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Children with developmental language disorder (DLD) often struggle with theory of mind (ToM). This study explored the link between parental reflective functioning (PRF) and children’s ToM, focusing on the mediating role of parental stress (PS). A total of 80 children aged 4–7 years (40 with DLD and 40 with typical language development, TLD) and their parents were included for analysis. Assessments included the WPPSI-IV, NEPSY-II, TEC, and ELT for children and the PRFQ and PSI-SF4 for parents. Results showed that children with DLD performed similarly to their TLD peers in terms of nonverbal intelligence but faced difficulties with cognitive and affective ToM and understanding of emotional terms (UET). Parents of DLD children exhibited low interest and curiosity (PRF components) and high PS, particularly due to dysfunctional interactions and challenging behaviors. Mediation analysis revealed that low parental interest and curiosity negatively affected children’s cognitive ToM and UET through increased PS from dysfunctional interactions. These findings highlight the need for early interventions to enhance ToM in children with DLD and support parents in better understanding and interacting with their child. Such interventions can reduce parent–child stress and promote ToM development of children with DLD, aligning with bioecological models of development.
In this paper, a novel special structure derived from the double-slider mechanism is presented and apply it to the design of a parallel mechanism, endowing the designed parallel mechanism with reconfigurable characteristics. First, a comprehensive analysis of the motion modes of the double-slider mechanism is carried out. By ingeniously varying the slider structure of the double-slider mechanism, a special structure capable of three distinct motion modes is obtained. This special structure is then integrated into the 3UPU parallel mechanism. As a result, the redesigned 3UPU parallel mechanism exhibits reconfigurability and can seamlessly switch among the three motion modes. Subsequently, the inverse kinematics, workspace, and singular pose of the parallel mechanism in these three modes are meticulously analyzed. Moreover, the Jacobian matrix is utilized to evaluate its flexibility and load-bearing performance. The analysis reveals that in different motion modes, all performance indicators of the mechanism are remarkable, indicating a promising application prospect. Finally, a prototype is fabricated using 3D printing technology to further validate the effectiveness of the proposed special structure. Additionally, its versatility is further explored and analyzed in-depth.
Significant differences in life-history traits between the southern population (S) and northern (N) population of the cabbage beetle Colaphellus bowringi make it an excellent model for studying inheritance in this insect. In the present study, we observed the life-history traits of pure strains, F1, reciprocal backcross and reciprocal F2 progeny under a photoperiod of L:D 15:9 h at 22 °C. The S population had shorter larval development time, longer pupal time, higher body weight, growth rate and weight loss compared with the N population. In the F1 testing, the larval development time and body weight in hybrid populations were intermediate between the parents, and the paternal parents played a greater role in determining the larval development time, while the maternal parents exhibited a greater role in determining the body weight. The pupal time of hybrid populations was significantly shorter than that of the parents. In the reciprocal backcross testing, both father and grandfather affected the larval development time, while both mother and grandmother affected the body weight. Consistently, in the reciprocal F2 cross testing, the grandfather was more influential in determining the larval development time, and grandmother was more important in determining the body weight. In all tested populations, females had greater body weight, higher growth rate and weight loss than males. Hybridization pattern did not affect sex dimorphism and sex ratio. Overall, these findings suggest that different pathways (maternal or paternal effects) were involved in the inheritance of various life-history traits in C. bowringi.
The exploration of molecular characteristics has emerged as a prominent trend to advance precision medicine. The utilization of genetic testing to guide therapy is integral to precision medicine. This study aims to investigate the potential patient populations for the reimbursement of next-generation sequencing (NGS) and assess the budget impact from the perspective of Taiwan’s single insurer, the National Health Insurance Administration.
Methods
To comprehend the scope for medicines with companion diagnostics (CDx) involved, we analyze the U.S. Food and Drug Administration-approved/cleared diagnostic tests, conduct a literature review to identify medicines approved by the European Medicines Agency that require a CDx, and identify the medicines with CDx involved covered by the National Health Insurance (NHI) in Taiwan. Subsequently, we explore the potential reimbursement indications for NGS testing and conduct a budget impact analysis to evaluate the expected financial impact for the NHI over a five-year period. Furthermore, sensitivity analyses are conducted to deal with uncertainty.
