The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.published_or_final_versio

Comparative analysis of models and performance indicators for optimal service facility location

This study investigates the optimal process for locating generic service facilities by applying and comparing several well-known basic models from the literature. At a strategic level, we emphasize that selecting the right location model to use could result in a problematic and possibly misleading task if not supported by appropriate quantitative analysis. For this reason, we propose a general methodological framework to analyze and compare the solutions provided by several models to obtain a comprehensive evaluation of the location decisions from several different perspectives. Therefore, a battery of key performance indicators (KPIs) has been developed and calculated for the different models’ solutions. Additional insights into the decision process have been obtained through a comparative analysis. The indicators involve topological, coverage, equity, robustness, dispersion, and accessibility aspects. Moreover, a specific part of the analysis is devoted to progressive location interventions over time and identifying core location decisions. Results on randomly generated instances, which simulate areas characterized by realistic geographical or demographic features, are reported to analyze the models’ behavior in different settings and demonstrate the methodology's general applicability. Our experimental campaign shows that the p-median model behaves very well against the proposed KPIs. In contrast, the maximal covering problem and some proposed back-up coverage models return very robust solutions when the location plan is implemented through several progressive interventions over time

Logic Synthesis for Interpolant Circuit Compaction

We address the problem of reducing the size of Craig's interpolants used in SAT-based model checking. Craig's interpolants are AND-OR circuits, generated by post-processing refutation proofs of SAT solvers. Being highly redundant, their compaction is typically tackled by reducing the proof graph and/or by exploiting standard logic synthesis techniques. In this paper, we propose a set of ad-hoc logic synthesis functions that, revisiting known logic synthesis approaches, specifically address speed and scalability. Though general and not restricted to interpolants, these techniques target the main sources of redundancy in combinational circuits. This paper includes an experimental evaluation, showing the benefits of the proposed techniques, on a set of benchmark interpolants arising from hardware model checking problems

Logic Synthesis for Interpolant Circuit Compaction

We address the problem of reducing the size of Craig's interpolants used in SAT-based model checking. Craig's interpolants are AND-OR circuits, generated by post-processing refutation proofs of SAT solvers. Being highly redundant, their compaction is typically tackled by reducing the proof graph and/or by exploiting standard logic synthesis techniques. In this paper, we propose a set of ad-hoc logic synthesis functions that, revisiting known logic synthesis approaches, specifically address speed and scalability. Though general and not restricted to interpolants, these techniques target the main sources of redundancy in combinational circuits. This paper includes an experimental evaluation, showing the benefits of the proposed techniques, on a set of benchmark interpolants arising from hardware model checking problems