The Relationship among Internet Addiction, Moral Potency, Mindfulness, and Psychological Capital.

This research aimed to contribute to the literature on internet addiction (IA) and moral development among university students. Moral potency (MP) encompasses the interconnected dimensions of moral courage, moral ownership, and moral efficacy. Studies on the relationships between students' problematic behaviors (e.g., IA) and cognitive processes like MP, mindfulness (MI), and psychological capital (PsyCap) are scarce in educational research. Therefore, this study investigated the relationships among IA, MP, MI, and PsyCap in university students. This study included 868 undergraduate students from a state university in Ethiopia, with 526 male students (60.6%) and 342 female students (39.4%). Participants' ages ranged from 21 to 29 years, with a mean age of 22.31 and a standard deviation of 4.03. The findings indicated that IA was negatively correlated with MI, PsyCap, and MP. Both MI and PsyCap showed positive correlations with MP. Importantly, this study revealed that IA had a direct and negative impact on MI, PsyCap, and MP. Further, MI and PsyCap partially mediated and fully mediated the relationship between IA and MP. These findings suggest that cultivating MI and positive PsyCap among university students could be an important strategy to reduce the risks of IA and enhance their moral development. This study contributes to the limited research on the complex relationships between technology use, psychological resources, and moral functioning in emerging adulthood.

Atrial Tachycardias After "Multiple" Previous Ablations for Tachyarrhythmias: Treatment by Anti-arrhythmic Drugs or Additional Ablation?

Pulmonary vein (PV) isolation (PVI) ablation as the first-line therapy for atrial fibrillation (AF) and repeat PVIs for patients who had symptomatic improvement with the index PVI but who develop AF recurrence are directed by practice guidelines. How many catheter ablation (CA) procedures constitute the definition of "multiple" ablations is not known. Whether atrial tachyarrhythmias (AF, atrial tachycardia [AT], atrial flutter [AFL]) that occur post-ablation are due entirely to the proarrhythmic effects of CA or a continuum of the arrhythmia spectrum from the underlying atriopathy is debatable. Herein, we describe a case of a 65-year-old man with a CHA2DS2-VASc score of 5 points who suffered from atrial tachyarrhythmias for which seven CA procedures were performed. Because of symptomatic and drug-refractory AT/AFL that failed cardioversions, he requested another ablation procedure. During the eighth procedure, high-density three-dimensional electroanatomic mapping, including Coherent and Ripple mapping (CARTO® 3; Biosense Webster, Diamond Bar, CA, USA), of AT/AFL was performed. Small discrete areas of relatively viable tissue within an extensively scarred left atrium and a macro-re-entrant circuit with early-meets-late activation between the left atrial anterior wall and the right superior PV were found. Radiofrequency ablation performed at this site resulted in the termination of the tachycardia, and bidirectional conduction block across the line was achieved. On clinical follow-ups and rhythm monitoring by an implantable loop recorder, the patient remained in sinus rhythm with significant clinical improvement. Our case suggests that, in patients with prior multiple CAs, additional clinically indicated ablation should be performed using high-density mapping to accurately identify arrhythmia mechanisms, elucidate the disease substrate, and restore the sinus rhythm successfully.

Deductive Reasoning Skills in Children Aged 4-8 Years Old.

Young children possess the fundamental deductive reasoning skills for solving their upcoming problems in their daily lives. These skills are of great importance for their school readiness and academic development. Therefore, this study aimed to explore the age differences and predictive variables of deductive reasoning skills in young Hungarian children aged 4-8 years old who reside in Hungary and Slovakia. Face-to-face data were collected from 3050 participants. The instrument of deductive reasoning skills assessment was extracted from the school readiness test, DIFER (Diagnostic System for Assessing Development). Utilizing various statistical analyses with R, AMOS, and MPlus8 packages, it was found that there were significant differences in young children's deductive reasoning skills across countries and age groups. Parents' education levels had significant positive relationships with children's deductive reasoning skills development. And the variables of country and age were identified as significant predictors of children's deductive reasoning skills. And children's family background variables such as parental education played a significant role in predicting children's deductive reasoning skills in Hungary. The implications of this study emphasize the importance of educational contexts, parental involvement, cross-cultural exchange, and further research, with the potential to enhance young children's educational experiences and prospects in Hungary, Slovakia, and beyond.

The effect of reading strategy use on online reading comprehension.

