2010,the Guangzhou government carried out a number of emission control measures that significantly improved the air quality.In this paper,we estimated the acute health outcome changes related to the air quality improvement during the 2010 Guangzhou Asian Games using a next-generation,fully-integrated assessment system for air quality and health benefits.This advanced system generates air quality data by fusing model and monitoring data instead of using monitoring data alone,which provides more reliable results.The air quality estimates retain the spatial distribution of model results while calibrating the value with observations.The results show that the mean PM2.5concentration in November 2010 decreased by 3.5μg/m^3 compared to that in 2009 due to the emission control measures.From the analysis,we estimate that the air quality improvement avoided 106 premature deaths,1869 cases of hospital admission,and 20,026 cases of outpatient visits.The overall cost benefit of the improved air quality is estimated to be 165 million CNY,with the avoided premature death contributing 90%of this figure.The research demonstrates that Ben MAP-CE is capable of assessing the health and cost benefits of air pollution control for sound policy making.展开更多
Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face ...Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.展开更多
In conjunction with association rules for data mining, the connections between testing indices and strong and weak association rules were determined, and new derivative rules were obtained by further reasoning. Associ...In conjunction with association rules for data mining, the connections between testing indices and strong and weak association rules were determined, and new derivative rules were obtained by further reasoning. Association rules were used to analyze correlation and check consistency between indices. This study shows that the judgment obtained by weak association rules or non-association rules is more accurate and more credible than that obtained by strong association rules. When the testing grades of two indices in the weak association rules are inconsistent, the testing grades of indices are more likely to be erroneous, and the mistakes are often caused by human factors. Clustering data mining technology was used to analyze the reliability of a diagnosis, or to perform health diagnosis directly. Analysis showed that the clustering results are related to the indices selected, and that if the indices selected are more significant, the characteristics of clustering results are also more significant, and the analysis or diagnosis is more credible. The indices and diagnosis analysis function produced by this study provide a necessary theoretical foundation and new ideas for the development of hydraulic metal structure health diagnosis technology.展开更多
This study utilized Data Envelopment Analysis (DEA) in assessing the efficiency of health center in tuberculosis (TB) treatment. Assessing the efficiency of health center treating TB is a vital and sensitive topic, be...This study utilized Data Envelopment Analysis (DEA) in assessing the efficiency of health center in tuberculosis (TB) treatment. Assessing the efficiency of health center treating TB is a vital and sensitive topic, because there is a cumulative amount of public funds devoted to healthcare. In this research, a DEA model has been correlated to evaluate and assess the efficiency of 17 health centers. The researchers selected the health budget and the number of health workers as input variables likewise, the number of people served, number of TB patients served, and TB patients treated (%) as output variables. Based on the result of the study, only five (5) health centers out of seventeen (17) have 100% efficiencies throughout the 2 years period. It is recommended that other health centers should learn from their efficient peers recognized by the DEA model so as to increase the overall performance of the healthcare system. Likewise, health centers should integrate Health Information Technology to deliver healthier care for their patients.展开更多
OBJECTIVE: To apply data mining methods to research on the state of sub-mental health among residents in eight provinces and cities in China and to mine latent knowledge about many conditions through data mining and a...OBJECTIVE: To apply data mining methods to research on the state of sub-mental health among residents in eight provinces and cities in China and to mine latent knowledge about many conditions through data mining and analysis of data on 3970 sub-mentally healthy individuals selected from 13385 relevant question naires.METHODS: The strategic tree algorithm was used to identify the main mani festations of the state of sub-mental health. The backpropogation artificial neural network was used to analyze the main mani festations of sub-healthy mental states of three different degrees. A sub-mental health evaluation model was then established to achieve predictive evaluationresults.RESULTS: Using classifications from the Scale of Chinese Sub-healthy State, the main manifestations of sub-mental health selected using the strate gictree were F1101(Do you lack peace of mind?),F1102(Are you easily nervous when something comes up?), and F1002(Do you often sigh?). The relative intensity of manifestations of sub-mental health was highest for F1101, followed by F1102,and then F1002. Through study of the neural network, better differentiation could be made between moderate and severe and between mild and severe states of sub-mental health. The differentiation between mild and moderate sub-mental health states was less apparent. Additionally, the sub-mental health state evaluation model, which could be used to predict states of sub-mental health of different individuals, was established using F1101, F1102, F1002, and the mental self-assessment totals core.CONCLUSION: The main manifestations of the state of sub-mental health can be discovered using data mining methods to research and analyze the latent laws and knowledge hidden in research evidence on the state of sub-mental health. The state of sub-mental health of different individuals can be rapidly predicted using the model established here.This can provide a basis for assessment and intervention for sub-mental health. It can also replace the relatively outdated approaches to research on sub-health in the technical era of information and digitization by combining the study of states of sub-mental health with information techniques and by further quantifying the relevant information.展开更多
