How to barf: Keep your face upright to make vomiting less uncomfortable

One of the more memorable lines from Chapman years ago was, “I’ve never had barf come out my nose.”

vomit.family.guyA few years later, he said, “it happened.”

According to Eric Ravenscraft of Life Hacker, we’re all barfing the wrong way.

The next time you feel like you need to vomit, try facing straight forward (perhaps using a bucket) to avoid uncomfortable drainage in nasal passages.

Most people (and, indeed, nearly every TV and movie depiction of the act) use a toilet or a sink when vomiting is necessary. While this makes for quick cleanup, it also requires you to point your face directly downwards. Combined with the upwards flow of your stomach contents, your nasal passages can become affected. Keeping your face upright by using a bucket (or having really, really good aim) can avoid that burning sensation and uncomfortable cleanup. Alternatively, if you don’t have a bucket handy or simply can’t manage that self control, holding or plugging your nose can help minimize this effect.

Saturday barf: Tiger, football, airplane

It is called barfblog.

First up, Tiger Woods doing his best Ben Chapman impersonation on the first tee at his charity tournament — the Hero World Challenge — and he still made birdie.

Next, Arizona center Carter Wood vomits just before snapping ball during a barf-inducing loss to Oregon.

Finally, a US Airways plane was forced to land when 16 people aboard it started vomiting and suffering from red eyes.

The entire crew of 14 and two passengers were taken ill on the plane which made an emergency landing in Rome on Friday.

The stench of vomit could be smelt from the cabin, alerting those on board to the problem.

Sharing barf stories from Yelp helps NYC identify unreported cases of foodborne illness

Social media and sharing of information has tremendous potential to identify foodborne and other illnesses. It also has tremendous potential to drain scarce public health resources.

The U.S. Centers for Disease Control reports that while investigating an outbreak of gastrointestinal disease associated with a restaurant, the New York City Department of Health and Mental Hygiene (DOHMH) noted that patrons had reported illnesses on the business review website Yelp (http://www.yelp.com) that had not been reported to DOHMH. To explore the potential of using Yelp to identify unreported outbreaks, DOHMH worked with Columbia University and Yelp on a pilot project to prospectively identify restaurant reviews on Yelp that referred to foodborne illness. During July 1, 2012–March 31, 2013, approximately 294,000 Yelp restaurant reviews were analyzed by a software program developed for the project. The program identified 893 reviews that required further evaluation by a foodborne disease epidemiologist. Of the 893 reviews, 499 (56%) described an event consistent with foodborne illness (e.g., patrons reported diarrhea or vomiting after their meal), and 468 of those described an illness within 4 weeks of the review or did not provide a period. Only 3% of the illnesses referred to in the 468 reviews had also been reported directly to DOHMH via telephone and online systems during the same period. Closer examination determined that 129 of the 468 reviews required further investigation, resulting in telephone interviews with 27 reviewers. From those 27 interviews, three previously unreported restaurant-related outbreaks linked to 16 illnesses met DOHMH outbreak investigation criteria; environmental investigation of the three restaurants identified multiple food-handling violations. The results suggest that online restaurant reviews might help to identify unreported outbreaks of foodborne illness and restaurants with deficiencies in food handling. However, investigating reports of illness in this manner might require considerable time and resources.

cdc.rest.yelpProject Protocol

Beginning in April 2012, Yelp provided DOHMH with a private data feed of New York City restaurant reviews. The feed provided data publicly available on the website but in an XML format, and text classification programs were trained to automatically analyze reviews. For this pilot project, a narrow set of criteria were chosen to identify those reviews with a high likelihood of describing foodborne illness. Reviews were assessed retrospectively, using the following criteria: 1) presence of the keywords “sick,” “vomit,” “diarrhea,” or “food poisoning” in contexts denoting foodborne illness; 2) two or more persons reported ill; and 3) an incubation period ≥10 hours. Ten hours was chosen because most foodborne illnesses are not caused by toxins but rather by organisms with an incubation period of ≥10 hours (1). Data mining software was used to train the text classification programs (2). A foodborne disease epidemiologist manually examined output results to determine whether reviews selected by text classification met the criteria for inclusion, and programs with the highest accuracy rate were incorporated into the final software used for the pilot project to analyze reviews prospectively.

