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/Title (Swine origin influenza A \(H1N1\) virus and ICU capacity in the US � PLOS Currents Influenza)
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Swine origin influenza A \(H1N1\) virus and ICU capacity in the )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(US)] TJ ET
0.271 0.267 0.267 rg
BT 15.000 671.524 Td /F2 13.5 Tf  [(Are we prepared?)] TJ ET
Q
BT 15.000 653.050 Td /F3 9.8 Tf  [(August 22, 2009)] TJ ET
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BT 26.250 641.209 Td /F1 9.8 Tf  [(Marya D. Zilberberg)] TJ ET
0.271 0.267 0.267 rg
BT 112.391 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
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BT 117.812 641.209 Td /F1 9.8 Tf  [(Christian Sandrock)] TJ ET
0.271 0.267 0.267 rg
BT 200.171 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 205.591 641.209 Td /F1 9.8 Tf  [(Andrew Shorr)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 629.304 Td /F1 9.8 Tf  [(Zilberberg MD, Sandrock C, Shorr A. Swine origin influenza A \(H1N1\) virus and ICU capacity in the US: Are we prepared?. )] TJ ET
BT 26.250 617.400 Td /F1 9.8 Tf  [(PLOS Currents Influenza. 2009 Aug 22 . Edition 1. doi: 10.1371/currents.RRN1009.)] TJ ET
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BT 26.250 588.297 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 568.343 Td /F1 9.8 Tf  [(We developed a model simulating the potential impact of influenza H1N1 pandemic on the volume of acute respiratory failure )] TJ ET
BT 26.250 556.438 Td /F1 9.8 Tf  [(requiring mechanical ventilation \(ARF-MV\) and the accompanying mortality rate in the US. We calculate that 46 million people )] TJ ET
BT 26.250 544.533 Td /F1 9.8 Tf  [(will contract the infection, resulting in 2.7 million hospitalizations, 331,587 episodes of ARF-MV and nearly 200,000 deaths, )] TJ ET
BT 26.250 532.629 Td /F1 9.8 Tf  [(suggesting that the US may require the ability to provide MV at a volume approximately 33% over the current annual use.)] TJ ET
BT 26.250 496.026 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 476.072 Td /F1 9.8 Tf  [(In March of 2009 a novel strain of swine origin influenza A \(H1N1\) virus \(S-OIV\) was detected in Mexico. It has now spread to )] TJ ET
BT 26.250 464.167 Td /F1 9.8 Tf  [(the rest of the world. With over 170,000 laboratory-confirmed cases worldwide, the World Health Organization \(WHO\) has )] TJ ET
BT 26.250 452.262 Td /F1 9.8 Tf  [(declared a global pandemic )] TJ ET
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BT 148.183 452.262 Td /F1 9.8 Tf  [([1])] TJ ET
0.271 0.267 0.267 rg
BT 159.025 452.262 Td /F1 9.8 Tf  [( . In the United States, current estimates suggest an attack rate of approximately 6-8% in )] TJ ET
BT 26.250 440.358 Td /F1 9.8 Tf  [(affected communities, which according to officials from the Centers for Disease Control and Prevention \(CDC\) may more than )] TJ ET
BT 26.250 428.453 Td /F1 9.8 Tf  [(double during the traditional flu season )] TJ ET
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BT 196.427 428.453 Td /F1 9.8 Tf  [([2])] TJ ET
0.271 0.267 0.267 rg
BT 207.269 428.453 Td /F1 9.8 Tf  [( . Although reports of both severe illness and fatalities are uncommon, concern exists )] TJ ET
BT 26.250 416.548 Td /F1 9.8 Tf  [(about the potential for this virus to cause severe acute respiratory failure necessitating mechanical ventilation \(ARF-MV\) with )] TJ ET
BT 26.250 404.643 Td /F1 9.8 Tf  [(specialized methods )] TJ ET
0.267 0.267 0.267 rg
BT 117.286 404.643 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 128.128 404.643 Td /F1 9.8 Tf  [( . Since H1N1 is predicted to affect a significant proportion of the population, even a low incidence of )] TJ ET
BT 26.250 392.739 Td /F1 9.8 Tf  [(concomitant ARF-MV may overwhelm the already-stretched emergency department and intensive care unit \(ICU\) resources )] TJ ET
0.267 0.267 0.267 rg
BT 561.593 392.739 Td /F1 9.8 Tf  [([4])] TJ ET
0.271 0.267 0.267 rg
BT 572.435 392.739 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 380.834 Td /F1 9.8 Tf  [(To estimate what the S-OIV may portend for the ARF-MV in the US, we developed a model simulating its potential impact on )] TJ ET
BT 26.250 368.929 Td /F1 9.8 Tf  [(the volume of ARF-MV and the accompanying mortality rate.)] TJ ET
BT 26.250 332.327 Td /F4 12.0 Tf  [(METHODS)] TJ ET
BT 26.250 312.372 Td /F1 9.8 Tf  [(Because the situation is evolving rapidly and information is scant, in addition to peer-reviewed studies we relied on other )] TJ ET
BT 26.250 300.468 Td /F1 9.8 Tf  [(sources of credible estimates and reasonable assumptions for model inputs )] TJ ET
BT 354.640 300.468 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 394.732 300.468 Td /F1 9.8 Tf  [(. We employed data from the CDC to )] TJ ET
BT 26.250 288.563 Td /F1 9.8 Tf  [(estimate the H1N1 incidence and mortality in the US population, and those from the Mexican experience for our baseline rates )] TJ ET
BT 26.250 276.658 Td /F1 9.8 Tf  [(of hospitalization and ARF-MV )] TJ ET
0.267 0.267 0.267 rg
BT 160.634 276.658 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 171.476 276.658 Td /F1 9.8 Tf  [( . We explored a range of potential values for model inputs given the uncertainties surrounding )] TJ ET
BT 26.250 264.753 Td /F1 9.8 Tf  [(them, and each outcome was subjected to 10,000 Monte Carlo simulation trials.)] TJ ET
BT 26.250 228.151 Td /F4 12.0 Tf  [(RESULTS AND DISCUSSION)] TJ ET
BT 26.250 208.197 Td /F1 9.8 Tf  [(In the base case, we calculate that 46 million people will contract the infection, resulting in 2.7 million hospitalizations, 331,587 )] TJ ET
BT 26.250 196.292 Td /F1 9.8 Tf  [(episodes of ARF-MV and nearly 200,000 deaths )] TJ ET
BT 237.065 196.292 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 277.156 196.292 Td /F1 9.8 Tf  [(, suggesting that the US may require the ability to provide MV at a )] TJ ET
BT 26.250 184.387 Td /F1 9.8 Tf  [(volume between 23% and 45% over the current use )] TJ ET
0.267 0.267 0.267 rg
BT 252.781 184.387 Td /F1 9.8 Tf  [([4])] TJ ET
0.271 0.267 0.267 rg
BT 263.624 184.387 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 303.716 184.387 Td /F1 9.8 Tf  [(. Tornado diagrams for each outcome indicated that the )] TJ ET
BT 26.250 172.482 Td /F1 9.8 Tf  [(estimates are equally sensitive to all corresponding inputs \(data not shown\).)] TJ ET
BT 26.250 153.078 Td /F1 9.8 Tf  [(Our model is limited by the accuracy of the input parameters. As the flu season progresses, more precise inputs may become )] TJ ET
BT 26.250 141.173 Td /F1 9.8 Tf  [(available. Additionally, we did not model the impact of an effective vaccine on the attack rates or the outcomes; however, )] TJ ET
BT 26.250 129.268 Td /F1 9.8 Tf  [(because of the uncertainties surrounding the timing and the number of doses available, and its effectiveness, this too will )] TJ ET
BT 26.250 117.363 Td /F1 9.8 Tf  [(require updating when the information becomes available. Finally, the applicability of data from Mexico is uncertain )] TJ ET