In the current age, digital technology is rapidly changing daily routines, and young people today spend most of their time using various digital tools. Therefore, traditional reading of the printed page is being transformed into digital reading of online texts among students. Thus, online reading strategies have become crucial for their development in online reading performance. This study aimed to investigate the effects of online reading strategies used by lower secondary students on reading comprehension achievement. It conducted an online survey of reading strategies, involving three types of reading strategies, global, problem-solving, and support. The study recruited 4527 students at the lower secondary school level in Hungary. The study examined the students' attitudes toward literature and grammar in their native language (L1), use of online reading strategies, reading comprehension skills, and language arts achievement as well as examining the relations between them with various methods of analysis (descriptive/inferential, Rasch and path analyses). The findings demonstrated that the students' problem-solving strategies (from among the three reading strategies) exerted significant and positive impacts on reading comprehension. Additionally, the students' attitudes toward L1 had a positively significant effect on their use of online reading strategies and language arts achievement and an indirect effect on reading comprehension skills. The study also found a significant relationship between language arts achievement and reading comprehension achievement. Therefore, this study is beneficial for language teachers in helping students improve reading comprehension skills.

Exploring the Accuracy and Consistency of a School Readiness Assessment Tool for Preschoolers: Reliability, Validity and Measurement Invariance Analysis.

This study focuses on examining the psychometric properties of the DIFER test, a widely used assessment tool for measuring school readiness. DIFER, which stands for Diagnostic Assessment Systems for Development, has gained prominence in Hungary and some European countries as an effective means of evaluating children's readiness for school. By investigating the reliability and validity of the DIFER test, this study aims to enhance the understanding of the suitability of the DIFER test for cross-cultural and longitudinal studies in assessing school readiness. Conducted as a survey study, the research involved 3050 Hungarian students from Slovakia and Hungary. Employing Rasch analysis and multi-group confirmatory factor analysis (MG-CFA) aid in verifying the precision of the DIFER test as a valuable assessment instrument for determining school readiness. The results revealed a strong alignment between the difficulty level of the test and students' actual abilities, demonstrating its reliability and validity. Importantly, the analysis found measurement invariance across various factors, including country, gender, and age. This indicates the consistent performance of the DIFER test in assessing school readiness across diverse groups. However, mean differences in latent abilities were observed among different age groups, indicating that older students exhibited notably higher proficiency in pre-mathematical skills compared to their younger counterparts. The findings offer valuable insights to educators, providing a reliable tool for assessing school readiness and identifying areas for improvement.

The Dynamics of Mastery Motivation and Its Relationship with Self-Concept in Music Education.

Musical education hinges on students' mastery motivation and self-concept, which are crucial for effective musical learning. Despite the acknowledgement of their individual importance, the relationship between these factors within music education remains unexplored. Hence, this study aimed to investigate the dynamics of mastery motivation (MM) and its relationship with self-concept (SC) in the context of music education. A survey was administered to 139 Hungarian grade 7 students, employing a musical MM questionnaire, a musical SC inquiry, and the collection of demographic information collection. We employed descriptive statistics (IBM SPSS 23), a Rasch analysis (WINSTEPS), and correlational and regression analyses (R programming and SmartPLS4) for data analysis. The findings demonstrated that the utilized instruments were reliable and valid in measuring students' MM and SC in music education. This study revealed a strong positive correlation (r = 0.778) between students' MM and SC, with moderate to strong inter-relationships among various subfactors. Furthermore, comparisons unveiled significant disparities in musical MM across school levels, with higher MM and SC observed among female students. Furthermore, gender, a musical family background, and awareness of musical lesson usefulness were predictive factors for both students' MM and SC within music education. This study provides valuable insights for professionals and policy makers to enhance music education, nurturing students' musical growth effectively. By understanding the relationship between MM and SC and considering predictive factors, stakeholders can develop strategies that optimize the impact of music education on students' musical development.

The community acceptance of COVID-19 vaccines in Rakhine State: A cross-sectional study in Myanmar.