This commentary shows the exponential growth of digital health and the accompanying explosion of health data.It discusses three major shifts in the global health landscape.The first will be the move of the big tech co...This commentary shows the exponential growth of digital health and the accompanying explosion of health data.It discusses three major shifts in the global health landscape.The first will be the move of the big tech companies into healthcare,the second will be the monetization of consumer data and the creation of health data marketplaces;and the third will be the growth of Asia as a leader in digital health.Big tech already has the advantage of a massive consiuner base,data and analytics which enable them to understand consumers;and complementary technologies,like wearables,that will drive the consumerization of healthcare.This expansion can happen quickly and already is creating challenges for regulators as they try to catch up.The vast volumes of data and the ability of technology such as blockchain to enable data owners to monetize their data,will lead to the development of health data marketplaces,which can connect and monetize data for data owners and make it available for scientific discovery.The developments in self-sovereign identity,will make it possible for individuals to monetize their health data in the future.Finally,we see the emergence of Asia as a powerhouse for the digital health of the future,with vast populations,mobile technology and increasing adoption of wearable devices.Consumer focused health care driven by data will change the institutional models of the past.展开更多
To achieve the high availability of health data in erasure-coded cloud storage systems,the data update performance in erasure coding should be continuously optimized.However,the data update performance is often bottle...To achieve the high availability of health data in erasure-coded cloud storage systems,the data update performance in erasure coding should be continuously optimized.However,the data update performance is often bottlenecked by the constrained cross-rack bandwidth.Various techniques have been proposed in the literature to improve network bandwidth efficiency,including delta transmission,relay,and batch update.These techniques were largely proposed individually previously,and in this work,we seek to use them jointly.To mitigate the cross-rack update traffic,we propose DXR-DU which builds on four valuable techniques:(i)delta transmission,(ii)XOR-based data update,(iii)relay,and(iv)batch update.Meanwhile,we offer two selective update approaches:1)data-deltabased update,and 2)parity-delta-based update.The proposed DXR-DU is evaluated via trace-driven local testbed experiments.Comprehensive experiments show that DXR-DU can significantly improve data update throughput while mitigating the cross-rack update traffic.展开更多
Without ascertaining workers’ perceived health, it is difficult to achieve behavioral modification even if health guidance is conducted. To investigate physical and mental health support emphasizing “positive health...Without ascertaining workers’ perceived health, it is difficult to achieve behavioral modification even if health guidance is conducted. To investigate physical and mental health support emphasizing “positive health,” we used the Total Health Index (THI) survey with the purpose of elucidating the association between medical examination data and perceived health. After obtaining medical examination data from 90 men, we analyzed their responses to the THI survey. The results suggested that age and abnormal medical examination data are associated with physical and mental complaints. In the analysis by age group, we found that men in their 20s had more complaints of irregularity of daily life on the THI scale. The group who responded that they were not getting enough sleep had higher mean values of total cholesterol and fasting blood sugar. The group who responded that their meals were irregular had higher mean values of Body Mass Index, aspartate aminotransferase, and alanine aminotransferase. As confirmed by the THI, continuously supporting lifestyle improvement is important. The THI of the “health guidance” group indicated fewer physical health complaints and more aggression/extroversion than the “normal” group. In those for whom health guidance was applicable, participants who were “obese” and “hypertensive” had more aggression/extroversion and lesser extent of nervousness. Based on these findings, it was suggested that meaningful, personalized health support can be developed.展开更多