0.267 0.267 0.267 rg
BT 522.622 117.363 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 533.465 117.363 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 105.459 Td /F1 9.8 Tf  [(Differences in the delivery of and access to healthcare between the US and Mexico may alter both rates of progression to ARF-)] TJ ET
BT 26.250 93.554 Td /F1 9.8 Tf  [(MV and mortality.)] TJ ET
BT 26.250 74.149 Td /F1 9.8 Tf  [(These limitations notwithstanding, the model is informative in several ways. First, our findings represent an attempt to quantify )] TJ ET
BT 26.250 62.244 Td /F1 9.8 Tf  [(the potential need for surge capacity in our ICUs in response to this evolving pandemic. We should point out that, although we )] TJ ET
BT 26.250 50.340 Td /F1 9.8 Tf  [(modeled the burden over the entire epidemic period, the vast majority of the cases will likely occur during the peak flu months, )] TJ ET
BT 26.250 38.435 Td /F1 9.8 Tf  [(thus straining the ICU and MV capacity even more intensely over a shorter period of time. For this reason, our estimates )] TJ ET
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15.000 662.316 577.500 75.684 re W n
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BT 15.000 718.042 Td /F2 21.0 Tf  [(Swine origin influenza A \(H1N1\) virus and ICU capacity in the )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(US)] TJ ET
0.271 0.267 0.267 rg
BT 15.000 671.524 Td /F2 13.5 Tf  [(Are we prepared?)] TJ ET
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BT 15.000 653.050 Td /F3 9.8 Tf  [(August 22, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 641.209 Td /F1 9.8 Tf  [(Marya D. Zilberberg)] TJ ET
0.271 0.267 0.267 rg
BT 112.391 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 117.812 641.209 Td /F1 9.8 Tf  [(Christian Sandrock)] TJ ET
0.271 0.267 0.267 rg
BT 200.171 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 205.591 641.209 Td /F1 9.8 Tf  [(Andrew Shorr)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 629.304 Td /F1 9.8 Tf  [(Zilberberg MD, Sandrock C, Shorr A. Swine origin influenza A \(H1N1\) virus and ICU capacity in the US: Are we prepared?. )] TJ ET
BT 26.250 617.400 Td /F1 9.8 Tf  [(PLOS Currents Influenza. 2009 Aug 22 . Edition 1. doi: 10.1371/currents.RRN1009.)] TJ ET
q
15.000 24.149 577.500 590.870 re W n
0.271 0.267 0.267 rg
BT 26.250 588.297 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 568.343 Td /F1 9.8 Tf  [(We developed a model simulating the potential impact of influenza H1N1 pandemic on the volume of acute respiratory failure )] TJ ET
BT 26.250 556.438 Td /F1 9.8 Tf  [(requiring mechanical ventilation \(ARF-MV\) and the accompanying mortality rate in the US. We calculate that 46 million people )] TJ ET
BT 26.250 544.533 Td /F1 9.8 Tf  [(will contract the infection, resulting in 2.7 million hospitalizations, 331,587 episodes of ARF-MV and nearly 200,000 deaths, )] TJ ET
BT 26.250 532.629 Td /F1 9.8 Tf  [(suggesting that the US may require the ability to provide MV at a volume approximately 33% over the current annual use.)] TJ ET
BT 26.250 496.026 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 476.072 Td /F1 9.8 Tf  [(In March of 2009 a novel strain of swine origin influenza A \(H1N1\) virus \(S-OIV\) was detected in Mexico. It has now spread to )] TJ ET
BT 26.250 464.167 Td /F1 9.8 Tf  [(the rest of the world. With over 170,000 laboratory-confirmed cases worldwide, the World Health Organization \(WHO\) has )] TJ ET
BT 26.250 452.262 Td /F1 9.8 Tf  [(declared a global pandemic )] TJ ET
0.267 0.267 0.267 rg
BT 148.183 452.262 Td /F1 9.8 Tf  [([1])] TJ ET
0.271 0.267 0.267 rg
BT 159.025 452.262 Td /F1 9.8 Tf  [( . In the United States, current estimates suggest an attack rate of approximately 6-8% in )] TJ ET
BT 26.250 440.358 Td /F1 9.8 Tf  [(affected communities, which according to officials from the Centers for Disease Control and Prevention \(CDC\) may more than )] TJ ET
BT 26.250 428.453 Td /F1 9.8 Tf  [(double during the traditional flu season )] TJ ET
0.267 0.267 0.267 rg
BT 196.427 428.453 Td /F1 9.8 Tf  [([2])] TJ ET
0.271 0.267 0.267 rg
BT 207.269 428.453 Td /F1 9.8 Tf  [( . Although reports of both severe illness and fatalities are uncommon, concern exists )] TJ ET
BT 26.250 416.548 Td /F1 9.8 Tf  [(about the potential for this virus to cause severe acute respiratory failure necessitating mechanical ventilation \(ARF-MV\) with )] TJ ET
BT 26.250 404.643 Td /F1 9.8 Tf  [(specialized methods )] TJ ET
0.267 0.267 0.267 rg
BT 117.286 404.643 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 128.128 404.643 Td /F1 9.8 Tf  [( . Since H1N1 is predicted to affect a significant proportion of the population, even a low incidence of )] TJ ET
BT 26.250 392.739 Td /F1 9.8 Tf  [(concomitant ARF-MV may overwhelm the already-stretched emergency department and intensive care unit \(ICU\) resources )] TJ ET
0.267 0.267 0.267 rg
BT 561.593 392.739 Td /F1 9.8 Tf  [([4])] TJ ET
0.271 0.267 0.267 rg
BT 572.435 392.739 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 380.834 Td /F1 9.8 Tf  [(To estimate what the S-OIV may portend for the ARF-MV in the US, we developed a model simulating its potential impact on )] TJ ET
BT 26.250 368.929 Td /F1 9.8 Tf  [(the volume of ARF-MV and the accompanying mortality rate.)] TJ ET
BT 26.250 332.327 Td /F4 12.0 Tf  [(METHODS)] TJ ET
BT 26.250 312.372 Td /F1 9.8 Tf  [(Because the situation is evolving rapidly and information is scant, in addition to peer-reviewed studies we relied on other )] TJ ET
BT 26.250 300.468 Td /F1 9.8 Tf  [(sources of credible estimates and reasonable assumptions for model inputs )] TJ ET
BT 354.640 300.468 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 394.732 300.468 Td /F1 9.8 Tf  [(. We employed data from the CDC to )] TJ ET
BT 26.250 288.563 Td /F1 9.8 Tf  [(estimate the H1N1 incidence and mortality in the US population, and those from the Mexican experience for our baseline rates )] TJ ET
BT 26.250 276.658 Td /F1 9.8 Tf  [(of hospitalization and ARF-MV )] TJ ET
0.267 0.267 0.267 rg
BT 160.634 276.658 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 171.476 276.658 Td /F1 9.8 Tf  [( . We explored a range of potential values for model inputs given the uncertainties surrounding )] TJ ET
BT 26.250 264.753 Td /F1 9.8 Tf  [(them, and each outcome was subjected to 10,000 Monte Carlo simulation trials.)] TJ ET
BT 26.250 228.151 Td /F4 12.0 Tf  [(RESULTS AND DISCUSSION)] TJ ET
BT 26.250 208.197 Td /F1 9.8 Tf  [(In the base case, we calculate that 46 million people will contract the infection, resulting in 2.7 million hospitalizations, 331,587 )] TJ ET
BT 26.250 196.292 Td /F1 9.8 Tf  [(episodes of ARF-MV and nearly 200,000 deaths )] TJ ET
BT 237.065 196.292 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 277.156 196.292 Td /F1 9.8 Tf  [(, suggesting that the US may require the ability to provide MV at a )] TJ ET
BT 26.250 184.387 Td /F1 9.8 Tf  [(volume between 23% and 45% over the current use )] TJ ET
0.267 0.267 0.267 rg
BT 252.781 184.387 Td /F1 9.8 Tf  [([4])] TJ ET
0.271 0.267 0.267 rg