Results
We have compiled 13 cancer types for which NGS can serve as a companion diagnostic. These encompass non-small-cell lung cancer, colorectal cancer, breast cancer, ovarian cancer, biliary tract cancer, acute myeloid leukemia, acute lymphoblastic leukemia, melanoma, cholangiocarcinoma, prostate cancer, pancreatic cancer, gastrointestinal stromal tumor, and thyroid cancer/medullary thyroid cancer. The implementation of NGS reimbursement in NHI will benefit 25,000 to 30,000 patients undergoing targeted therapies. The projected incremental budget impact ranges from TWD570 million to TWD650 million (USD19 million to USD22 million) over five years.
Conclusions
This study focuses on evaluating the financial impact of incorporating NGS testing into NHI reimbursement for relevant cancer drug indications. The findings can serve as references for the planning of reimbursement policies. However, with the advancement of precision medicine, it is foreseeable that there will be a broader range of applications for NGS, and its cost will gradually decrease.
Timing of food intake is an emerging aspect of nutrition; however, there is a lack of research accurately assessing food timing in the context of the circadian system. The study aimed to investigate the relation between food timing relative to clock time and endogenous circadian timing with adiposity and further explore sex differences in these associations among 151 young adults aged 18–25 years. Participants wore wrist actigraphy and documented sleep and food schedules in real time for 7 consecutive days. Circadian timing was determined by dim-light melatonin onset (DLMO). The duration between last eating occasion and DLMO (last EO-DLMO) was used to calculate the circadian timing of food intake. Adiposity was assessed using bioelectrical impedance analysis. Of the 151 participants, 133 were included in the statistical analysis finally. The results demonstrated that associations of adiposity with food timing relative to circadian timing rather than clock time among young adults living in real-world settings. Sex-stratified analyses revealed that associations between last EO-DLMO and adiposity were significant in females but not males. For females, each hour increase in last EO-DLMO was associated with higher BMI by 0·51 kg/m2 (P = 0·01), higher percent body fat by 1·05 % (P = 0·007), higher fat mass by 0·99 kg (P = 0·01) and higher visceral fat area by 4·75 cm2 (P = 0·02), whereas non-significant associations were present among males. The findings highlight the importance of considering the timing of food intake relative to endogenous circadian timing instead of only as clock time.
Coccidiosis is a parasitic disease caused by Eimeria spp., and the emergence of drug resistance has seriously affected the control of the disease. Using RNA-seq, we previously found that phosphoglycerate kinase of Eimeria tenella (EtPGK) was differentially downregulated in diclazuril-resistant (DZR) and maduramicin-resistant (MRR) strains compared with drug-sensitive (DS) strain. In this study, we further analysed the characteristics and functions of EtPGK to find the possible mechanism of drug resistance of E. tenella. Quantitative real-time PCR (qRT-PCR) and western blot found that EtPGK was highly expressed in sporulated oocysts, followed by sporozoites and second-generation merozoites of E. tenella. Indirect immunofluorescence localization showed that EtPGK was located mainly in the cytoplasm and on the surface of the parasites. Invasion inhibition assays showed that anti-rEtPGK antibody significantly inhibited the invasion of parasites. Further studies using qRT-PCR and western blot found that the transcription and translation levels of EtPGK were downregulated in both resistant (DZR and MRR) strains compared with the DS strain, and the transcription level correlated negatively with the drug concentration. The enzyme activity assay revealed that EtPGK enzyme activity was decreased in the DZR strain compared with the DS strain. qRT-PCR revealed that the mRNA transcription level of EtPGK was significantly downregulated in the field DZR strain and salinomycin-resistant strain compared with the DS strain. These results suggested that EtPGK has other important roles that are separate and distinct from its function in glycolysis, and it might be involved in the development of drug resistance of E. tenella.
The local structure of rotationally symmetric Finsler surfaces with vanishing flag curvature is completely determined in this paper. A geometric method for constructing such surfaces is introduced. The construction begins with a planar vector field X that depends on two functions of one variable. It is shown that the flow of X could be used to generate a generalized Finsler surface with zero flag curvature. Moreover, this generalized structure reduces to a regular Finsler metric if and only if X has an isochronous center. By relating X to a Liénard system, we obtain the isochronicity condition and discover numerous new examples of complete flat Finsler surfaces, depending on an odd function and an even function.