Purpose:The study aimed to describe youth time-use compositions,focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity(PA),and to examine associations of these time-use composit...Purpose:The study aimed to describe youth time-use compositions,focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity(PA),and to examine associations of these time-use compositions with cardiometabolic biomarkers.Methods:Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled(complete cases with accelerometry and adiposity marker data,n=782).A 9-component time-use composition was formed using compositional data analysis:time in shorter and longer bouts of sedentary behavior;time in shorter and longer bouts of light-,moderate-,or vigorous-intensity PA;and"other time"(i.e.,non-wear/sleep).Shorter and longer bouts of sedentary time were defined as<5 min and>5 min,respectively.Shorter bouts of light-,moderate-,and vigorous-intensity PA were defined as<1 min;longer bouts were defined as≥1 min.Regression models examined associations between overall time-use composition and cardiometabolic biomarkers.Then,associations were derived between ratios of longer activity patterns relative to shorter activity patterns,and of each intensity level relative to the other intensity levels and"other time",and cardiometabolic biomarkers.Results:Confounder-adjusted models showed that the overall time-use composition was associated with adiposity,blood pressure,lipids,and the summary score.Specifically,more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score(zBMI)(β=1.79;SE=0.68)and waist circumference(β=18.35,SE=4.78).When each activity intensity was considered relative to all higher intensities and"other time",more time in light-and vigorous-intensity PA,and less time in sedentary behavior and moderate-intensity PA,were associated with lower waist circumference.Conclusion:Accumulating PA,particularly light-intensity PA,in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts.展开更多
Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producin...Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producing a pseudo likeli-hood. In a 3-level weighted analysis for a binary outcome, we implemented two methods for scaling the sampling weights in the National Health Survey of Pa-kistan (NHSP). For NHSP with health care utilization as a binary outcome we found age, gender, household (HH) goods, urban/rural status, community de-velopment index, province and marital status as significant predictors of health care utilization (p-value < 0.05). The variance of the random intercepts using scaling method 1 is estimated as 0.0961 (standard error 0.0339) for PSU level, and 0.2726 (standard error 0.0995) for household level respectively. Both esti-mates are significantly different from zero (p-value < 0.05) and indicate consid-erable heterogeneity in health care utilization with respect to households and PSUs. The results of the NHSP data analysis showed that all three analyses, weighted (two scaling methods) and un-weighted, converged to almost identical results with few exceptions. This may have occurred because of the large num-ber of 3rd and 2nd level clusters and relatively small ICC. We performed a sim-ulation study to assess the effect of varying prevalence and intra-class correla-tion coefficients (ICCs) on bias of fixed effect parameters and variance components of a multilevel pseudo maximum likelihood (weighted) analysis. The simulation results showed that the performance of the scaled weighted estimators is satisfactory for both scaling methods. Incorporating simulation into the analysis of complex multilevel surveys allows the integrity of the results to be tested and is recommended as good practice.展开更多
文摘National Population Health Data Center(NPHDC)is one of China's 20 national-level science data centers,jointly designated by the Ministry of Science and Technology and the Ministry of Finance.Operated by the Chinese Academy of Medical Sciences under the oversight of the National Health Commission,NPHDC adheres to national regulations including the Scientific Data Management Measures and the National Science and Technology Infrastructure Service Platform Management Measures,and is committed to collecting,integrating,managing,and sharing biomedical and health data through openaccess platform,fostering open sharing and engaging in international cooperation.
文摘In the rapidly evolving landscape of digital health,the integration of data analytics and Internet healthserviceshasbecome a pivotal area of exploration.To meet keen social needs,Prof.Shan Liu(Xi'an Jiaotong University)and Prof.Xing Zhang(Wuhan Textile University)have published the timely book Datadriven Internet Health Platform Service Value Co-creation through China Science Press.The book focuses on the provision of medical and health services from doctors to patients through Internet health platforms,where the service value is co-created by three parties.
文摘Data space,as an innovative data management and sharing model,is emerging in the medical and health sectors.This study expounds on the conceptual connotation of data space and delineates its key technologies,including distributed data storage,standardization and interoperability of data sharing,data security and privacy protection,data analysis and mining,and data space assessment.By analyzing the real-world cases of data spaces within medicine and health,this study compares the similarities and differences across various dimensions such as purpose,architecture,data interoperability,and privacy protection.Meanwhile,data spaces in these fields are challenged by the limited computing resources,the complexities of data integration,and the need for optimized algorithms.Additionally,legal and ethical issues such as unclear data ownership,undefined usage rights,risks associated with privacy protection need to be addressed.The study notes organizational and management difficulties,calling for enhancements in governance framework,data sharing mechanisms,and value assessment systems.In the future,technological innovation,sound regulations,and optimized management will help the development of the medical and health data space.These developments will enable the secure and efficient utilization of data,propelling the medical industry into an era characterized by precision,intelligence,and personalization.