The global pandemic situation of SARS-CoV-2 (COVID-19) has been ongoing for more than 2 years with the emergence of different variants. With the rapid development of vaccines, countries including Myanmar rolled out vaccination programs to reduce the morbidity and mortality due to COVID-19 with the ultimate goal to end the pandemic. This study seeks to explore the acceptance of the general adult population towards the COVID-19 vaccines administered by the Ministry of Health, and barriers to vaccine acceptance. A quantitative cross-sectional study was conducted by adopting valid and reliable questionnaires from similar studies around the world. Simple random sampling was used to select 288 participants from 12 townships of Rakhine State, Myanmar. The interview was performed using standardized paper-based documents. While the data entry and manipulation were performed using Microsoft Excel, the data analysis process was performed using the Statistical Package for Social Science (SPSS) software. As descriptive statistics, the level of vaccine acceptance, and barriers to vaccine acceptance were calculated. Chi-square analysis and bivariate logistics regression was performed to explore the associated socio-demographic characteristics, COVID-19 and vaccine-related experience, and perceptions of participants on the health belief model (HBM) domains related to vaccine acceptance. A total of 276 participants entered the study and revealed an overall vaccine acceptance level of 91.3%. Higher level of education, working in skilled manual and sales services, monthly income of more than 200,000 MMK (111 USD), history of previous vaccination, not experiencing side effects of vaccine after previous immunization, and elements of the health belief model (HBM) were associated with higher vaccine acceptance. The barriers to vaccine acceptance were mistrust of the efficacy of vaccines and potential major adverse events of COVID-19 vaccines. The high level of vaccine acceptance among the general population in Rakhine state provides an opportunity for health authorities to achieve high vaccination coverage within the community. Nevertheless, the vaccine-related education campaigns should be targeted and conveyed frequently to the sub-groups of the population with vaccine hesitancy to obtain the highest achievable level of vaccine coverage within the community for the ultimate goal to end the pandemic.

Assessment of Mastery Motivation and Neurodevelopment of Young Children at High Risk for Developmental Delays.

Young children's mastery motivation and neurodevelopmental evaluation can contribute to overall early assessment for early intervention evaluation. At present, children born preterm (<37 weeks gestation) and with a low birth weight (LBW; <2500 g) are at increased risk of experiencing developmental delays and more nuanced cognitive and language challenges. The main objective of this exploratory study was to examine the connection between preterm children's mastery motivation and their neurodevelopment, as well as to determine whether assessing mastery motivation can enhance assessment practices for early intervention (EI) programs. Parents of children born preterm completed the revised Dimensions of Mastery Motivation Questionnaire (DMQ18). Neurodevelopment was measured on the Bayley Scales of Infant and Toddler Development (BSID-III). Results revealed significant correlations between DMQ18 and BSID-III measures. Multivariate analysis showed that infants and toddlers born with a very low birth weight (VLBW; <1500 g) scored significantly lower on the infant DMQ18 and the BSID-III measures. Regression analyses revealed that birth weight and home environment were significant predictors of the children's eligibility for EI programs. Infants' social persistence with other children, gross motor persistence, and mastery pleasure, as well as toddlers' objective cognitive persistence, social persistence with adults, gross motor persistence, mastery pleasure, and negative reaction to frustration, were important markers for evidenced-based practices in EI programs. This study demonstrates the utility of the DMQ18 as a contributory assessment measure and the importance of birth weight and home environment in predicting EI enrollment.

Prevalence of G6PD deficiency and diagnostic accuracy of a G6PD point-of-care test among a population at risk of malaria in Myanmar.

BACKGROUND: Over the past decade, the incidence of malaria has steadily declined in Myanmar, with Plasmodium vivax becoming predominant. The resilience of P. vivax to malaria control is attributed to the parasite's ability to form hypnozoites in the host's liver, which can cause relapse. Primaquine is used to eliminate hypnozoites but can cause haemolysis in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals. It is thus necessary to estimate the frequency and variant types of G6PD deficiency in areas where primaquine will be widely used for P. vivax elimination. METHODS: In this study, a descriptive cross-sectional survey was conducted to determine the prevalence of G6PD deficiency in a population residing in Nay Pyi Taw, Myanmar, using a standard spectrophotometric assay, a rapid diagnostic test (RDT), Biosensor, and by genotyping G6PD variants. RESULTS: G6PD enzyme activity was determined from 772 leukocyte-depleted samples, with an adjusted male median G6PD activity value of 6.3 U/g haemoglobin. Using a cut-off value of 30% enzyme activity, the overall prevalence of G6PD deficiency was 10.8%. Genotyping of G6PD variants was performed for 536 samples, of which 131 contained mutations. The Mahidol variant comprised the majority, and males with the Mahidol variant showed lower G6PD enzyme activity. The G6PD Andalus variant, which has not been reported in Myanmar before, was also identified in this study. CONCLUSION: This study provides a G6PD enzyme activity reference value for the Myanmar population and further information on the prevalence and variants of G6PD deficiency among the Myanmar population; it also evaluates the feasibility of G6PD deficiency tests.