The assessment of seed quality and physiological potential is essential in seed production and crop breeding. In the process of rapid detection of seed viability using tetrazolium (TZ) staining, it is necessary to spend a lot of labour and material resources to explore the pretreatment and staining methods of hard and solid seeds with physical barriers. This study explores the TZ staining methods of six hard seeds (Tilia miqueliana, Tilia henryana, Sassafras tzumu, Prunus subhirtella, Prunus sibirica, and Juglans mandshurica) and summarizes the TZ staining conditions required for hard seeds by combining the difference in fat content between seeds and the kinship between species, thus providing a rapid viability test method for the protection of germplasm resources of endangered plants and the optimization of seed bank construction. The TZ staining of six species of hard seeds requires a staining temperature above 35 °C and a TZ solution concentration higher than 1%. Endospermic seeds require shorter staining times than exalbuminous seeds. The higher the fat content of the seeds, the lower the required incubation temperature and TZ concentration for staining, and the longer the staining time. And the closer the relationship between the two species, the more similar their staining conditions become. The TZ staining method of similar species can be predicted according to the genetic distance between the phylogenetic trees, and the viability of new species can be detected quickly.
Although federal judges are the ultimate arbiters of insider trading enforcement, the role of their political ideology in insider trading is unclear. Using the partisanship of judges’ nominating presidents to measure judge ideology, we first document that liberal judges are associated with heavier penalties in insider trading lawsuits than conservative judges. Next, we find that firms located in circuits with more liberal judges have fewer opportunistic insider sales. Cross-sectional analyses show that this deterrent effect is stronger when managers face a higher risk of insider trading lawsuits. Finally, we find that the Securities and Exchange Commission considers judges’ ideology when selecting litigation forums.
The production and industrial use of asbestos cement and other asbestos-containing materials have been restricted in most countries because of the potential detrimental effects on human health and the environment. Chrysotile is the most common form of asbestos and investigations into how to recycle this serpentine phyllosilicate mineral have attracted extensive attention. Chrysotile asbestos tailings can be transformed thermally, at high temperature, by in situ carbothermal reduction (CR). The CR method aims to maximize use of the chrysotile available and uses high temperatures and carbon to change the mineral form and structure of the chrysotile asbestos tailings. When chrysotile asbestos is employed as the raw material and coke (carbon) powder is used as the reducing agent for CR transformation, stable, high-temperature composites consisting of forsterite, stishovite, and silicon carbide are formed. Forsterite (Mg2SiO4) was the most abundant crystalline phase formed in samples heat treated below 1500ºC. At 1600ºC, forsterite was exhausted through decomposition and β-SiC formed by reduction of stishovite. A larger proportion of β-SiC was generated as the carbon content was increased. This research revealed that both temperature and carbon addition play key roles in the transformation of chrysotile asbestos tailings.
Organo-montmorillonite (OMnt) has wide applications in paints, clay-polymer nanocomposites, biomaterials, etc. In most cases, the dispersibility and swellability of OMnt dictate the performance of OMnt in the target products. Previous studies have revealed that the properties can be improved when multiple organic species are co-introduced into the interlayer space of montmorillonite (Mnt). In the present study, single surfactant erucylamide (EA), dual-surfactants cetyltrimethyl ammonium bromide (CTAB) and octadecyltrimethyl ammonium chloride (OTAC), and ternary-surfactants EA, CTAB, and OTAC were co-introduced into Mnt by solution intercalation. The resulting OMnts were characterized by powder X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, thermogravimetry-differential thermogravimetry (TG-DTG), water contact-angle tests, scanning electronic microscopy (SEM), laser particle-size analysis, and swelling indices. Mnt co-modified by ternary CTAB, OTAC, and EA led to a large d001 value (4.20 nm), surface hydrophobicity with a contact angle of 95.6°, swellability (50 mL/g) with small average particle sizes (2.1−2.8 μm) in xylene, and >99% of the OMnt particles were kept as <5 μm in deionized water. The formation of EA-modified-Mnt was proposed according to hydrophobic affinity, hydrogen bonding, and van der Waals forces. The nanoplatelets of the CTA+, OTA+, and EA co-modified OMnts in xylene were assembled into a house-of-cards structure by face-to-edge and edge-to-edge associations. The electrostatic attractions, electrostatic and steric repulsions, and hydrophobic interactions were responsible for the good dispersibility of OMnt in xylene. The ternary surfactant co-modified OMnt with high dispersion and swellability will make OMnt better suited for real-world applications.