基金supported by the National Natural Science Foundation of China(62373224,62333013,U23A20327)the Natural Science Foundation of Shandong Province(ZR2024JQ021)
文摘Dear Editor,Health management is essential to ensure battery performance and safety, while data-driven learning system is a promising solution to enable efficient state of health(SoH) estimation of lithium-ion(Liion) batteries. However, the time-consuming signal data acquisition and the lack of interpretability of model still hinder its efficient deployment. Motivated by this, this letter proposes a novel and interpretable data-driven learning strategy through combining the benefits of explainable AI and non-destructive ultrasonic detection for battery SoH estimation. Specifically, after equipping battery with advanced ultrasonic sensor to promise fast real-time ultrasonic signal measurement, an interpretable data-driven learning strategy named generalized additive neural decision ensemble(GANDE) is designed to rapidly estimate battery SoH and explain the effects of the involved ultrasonic features of interest.
基金supported by the National Natural Science Foundation of China(82225049,72104155)the Sichuan Provincial Central Government Guides Local Science and Technology Development Special Project(2022ZYD0127)the 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYGD23004).
文摘Background:In recent years,there has been a growing trend in the utilization of observational studies that make use of routinely collected healthcare data(RCD).These studies rely on algorithms to identify specific health conditions(e.g.,diabetes or sepsis)for statistical analyses.However,there has been substantial variation in the algorithm development and validation,leading to frequently suboptimal performance and posing a significant threat to the validity of study findings.Unfortunately,these issues are often overlooked.Methods:We systematically developed guidance for the development,validation,and evaluation of algorithms designed to identify health status(DEVELOP-RCD).Our initial efforts involved conducting both a narrative review and a systematic review of published studies on the concepts and methodological issues related to algorithm development,validation,and evaluation.Subsequently,we conducted an empirical study on an algorithm for identifying sepsis.Based on these findings,we formulated specific workflow and recommendations for algorithm development,validation,and evaluation within the guidance.Finally,the guidance underwent independent review by a panel of 20 external experts who then convened a consensus meeting to finalize it.Results:A standardized workflow for algorithm development,validation,and evaluation was established.Guided by specific health status considerations,the workflow comprises four integrated steps:assessing an existing algorithm’s suitability for the target health status;developing a new algorithm using recommended methods;validating the algorithm using prescribed performance measures;and evaluating the impact of the algorithm on study results.Additionally,13 good practice recommendations were formulated with detailed explanations.Furthermore,a practical study on sepsis identification was included to demonstrate the application of this guidance.Conclusions:The establishment of guidance is intended to aid researchers and clinicians in the appropriate and accurate development and application of algorithms for identifying health status from RCD.This guidance has the potential to enhance the credibility of findings from observational studies involving RCD.
文摘The growing demand for international travel has highlighted the critical need for reliable tools to verify travelers’healthcare status and meet entry requirements.Personal health passports,while essential,face significant challenges related to data silos,privacy protection,and forgery risks in global sharing.To address these issues,this study proposes a blockchain-based solution designed for the secure storage,sharing,and verification of personal health passports.This innovative approach combines on-chain and off-chain storage,leveraging searchable encryption to enhance data security and optimize blockchain storage efficiency.By reducing the storage burden on the blockchain,the system ensures both the secure handling and reliable sharing of sensitive personal health data.An optimized consensus mechanism streamlines the process into two stages,minimizing communication complexity among nodes and significantly improving the throughput of the blockchain system.Additionally,the introduction of advanced aggregate signature technology accommodates multi-user scenarios,reducing computational overhead for signature verification and enabling swift identification ofmalicious forgers.Comprehensive security analyses validate the system’s robustness and reliability.Simulation results demonstrate notable performance improvements over existing solutions,with reductions in computational overhead of up to 49.89%and communication overhead of up to 25.81%inmulti-user scenarios.Furthermore,the optimized consensus mechanism shows substantial efficiency gains across varying node configurations.This solution represents a significant step toward addressing the pressing challenges of health passport management in a secure,scalable,and efficient manner.
基金supported by the National Science Foundation of China(62263020)the Key Project of Natural Science Foundation of Gansu Province(25JRRA061)+1 种基金the Key R&D Program of Gansu Province(23YFGA0061)the Scientific Research Initiation Fund of Lanzhou University of Technology(061602).