Employing T-Cell Memory to Effectively Target SARS-CoV-2.

Well-trained T-cell immunity is needed for early viral containment, especially with the help of an ideal vaccine. Although most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected convalescent cases have recovered with the generation of virus-specific memory T cells, some cases have encountered T-cell abnormalities. The emergence of several mutant strains has even threatened the effectiveness of the T-cell immunity that was established with the first-generation vaccines. Currently, the development of next-generation vaccines involves trying several approaches to educate T-cell memory to trigger a broad and fast response that targets several viral proteins. As the shaping of T-cell immunity in its fast and efficient form becomes important, this review discusses several interesting vaccine approaches to effectively employ T-cell memory for efficient viral containment. In addition, some essential facts and future possible consequences of using current vaccines are also highlighted.

Subject Specific Mastery Motivation in Moldovan Middle School Students.

Given the crucial role of mastery motivation in the cognitive development of children, the present study investigates subject-specific mastery motivation in the multilingual educational system of the Republic of Moldova. We applied cross-sectional data from fifth, seventh, and ninth graders studying either in the Romanian (n = 583) or Russian (n = 353) language using the Subject Specific Mastery Motivation Questionnaire (SSMMQ). To ensure the validity of the comparison of latent mean differences, the Romanian and Russian versions of SSMMQ were validated and measurement invariance of the constructs across language, grade, and gender was assessed. The full scalar invariance across grades and gender and the partial scalar invariance across language held. Thus, a comparison of latent mean differences across these three groups is plausible. The findings proved that there was no difference between the Romanian and Russian samples, but we found girls self-rated themselves significantly higher than boys in the Reading, Art, and Music mastery motivation scales. Results with respect to the comparison of latent mean differences between the grade levels demonstrated that the Reading mastery motivation of the Moldovan students stayed stable from fifth to ninth grades, whereas Art had a constant declining path.

Reflection-based questioning: Aspects affecting Myanmar students' reading comprehension.

This study aimed to scrutinize the effects of the reflection-based questioning approach (RBQA) on Myanmar students' achievement in English reading comprehension. The RBQA approach covers Oo et al.'s (2021) reflective teaching model for reading comprehension (based on planning, acting, reflecting, and evaluating) in which the teacher uses a questioning strategy (initiate-response-evaluate model). Employing cluster randomized trials, quasi-experimental research was conducted to investigate RBQA's effectiveness in teaching reading comprehension skills to Grade-9 students. The experimental group (N = 228) received the RBQA intervention; the control group (N = 230) did not receive the intervention but was provided with traditional instruction. During RBQA intervention, teachers used the anonymous student questionnaire and observation scheme as effective reflection tools. After a five-week intervention, both groups completed post-tests to assess their achievement. The study findings revealed that teaching with RBQA had a significant positive effect on students' reading comprehension. Therefore, this study is of immense significance to English language teachers and their students.

Public acceptability of COVID-19 control measures in Singapore, Hong Kong, and Malaysia: A cross-sectional survey.

BACKGROUND: Several countries have implemented control measures to limit SARS-CoV-2 spread, including digital contact tracing, digital monitoring of quarantined individuals, and testing of travelers. These raise ethical issues around privacy, personal freedoms, and equity. However, little is known regarding public acceptability of these measures. METHODS: In December 2020, we conducted a survey among 3635 respondents in Singapore, Hong Kong, and Malaysia to understand public perceptions on the acceptability of COVID-19 control measures. FINDINGS: Hong Kong respondents were much less supportive of digital contact tracing and monitoring devices than those in Malaysia and Singapore. Around three-quarters of Hong Kong respondents perceived digital contact tracing as an unreasonable restriction of individual freedom; <20% trusted that there were adequate local provisions preventing these data being used for other purposes. This was the opposite in Singapore, where nearly 3/4 of respondents agreed that there were adequate data protection rules locally. In contrast, only a minority of Hong Kong respondents viewed mandatory testing and vaccination for travelers as unreasonable infringements of privacy or freedom. Less than 2/3 of respondents in all territories were willing to be vaccinated against COVID-19, with a quarter of respondents undecided. However, support for differential travel restrictions for vaccinated and unvaccinated individuals was high in all settings. INTERPRETATION: Our findings highlight the importance of sociopolitical context in public perception of public health measures and emphasize the need to continually monitor public attitudes toward such measures to inform implementation and communication strategies.