BT 263.624 184.387 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 303.716 184.387 Td /F1 9.8 Tf  [(. Tornado diagrams for each outcome indicated that the )] TJ ET
BT 26.250 172.482 Td /F1 9.8 Tf  [(estimates are equally sensitive to all corresponding inputs \(data not shown\).)] TJ ET
BT 26.250 153.078 Td /F1 9.8 Tf  [(Our model is limited by the accuracy of the input parameters. As the flu season progresses, more precise inputs may become )] TJ ET
BT 26.250 141.173 Td /F1 9.8 Tf  [(available. Additionally, we did not model the impact of an effective vaccine on the attack rates or the outcomes; however, )] TJ ET
BT 26.250 129.268 Td /F1 9.8 Tf  [(because of the uncertainties surrounding the timing and the number of doses available, and its effectiveness, this too will )] TJ ET
BT 26.250 117.363 Td /F1 9.8 Tf  [(require updating when the information becomes available. Finally, the applicability of data from Mexico is uncertain )] TJ ET
0.267 0.267 0.267 rg
BT 522.622 117.363 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 533.465 117.363 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 105.459 Td /F1 9.8 Tf  [(Differences in the delivery of and access to healthcare between the US and Mexico may alter both rates of progression to ARF-)] TJ ET
BT 26.250 93.554 Td /F1 9.8 Tf  [(MV and mortality.)] TJ ET
BT 26.250 74.149 Td /F1 9.8 Tf  [(These limitations notwithstanding, the model is informative in several ways. First, our findings represent an attempt to quantify )] TJ ET
BT 26.250 62.244 Td /F1 9.8 Tf  [(the potential need for surge capacity in our ICUs in response to this evolving pandemic. We should point out that, although we )] TJ ET
BT 26.250 50.340 Td /F1 9.8 Tf  [(modeled the burden over the entire epidemic period, the vast majority of the cases will likely occur during the peak flu months, )] TJ ET
BT 26.250 38.435 Td /F1 9.8 Tf  [(thus straining the ICU and MV capacity even more intensely over a shorter period of time. For this reason, our estimates )] TJ ET
Q
q
15.000 662.316 577.500 75.684 re W n
0.267 0.267 0.267 rg
BT 15.000 718.042 Td /F2 21.0 Tf  [(Swine origin influenza A \(H1N1\) virus and ICU capacity in the )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(US)] TJ ET
0.271 0.267 0.267 rg
BT 15.000 671.524 Td /F2 13.5 Tf  [(Are we prepared?)] TJ ET
Q
BT 15.000 653.050 Td /F3 9.8 Tf  [(August 22, 2009)] TJ ET
0.267 0.267 0.267 rg
BT 26.250 641.209 Td /F1 9.8 Tf  [(Marya D. Zilberberg)] TJ ET
0.271 0.267 0.267 rg
BT 112.391 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 117.812 641.209 Td /F1 9.8 Tf  [(Christian Sandrock)] TJ ET
0.271 0.267 0.267 rg
BT 200.171 641.209 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 205.591 641.209 Td /F1 9.8 Tf  [(Andrew Shorr)] TJ ET
0.271 0.267 0.267 rg
BT 26.250 629.304 Td /F1 9.8 Tf  [(Zilberberg MD, Sandrock C, Shorr A. Swine origin influenza A \(H1N1\) virus and ICU capacity in the US: Are we prepared?. )] TJ ET
BT 26.250 617.400 Td /F1 9.8 Tf  [(PLOS Currents Influenza. 2009 Aug 22 . Edition 1. doi: 10.1371/currents.RRN1009.)] TJ ET
q
15.000 24.149 577.500 590.870 re W n
0.271 0.267 0.267 rg
BT 26.250 588.297 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 568.343 Td /F1 9.8 Tf  [(We developed a model simulating the potential impact of influenza H1N1 pandemic on the volume of acute respiratory failure )] TJ ET
BT 26.250 556.438 Td /F1 9.8 Tf  [(requiring mechanical ventilation \(ARF-MV\) and the accompanying mortality rate in the US. We calculate that 46 million people )] TJ ET
BT 26.250 544.533 Td /F1 9.8 Tf  [(will contract the infection, resulting in 2.7 million hospitalizations, 331,587 episodes of ARF-MV and nearly 200,000 deaths, )] TJ ET
BT 26.250 532.629 Td /F1 9.8 Tf  [(suggesting that the US may require the ability to provide MV at a volume approximately 33% over the current annual use.)] TJ ET
BT 26.250 496.026 Td /F4 12.0 Tf  [(INTRODUCTION)] TJ ET
BT 26.250 476.072 Td /F1 9.8 Tf  [(In March of 2009 a novel strain of swine origin influenza A \(H1N1\) virus \(S-OIV\) was detected in Mexico. It has now spread to )] TJ ET
BT 26.250 464.167 Td /F1 9.8 Tf  [(the rest of the world. With over 170,000 laboratory-confirmed cases worldwide, the World Health Organization \(WHO\) has )] TJ ET
BT 26.250 452.262 Td /F1 9.8 Tf  [(declared a global pandemic )] TJ ET
0.267 0.267 0.267 rg
BT 148.183 452.262 Td /F1 9.8 Tf  [([1])] TJ ET
0.271 0.267 0.267 rg
BT 159.025 452.262 Td /F1 9.8 Tf  [( . In the United States, current estimates suggest an attack rate of approximately 6-8% in )] TJ ET
BT 26.250 440.358 Td /F1 9.8 Tf  [(affected communities, which according to officials from the Centers for Disease Control and Prevention \(CDC\) may more than )] TJ ET
BT 26.250 428.453 Td /F1 9.8 Tf  [(double during the traditional flu season )] TJ ET
0.267 0.267 0.267 rg
BT 196.427 428.453 Td /F1 9.8 Tf  [([2])] TJ ET
0.271 0.267 0.267 rg
BT 207.269 428.453 Td /F1 9.8 Tf  [( . Although reports of both severe illness and fatalities are uncommon, concern exists )] TJ ET
BT 26.250 416.548 Td /F1 9.8 Tf  [(about the potential for this virus to cause severe acute respiratory failure necessitating mechanical ventilation \(ARF-MV\) with )] TJ ET
BT 26.250 404.643 Td /F1 9.8 Tf  [(specialized methods )] TJ ET
0.267 0.267 0.267 rg
BT 117.286 404.643 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 128.128 404.643 Td /F1 9.8 Tf  [( . Since H1N1 is predicted to affect a significant proportion of the population, even a low incidence of )] TJ ET
BT 26.250 392.739 Td /F1 9.8 Tf  [(concomitant ARF-MV may overwhelm the already-stretched emergency department and intensive care unit \(ICU\) resources )] TJ ET
0.267 0.267 0.267 rg
BT 561.593 392.739 Td /F1 9.8 Tf  [([4])] TJ ET
0.271 0.267 0.267 rg
BT 572.435 392.739 Td /F1 9.8 Tf  [( . )] TJ ET
BT 26.250 380.834 Td /F1 9.8 Tf  [(To estimate what the S-OIV may portend for the ARF-MV in the US, we developed a model simulating its potential impact on )] TJ ET
BT 26.250 368.929 Td /F1 9.8 Tf  [(the volume of ARF-MV and the accompanying mortality rate.)] TJ ET
BT 26.250 332.327 Td /F4 12.0 Tf  [(METHODS)] TJ ET
BT 26.250 312.372 Td /F1 9.8 Tf  [(Because the situation is evolving rapidly and information is scant, in addition to peer-reviewed studies we relied on other )] TJ ET
BT 26.250 300.468 Td /F1 9.8 Tf  [(sources of credible estimates and reasonable assumptions for model inputs )] TJ ET
BT 354.640 300.468 Td /F4 9.8 Tf  [(\(Table 1\))] TJ ET
BT 394.732 300.468 Td /F1 9.8 Tf  [(. We employed data from the CDC to )] TJ ET
BT 26.250 288.563 Td /F1 9.8 Tf  [(estimate the H1N1 incidence and mortality in the US population, and those from the Mexican experience for our baseline rates )] TJ ET
BT 26.250 276.658 Td /F1 9.8 Tf  [(of hospitalization and ARF-MV )] TJ ET
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BT 26.250 264.753 Td /F1 9.8 Tf  [(them, and each outcome was subjected to 10,000 Monte Carlo simulation trials.)] TJ ET
BT 26.250 228.151 Td /F4 12.0 Tf  [(RESULTS AND DISCUSSION)] TJ ET