文摘In the production processes of modern industry,accurate assessment of the system’s health state and traceability non-optimal factors are key to ensuring“safe,stable,long-term,full load and optimal”operation of the production process.The benzene-to-ethylene ratio control system is a complex system based on anMPC-PID doublelayer architecture.Taking into consideration the interaction between levels,coupling between loops and conditions of incomplete operation data,this paper proposes a health assessment method for the dual-layer control system by comprehensively utilizing deep learning technology.Firstly,according to the results of the pre-assessment of the system layers and loops bymultivariate statisticalmethods,seven characteristic parameters that have a significant impact on the health state of the system are identified.Next,aiming at the problem of incomplete assessment data set due to the uneven distribution of actual system operating health state,the original unbalanced dataset is augmented using aWasserstein generative adversarial network with gradient penalty term,and a complete dataset is obtained to characterise all the health states of the system.On this basis,a new deep learning-based health assessment framework for the benzeneto-ethylene ratio control system is constructed based on traditionalmultivariate statistical assessment.This framework can overcome the shortcomings of the linear weighted fusion related to the coupling and nonlinearity of the subsystem health state at different layers,and reduce the dependence of the prior knowledge.Furthermore,by introducing a dynamic attention mechanism(AM)into the convolutional neural network(CNN),the assessment model integrating both assessment and traceability is constructed,which can achieve the health assessment and trace the non-optimal factors of the complex control systems with the double-layer architecture.Finally,the effectiveness and superiority of the proposed method have been verified by the benzene-ethylene ratio control system of the alkylation process unit in a styrene plant.
基金supported in part by the National Natural Science Foundation of China(under Grant 62473309,62203352)the Shaanxi Outstanding Youth Science Fund Project(under Grant 2024JC-JCQN-68)+1 种基金the Xi’an Science and Technology Plan Project(under Grant 24GXFW0050)the Xi’an Key Laboratory(under Grant 24ZDSY0015).
文摘Accurate estimation of battery health status plays a crucial role in battery management systems.However,the lack of operational data still affects the accuracy of battery state of health(SOH)estimation.For this reason,a SOH estimation method is proposed based on charging data reconstruction combined with image processing.The charging voltage data is used to train the least squares generative adversarial network(LSGAN),which is validated under different levels of missing data.From a visual perspective,the Gram angle field method is applied to convert one-dimensional time series data into image data.This method fully preserves the time series characteristics and nonlinear evolution patterns,which avoids the difficulties and limited expressive power associated with manual feature extraction.At the same time,the Swin Transformer model is introduced to extract global structures and local details from images,enabling better capture of sequence change trends.Combined with the long short-term memory network(LSTM),this enables accurate estimation of battery SOH.Two different types of batteries are used to validate the test.The experimental results show that the proposed method has good estimation accuracy under different training proportions.
基金the National Natural Science Foundation of China (51638007, 51478149, 51678203,and 51678204).
文摘Structural health monitoring (SHM) is a multi-discipline field that involves the automatic sensing of structural loads and response by means of a large number of sensors and instruments, followed by a diagnosis of the structural health based on the collected data. Because an SHM system implemented into a structure automatically senses, evaluates, and warns about structural conditions in real time, massive data are a significant feature of SHM. The techniques related to massive data are referred to as data science and engineering, and include acquisition techniques, transition techniques, management techniques, and processing and mining algorithms for massive data. This paper provides a brief review of the state of the art of data science and engineering in SHM as investigated by these authors, and covers the compressive sampling-based data-acquisition algorithm, the anomaly data diagnosis approach using a deep learning algorithm, crack identification approaches using computer vision techniques, and condition assessment approaches for bridges using machine learning algorithms. Future trends are discussed in the conclusion.