Montmorillonite (Mnt)-based solid acids have a wide range of applications in catalysis and adsorption of pollutants. For such solid acids, the acidic characteristic often plays a significant role in these applications. The objective of the current study was to examine the effects of H3PO4-activation and supporting WO3 on the textural structure and surface acidic properties of Mnt. The Mnt-based solid acid materials were prepared by H3PO4 treatment and an impregnation method with a solution of ammonium metatungstate (AMT) and were examined as catalysts in the dehydration of glycerol to acrolein. The catalysts were characterized by nitrogen adsorption-desorption, powder X-ray diffraction (XRD), Fourier-transform infrared (FTIR) spectroscopy, scanning electronic microscopy (SEM), X-ray photoelectron spectroscopy (XPS), diffuse reflectance ultraviolet-visible (DR UV-Vis) spectroscopy, temperature programmed desorption of NH3 (NH3-TPD), diffuse reflectance Fourier-transform infrared (DR FTIR) spectroscopy of adsorbed pyridine, and thermogravimetric (TG) analyses. The phosphoric acid treatment of Mnt created Brönsted and Lewis acid sites and led to increases in specific surface areas, porosity, and acidity. WO3 species influenced total acidity, acid strength, the numbers of Brönsted and Lewis acid sites, and catalytic performances. A high turnover frequency (TOF) value (31.2 h−1) based on a maximal 60.7% yield of acrolein was reached. The correlation of acrolein yield with acidic properties indicated that the cooperative role of Brönsted and Lewis acid sites was beneficial to the formation of acrolein and a little coke deposition (<3.3 wt.%). This work provides a new idea for the design of solid acid catalysts with cooperative Brönsted and Lewis acidity for the dehydration of glycerol.
Preterm children with very low birthweight (VLBW) / extremely low birthweight (ELBW) with normal early development had been found poorer executive functions (EFs) at preschool-age (Ni, Huang & Guo, 2011). The previous study found that the risks of deficits in EFs at preschool-age of preterm children can be attenuated by more supportive home environment (Taylor & Clark, 2016). However, former studies didn't investigate the effect of birthweight and home environment on cognitive EFs of preterm children simultaneously, especially those with normal early development. The present study aims to investigate the predictive effect of birthweight and home environment on the cognitive EFs of VLBW / ELBW preterm children.
Participants and Methods:
The preterm children were recruited from the Premature Baby Foundation of Taiwan. Inclusion criteria were their scores of Bayley Scales of Infant and Toddler Development, second or third edition at 12 and 24 months, and Wechsler Preschool and Primary Scale of Intelligence, Revised Edition at 5 years old were higher than 70. Exclusion criteria were visual impairment, hearing impairment, and cerebral palsy. There was a total of 287 preterm children with age 6 recruited in the present study. Preterm children were then divided into VLBW group (n=202, birthweight between 1001-1500g) and ELBW group (n=85, birthweight less than 1000g). The typical children included 89 term-born healthy and typically developing children with age 6, who were recruited from comparable social status families in the community. Four types of cognitive EFs including 22 indicators were assessed. Inhibition ability including 8 indicators was assessed through Comprehensive Nonverbal Attention Test Battery (CNAT), cognitive flexibility including 6 indicators was assessed through Wisconsin Card Sorting Test (WCST), working memory including 2 indicators was assessed through Digit Span Subtest of Wechsler Intelligence Scale for Children-IV (WISC-IV) and Knox's Cube Test (KCT), planning ability including 6 indicators was assessed through Tower of London (ToL). The home environment was assessed through Home Observation for Measurement of the Environment (HOME), Revised edition. Data were analyzed with Stepwise Regression.
Results:
Results showed that the regression model with birthweight significantly predicted 83.3% of planning ability indicators, 83.3% of cognitive flexibility indicators, and 50% of working memory indicators. Among indicators mentioned above, birthweight has been found the greatest predictive effect on summation-of score of ToL (R2=.04, p<.001). The regression model with HOME significantly predicted 66.7% of planning ability indicators, 16.7% of cognitive flexibility indicators, and 12.5% of inhibition ability indicators. Among the indicators mentioned above, HOME has been found the greatest predictive effect on rule-1 of ToL (R2=.027, p=.001). The regression model with birthweight and HOME significantly predicted 50% of planning ability indicators. Among indicators mentioned above, the regression model has been found the greatest predictive effect on summation-of-score of ToL (R2=.061, p<.001).