BT 26.250 208.197 Td /F1 9.8 Tf  [(In the base case, we calculate that 46 million people will contract the infection, resulting in 2.7 million hospitalizations, 331,587 )] TJ ET
BT 26.250 196.292 Td /F1 9.8 Tf  [(episodes of ARF-MV and nearly 200,000 deaths )] TJ ET
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BT 303.716 184.387 Td /F1 9.8 Tf  [(. Tornado diagrams for each outcome indicated that the )] TJ ET
BT 26.250 172.482 Td /F1 9.8 Tf  [(estimates are equally sensitive to all corresponding inputs \(data not shown\).)] TJ ET
BT 26.250 153.078 Td /F1 9.8 Tf  [(Our model is limited by the accuracy of the input parameters. As the flu season progresses, more precise inputs may become )] TJ ET
BT 26.250 141.173 Td /F1 9.8 Tf  [(available. Additionally, we did not model the impact of an effective vaccine on the attack rates or the outcomes; however, )] TJ ET
BT 26.250 129.268 Td /F1 9.8 Tf  [(because of the uncertainties surrounding the timing and the number of doses available, and its effectiveness, this too will )] TJ ET
BT 26.250 117.363 Td /F1 9.8 Tf  [(require updating when the information becomes available. Finally, the applicability of data from Mexico is uncertain )] TJ ET
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BT 533.465 117.363 Td /F1 9.8 Tf  [(. )] TJ ET
BT 26.250 105.459 Td /F1 9.8 Tf  [(Differences in the delivery of and access to healthcare between the US and Mexico may alter both rates of progression to ARF-)] TJ ET
BT 26.250 93.554 Td /F1 9.8 Tf  [(MV and mortality.)] TJ ET
BT 26.250 74.149 Td /F1 9.8 Tf  [(These limitations notwithstanding, the model is informative in several ways. First, our findings represent an attempt to quantify )] TJ ET
BT 26.250 62.244 Td /F1 9.8 Tf  [(the potential need for surge capacity in our ICUs in response to this evolving pandemic. We should point out that, although we )] TJ ET
BT 26.250 50.340 Td /F1 9.8 Tf  [(modeled the burden over the entire epidemic period, the vast majority of the cases will likely occur during the peak flu months, )] TJ ET
BT 26.250 38.435 Td /F1 9.8 Tf  [(thus straining the ICU and MV capacity even more intensely over a shorter period of time. For this reason, our estimates )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Influenza)] TJ ET

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0.271 0.267 0.267 rg
q
15.000 34.499 577.500 742.501 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(emphasize the need for careful planning and prioritization schemes as they relate to the allocation of scarce ICU resources. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(Second, in light of the recent report of severe ARF-MV cases requiring advanced MV modes available only in specialized )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(centers and requiring special equipment not commonly stockpiled at the state and federal levels, planners must explore the )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(feasibility of regionalizing S-OIV-related ARF-MV care )] TJ ET
0.267 0.267 0.267 rg
BT 261.400 731.762 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 272.243 731.762 Td /F1 9.8 Tf  [(. Third, as this infection will likely disproportionately affect areas of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(higher population density, regional response plans are urgently needed.)] TJ ET
BT 26.250 683.255 Td /F4 12.0 Tf  [(CONCLUSION)] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(In summary, estimates of what may be expected with S-OIV should help ICU directors, hospital administrators and other policy )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(makers allocate appropriate resources for an effective coordinated response. In addition to education and prevention, efforts )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(must focus on planning for the impact of this virus on ARF-MV.)] TJ ET
BT 26.250 620.086 Td /F4 9.8 Tf  [(Table 1. Model input parameters and outcome estimates)] TJ ET
1.000 1.000 1.000 rg
26.250 392.154 555.000 218.051 re f
0.267 0.267 0.267 rg
26.625 609.080 185.250 0.750 re f
26.625 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 599.225 Td /F4 9.8 Tf  [(Input Parameters)] TJ ET
0.267 0.267 0.267 rg
211.125 609.080 185.250 0.750 re f
211.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 599.225 Td /F4 9.8 Tf  [(Estimate*)] TJ ET
0.267 0.267 0.267 rg
395.625 609.080 185.250 0.750 re f
395.625 593.199 0.750 16.631 re f
580.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 599.225 Td /F4 9.8 Tf  [(Source)] TJ ET
0.267 0.267 0.267 rg
26.625 593.199 185.250 0.750 re f
26.625 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 583.344 Td /F1 9.8 Tf  [(US population)] TJ ET
0.267 0.267 0.267 rg
211.125 593.199 185.250 0.750 re f
211.125 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 583.344 Td /F1 9.8 Tf  [(307,024,641)] TJ ET
0.267 0.267 0.267 rg
395.625 593.199 185.250 0.750 re f
395.625 577.318 0.750 16.631 re f
580.125 577.318 0.750 16.631 re f
BT 400.875 583.344 Td /F1 9.8 Tf  [([6])] TJ ET
26.625 577.318 185.250 0.750 re f
26.625 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 567.463 Td /F1 9.8 Tf  [(Estimated attack rate)] TJ ET
0.267 0.267 0.267 rg
211.125 577.318 185.250 0.750 re f
211.125 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 567.463 Td /F1 9.8 Tf  [(15% \(6%-24%\))] TJ ET
0.267 0.267 0.267 rg
395.625 577.318 185.250 0.750 re f
395.625 561.436 0.750 16.631 re f
580.125 561.436 0.750 16.631 re f
BT 400.875 567.463 Td /F1 9.8 Tf  [([2])] TJ ET
26.625 561.437 185.250 0.750 re f
26.625 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 551.582 Td /F1 9.8 Tf  [(Hospitalization rate, relative to attack )] TJ ET
BT 31.875 543.950 Td /F1 9.8 Tf  [(rate)] TJ ET
0.267 0.267 0.267 rg
211.125 561.437 185.250 0.750 re f
211.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 216.375 551.582 Td /F1 9.8 Tf  [(6% \(2%-10%\))] TJ ET
0.267 0.267 0.267 rg
395.625 561.437 185.250 0.750 re f
395.625 522.662 0.750 39.525 re f
580.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 400.875 551.582 Td /F1 9.8 Tf  [(6% = CA experience, personal )] TJ ET
BT 400.875 543.950 Td /F1 9.8 Tf  [(communication)] TJ ET
BT 400.875 536.319 Td /F1 9.8 Tf  [(2% = assumption)] TJ ET
BT 400.875 528.688 Td /F1 9.8 Tf  [(10% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 528.688 Td /F1 9.8 Tf  [([5])] TJ ET
26.625 522.661 185.250 0.750 re f
26.625 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 512.807 Td /F1 9.8 Tf  [(ARF rate \(relative to hospitalization\))] TJ ET
0.267 0.267 0.267 rg
211.125 522.661 185.250 0.750 re f
211.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 512.807 Td /F1 9.8 Tf  [(12% \(6%-18%\))] TJ ET
0.267 0.267 0.267 rg
395.625 522.661 185.250 0.750 re f
395.625 499.149 0.750 24.262 re f
580.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 512.807 Td /F1 9.8 Tf  [(12% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 512.807 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 505.175 Td /F1 9.8 Tf  [(6% and 18% = assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 499.149 185.250 0.750 re f