基金supported by funding from Beijing Municipal Science & Technology Commission, Clinical Application and Development of Capital Characteristic (No. Z161100000516003)National Natural Science Foundation of China (No. 31871266)
文摘Objective: Challenges remain in current practices of colorectal cancer(CRC) screening, such as low compliance,low specificities and expensive cost. This study aimed to identify high-risk groups for CRC from the general population using regular health examination data.Methods: The study population consist of more than 7,000 CRC cases and more than 140,000 controls. Using regular health examination data, a model detecting CRC cases was derived by the classification and regression trees(CART) algorithm. Receiver operating characteristic(ROC) curve was applied to evaluate the performance of models. The robustness and generalization of the CART model were validated by independent datasets. In addition, the effectiveness of CART-based screening was compared with stool-based screening.Results: After data quality control, 4,647 CRC cases and 133,898 controls free of colorectal neoplasms were used for downstream analysis. The final CART model based on four biomarkers(age, albumin, hematocrit and percent lymphocytes) was constructed. In the test set, the area under ROC curve(AUC) of the CART model was 0.88 [95%confidence interval(95% CI), 0.87-0.90] for detecting CRC. At the cutoff yielding 99.0% specificity, this model’s sensitivity was 62.2%(95% CI, 58.1%-66.2%), thereby achieving a 63-fold enrichment of CRC cases. We validated the robustness of the method across subsets of test set with diverse CRC incidences, aging rates, genders ratio, distributions of tumor stages and locations, and data sources. Importantly, CART-based screening had the higher positive predictive value(1.6%) than fecal immunochemical test(0.3%).Conclusions: As an alternative approach for the early detection of CRC, this study provides a low-cost method using regular health examination data to identify high-risk individuals for CRC for further examinations. The approach can promote early detection of CRC especially in developing countries such as China, where annual health examination is popular but regular CRC-specific screening is rare.
基金provided by the US Environmental Protection Agency(No.5-312-0212979-51786L)the Guangzhou EnvironmentalProtection Bureau(No.x2hj B2150020)+3 种基金the project of an integrated modeling and filed observational verification on the deposition of typical industrial point-source mercury emissions in the Pearl River Deltsupported by the funding of the Guangdong Provincial Key Laboratory of Atmospheric Environment and Pollution Control(No.2011A060901011)the project of Atmospheric Haze Collaboration Control Technology Design from the Chinese Academy of Sciences(No.XDB05030400)the National Environmental Protection Public Welfare Industry Targeted Research Foundation of China(No.201409019)
文摘Guangzhou is the capital and largest city（land area：7287 km2）of Guangdong province in South China.The air quality in Guangzhou typically worsens in November due to unfavorable meteorological conditions for pollutant dispersion.During the Guangzhou Asian Games in November 2010,the Guangzhou government carried out a number of emission control measures that significantly improved the air quality.In this paper,we estimated the acute health outcome changes related to the air quality improvement during the 2010 Guangzhou Asian Games using a next-generation,fully-integrated assessment system for air quality and health benefits.This advanced system generates air quality data by fusing model and monitoring data instead of using monitoring data alone,which provides more reliable results.The air quality estimates retain the spatial distribution of model results while calibrating the value with observations.The results show that the mean PM2.5concentration in November 2010 decreased by 3.5μg/m^3 compared to that in 2009 due to the emission control measures.From the analysis,we estimate that the air quality improvement avoided 106 premature deaths,1869 cases of hospital admission,and 20,026 cases of outpatient visits.The overall cost benefit of the improved air quality is estimated to be 165 million CNY,with the avoided premature death contributing 90%of this figure.The research demonstrates that Ben MAP-CE is capable of assessing the health and cost benefits of air pollution control for sound policy making.
基金Supported by the National Major Scientific and Technological Special Project for"Significant New Drugs Development’’(No.2018ZX09201008)Special Fund Project for Information Development from Shanghai Municipal Commission of Economy and Information(No.201701013)
文摘Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.
基金supported by the Key Program of the National Natural Science Foundation of China(Grant No.50539010)the Special Fund for Public Welfare Industry of the Ministry of Water Resources of China(Grant No.200801019)
文摘In conjunction with association rules for data mining, the connections between testing indices and strong and weak association rules were determined, and new derivative rules were obtained by further reasoning. Association rules were used to analyze correlation and check consistency between indices. This study shows that the judgment obtained by weak association rules or non-association rules is more accurate and more credible than that obtained by strong association rules. When the testing grades of two indices in the weak association rules are inconsistent, the testing grades of indices are more likely to be erroneous, and the mistakes are often caused by human factors. Clustering data mining technology was used to analyze the reliability of a diagnosis, or to perform health diagnosis directly. Analysis showed that the clustering results are related to the indices selected, and that if the indices selected are more significant, the characteristics of clustering results are also more significant, and the analysis or diagnosis is more credible. The indices and diagnosis analysis function produced by this study provide a necessary theoretical foundation and new ideas for the development of hydraulic metal structure health diagnosis technology.