Conclusions:
Both birthweight and home environment have been found significantly predicted different types of cognitive EFs at preschool-age of VLBW / ELBW preterm children with normal early development. Though the home environment doesn't have such a great predictive effect as birthweight is, both birthweight and home environment are significant predictors of planning ability.
During the COVID-19 pandemic, wearing face masks is an important strategy to prevent people from infection, allowing people to find a balance between maintaining social interaction and keeping social distancing. Since face mask might disrupt information processing of social cognition, it could lead to less functional connectivity of occipital face area, fusiform face area, and superior temporal sulcus which interrupted the development of medial prefrontal cortex (MPFC) for mentalizing. However with better executive function (EF) people could process facial stimuli more efficiently. The objective of this study is to examine the effect of wearing face masks on preschoolers' facial emotion recognition, and the factors which might affect the development of facial emotion recognition.
Participants and Methods:
In this study, preschoolers (N=44, 24 boys and 20 girls, aged 3 to 5 years-old) recruited from the community were asked to identify the emotions expressed in the 36 stimulus photos, each randomly presented with six emotion (happy, sad, angry, surprised, fearful, and disgusted). The total face stimulus photos were 2 (face sex) × 6 emotions × 3 facial features (full face, presenting upper counterparts of face with face mask covering the mouth, and presenting lower counterparts of face with hat covering the eyes). The EF of preschoolers and their parent were also evaluated to examine whether EF could predict the correct score of facial emotion recognition.
Results:
It was found that the correct score of emotion recognition increased with age. The recognition with full face feature were better than with upper feature and lower feature. When recognizing happy and disgust, participant tended to use lower features. When recognizing sad and angry, participant tended to use upper features. The EF of preschoolers could predict the correct score of emotion recognition. The EF of parents could predict the preschoolers' correct score of positive emotion recognition.
Conclusions:
The ability of facial emotion recognition evolved rapidly in preschool age with the accumulation of social interaction experience and improved the development of auditory and visual subcortical cortex and the connectivity of MPFC. This study examined the emotion recognition ability of preschoolers and found that the face features preschoolers used to recognized emotion were consist with previous study. However, when the presenting stimulus were covered by face mask or hat, it was more difficult for preschoolers to recognizing emotion which would result in difficulty of understanding the social context and development of MPFC for mentalizing. In this study, it was found that preschooler's with better EF could be more efficiently recognizing facial emotion. Also, parents with better EF showed more positive emotion in daily life which lead to their children more sensitive to positive facial emotion.
This article uses the enactment of China’s 2007 Property Law (the Law), which reduces the risk of expropriation by local governments, as the setting to investigate the importance of property rights protection for private firm investment. Using propensity score matching and a difference-in-differences design, we find that firms facing weaker property rights protection prior to the Law significantly increase their investment and investment efficiency after the Law. Cross-sectional analyses document evidence consistent with a decrease in firms’ perceived expropriation risk as the main mechanism underlying the Law’s effect. Finally, we show that the Law improves local economic outcomes and employment.
SARS-CoV-2 rapidly spreads among humans via social networks, with social mixing and network characteristics potentially facilitating transmission. However, limited data on topological structural features has hindered in-depth studies. Existing research is based on snapshot analyses, preventing temporal investigations of network changes. Comparing network characteristics over time offers additional insights into transmission dynamics. We examined confirmed COVID-19 patients from an eastern Chinese province, analyzing social mixing and network characteristics using transmission network topology before and after widespread interventions. Between the two time periods, the percentage of singleton networks increased from 38.9$ \% $ to 62.8$ \% $$ (p<0.001) $; the average shortest path length decreased from 1.53 to 1.14 $ (p<0.001) $; the average betweenness reduced from 0.65 to 0.11$ (p<0.001) $; the average cluster size dropped from 4.05 to 2.72 $ (p=0.004) $; and the out-degree had a slight but nonsignificant decline from 0.75 to 0.63 $ (p=0.099). $ Results show that nonpharmaceutical interventions effectively disrupted transmission networks, preventing further disease spread. Additionally, we found that the networks’ dynamic structure provided more information than solely examining infection curves after applying descriptive and agent-based modeling approaches. In summary, we investigated social mixing and network characteristics of COVID-19 patients during different pandemic stages, revealing transmission network heterogeneities.