26.625 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 489.294 Td /F1 9.8 Tf  [(Mortality rate \(relative to ARF\))] TJ ET
0.267 0.267 0.267 rg
211.125 499.149 185.250 0.750 re f
211.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 489.294 Td /F1 9.8 Tf  [(58% \(40%-80%\))] TJ ET
0.267 0.267 0.267 rg
395.625 499.149 185.250 0.750 re f
395.625 475.637 0.750 24.262 re f
580.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 489.294 Td /F1 9.8 Tf  [(58% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 489.294 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 481.663 Td /F1 9.8 Tf  [(40% and 80% =assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 475.637 185.250 0.750 re f
26.625 474.887 0.750 1.500 re f
211.125 475.637 185.250 0.750 re f
211.125 474.887 0.750 1.500 re f
395.625 475.637 185.250 0.750 re f
395.625 474.887 0.750 1.500 re f
580.125 474.887 0.750 1.500 re f
26.625 474.887 185.250 0.750 re f
26.625 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 31.875 462.671 Td /F4 9.8 Tf  [(Outcomes)] TJ ET
BT 79.553 465.236 Td /F4 8.7 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
211.125 474.887 185.250 0.750 re f
211.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 216.375 465.031 Td /F4 9.8 Tf  [(Mean estimate)] TJ ET
0.267 0.267 0.267 rg
395.625 474.887 185.250 0.750 re f
395.625 456.055 0.750 19.582 re f
580.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 400.875 465.031 Td /F4 9.8 Tf  [(95% CI)] TJ ET
0.267 0.267 0.267 rg
26.625 456.055 185.250 0.750 re f
26.625 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 446.200 Td /F1 9.8 Tf  [(Total cases)] TJ ET
0.267 0.267 0.267 rg
211.125 456.055 185.250 0.750 re f
211.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 446.200 Td /F1 9.8 Tf  [(46,053,696)] TJ ET
0.267 0.267 0.267 rg
395.625 456.055 185.250 0.750 re f
395.625 440.173 0.750 16.631 re f
580.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 446.200 Td /F1 9.8 Tf  [(36,937,583-55,094,920)] TJ ET
0.267 0.267 0.267 rg
26.625 440.173 185.250 0.750 re f
26.625 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 430.318 Td /F1 9.8 Tf  [(Number hospitalizations)] TJ ET
0.267 0.267 0.267 rg
211.125 440.173 185.250 0.750 re f
211.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 430.318 Td /F1 9.8 Tf  [(2,763,222)] TJ ET
0.267 0.267 0.267 rg
395.625 440.173 185.250 0.750 re f
395.625 424.292 0.750 16.631 re f
580.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 430.318 Td /F1 9.8 Tf  [(2,034,413-3,585,032)] TJ ET
0.267 0.267 0.267 rg
26.625 424.292 185.250 0.750 re f
26.625 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 414.437 Td /F1 9.8 Tf  [(ARF cases)] TJ ET
0.267 0.267 0.267 rg
211.125 424.292 185.250 0.750 re f
211.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 414.437 Td /F1 9.8 Tf  [(331,587)] TJ ET
0.267 0.267 0.267 rg
395.625 424.292 185.250 0.750 re f
395.625 408.411 0.750 16.631 re f
580.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 414.437 Td /F1 9.8 Tf  [(227,866-454,001)] TJ ET
0.267 0.267 0.267 rg
26.625 408.411 185.250 0.750 re f
26.625 392.529 185.250 0.750 re f
26.625 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 398.556 Td /F1 9.8 Tf  [(Deaths)] TJ ET
0.267 0.267 0.267 rg
211.125 408.411 185.250 0.750 re f
211.125 392.529 185.250 0.750 re f
211.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 398.556 Td /F1 9.8 Tf  [(192,320)] TJ ET
0.267 0.267 0.267 rg
395.625 408.411 185.250 0.750 re f
395.625 392.529 185.250 0.750 re f
395.625 392.529 0.750 16.631 re f
580.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 398.556 Td /F1 9.8 Tf  [(125,945-276,482)] TJ ET
BT 26.250 345.131 Td /F1 9.8 Tf  [(*Each input parameter was assumed to be normally distributed)] TJ ET
BT 26.250 329.614 Td /F4 8.7 Tf  [(�)] TJ ET
BT 31.545 325.726 Td /F1 9.8 Tf  [( Outcome estimates and corresponding confidence intervals are based on Monte Carlo simulations, 10,000 trials for each )] TJ ET
BT 26.250 313.821 Td /F1 9.8 Tf  [(outcome)] TJ ET
BT 26.250 294.416 Td /F1 9.8 Tf  [(CA = California, ARF = acute respiratory failure, CI = confidence interval)] TJ ET
BT 26.250 257.814 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 237.860 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 201.257 Td /F4 12.0 Tf  [(Funding information)] TJ ET
BT 26.250 181.303 Td /F1 9.8 Tf  [(The authors received no funding for this study)] TJ ET
BT 26.250 152.200 Td /F4 12.0 Tf  [(Competing interests)] TJ ET
BT 26.250 132.246 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 95.644 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 68.189 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 68.189 Td /F1 9.8 Tf  [(Available at http://en.wikipedia.org/wiki/2009_flu_pandemic; accessed July 28, 2009)] TJ ET
BT 26.250 48.785 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 48.785 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\) Press Brief from August 24, 2009; available at )] TJ ET
Q
q
15.000 34.499 577.500 742.501 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(emphasize the need for careful planning and prioritization schemes as they relate to the allocation of scarce ICU resources. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(Second, in light of the recent report of severe ARF-MV cases requiring advanced MV modes available only in specialized )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(centers and requiring special equipment not commonly stockpiled at the state and federal levels, planners must explore the )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(feasibility of regionalizing S-OIV-related ARF-MV care )] TJ ET
0.267 0.267 0.267 rg
BT 261.400 731.762 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 272.243 731.762 Td /F1 9.8 Tf  [(. Third, as this infection will likely disproportionately affect areas of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(higher population density, regional response plans are urgently needed.)] TJ ET
BT 26.250 683.255 Td /F4 12.0 Tf  [(CONCLUSION)] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(In summary, estimates of what may be expected with S-OIV should help ICU directors, hospital administrators and other policy )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(makers allocate appropriate resources for an effective coordinated response. In addition to education and prevention, efforts )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(must focus on planning for the impact of this virus on ARF-MV.)] TJ ET
BT 26.250 620.086 Td /F4 9.8 Tf  [(Table 1. Model input parameters and outcome estimates)] TJ ET
1.000 1.000 1.000 rg
26.250 392.154 555.000 218.051 re f
0.267 0.267 0.267 rg
26.625 609.080 185.250 0.750 re f
26.625 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 599.225 Td /F4 9.8 Tf  [(Input Parameters)] TJ ET
0.267 0.267 0.267 rg
211.125 609.080 185.250 0.750 re f
211.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 599.225 Td /F4 9.8 Tf  [(Estimate*)] TJ ET
0.267 0.267 0.267 rg
395.625 609.080 185.250 0.750 re f
395.625 593.199 0.750 16.631 re f