The software program downloaded weekly data and provided the date of the restaurant review, a link to the review, the full review text, establishment name, establishment address, and scores for each of three outbreak criteria (i.e., keywords, number of persons ill, and incubation period), plus an average of the three criteria. Scores for individual criteria ranged from 0 to 1, with a score closer to 1 indicating the review likely met the score criteria.

Reviews submitted to Yelp during July 1, 2012–March 31, 2013 were analyzed. All reviews with an average review score of ≥0.5 were evaluated by a foodborne disease epidemiologist (Figure). Because the average review score was calculated by averaging the individual criteria scores, reviews could receive an average score of ≥0.5 without meeting all individual criteria. Reviews with an average review score of ≥0.5 were evaluated for the following three criteria: 1) consistent with foodborne illness occurring after a meal, rather than an alternative explanation for the illness keyword; 2) meal date within 4 weeks of review (or no meal date provided); 3) two or more persons ill or a single person with symptoms of scombroid poisoning or severe neurologic illness. Reviews that met all three of these criteria were then investigated further by DOHMH. In addition, reviews were investigated further if manual checking identified multiple reviews within 1 week that described recent foodborne illness at the same restaurant.

To identify previously reported complaints of foodborne illness, reviews were compared with complaints reported to DOHMH by telephone or online at 311, New York City’s nonemergency information service that can be used by the public to report suspected foodborne illness (3). Yelp reviews categorized as indicating recent or potentially recent illness were compared with complaints from the previous 4 weeks in the 311 database. To follow up with reviewers, DOHMH created a Yelp account to send private messages to reviewers’ Yelp accounts. Reviewers needed to log in at Yelp to view their messages.

For reviews not requiring further investigation and not found in the 311 database, DOHMH sent messages advising reviewers of the availability of 311 reporting. For reviews requiring further investigation, DOHMH sent messages requesting telephone interviews. Reviewers consenting to interviews were asked to provide details about the restaurant visit, meal date, foods consumed during the meal, party size, illness symptoms, and a history of foods consumed in the 3 days before symptom onset.

yelp.rest.inspection.may.14Review-Based Findings

During July 1, 2012–March 31, 2013, the software system screened approximately 294,000 reviews and identified 893 with an average score of ≥0.5, indicating possible foodborne illness (Figure). Of these reviews, 499 (56%) described an event consistent with foodborne illness, as determined by the manual checking of a foodborne epidemiologist. This equated to an average of 23 reviews evaluated by a foodborne epidemiologist each week, with an average of 13 reviews categorized as consistent with foodborne illness. The remaining 394 (44%) reviews contained keywords but did not suggest foodborne illness (e.g., “I didn’t get sick at all after my meal”).

Of the 499 reviews describing an event consistent with foodborne illness, 468 (94%) indicated recent or potentially recent illness. Of these 468 reviews, only 15 (3%) were also reported to 311 during the same period. A total of 339 reviews that indicated only one person became ill and had no scombroid poisoning or severe neurologic symptoms were excluded, leaving 129 reviews that required further investigation (Figure). Of the 129, a total of 27 (21%) reviewers completed a telephone interview inquiring about meals and illnesses. The median time from review date to DOHMH contact to schedule a telephone interview was 8 days. The interviews provided information on 27 restaurants, and 24 restaurants were identified as potential locations of recent exposure because the meal dates were within 4 weeks of the interview.

From the 27 interviews, DOHMH determined whether the complaints warranted an outbreak investigation by considering the following criteria: 1) more than one person became ill, 2) no other common meals were suspected, 3) ill persons lived in different households, and 4) the cases had similar onset periods (indicating a likely foodborne cause rather than person-to-person transmission). For scombroid poisoning or neurologic symptoms, DOHMH considered whether symptoms and onset were consistent with scombrotoxin, ciguatera toxin, or botulism poisoning.