Abnormal reward functioning is central to anhedonia and amotivation symptoms of schizophrenia (SCZ). Reward processing encompasses a series of psychological components. This systematic review and meta-analysis examined the brain dysfunction related to reward processing of individuals with SCZ spectrum disorders and risks, covering multiple reward components.
Methods
After a systematic literature search, 37 neuroimaging studies were identified and divided into four groups based on their target psychology components (i.e. reward anticipation, reward consumption, reward learning, effort computation). Whole-brain Seed-based d Mapping (SDM) meta-analyses were conducted for all included studies and each component.
Results
The meta-analysis for all reward-related studies revealed reduced functional activation across the SCZ spectrum in the striatum, orbital frontal cortex, cingulate cortex, and cerebellar areas. Meanwhile, distinct abnormal patterns were found for reward anticipation (decreased activation of the cingulate cortex and striatum), reward consumption (decreased activation of cerebellum IV/V areas, insula and inferior frontal gyri), and reward learning processing (decreased activation of the striatum, thalamus, cerebellar Crus I, cingulate cortex, orbitofrontal cortex, and parietal and occipital areas). Lastly, our qualitative review suggested that decreased activation of the ventral striatum and anterior cingulate cortex was also involved in effort computation.
Conclusions
These results provide deep insights on the component-based neuro-psychopathological mechanisms for anhedonia and amotivation symptoms of the SCZ spectrum.
Objectives: Medical devices and the hospital environment can be contaminated easily by multidrug-resistant bacteria. The effectiveness of cleaning practices is often suboptimal because environmental cleaning in hospitals is complex and depends on human factors, the physical and chemical characteristics of environment, and the viability of the microorganisms. Ultraviolet-C (UV-C) lamps can be used to reduce the spread of microorganisms. We evaluated the effectiveness of an ultraviolet-C (UV-C) device on terminal room cleaning and disinfection. Methods: The study was conducted at an ICU of a medical center in Taiwan. We performed a 3-stage evaluation for the effectiveness of UV-C radiation, including pre–UV-C radiation, UV-C radiation, and a bleaching procedure. The 3 stages of evaluation were implemented in the ICU rooms from which a patient had been discharged or transferred. We collected the data from adenosine triphosphate (ATP) bioluminescence testing, colonized strains, and their corresponding colony counts by sampling from the environmental surfaces and air. We tested 8 high-touch surfaces, including 2 sides of bed rails, headboards, footboards, bedside tables, monitors, pumping devices, IV stands, and oxygen flow meters. Results: In total, 1,696 environmental surfaces and 72 air samples were analyzed. The levels of ATP bioluminescence and colony counts of isolated bacteria decreased significantly after UV-C radiation and bleaching disinfection for both the environmental and air samples (P < .001). Resistant bacteria (vancomycin-resistant Enterococcus, VRE) were commonly isolated on the hard-to-clean surfaces of monitors, oxygen flow meters, and IV pumps. However, they were also eradicated (P < .001). Conclusions: UV-C can significantly reduce environmental contamination by multidrug-resistant microorganisms. UV-C is an effective device to assist staff in cleaning the hospital environment.
Coronavirus disease 2019 (COVID-19) asymptomatic cases are hard to identify, impeding transmissibility estimation. The value of COVID-19 transmissibility is worth further elucidation for key assumptions in further modelling studies. Through a population-based surveillance network, we collected data on 1342 confirmed cases with a 90-days follow-up for all asymptomatic cases. An age-stratified compartmental model containing contact information was built to estimate the transmissibility of symptomatic and asymptomatic COVID-19 cases. The difference in transmissibility of a symptomatic and asymptomatic case depended on age and was most distinct for the middle-age groups. The asymptomatic cases had a 66.7% lower transmissibility rate than symptomatic cases, and 74.1% (95% CI 65.9–80.7) of all asymptomatic cases were missed in detection. The average proportion of asymptomatic cases was 28.2% (95% CI 23.0–34.6). Simulation demonstrated that the burden of asymptomatic transmission increased as the epidemic continued and could potentially dominate total transmission. The transmissibility of asymptomatic COVID-19 cases is high and asymptomatic COVID-19 cases play a significant role in outbreaks.