580.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 599.225 Td /F4 9.8 Tf  [(Source)] TJ ET
0.267 0.267 0.267 rg
26.625 593.199 185.250 0.750 re f
26.625 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 583.344 Td /F1 9.8 Tf  [(US population)] TJ ET
0.267 0.267 0.267 rg
211.125 593.199 185.250 0.750 re f
211.125 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 583.344 Td /F1 9.8 Tf  [(307,024,641)] TJ ET
0.267 0.267 0.267 rg
395.625 593.199 185.250 0.750 re f
395.625 577.318 0.750 16.631 re f
580.125 577.318 0.750 16.631 re f
BT 400.875 583.344 Td /F1 9.8 Tf  [([6])] TJ ET
26.625 577.318 185.250 0.750 re f
26.625 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 567.463 Td /F1 9.8 Tf  [(Estimated attack rate)] TJ ET
0.267 0.267 0.267 rg
211.125 577.318 185.250 0.750 re f
211.125 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 567.463 Td /F1 9.8 Tf  [(15% \(6%-24%\))] TJ ET
0.267 0.267 0.267 rg
395.625 577.318 185.250 0.750 re f
395.625 561.436 0.750 16.631 re f
580.125 561.436 0.750 16.631 re f
BT 400.875 567.463 Td /F1 9.8 Tf  [([2])] TJ ET
26.625 561.437 185.250 0.750 re f
26.625 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 551.582 Td /F1 9.8 Tf  [(Hospitalization rate, relative to attack )] TJ ET
BT 31.875 543.950 Td /F1 9.8 Tf  [(rate)] TJ ET
0.267 0.267 0.267 rg
211.125 561.437 185.250 0.750 re f
211.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 216.375 551.582 Td /F1 9.8 Tf  [(6% \(2%-10%\))] TJ ET
0.267 0.267 0.267 rg
395.625 561.437 185.250 0.750 re f
395.625 522.662 0.750 39.525 re f
580.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 400.875 551.582 Td /F1 9.8 Tf  [(6% = CA experience, personal )] TJ ET
BT 400.875 543.950 Td /F1 9.8 Tf  [(communication)] TJ ET
BT 400.875 536.319 Td /F1 9.8 Tf  [(2% = assumption)] TJ ET
BT 400.875 528.688 Td /F1 9.8 Tf  [(10% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 528.688 Td /F1 9.8 Tf  [([5])] TJ ET
26.625 522.661 185.250 0.750 re f
26.625 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 512.807 Td /F1 9.8 Tf  [(ARF rate \(relative to hospitalization\))] TJ ET
0.267 0.267 0.267 rg
211.125 522.661 185.250 0.750 re f
211.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 512.807 Td /F1 9.8 Tf  [(12% \(6%-18%\))] TJ ET
0.267 0.267 0.267 rg
395.625 522.661 185.250 0.750 re f
395.625 499.149 0.750 24.262 re f
580.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 512.807 Td /F1 9.8 Tf  [(12% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 512.807 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 505.175 Td /F1 9.8 Tf  [(6% and 18% = assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 499.149 185.250 0.750 re f
26.625 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 489.294 Td /F1 9.8 Tf  [(Mortality rate \(relative to ARF\))] TJ ET
0.267 0.267 0.267 rg
211.125 499.149 185.250 0.750 re f
211.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 489.294 Td /F1 9.8 Tf  [(58% \(40%-80%\))] TJ ET
0.267 0.267 0.267 rg
395.625 499.149 185.250 0.750 re f
395.625 475.637 0.750 24.262 re f
580.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 489.294 Td /F1 9.8 Tf  [(58% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 489.294 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 481.663 Td /F1 9.8 Tf  [(40% and 80% =assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 475.637 185.250 0.750 re f
26.625 474.887 0.750 1.500 re f
211.125 475.637 185.250 0.750 re f
211.125 474.887 0.750 1.500 re f
395.625 475.637 185.250 0.750 re f
395.625 474.887 0.750 1.500 re f
580.125 474.887 0.750 1.500 re f
26.625 474.887 185.250 0.750 re f
26.625 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 31.875 462.671 Td /F4 9.8 Tf  [(Outcomes)] TJ ET
BT 79.553 465.236 Td /F4 8.7 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
211.125 474.887 185.250 0.750 re f
211.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 216.375 465.031 Td /F4 9.8 Tf  [(Mean estimate)] TJ ET
0.267 0.267 0.267 rg
395.625 474.887 185.250 0.750 re f
395.625 456.055 0.750 19.582 re f
580.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 400.875 465.031 Td /F4 9.8 Tf  [(95% CI)] TJ ET
0.267 0.267 0.267 rg
26.625 456.055 185.250 0.750 re f
26.625 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 446.200 Td /F1 9.8 Tf  [(Total cases)] TJ ET
0.267 0.267 0.267 rg
211.125 456.055 185.250 0.750 re f
211.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 446.200 Td /F1 9.8 Tf  [(46,053,696)] TJ ET
0.267 0.267 0.267 rg
395.625 456.055 185.250 0.750 re f
395.625 440.173 0.750 16.631 re f
580.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 446.200 Td /F1 9.8 Tf  [(36,937,583-55,094,920)] TJ ET
0.267 0.267 0.267 rg
26.625 440.173 185.250 0.750 re f
26.625 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 430.318 Td /F1 9.8 Tf  [(Number hospitalizations)] TJ ET
0.267 0.267 0.267 rg
211.125 440.173 185.250 0.750 re f
211.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 430.318 Td /F1 9.8 Tf  [(2,763,222)] TJ ET
0.267 0.267 0.267 rg
395.625 440.173 185.250 0.750 re f
395.625 424.292 0.750 16.631 re f
580.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 430.318 Td /F1 9.8 Tf  [(2,034,413-3,585,032)] TJ ET
0.267 0.267 0.267 rg
26.625 424.292 185.250 0.750 re f
26.625 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 414.437 Td /F1 9.8 Tf  [(ARF cases)] TJ ET
0.267 0.267 0.267 rg
211.125 424.292 185.250 0.750 re f
211.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 414.437 Td /F1 9.8 Tf  [(331,587)] TJ ET
0.267 0.267 0.267 rg
395.625 424.292 185.250 0.750 re f
395.625 408.411 0.750 16.631 re f
580.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 414.437 Td /F1 9.8 Tf  [(227,866-454,001)] TJ ET
0.267 0.267 0.267 rg
26.625 408.411 185.250 0.750 re f
26.625 392.529 185.250 0.750 re f
26.625 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 398.556 Td /F1 9.8 Tf  [(Deaths)] TJ ET
0.267 0.267 0.267 rg
211.125 408.411 185.250 0.750 re f
211.125 392.529 185.250 0.750 re f
211.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 398.556 Td /F1 9.8 Tf  [(192,320)] TJ ET
0.267 0.267 0.267 rg
395.625 408.411 185.250 0.750 re f
395.625 392.529 185.250 0.750 re f
395.625 392.529 0.750 16.631 re f
580.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 398.556 Td /F1 9.8 Tf  [(125,945-276,482)] TJ ET
BT 26.250 345.131 Td /F1 9.8 Tf  [(*Each input parameter was assumed to be normally distributed)] TJ ET
BT 26.250 329.614 Td /F4 8.7 Tf  [(�)] TJ ET
BT 31.545 325.726 Td /F1 9.8 Tf  [( Outcome estimates and corresponding confidence intervals are based on Monte Carlo simulations, 10,000 trials for each )] TJ ET
BT 26.250 313.821 Td /F1 9.8 Tf  [(outcome)] TJ ET
BT 26.250 294.416 Td /F1 9.8 Tf  [(CA = California, ARF = acute respiratory failure, CI = confidence interval)] TJ ET
BT 26.250 257.814 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 237.860 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 201.257 Td /F4 12.0 Tf  [(Funding information)] TJ ET
BT 26.250 181.303 Td /F1 9.8 Tf  [(The authors received no funding for this study)] TJ ET
