The economic burden of autism spectrum disorder with and without intellectual disability in China: A nationwide cost-of-illness study.

OBJECTIVE: The economic burden of autism spectrum disorder (ASD) on individuals, their families and society as a whole is poorly understood. Accurate figures are crucial for economic estimates and service planning. METHODS: The total lifetime individual costs and annual societal costs of ASD in China were estimated with a prevalence-based, gross cost of illness approach and data from multiple sources. The direct medical costs in outpatient and inpatient settings from the electronic health records (EHRs) of hospitals, and direct nonmedical costs from a national survey were included. The indirect costs were from both the national survey and the estimation using human capital methods. Age-specific lifetime incremental societal costs were measured. Comorbidity-related and unrelated costs were analyzed separately. RESULTS: The discounted lifetime cost for an individual with ASD in China was $2.65 million (at 2020 prices, $) for those without intellectual disability (ID) and $4.61 million (at 2020 prices, $) for those with ID. The total cost of ASD amounted to $41.8 billion in 2020. Productivity loss were major cost drivers for ASD individuals without ID. Direct nonmedical costs (rehabilitation or adult care costs etc.) were major drivers for ASD individuals with ID. In a lifetime course, the total annual costs for middle aged and elderly (>42 years) were highest, followed by transitional adults (18-29 years) and preschoolers, both for individuals with or without ID. The distribution of costs over the lifespan varied by the cost category. CONCLUSIONS: ASD imposes a substantial economic burden on families and health care systems. Sectors and services coordination should be given policy considerations.

Medical service utilization and costs of autism spectrum disorder: Evidence from hospital records in Beijing, China.

As more and more people are diagnosed with autism spectrum disorder (ASD), it is necessary to better understand their costs. Detailed information on medical service utilization and costs could aid in designing equitable, effective policies to support individuals with ASD and their families. In this retrospective analysis, individuals with a hospital encounter (outpatient visit or inpatient admission) were collected from Beijing Municipal Health Big Data and Policy Research Center (BMHBD), from January 1, 2017 to December 31, 2021. We analyzed the costs, hospital visits/admissions and their changing trends over 5 years. Poisson regression and logit regression were conducted to analyze the influencing factors of visits, admissions and costs. The study population consisted of 26,826 users of medical services (26,583 outpatients and 243 inpatients; mean age: 4.82 ± 3.47 years for outpatients; 11.62 ± 6.74 years for inpatients). 99.1% were outpatients (mean ± standard deviation (SD) costs per year: $422.06 ± $11.89), while 0.9% were inpatients (mean ± SD costs per year: $4411.71 ± $925.81). More than 50% of outpatients received medication and diagnostic testing services. Among those with an inpatient admission, 91% received treatment services. Medication costs were the major contributor to medical costs for adults. Diagnostic test and treatment costs were the major contributors for children and adolescents. The findings demonstrated a significant economic burden for those diagnosed with ASD and highlighted opportunities for improving the care of this vulnerable group. This study adds to the literature by focusing on age differences among health-care utilization in individuals with ASD.

Direct and indirect costs for families of children with autism spectrum disorder in China.

LAY ABSTRACT: This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents' productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.

Traffic Risk Environment Impact Analysis and Complexity Assessment of Autonomous Vehicles Based on the Potential Field Method.

Although autonomous vehicles have introduced a promising potential for improving traffic safety and efficiency, ensuring the safety of autonomous vehicles in complex road traffic environments is still a huge challenge to be tackled. To quickly quantify the potential risk factors of autonomous vehicles in traffic environments, this paper focuses mainly on the influence of the depth and breadth of the environment elements on the autonomous driving system, uses the potential field theory to establish a model of the impact of the environmental elements on the autonomous driving system, and combines AHP to quantify equivalent virtual electric quantity of each environment element, so as to realize the quantitative evaluation of the traffic environment complexity. The proposed method comprehensively considers the physical attributes and state parameters of the environmental elements, which compensates for the fact that the shortage of the factors considered in the traffic environment complexity assessment is not comprehensive. Finally, a series of experiments was carried out to verify the reliability of our proposed method. The results show that the complexity of the static elements is determined only by the physical attributes and shape of the obstacle; the complexity of the dynamic elements is determined by the movement of the obstacle and the movement of the autonomous vehicle, and the comprehensive complexity mainly depends on the complexity of their dynamic elements. Compared with other methods, the complexity evaluation values are generally consistent, the absolute percentage error of the majority of samples was within ±5%, and the degree of deviation was -1.143%, which provides theoretical support for autonomous vehicles on safety and the risk assessment in future.

Heavy metal pollution characteristics and health risk assessment of dust fall related to industrial activities in desert steppes.

