2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people.

Alaska Native people have suffered disproportionately from previous influenza pandemics. We evaluated 3 separate syndromic data sources to determine temporal and geographic patterns of spread of 2009 pandemic influenza A H1N1 (pH1N1) in Alaska, and reviewed records from persons hospitalized with pH1N1 disease in 3 areas in Alaska to characterize clinical and epidemiologic features of disease in Alaskans. A wave of pH1N1 disease swept through Alaska beginning in most areas in August or early September. In rural regions, where Alaska Native people comprise a substantial proportion of the population, disease occurred earlier than in other regions. Alaska Native people and Asian/Pacific Islanders (A/PI) were 2-4 times more likely to be hospitalized than whites. Alaska Native people and other minorities remain at high risk for early and substantial morbidity from pandemic influenza episodes. These findings should be integrated into plans for distribution and use of vaccine and antiviral agents.

Transient drifts between Finapres and continuous intra-aortic measurements of blood pressure.

OBJECTIVES: The accuracy of noninvasive measurements of arterial blood pressure (BP), in comparison to intra-arterial recordings, is normally quantified by the bias, which is usually assumed to be a constant parameter. We tested the hypothesis that continuous beat-to-beat differences are not random and aimed to describe the temporal pattern of any transient drifts. METHODS: Forty participants were studied after undergoing elective cardiac catheterization. Continuous recordings of noninvasive finger BP (Finapres), intra-aortic BP (Millar catheter-tip transducer) and electrocardiogram were carried out for two periods of 10 min each. The mean of continuous beat-to-beat differences between the two BP sources was removed for the entire recording (null bias) and any linear trends were also removed. Stochastic properties of the time series of differences were described by the autocorrelation function. The temporal pattern of transient drifts was characterized by the coherent averaging of positive and negative transients, synchronized by their peak/trough values. RESULTS: On average, autocorrelation functions for differences between mean, systolic and diastolic values were significantly greater than zero for at least 24 beats, implying nonrandom differences. For mean BP, the peak value of positive and negative transient drifts were 4.98+/-3.61% and -6.75+/-7.48%, respectively. The average duration of these transients was approximately 20 s. Patients receiving (N=26) and not receiving beta-blockers (N=14) had similar autocorrelation functions indicative of nonrandom differences. The former showed lower peak/trough values in comparison with the latter, but differences were not statistically significant. CONCLUSION: The presence of transient drifts in beat-to-beat differences between finger and aortic BP can lead to erroneous results if biases are calculated using very short segments of data. Clinical and/or research applications using the Finapres, such as dynamic cerebral autoregulation modelling or sequence analysis for assessment of baroreceptor sensitivity can also be corrupted by the presence of nonrandom short-term fluctuations of the difference signal unless results are averaged for multiple segments of data.

Influence of noninvasive peripheral arterial blood pressure measurements on assessment of dynamic cerebral autoregulation.

Assessment of dynamic cerebral autoregulation (CA) requires continuous recording of arterial blood pressure (ABP). In humans, noninvasive ABP recordings with the Finapres device have often been used for this purpose. We compared estimates of dynamic CA derived from Finapres with those from invasive recordings in the aorta. Measurements of finger noninvasive ABP (Finapres), intra-aortic ABP (Millar catheter), surface ECG, transcutaneous CO2, and bilateral cerebral blood flow velocity (CBFV) in the middle cerebral arteries were simultaneously and continuously recorded in 27 patients scheduled for percutaneous coronary interventions. Phase, gain, coherence, and CBFV step response from both the Finapres and intra-arterial catheter were estimated by transfer function analysis. A dynamic autoregulation index (ARI) was also calculated. For both hemispheres, the ARI index and the CBFV step response recovery at 4 s were significantly greater for the Finapres-derived estimates than for the values obtained from aortic pressure. The transfer function gain for frequencies <0.1 Hz was significantly smaller for the Finapres estimates. The phase frequency response was significantly greater for the Finapres estimates at frequencies >0.1 Hz, but not at lower frequencies. The Finapres gives higher values for the efficiency of dynamic CA compared with values derived from aortic pressure measurements, as indicated by biases in the ARI index, CBFV step response, gain, and phase. Despite the significance of these biases, their relatively small amplitude indicates a good level of agreement between indexes of CA derived from the Finapres compared with corresponding estimates obtained from invasive measurements of aortic ABP.