BT 26.250 152.200 Td /F4 12.0 Tf  [(Competing interests)] TJ ET
BT 26.250 132.246 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 95.644 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 68.189 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 68.189 Td /F1 9.8 Tf  [(Available at http://en.wikipedia.org/wiki/2009_flu_pandemic; accessed July 28, 2009)] TJ ET
BT 26.250 48.785 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 48.785 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\) Press Brief from August 24, 2009; available at )] TJ ET
Q
q
15.000 34.499 577.500 742.501 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(emphasize the need for careful planning and prioritization schemes as they relate to the allocation of scarce ICU resources. )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(Second, in light of the recent report of severe ARF-MV cases requiring advanced MV modes available only in specialized )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(centers and requiring special equipment not commonly stockpiled at the state and federal levels, planners must explore the )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(feasibility of regionalizing S-OIV-related ARF-MV care )] TJ ET
0.267 0.267 0.267 rg
BT 261.400 731.762 Td /F1 9.8 Tf  [([3])] TJ ET
0.271 0.267 0.267 rg
BT 272.243 731.762 Td /F1 9.8 Tf  [(. Third, as this infection will likely disproportionately affect areas of )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(higher population density, regional response plans are urgently needed.)] TJ ET
BT 26.250 683.255 Td /F4 12.0 Tf  [(CONCLUSION)] TJ ET
BT 26.250 663.300 Td /F1 9.8 Tf  [(In summary, estimates of what may be expected with S-OIV should help ICU directors, hospital administrators and other policy )] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(makers allocate appropriate resources for an effective coordinated response. In addition to education and prevention, efforts )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(must focus on planning for the impact of this virus on ARF-MV.)] TJ ET
BT 26.250 620.086 Td /F4 9.8 Tf  [(Table 1. Model input parameters and outcome estimates)] TJ ET
1.000 1.000 1.000 rg
26.250 392.154 555.000 218.051 re f
0.267 0.267 0.267 rg
26.625 609.080 185.250 0.750 re f
26.625 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 599.225 Td /F4 9.8 Tf  [(Input Parameters)] TJ ET
0.267 0.267 0.267 rg
211.125 609.080 185.250 0.750 re f
211.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 599.225 Td /F4 9.8 Tf  [(Estimate*)] TJ ET
0.267 0.267 0.267 rg
395.625 609.080 185.250 0.750 re f
395.625 593.199 0.750 16.631 re f
580.125 593.199 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 599.225 Td /F4 9.8 Tf  [(Source)] TJ ET
0.267 0.267 0.267 rg
26.625 593.199 185.250 0.750 re f
26.625 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 583.344 Td /F1 9.8 Tf  [(US population)] TJ ET
0.267 0.267 0.267 rg
211.125 593.199 185.250 0.750 re f
211.125 577.318 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 583.344 Td /F1 9.8 Tf  [(307,024,641)] TJ ET
0.267 0.267 0.267 rg
395.625 593.199 185.250 0.750 re f
395.625 577.318 0.750 16.631 re f
580.125 577.318 0.750 16.631 re f
BT 400.875 583.344 Td /F1 9.8 Tf  [([6])] TJ ET
26.625 577.318 185.250 0.750 re f
26.625 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 567.463 Td /F1 9.8 Tf  [(Estimated attack rate)] TJ ET
0.267 0.267 0.267 rg
211.125 577.318 185.250 0.750 re f
211.125 561.436 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 567.463 Td /F1 9.8 Tf  [(15% \(6%-24%\))] TJ ET
0.267 0.267 0.267 rg
395.625 577.318 185.250 0.750 re f
395.625 561.436 0.750 16.631 re f
580.125 561.436 0.750 16.631 re f
BT 400.875 567.463 Td /F1 9.8 Tf  [([2])] TJ ET
26.625 561.437 185.250 0.750 re f
26.625 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 31.875 551.582 Td /F1 9.8 Tf  [(Hospitalization rate, relative to attack )] TJ ET
BT 31.875 543.950 Td /F1 9.8 Tf  [(rate)] TJ ET
0.267 0.267 0.267 rg
211.125 561.437 185.250 0.750 re f
211.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 216.375 551.582 Td /F1 9.8 Tf  [(6% \(2%-10%\))] TJ ET
0.267 0.267 0.267 rg
395.625 561.437 185.250 0.750 re f
395.625 522.662 0.750 39.525 re f
580.125 522.662 0.750 39.525 re f
0.271 0.267 0.267 rg
BT 400.875 551.582 Td /F1 9.8 Tf  [(6% = CA experience, personal )] TJ ET
BT 400.875 543.950 Td /F1 9.8 Tf  [(communication)] TJ ET
BT 400.875 536.319 Td /F1 9.8 Tf  [(2% = assumption)] TJ ET
BT 400.875 528.688 Td /F1 9.8 Tf  [(10% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 528.688 Td /F1 9.8 Tf  [([5])] TJ ET
26.625 522.661 185.250 0.750 re f
26.625 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 512.807 Td /F1 9.8 Tf  [(ARF rate \(relative to hospitalization\))] TJ ET
0.267 0.267 0.267 rg
211.125 522.661 185.250 0.750 re f
211.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 512.807 Td /F1 9.8 Tf  [(12% \(6%-18%\))] TJ ET
0.267 0.267 0.267 rg
395.625 522.661 185.250 0.750 re f
395.625 499.149 0.750 24.262 re f
580.125 499.149 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 512.807 Td /F1 9.8 Tf  [(12% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 512.807 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 505.175 Td /F1 9.8 Tf  [(6% and 18% = assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 499.149 185.250 0.750 re f
26.625 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 489.294 Td /F1 9.8 Tf  [(Mortality rate \(relative to ARF\))] TJ ET
0.267 0.267 0.267 rg
211.125 499.149 185.250 0.750 re f
211.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 216.375 489.294 Td /F1 9.8 Tf  [(58% \(40%-80%\))] TJ ET
0.267 0.267 0.267 rg
395.625 499.149 185.250 0.750 re f
395.625 475.637 0.750 24.262 re f
580.125 475.637 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 400.875 489.294 Td /F1 9.8 Tf  [(58% = )] TJ ET
0.267 0.267 0.267 rg
BT 431.500 489.294 Td /F1 9.8 Tf  [([5])] TJ ET
0.271 0.267 0.267 rg
BT 400.875 481.663 Td /F1 9.8 Tf  [(40% and 80% =assumption)] TJ ET
0.267 0.267 0.267 rg
26.625 475.637 185.250 0.750 re f
26.625 474.887 0.750 1.500 re f
211.125 475.637 185.250 0.750 re f
211.125 474.887 0.750 1.500 re f
395.625 475.637 185.250 0.750 re f
395.625 474.887 0.750 1.500 re f
580.125 474.887 0.750 1.500 re f
26.625 474.887 185.250 0.750 re f
26.625 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 31.875 462.671 Td /F4 9.8 Tf  [(Outcomes)] TJ ET
BT 79.553 465.236 Td /F4 8.7 Tf  [(�)] TJ ET
0.267 0.267 0.267 rg
211.125 474.887 185.250 0.750 re f
211.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 216.375 465.031 Td /F4 9.8 Tf  [(Mean estimate)] TJ ET
0.267 0.267 0.267 rg
395.625 474.887 185.250 0.750 re f
395.625 456.055 0.750 19.582 re f
580.125 456.055 0.750 19.582 re f
0.271 0.267 0.267 rg
BT 400.875 465.031 Td /F4 9.8 Tf  [(95% CI)] TJ ET
0.267 0.267 0.267 rg
26.625 456.055 185.250 0.750 re f
26.625 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 446.200 Td /F1 9.8 Tf  [(Total cases)] TJ ET
0.267 0.267 0.267 rg
211.125 456.055 185.250 0.750 re f