Three outbreaks meeting DOHMH outbreak investigation criteria were identified, accounting for 16 illnesses not previously reported to DOHMH. Interviews with reviewers identified likely food items associated with illness at each of the three restaurants: house salad, shrimp and lobster cannelloni, and macaroni and cheese spring rolls (Table). The reviews of the three restaurants had been posted on Yelp 2–5 days after the meals. Environmental investigations were conducted at two of the three restaurants during the week after the interviews; a routine DOHMH inspection had already been conducted at the other restaurant 2 days after the meal. The two investigations and the routine inspection identified multiple violations at each of the outbreak restaurants (Table). Investigators were unable to obtain laboratory data that might have identified the infectious agents.

Discussion

In a New York City DOHMH pilot project, of 468 recent or potentially recent online foodborne illness complaints posted on Yelp and reviewed by foodborne epidemiologists, three previously unreported restaurant outbreaks were identified. Because foodborne cases have a common exposure, a restaurant patron review-based system can identify small, point-source outbreaks that are not easily found by systems reviewing large sources of data, such as syndromic surveillance of emergency department visits (4), Google Flu Trends (5), and analysis of Twitter data for influenza and other public health trends (6–8). Most importantly, foodborne epidemiologists can confirm reports because Yelp offers a way to follow-up with reviewers for interview.

In this project, only 15 (3%) of the 468 recent or potentially recent illnesses identified on Yelp were also reported directly to New York City’s nonemergency 311 service, suggesting that knowledge about 311 reporting is limited. Of further note, after messages regarding the availability of 311 were sent to 290 reviewers who did not meet the project criteria, 32 responded, of whom 25 (78%) said they were unaware of the 311 system or would keep 311 in mind for the future. The 311 service receives approximately 3,000 food poisoning complaints each year, and from that number, about 1% are identified as outbreak-related (DOHMH, unpublished data, 2014).

As social media usage continues to grow among U.S. adults (9), health departments might consider additional surveillance methods to capture illness reports from those more likely to post a restaurant review online than to contact a health department. By incorporating website review data into public health surveillance programs, health departments might find additional illnesses and improve detection of foodborne disease outbreaks in the community. Similar programs could be developed to identify other public health hazards that reviewers might describe, such as vermin in food establishments.

The findings in this report are subject to at least four limitations. First, to increase the likelihood of identifying true foodborne illness, a narrow focus was chosen for the individual criteria used to score reviews. Therefore, it is possible that some foodborne illnesses were not picked up by the screening software because of low average review scores (e.g., because of illnesses resulting from toxins with short incubation periods). Second, personal contact information for reviewers was unavailable, requiring reviewers to check their Yelp accounts and provide a telephone number to participate, which extended the time from review to interview and might have affected the response rate. Third, investigators were not able to identify any of the infectious agents in the outbreaks. Finally, the system required substantial resources; in addition to programming expertise, staff members were needed to read reviews, send e-mails, interview reviewers, and perform follow-up inspections.

Additional work using social media might improve health department abilities to use the Internet for disease detection. Working with the Chicago Department of Public Health, the Smart Chicago Collaborative recently developed a system to contact those who post foodborne illness complaints either on its website or on Twitter.* For health departments looking for an alternative to analyzing review data weekly, creating an illness-reporting vehicle such as the Utah Department of Health’s “I Got Sick” website (10) could be a more practical solution, although it might be less widely used than a review website such as Yelp. Review websites could assist by offering a link to the reviewer’s local health department’s reporting system at the time of review posting.

DOHMH plans to continue to refine this project. To shorten the time from review to investigation, Yelp will provide daily instead of weekly review feeds, and, to increase sensitivity, the project will be expanded to include additional review websites. To improve response rates, DOHMH will offer a link to an electronic survey. Finally, DOHMH is exploring the possibility of linking multiple complaints pertaining to the same restaurant, using data from different review websites and DOHMH databases.

What is already known on this topic?

Health departments rely on the public to report restaurant-related foodborne illness directly to them, yet many outbreaks go unreported. A large amount of publicly reported information about foodborne illness is available on restaurant review websites.

What is added by this report?

During a 9-month period, approximately 294,000 reviews of New York City restaurants posted on Yelp.com were screened by software programs for possible cases of foodborne illness. The software flagged 893 reviews for evaluation by an epidemiologist, resulting in the identification of 468 reviews that were consistent with recent or potentially recent foodborne illness. Only 15 (3%) of these reviews described events that had been reported to the health department. After further evaluation of reviews and interviews with 27 reviewers, three previously unreported restaurant-related outbreaks were identified.