文摘This study utilized Data Envelopment Analysis (DEA) in assessing the efficiency of health center in tuberculosis (TB) treatment. Assessing the efficiency of health center treating TB is a vital and sensitive topic, because there is a cumulative amount of public funds devoted to healthcare. In this research, a DEA model has been correlated to evaluate and assess the efficiency of 17 health centers. The researchers selected the health budget and the number of health workers as input variables likewise, the number of people served, number of TB patients served, and TB patients treated (%) as output variables. Based on the result of the study, only five (5) health centers out of seventeen (17) have 100% efficiencies throughout the 2 years period. It is recommended that other health centers should learn from their efficient peers recognized by the DEA model so as to increase the overall performance of the healthcare system. Likewise, health centers should integrate Health Information Technology to deliver healthier care for their patients.
基金Supported by Chinese"Disease"Sub-health Medicine Research and Intervention of the Eleventh Five-Year Science and Technology Support Project of China(No.2006BAI13B01)Financial Support Case Studies of Traditional Chinese Medicine Treatment of Disease and Health Management Ideas of Shanghai Health Bureau(No.2010227)+2 种基金Scientific Innovation Research Funds of Shanghai Municipal Education Commission(No.14YZ061)Teacher Academic Community Fund of Shanghai University of Traditional Chinese Medicine(No.2013JXG03)Chinese Culture and Its Core Value System Modernization Transformation of the National Social Science Funds(No.12AZD094)
文摘OBJECTIVE: To apply data mining methods to research on the state of sub-mental health among residents in eight provinces and cities in China and to mine latent knowledge about many conditions through data mining and analysis of data on 3970 sub-mentally healthy individuals selected from 13385 relevant question naires.METHODS: The strategic tree algorithm was used to identify the main mani festations of the state of sub-mental health. The backpropogation artificial neural network was used to analyze the main mani festations of sub-healthy mental states of three different degrees. A sub-mental health evaluation model was then established to achieve predictive evaluationresults.RESULTS: Using classifications from the Scale of Chinese Sub-healthy State, the main manifestations of sub-mental health selected using the strate gictree were F1101(Do you lack peace of mind?),F1102(Are you easily nervous when something comes up?), and F1002(Do you often sigh?). The relative intensity of manifestations of sub-mental health was highest for F1101, followed by F1102,and then F1002. Through study of the neural network, better differentiation could be made between moderate and severe and between mild and severe states of sub-mental health. The differentiation between mild and moderate sub-mental health states was less apparent. Additionally, the sub-mental health state evaluation model, which could be used to predict states of sub-mental health of different individuals, was established using F1101, F1102, F1002, and the mental self-assessment totals core.CONCLUSION: The main manifestations of the state of sub-mental health can be discovered using data mining methods to research and analyze the latent laws and knowledge hidden in research evidence on the state of sub-mental health. The state of sub-mental health of different individuals can be rapidly predicted using the model established here.This can provide a basis for assessment and intervention for sub-mental health. It can also replace the relatively outdated approaches to research on sub-health in the technical era of information and digitization by combining the study of states of sub-mental health with information techniques and by further quantifying the relevant information.
文摘This commentary shows the exponential growth of digital health and the accompanying explosion of health data.It discusses three major shifts in the global health landscape.The first will be the move of the big tech companies into healthcare,the second will be the monetization of consumer data and the creation of health data marketplaces;and the third will be the growth of Asia as a leader in digital health.Big tech already has the advantage of a massive consiuner base,data and analytics which enable them to understand consumers;and complementary technologies,like wearables,that will drive the consumerization of healthcare.This expansion can happen quickly and already is creating challenges for regulators as they try to catch up.The vast volumes of data and the ability of technology such as blockchain to enable data owners to monetize their data,will lead to the development of health data marketplaces,which can connect and monetize data for data owners and make it available for scientific discovery.The developments in self-sovereign identity,will make it possible for individuals to monetize their health data in the future.Finally,we see the emergence of Asia as a powerhouse for the digital health of the future,with vast populations,mobile technology and increasing adoption of wearable devices.Consumer focused health care driven by data will change the institutional models of the past.
基金supported by Major Special Project of Sichuan Science and Technology Department(2020YFG0460)Central University Project of China(ZYGX2020ZB020,ZYGX2020ZB019).