China's desert steppe is the transition zone between the grasslands in central China and the arid desert. Ecological security in this region has long been a subject of debate, both in the local and academic communities. Heavy metals and other pollutants are readily released during industrial production, combustion, and transportation, aggravating the vulnerability of the desert steppes. To understand the impact of industrial activiteis on the heavy metal content of dust fall in the desert steppe, a total of 37 dust fall samples were collected over 90 days. An inductively-coupled plasma mass spectrometer (NexION 350X) was used to measure the concentration of heavy metals Cu, Cd, Cr, Pb, Mn, Co, and Zn in the dust. Using comprehensive pollution index and multivariate statistical analysis methods, we explored the characteristics and sources of heavy metal pollution. We also quantitatively assessed the carcinogenic risks of heavy metals resulting from dust reduction with the help of health risk assessment models. The heavy metals' comprehensive pollution index values in the study area's dust fall were ranked as follows: Zn > Cd > Pb > Mn > Cu > Co > Cr. Among these, Zn, Cd, and Pb were significant pollution factors in the study area, and were affected by industrial production and transportation. The high pollution index was concentrated in the north of the research industrial park and on both sides of a highway. The seven heavy metals' total non-carcinogenic risk index (HI) values were ranked as follows: Mn > Co > Pb > Zn > Cr > Cu > Cd (only the HI of Mn was greater than one). Excluding Mn, the non-carcinogenic and carcinogenic risk index values of the other six heavy metals were within acceptable ranges. Previous studies have also shown that industrial transportation and production have had a significant impact on the heavy metal content of dust fall in the desert steppe.

In vitro assessment and phase I randomized clinical trial of anfibatide a snake venom derived anti-thrombotic agent targeting human platelet GPIbα.

The interaction of platelet GPIbα with von Willebrand factor (VWF) is essential to initiate platelet adhesion and thrombosis, particularly under high shear stress conditions. However, no drug targeting GPIbα has been developed for clinical practice. Here we characterized anfibatide, a GPIbα antagonist purified from snake (Deinagkistrodon acutus) venom, and evaluated its interaction with GPIbα by surface plasmon resonance and in silico modeling. We demonstrated that anfibatide interferds with both VWF and thrombin binding, inhibited ristocetin/botrocetin- and low-dose thrombin-induced human platelet aggregation, and decreased thrombus volume and stability in blood flowing over collagen. In a single-center, randomized, and open-label phase I clinical trial, anfibatide was administered intravenously to 94 healthy volunteers either as a single dose bolus, or a bolus followed by a constant rate infusion of anfibatide for 24 h. Anfibatide inhibited VWF-mediated platelet aggregation without significantly altering bleeding time or coagulation. The inhibitory effects disappeared within 8 h after drug withdrawal. No thrombocytopenia or anti-anfibatide antibodies were detected, and no serious adverse events or allergic reactions were observed during the studies. Therefore, anfibatide was well-tolerated among healthy subjects. Interestingly, anfibatide exhibited pharmacologic effects in vivo at concentrations thousand-fold lower than in vitro, a phenomenon which deserves further investigation.Trial registration: Clinicaltrials.gov NCT01588132.

Screening metal-organic frameworks for adsorption-driven osmotic heat engines via grand canonical Monte Carlo simulations and machine learning.

Adsorption-driven osmotic heat engines offer an alternative way for harvesting low-grade waste heat below 80°C. In this study, we performed a high-throughput computational screening based on grand canonical Monte Carlo simulations to identify the high-performance metal-organic frameworks (MOFs) from 1322 computationally ready experimental MOF structures for adsorption-driven osmotic heat engines with LiCl-methanol as the working fluid. Structure-property relationship analysis reveals that MOFs exhibiting high energy efficiency possess large working capacity, pore size and surface area, and moderate adsorption enthalpy comparable to the evaporation enthalpy. Furthermore, machine learning is employed to accelerate the computational screening for satisfied MOFs via the structure properties. The optimal structure properties of the MOFs are further identified via the ensemble-based regression model by optimizing the energy efficiency via the genetic algorithm, which shed light on rationally designing and fabricating MOFs for desired heat-to-electricity conversion.

Fast and accurate quantification of insertion-site specific transgene levels from raw seed samples using solid-state nanopore technology.

Many modern crop varieties contain patented biotechnology traits, and an increasing number of these crops have multiple (stacked) traits. Fast and accurate determination of transgene levels is advantageous for a variety of use cases across the food, feed and fuel value chain. With the growing number of new transgenic crops, any technology used to quantify them should have robust assays that are simple to design and optimize, thereby facilitating the addition of new traits to an assay. Here we describe a PCR-based method that is simple to design, starts from whole seeds, and can be run to end-point in less than 5 minutes. Subsequent relative quantification (trait vs. non-trait) using capillary electrophoresis performed in 5% increments across the 0-100% range showed a mean absolute error of 1.9% (s.d. = 1.1%). We also show that the PCR assay can be coupled to non-optical solid-state nanopore sensors to give seed-to-trait quantification results with a mean absolute error of 2.3% (s.d. = 1.6%). In concert, the fast PCR and nanopore sensing stages demonstrated here can be fully integrated to produce seed-to-trait quantification results in less than 10 minutes, with high accuracy across the full dynamic range.