What are the implications for public health practice?

Review websites might be a valuable source of data in the public health setting. Restaurant patron reviews can help identify small, point-source outbreaks of foodborne illness because cases have a known common exposure. Such reviews might be particularly useful if the website offers a way to reach reviewers for follow-up interviews.

Lots of barfing as temperatures hit 42C at Australian Open

There was lots of barfing at the Australian Open yesterday but it wasn’t food – the temperature reached 42C.  It doesn’t even get that hot in Brisbane, the Tampa of Australia. But other parts of the country are prone to huge temperature fluctuations.

Andy Murray has warned the Australian Open it risks damaging the reputation of tennis barfing.australian.open.jan.14after players were forced to play in searing heat in Melbourne.

Canadian player Frank Dancevic and a ball boy both collapsed on court while China’s Peng Shuai vomited then suffered cramps during her defeat as temperatures soared above 40C.

Czech veteran Radek Stepanek also retired with heat exhaustion against Slovenian Blaz Kavcic.

Did Britney barf on way to GMA appearance?

Good Morning America airs on TV here about 3:30 a.m., and I’m usually up so have it on in background, not for any content, but because the hosts and guests are all so attractive and tight, and it britney.barf.sep.1emakes we want to be better – or not care.

Britney Spears – she of the it’s-OK-to-change-my-kid’s-diaper-on-a-restaurant table –flew by helicopter to the Nevada desert to announce her Las Vegas shtick – and apparently barfed.

According to TMZ, Britney didn’t say if “sick” meant hurled … but it’s a reasonable conclusion.  She wore gigantic sunglasses in the dark night as “GMA’s” Sam Champion tried to get her animated.

Even spacemen have to barf

When I get sick, my heaves get pretty violent. I’ve thrown up through my nose multiple times. Not fun. I usually have the benefit of gravity though – so I have a pretty decent idea where the vomit is going to end up. Canadian astronaut Chris Hadfield who has become an international space singing star, discusses what space folks do with their barf bags. According to NBC news, astronauts get sick even in the weightlessness of space and thanks to astronaut Chris Hadfield, folks now know how.

“When we first get to space, we feel sick,” Hadfield said to a group of students back on the planet. “Your body is really confused. You’re dizzy. Your lunch is floating around in your belly because you’re floating. What you see doesn’t match what you feel, and you want to throw up.”

The space station commander then opened up a “barf bag” and showed the students the proper method for up-chucking in space.”Think about what happens on Earth when you throw up,” Hadfield said. “You throw up and you have a bag of something horrible and then you throw it away, but if I have this bag, what am I going to do with it? This bag is going to stay with me in space for months, so we want a really good barf bag.”

Astronaut barf bags have liners that can be used to clean a spaceflyer’s face post-puke, added Hadfield. There is also a very durable zip-lock bag that prevents the waste from floating around the $100 billion orbiting laboratory.

Vomit samples, nail scrapings tracks down S. aureus outbreak at Barcelona sports club

Solano et al. report in Food Control that an outbreak of acute gastroenteritis due to staphylococcal food poisoning occurred in July 2011 at a summer school held by a sports club in Barcelona (Catalonia, Spain). Of the 42 cases involved, 20 were hospitalised. To identify the outbreak source, a retrospective cohort study was performed on the group at risk, which soccer.barf.mar.13included 73 summer school students and 18 staff members. Food exposure at the sports club restaurant was identified as the most relevant common link among the study cohort.

Although the preliminary microbiological investigation suggested that enterotoxigenic Staphylococcus aureus (S. aureus) infections were the possible source, enterotoxin types A and D were identified, quantified and confirmed in the different biological samples collected. A descriptive, in-depth epidemiological and clinical investigation subsequently pointed to food intoxication rather than bacterial infection as being the cause of the outbreak. Molecular investigation of the strain isolates, using pulsed-field gel electrophoresis typing, revealed that all eight strains of S. aureus had the same profile and spa type (t008).

Samples of the incriminated foods, i.e., boiled macaroni, tuna and fresh tomatoes, specimens of vomit of those affected, and bilateral fingernail scrapings and nasal swabs of food handlers were shown to be the common source of transmission of the contamination. Following the outbreak, appropriate hygiene and control measures could be implemented to prevent any recurrence.

