BackgroundThe Middle East respiratory syndrome (MERS) coronavirus has caused recurrent outbreaks in the Arabian Peninsula since 2012. Although MERS has low overall human-to-human transmission potential, there is occasional amplification in the healthcare setting, a pattern reminiscent of the dynamics of the severe acute respiratory syndrome (SARS) outbreaks in 2003. Here we provide a head-to-head comparison of exposure patterns and transmission dynamics of large hospital clusters of MERS and SARS, including the most recent South Korean outbreak of MERS in 2015.MethodsTo assess the unexpected nature of the recent South Korean nosocomial outbreak of MERS and estimate the probability of future large hospital clusters, we compared exposure and transmission patterns for previously reported hospital clusters of MERS and SARS, based on individual-level data and transmission tree information. We carried out simulations of nosocomial outbreaks of MERS and SARS using branching process models rooted in transmission tree data, and inferred the probability and characteristics of large outbreaks.ResultsA significant fraction of MERS cases were linked to the healthcare setting, ranging from 43.5 % for the nosocomial outbreak in Jeddah, Saudi Arabia, in 2014 to 100 % for both the outbreak in Al-Hasa, Saudi Arabia, in 2013 and the outbreak in South Korea in 2015. Both MERS and SARS nosocomial outbreaks are characterized by early nosocomial super-spreading events, with the reproduction number dropping below 1 within three to five disease generations. There was a systematic difference in the exposure patterns of MERS and SARS: a majority of MERS cases occurred among patients who sought care in the same facilities as the index case, whereas there was a greater concentration of SARS cases among healthcare workers throughout the outbreak. Exposure patterns differed slightly by disease generation, however, especially for SARS. Moreover, the distributions of secondary cases per single primary case varied highly across individual hospital outbreaks (Kruskal–Wallis test; P < 0.0001), with significantly higher transmission heterogeneity in the distribution of secondary cases for MERS than SARS. Simulations indicate a 2-fold higher probability of occurrence of large outbreaks (>100 cases) for SARS than MERS (2 % versus 1 %); however, owing to higher transmission heterogeneity, the largest outbreaks of MERS are characterized by sharper incidence peaks. The probability of occurrence of MERS outbreaks larger than the South Korean cluster (n = 186) is of the order of 1 %.ConclusionsOur study suggests that the South Korean outbreak followed a similar progression to previously described hospital clusters involving coronaviruses, with early super-spreading events generating a disproportionately large number of secondary infections, and the transmission potential diminishing greatly in subsequent generations. Differences in relative exposure patterns and transmission heterogeneity of MERS and SARS could point to changes in hospital practices since ...
The development of solution-processable, high-performance nchannel organic semiconductors is crucial to realizing low-cost, all-organic complementary circuits. Single-crystalline organic semiconductor nano/microwires (NWs/MWs) have great potential as active materials in solution-formed high-performance transistors. However, the technology to integrate these elements into functional networks with controlled alignment and density lags far behind their inorganic counterparts. Here, we report a solutionprocessing approach to achieve high-performance air-stable nchannel organic transistors (the field-effect mobility ( ) up to 0.24 cm 2 /Vs for MW networks) comprising high mobility, solutionsynthesized single-crystalline organic semiconducting MWs ( as high as 1.4 cm 2 /Vs for individual MWs) and a filtration-and-transfer (FAT) alignment method. The FAT method enables facile control over both alignment and density of MWs. Our approach presents a route toward solution-processed, high-performance organic transistors and could be used for directed assembly of various functional organic and inorganic NWs/MWs. organic semiconductors ͉ single crystals ͉ solution processing ͉ alignment S olution-processable, high-performance n-channel (electrontransporting) organic semiconductors are indispensable for cost-effective production of all-organic, flexible complementary logic elements (1-3). To date, however, very few solutionprocessable, air-stable organic n-channel semiconductors matching the performance of amorphous silicon (a-Si) ( Ն 0.1 cm 2 /Vs) have been reported (4-8). Organic semiconductor nano/microwires (NWs/MWs) have recently emerged as promising building blocks for various electronic and optical applications such as light-emitting diodes (LEDs) (9), field-effect transistors (FETs) (10), photoswitches (11), vapor sensors (12), solar cells (13), nanoscale lasers (14), optical waveguides (15), and memory devices (16). These unique materials combine the high-performance of singlecrystalline structures with solution-processability by dispersion (17,18). Several p-channel (hole-transporting) organic wires prepared by solution-processing have exhibited Ͼ 0.1 cm 2 /Vs for singlewire transistors (19)(20)(21)(22), whereas only a few solution-synthesized n-channel organic wires have been reported, typically with low performance ( Ϸ10 Ϫ3 Ϫ 10 Ϫ2 cm 2 /Vs) (23,24).Despite the intrinsic high mobility of single-crystalline wires, precise wire placement and wire-to-wire performance variation, due to the difference in the contact quality at the wire/insulator and wire/electrode interfaces, substantially hinder successful device integration (10, 25). Therefore, the technology to achieve network films of organic MWs deposited from a dispersion with controlled alignment and density is acutely desired. The integration of inorganic and metallic wires into functional network films has been extensively explored by using a number of methods such as the flow cell method (26), electric field (27, 28), magnetic field (29), electrospinning (30),...
Optimal control theory is applied to a system of ordinary differential equations modeling a two-strain tuberculosis model. Seeking to reduce the latent and infectious groups with the resistant-strain tuberculosis, we use controls representing two types of treatments. The optimal controls are characterized in terms of the optimality system, which is solved numerically for several scenarios.
Flow driven by pumping without valves is examined, motivated by biomedical applications: cardiopulmonary resuscitation (CPR) and the human fetus before the development of the heart valves. The direction of flow inside a loop of tubing which consists of (almost) rigid and flexible parts is investigated when the boundary of one end of the flexible segment is forced periodically in time. Despite the absence of valves, net flow around the loop may appear in these simulations. The magnitude and even the direction of this flow depend on the driving frequency of the periodic forcing.
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