文摘To achieve the high availability of health data in erasure-coded cloud storage systems,the data update performance in erasure coding should be continuously optimized.However,the data update performance is often bottlenecked by the constrained cross-rack bandwidth.Various techniques have been proposed in the literature to improve network bandwidth efficiency,including delta transmission,relay,and batch update.These techniques were largely proposed individually previously,and in this work,we seek to use them jointly.To mitigate the cross-rack update traffic,we propose DXR-DU which builds on four valuable techniques:(i)delta transmission,(ii)XOR-based data update,(iii)relay,and(iv)batch update.Meanwhile,we offer two selective update approaches:1)data-deltabased update,and 2)parity-delta-based update.The proposed DXR-DU is evaluated via trace-driven local testbed experiments.Comprehensive experiments show that DXR-DU can significantly improve data update throughput while mitigating the cross-rack update traffic.
文摘Without ascertaining workers’ perceived health, it is difficult to achieve behavioral modification even if health guidance is conducted. To investigate physical and mental health support emphasizing “positive health,” we used the Total Health Index (THI) survey with the purpose of elucidating the association between medical examination data and perceived health. After obtaining medical examination data from 90 men, we analyzed their responses to the THI survey. The results suggested that age and abnormal medical examination data are associated with physical and mental complaints. In the analysis by age group, we found that men in their 20s had more complaints of irregularity of daily life on the THI scale. The group who responded that they were not getting enough sleep had higher mean values of total cholesterol and fasting blood sugar. The group who responded that their meals were irregular had higher mean values of Body Mass Index, aspartate aminotransferase, and alanine aminotransferase. As confirmed by the THI, continuously supporting lifestyle improvement is important. The THI of the “health guidance” group indicated fewer physical health complaints and more aggression/extroversion than the “normal” group. In those for whom health guidance was applicable, participants who were “obese” and “hypertensive” had more aggression/extroversion and lesser extent of nervousness. Based on these findings, it was suggested that meaningful, personalized health support can be developed.
文摘Purpose:The study aimed to describe youth time-use compositions,focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity(PA),and to examine associations of these time-use compositions with cardiometabolic biomarkers.Methods:Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled(complete cases with accelerometry and adiposity marker data,n=782).A 9-component time-use composition was formed using compositional data analysis:time in shorter and longer bouts of sedentary behavior;time in shorter and longer bouts of light-,moderate-,or vigorous-intensity PA;and"other time"(i.e.,non-wear/sleep).Shorter and longer bouts of sedentary time were defined as<5 min and>5 min,respectively.Shorter bouts of light-,moderate-,and vigorous-intensity PA were defined as<1 min;longer bouts were defined as≥1 min.Regression models examined associations between overall time-use composition and cardiometabolic biomarkers.Then,associations were derived between ratios of longer activity patterns relative to shorter activity patterns,and of each intensity level relative to the other intensity levels and"other time",and cardiometabolic biomarkers.Results:Confounder-adjusted models showed that the overall time-use composition was associated with adiposity,blood pressure,lipids,and the summary score.Specifically,more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score(zBMI)(β=1.79;SE=0.68)and waist circumference(β=18.35,SE=4.78).When each activity intensity was considered relative to all higher intensities and"other time",more time in light-and vigorous-intensity PA,and less time in sedentary behavior and moderate-intensity PA,were associated with lower waist circumference.Conclusion:Accumulating PA,particularly light-intensity PA,in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts.
文摘Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producing a pseudo likeli-hood. In a 3-level weighted analysis for a binary outcome, we implemented two methods for scaling the sampling weights in the National Health Survey of Pa-kistan (NHSP). For NHSP with health care utilization as a binary outcome we found age, gender, household (HH) goods, urban/rural status, community de-velopment index, province and marital status as significant predictors of health care utilization (p-value < 0.05). The variance of the random intercepts using scaling method 1 is estimated as 0.0961 (standard error 0.0339) for PSU level, and 0.2726 (standard error 0.0995) for household level respectively. Both esti-mates are significantly different from zero (p-value < 0.05) and indicate consid-erable heterogeneity in health care utilization with respect to households and PSUs. The results of the NHSP data analysis showed that all three analyses, weighted (two scaling methods) and un-weighted, converged to almost identical results with few exceptions. This may have occurred because of the large num-ber of 3rd and 2nd level clusters and relatively small ICC. We performed a sim-ulation study to assess the effect of varying prevalence and intra-class correla-tion coefficients (ICCs) on bias of fixed effect parameters and variance components of a multilevel pseudo maximum likelihood (weighted) analysis. The simulation results showed that the performance of the scaled weighted estimators is satisfactory for both scaling methods. Incorporating simulation into the analysis of complex multilevel surveys allows the integrity of the results to be tested and is recommended as good practice.