Food Control

Volume 33, Issue 1, September 2013, Pages 114–118

Barf in dining area and other food safety failures: 305 sickened in Wyoming Gloden Corral norovirus outbreak

At least 305 individuals became ill with norovirus gastroenteritis after patronizing Golden Corral in Casper, WY from November 17, 2012 through December 19, 2012.

The Wyoming Department of Health has issued a complete report on the outbreak, and identified a number of potential environmental health concerns golden-corralthrough both patron and employee interviews.

Investigators received several reports of dirty dishes being stacked for use in the buffet line, vomitus accidents in the dining area, raw or undercooked food being set out for consumption, employees working while ill with gastrointestinal symptoms, refilling food on buffets without replacing service bowl or service utensils, lack of glove use when handling ready-to-eat foods, cross-contamination between raw and cooked foods, and other reports of general poor food-handling practices.

Both patrons and employees independently reported several vomitus accidents in the dining area and in the restaurant’s bathrooms. Investigators noted these events when the interviewee was able to provide a concise date of occurrence.

Recommendations were made for immediate control and as a result of the investigation.

 The restaurant must follow all rules and regulations contained in the Wyoming Food Safety Rule.

 The Wyoming Food Safety Rule currently states that any food-handling staff person who is known to be ill due to gastrointestinal symptoms such as diarrhea or vomiting should be excluded from work until at least 48 hours has passed since that individual’s last bout of diarrhea or vomiting (whichever occurred last). The 48 hour recommendation is the minimum, as many norovirus-21foodborne pathogens, including norovirus, can be shed by previously-ill persons for longer than 48 hours.

 The Wyoming Food Safety Rule also specifies that the restaurant shall require food-handling employees (i.e., kitchen staff, servers, etc.) to report to the person-in-charge information about their health and activities as they relate to diseases that are transmissible through food. A food-handling employee shall report the information in a manner that allows the person-in-charge to reduce the risk of foodborne disease transmission, including providing necessary additional information, such as date of onset of symptoms and illness, or of a diagnosis with symptoms if the food-handling employee has diarrhea, vomiting, jaundice, sore throat with fever or lesions containing pus, an infected wound, has been diagnosed with Salmonella, Shigella, E. coli, Hepatitis, or norovirus.

 Enhanced surface disinfection with a product effective against norovirus. A concentrated bleach solution was suggested.

 To minimize bare hand contact with ready-to-eat foods, such as lettuce, the restaurant should consider requiring the use of gloves when employees are handling those food items. Please note that glove use does not negate the need for proper hand-washing.

 All vomitus accidents should be treated as if they are highly contagious. Staff should use gloves and a concentrated bleach solution to disinfect affected areas. Staff should try to quarantine the area of the accident until the area is adequately disinfected. Staff should quarantine any rags, towels, or mops that were used to clean up the vomitus until they are adequately disinfected to prevent further transmission.

 Report any suspected cases of foodborne illness to health officials. Public health officials provide important services to business owners which include an objective investigation of the problem and providing quick, accurate, and effective mitigation strategies.

 Continue to consult with local environmental health specialists when questions arise about safe food-handling and consider ServSafe training for all kitchen staff.

Don’t make others barf, vomit into your elbow; norovirus control strategies

“Norovirus is much more contagious than people think,” said Doug Powell, professor of food safety at Kansas State University. “In the past, we’ve seen multiple outbreaks in group settings like cruise ships, care facilities, university residences, schools, sporting teams and restaurants. It’s a massive amount of barf.”

Even those who clean up vomit have to be especially careful because norovirus-2viral particles are dispersed in the air, Powell said.

“Many people say they routinely wash their hands, but even in an outbreak situation, observational research shows they really don’t,” Powell said. “And it’s not enough to say, ‘Wash your hands.’ There needs to be access to proper hand-washing tools — vigorous running water, soap and paper towels — as well as compelling behavioral messages, like ‘Don’t make others barf,’ to get people to wash their hands.” 

Powell includes more information about the current norovirus outbreak on his blog:http://barfblog.com/categories/norovirus/.