Factors associated with maternal tetanus vaccination in Myanmar: An analysis of demographic and health survey data.

BACKGROUND: Tetanus toxoid vaccination is a life-saving maternal and child health intervention. Understanding gaps in maternal vaccination coverage is key to informing progress towards universal health coverage. We assessed the vaccination coverage in Myanmar and investigated factors associated with being unvaccinated. METHOD: In this cross-sectional analysis of 2015-16 Demographic and Health Survey data including women aged 15-49 years with at least one childbirth in the last five years. The outcome maternal tetanus vaccination during her last pregnancy, defined as protected against neonatal tetanus based on the Myanmar National Guidelines for Antenatal Care. We also examined mothers who missed a second dose of tetanus toxoid containing vaccine (TTCV) by states and regions. We used logistic regression models to assess factors associated with being unvaccinated. RESULTS: Overall maternal tetanus vaccination coverage was 72%. At subnational level, the percent unvaccinated was highest in Shan State (42%), followed by Magway Region (33%), Kayin State (33%), and Sagaing Region (32%). The percentage of mothers who missed a second dose of TTCV was high predominantly in regions, rather than states. We found that the percentage of unvaccinated mothers was higher among younger mothers, and mothers with lower educational attainment. No antenatal care (ANC) or receiving ANC in non-public healthcare facilities were strongly associated with being unvaccinated. Differences in percent unvaccinated by maternal age were largely mediated through their healthcare access, particularly ANC services. INTERPRETATION: We identified regional, structural, and individual differences in maternal tetanus vaccination coverage. Factors influencing mothers who missed a second dose of TTCV warrant further investigation. Achieving universal coverage of maternal tetanus vaccination will largely depend on the ability to provide accessible antenatal care to most women who do not currently receive it.

Contrasting SARS-CoV-2 epidemics in Singapore: cohort studies in migrant workers and the general population.

IMPORTANCE: Since January 2020, Singapore has implemented comprehensive measures to suppress SARS-CoV-2. Despite this, the country has experienced contrasting epidemics, with limited transmission in the community and explosive outbreaks in migrant worker dormitories. OBJECTIVE: To estimate SARS-CoV-2 infection incidence among migrant workers and the general population in Singapore. DESIGN: Prospective serological cohort studies. SETTING: Two cohort studies - in a migrant worker dormitory and in the general population in Singapore. PARTICIPANTS: 478 residents of a SARS-CoV-2-affected migrant worker dormitory were followed up between May and July 2020, with blood samples collected on recruitment and after 2 and 6 weeks. In addition, 937 community-dwelling adult Singapore residents, for whom pre-pandemic sera were available, were recruited. These individuals also provided a serum sample on recruitment in November/December 2020. EXPOSURE: Exposure to SARS-CoV-2 in a densely populated migrant worker dormitory and in the general population. MAIN OUTCOMES AND MEASURES: The main outcome measures were the incidences of SARS-CoV-2 infection in migrant workers and in the general population, as determined by the detection of neutralizing antibodies against SARS-CoV-2, and adjusting for assay sensitivity and specificity using a Bayesian modeling framework. RESULTS: No evidence of community SARS-CoV-2 exposure was found in Singapore prior to September 2019. It was estimated that < 2 per 1000 adult residents in the community were infected with SARS-CoV-2 in 2020 (cumulative seroprevalence: 0.16%; 95% CrI: 0.008-0.72%). Comparison with comprehensive national case notification data suggested that around 1 in 4 infections in the general population were associated with symptoms. In contrast, in the migrant worker cohort, almost two-thirds had been infected by July 2020 (cumulative seroprevalence: 63.8%; 95% CrI: 57.9-70.3%); no symptoms were reported in almost all of these infections. CONCLUSIONS AND RELEVANCE: Our findings demonstrate that SARS-CoV-2 suppression is possible with strict and rapid implementation of border restrictions, case isolation, contact tracing, quarantining, and social-distancing measures. However, the risk of large-scale epidemics in densely populated environments requires specific consideration in preparedness planning. Prioritization of these settings in vaccination strategies should minimize the risk of future resurgences and potential spillover of transmission to the wider community.