Combined intracoronary assessment and treatment of a patient with coronary plaque rapid progression prior to acute myocardial infarction: A case report.

RATIONAL: Plaque rapid progression prior to acute myocardial infarction is not a common phenomenon, and its mechanism remains unknown. Intracoronary imaging may help to assess the plaque characteristics and progression. PATIENT CONCERN: A 37-year-old male patient suffered an acute myocardial infarction (AMI) 1 month after the diagnosis of a mildly stenosed coronary artery. Intracoronary imaging was done to seek the underlying causes and guide further treatment. DIAGNOSIS: Two coronary angiograms in 1 month showed plaque rapid progressing prior to the AMI. Intracoronary optical coherence tomography (OCT) post-AMI showed plaque erosion and heavy burden of thrombus. INTERVENTION: The patient was advised to defer stent deployment. The patient was then given intensified antithrombotic therapy. Three weeks later, OCT imaging revealed sufficient lumen area and the intact endothelium without remaining thrombus. Fractional flow reverse (FFR) showed no functional ischemia. Dual-antiplatelet therapy without stenting was recommended for 12 months. OUTCOMES: The 6-month follow-up showed good recovery and normal cardiac function. LESSONS: First, for patients with mild coronary stenosis and typical angina symptoms, further intracoronary assessment should be performed. Second, OCT can not only help to determine the plaque characteristics but can also help to develop patient-tailored strategies for AMI patients.

Use of a Survey to Assess the Environmental Exposure and Family Perception to Lead in Children (<6 Years) in Four Valley Cities, Northwestern China.

With the growth of industry, the extensive use of lead, and urban expansion in Northwestern Valley Cities (NVC) China, there is probable reason for presuming an increasing risk of lead exposure. However, little is known about the lead exposure of children less than 6 years old in NVC. As a first investigation, this study uses a survey to systematically determine the influences of various risk factors within the family environment, parents' background, children's behavior, mother's behavior during pregnancy, and parental perception about children's blood lead (CBL). A total of 596 families were recruited from the general population in Urumqi, Lanzhou, Xining and Yan'an. Parents, and their children (<6 years old), were asked about the environment and behaviors which could possibly relate with lead exposure. The results indicated that in the typical NVC of China, children's environment and behavior, parents' education level, and mother's pregnancy behavior, were associated with potential CBL. It was noted that not all parents in NVC China recognized the importance of children's lead exposure. Therefore, children's health care and medical screening campaigns need to be designed to improve family's fundamental knowledge of lead hazards, associated health effects, and prevention in the NVC of China.

Multi-Elements in Source Water (Drinking and Surface Water) within Five Cities from the Semi-Arid and Arid Region, NW China: Occurrence, Spatial Distribution and Risk Assessment.

The purpose of this study was to identify the concentration of multi-elements (MEs) in source water (surface and drinking water) and assess their quality for sustainability. A total of 161 water samples including 88 tap drinking waters (DW) and 73 surface waters (SW) were collected from five cities in Xi'an, Yan'an, Xining, Lanzhou, and Urumqi in northwestern China. Eighteen parameters including pH, electrical conductivity (EC), total organic carbon (TOC) total nitrogen (TN), chemical compositions of anions (F-, Cl-, NO3-,HCO3-, SO42-), cations (NH4⁺, K⁺, Na⁺, Ca2+,Mg2+), and metals (lead (Pb), chromium (Cr), cadmium (Cd), copper (Cu)) were analyzed in the first time at the five cities . The results showed that pH values and concentrations of Cl-, SO42-, Na⁺, K⁺, Ca2+, Mg2+ and Cd, Cr, Cu in DW were within the permissible limits of the Chinese Drinking Water Quality Criteria, whereas the concentrations of other ions (F-, NO3-, NH4⁺ and Pb) exceeded their permissible values. In terms of the SW, the concentrations of F-, Cl-, NO3-, SO42- were over the third range threshold i.e., water suitable for fishing and swimming of the Surface Water Quality Standards in China. The spatial distributions of most MEs in source water are similar, and there was no clear variation for all ions and metals. The metals in DW may be caused by water pipes, faucets and their fittings. The noncarcinogenic risk of metals in DW for local children are in decreasing order Cr > Cd > Pb > Cu. The carcinogenic risk from Cr exposure was at the acceptable level according to threshold of USEPA. Although the comprehensive index of potential ecological assessment of Cr, Cd, Pb and Cu in SW ranked at low risk level and was in the order of Huang River in Xining > Peaceful Canal in Urumqi > Yan River in Yan'an > Yellow River in Lanzhou, their adverse effects to ecology and human health at a low concentration in local semi-arid and arid areas should not be ignored in the long run.