211.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 446.200 Td /F1 9.8 Tf  [(46,053,696)] TJ ET
0.267 0.267 0.267 rg
395.625 456.055 185.250 0.750 re f
395.625 440.173 0.750 16.631 re f
580.125 440.173 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 446.200 Td /F1 9.8 Tf  [(36,937,583-55,094,920)] TJ ET
0.267 0.267 0.267 rg
26.625 440.173 185.250 0.750 re f
26.625 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 430.318 Td /F1 9.8 Tf  [(Number hospitalizations)] TJ ET
0.267 0.267 0.267 rg
211.125 440.173 185.250 0.750 re f
211.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 430.318 Td /F1 9.8 Tf  [(2,763,222)] TJ ET
0.267 0.267 0.267 rg
395.625 440.173 185.250 0.750 re f
395.625 424.292 0.750 16.631 re f
580.125 424.292 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 430.318 Td /F1 9.8 Tf  [(2,034,413-3,585,032)] TJ ET
0.267 0.267 0.267 rg
26.625 424.292 185.250 0.750 re f
26.625 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 414.437 Td /F1 9.8 Tf  [(ARF cases)] TJ ET
0.267 0.267 0.267 rg
211.125 424.292 185.250 0.750 re f
211.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 414.437 Td /F1 9.8 Tf  [(331,587)] TJ ET
0.267 0.267 0.267 rg
395.625 424.292 185.250 0.750 re f
395.625 408.411 0.750 16.631 re f
580.125 408.411 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 414.437 Td /F1 9.8 Tf  [(227,866-454,001)] TJ ET
0.267 0.267 0.267 rg
26.625 408.411 185.250 0.750 re f
26.625 392.529 185.250 0.750 re f
26.625 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 398.556 Td /F1 9.8 Tf  [(Deaths)] TJ ET
0.267 0.267 0.267 rg
211.125 408.411 185.250 0.750 re f
211.125 392.529 185.250 0.750 re f
211.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 216.375 398.556 Td /F1 9.8 Tf  [(192,320)] TJ ET
0.267 0.267 0.267 rg
395.625 408.411 185.250 0.750 re f
395.625 392.529 185.250 0.750 re f
395.625 392.529 0.750 16.631 re f
580.125 392.529 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 400.875 398.556 Td /F1 9.8 Tf  [(125,945-276,482)] TJ ET
BT 26.250 345.131 Td /F1 9.8 Tf  [(*Each input parameter was assumed to be normally distributed)] TJ ET
BT 26.250 329.614 Td /F4 8.7 Tf  [(�)] TJ ET
BT 31.545 325.726 Td /F1 9.8 Tf  [( Outcome estimates and corresponding confidence intervals are based on Monte Carlo simulations, 10,000 trials for each )] TJ ET
BT 26.250 313.821 Td /F1 9.8 Tf  [(outcome)] TJ ET
BT 26.250 294.416 Td /F1 9.8 Tf  [(CA = California, ARF = acute respiratory failure, CI = confidence interval)] TJ ET
BT 26.250 257.814 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 237.860 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 201.257 Td /F4 12.0 Tf  [(Funding information)] TJ ET
BT 26.250 181.303 Td /F1 9.8 Tf  [(The authors received no funding for this study)] TJ ET
BT 26.250 152.200 Td /F4 12.0 Tf  [(Competing interests)] TJ ET
BT 26.250 132.246 Td /F1 9.8 Tf  [(None)] TJ ET
BT 26.250 95.644 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 68.189 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 68.189 Td /F1 9.8 Tf  [(Available at http://en.wikipedia.org/wiki/2009_flu_pandemic; accessed July 28, 2009)] TJ ET
BT 26.250 48.785 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 48.785 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\) Press Brief from August 24, 2009; available at )] TJ ET
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0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(2)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Influenza)] TJ ET

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0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(http://www.cdc.gov/media/transcripts/2009/t090724.htm; accessed July 28, 2009)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Intensive-care patients with severe novel influenza A \(H1N1\) virus )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(infection - Michigan, June 2009. MMWR Morb Mortal Wkly Rep 2009;58:749-52)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 716.762 Td /F1 9.8 Tf  [(Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(implications for budgets, plant and personnel planning. BMC Health Serv Res 2008;8:242)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and Respiratory Failure from Swine-Origin )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Influenza A \(H1N1\) in Mexico. New Engl J Med 2009 Jun 29 [Epub ahead of print])] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(Available at http://www.census.gov; accessed July 28, 2009)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(http://www.cdc.gov/media/transcripts/2009/t090724.htm; accessed July 28, 2009)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Intensive-care patients with severe novel influenza A \(H1N1\) virus )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(infection - Michigan, June 2009. MMWR Morb Mortal Wkly Rep 2009;58:749-52)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 716.762 Td /F1 9.8 Tf  [(Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(implications for budgets, plant and personnel planning. BMC Health Serv Res 2008;8:242)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and Respiratory Failure from Swine-Origin )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Influenza A \(H1N1\) in Mexico. New Engl J Med 2009 Jun 29 [Epub ahead of print])] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(Available at http://www.census.gov; accessed July 28, 2009)] TJ ET
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q
15.000 636.762 577.500 140.238 re W n
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BT 26.250 767.476 Td /F1 9.8 Tf  [(http://www.cdc.gov/media/transcripts/2009/t090724.htm; accessed July 28, 2009)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 748.071 Td /F1 9.8 Tf  [(Centers for Disease Control and Prevention \(CDC\). Intensive-care patients with severe novel influenza A \(H1N1\) virus )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(infection - Michigan, June 2009. MMWR Morb Mortal Wkly Rep 2009;58:749-52)] TJ ET
BT 26.250 716.762 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 716.762 Td /F1 9.8 Tf  [(Zilberberg MD, Shorr AF. Prolonged acute mechanical ventilation and hospital bed utilization in 2020 in the United States: )] TJ ET
BT 26.250 704.857 Td /F1 9.8 Tf  [(implications for budgets, plant and personnel planning. BMC Health Serv Res 2008;8:242)] TJ ET
BT 26.250 685.452 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 685.452 Td /F1 9.8 Tf  [(Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and Respiratory Failure from Swine-Origin )] TJ ET
BT 26.250 673.548 Td /F1 9.8 Tf  [(Influenza A \(H1N1\) in Mexico. New Engl J Med 2009 Jun 29 [Epub ahead of print])] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 654.143 Td /F1 9.8 Tf  [(Available at http://www.census.gov; accessed July 28, 2009)] TJ ET
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q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(3)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Influenza)] TJ ET

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