A dilemma of hemorrhage vs thrombosis: a case of watchman device thrombus in a patient with intracranial hemorrhage history.

Recently updated guidelines for Atrial Fibrillation (AF) outline that percutaneous left atrial appendage (LAA) occlusion with the Watchman device may be a reasonable alternative for those who have contraindications to long-term oral anticoagulation. However, optimal periprocedural antithrombotic therapy remains disputable, particularly in patients who are ineligible for oral anticoagulation or those with history of intracranial hemorrhage (ICH). We present the case of a 67-year-old male with a history of ischemic stroke with hemorrhagic conversion and permanent AF, who was treated with the Watchman device and subsequently developed device related thrombus and recurrent ischemic stroke. We discuss the dilemma and review the literature regarding anticoagulation for device related thrombus in this patient with increased bleeding risk, given his history of ICH. His course and antithrombotic strategy are described and despite the use of anticoagulation with warfarin in the setting of recurrent ischemic stroke, he did not develop hemorrhagic transformation. He also did, ultimately, achieve device related thrombus resolution on repeat Transesophageal Echocardiogram (TEE). This case supported the use of warfarin for device related thrombus in the setting of ischemic stroke and history of ICH. However, evidence-based guidelines for periprocedural antithrombotic regimens in patients with high bleeding risk have yet to be released and further research is needed.

Ward-level factors associated with methicillin-resistant Staphylococcus aureus acquisition-an electronic medical records study in Singapore.

BACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. METHODS: We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years. RESULTS: Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders. CONCLUSION: Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.

Highly functional virus-specific cellular immune response in asymptomatic SARS-CoV-2 infection.

The efficacy of virus-specific T cells in clearing pathogens involves a fine balance between antiviral and inflammatory features. SARS-CoV-2-specific T cells in individuals who clear SARS-CoV-2 without symptoms could reveal nonpathological yet protective characteristics. We longitudinally studied SARS-CoV-2-specific T cells in a cohort of asymptomatic (n = 85) and symptomatic (n = 75) COVID-19 patients after seroconversion. We quantified T cells reactive to structural proteins (M, NP, and Spike) using ELISpot and cytokine secretion in whole blood. Frequencies of SARS-CoV-2-specific T cells were similar between asymptomatic and symptomatic individuals, but the former showed an increased IFN-γ and IL-2 production. This was associated with a proportional secretion of IL-10 and proinflammatory cytokines (IL-6, TNF-α, and IL-1ß) only in asymptomatic infection, while a disproportionate secretion of inflammatory cytokines was triggered by SARS-CoV-2-specific T cell activation in symptomatic individuals. Thus, asymptomatic SARS-CoV-2-infected individuals are not characterized by weak antiviral immunity; on the contrary, they mount a highly functional virus-specific cellular immune response.

Population anxiety and positive behaviour change during the COVID-19 epidemic: Cross-sectional surveys in Singapore, China and Italy.

BACKGROUND: On 31 December 2019, an epidemic of pneumonia of unknown aetiology was first reported in the city of Wuhan, Hubei Province, People's Republic of China. A rapidly progressing epidemic of COVID-19 ensued within China, with multiple exportations to other countries. We aimed to measure perceptions and responses towards COVID-19 in three countries to understand how population-level anxiety can be mitigated in the early phases of a pandemic. METHODS: Between February and March 2020, we conducted online surveys in Singapore, China and Italy with a total of 4505 respondents to measure respondents' knowledge, perceptions, anxiety and behaviours towards the COVID-19 epidemic, and identified factors associated with lower anxiety and more positive behavioural responses. RESULTS: Respondents reported high awareness of COVID-19 and its accompanying symptoms, comparable information-seeking habits and similarly high levels of information sufficiency, adherence to and acceptance of public health control measures. Higher self-efficacy was associated with lower anxiety levels in all three countries, while willingness to comply with restrictive measures and greater information sufficiency were associated with more positive behavioural changes to reduce spread of infection. CONCLUSION: Population-level anxiety and behavioural responses to an outbreak can be influenced by information provided. This should be used to inform future outbreak preparedness plans, taking into account the importance of increasing population-level self-efficacy and information sufficiency to reduce anxiety and promote positive behavioural changes.