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Goldflam K.,Brigham and Womens Hospital | Silvers C.T.,Childrens Hospital Informatics Program
Journal of Emergency Medicine | Year: 2012

Background: Exercise-induced anaphylaxis (EIA) is an under-recognized condition that is a distinct physical allergy. Triggers include varying amounts of exercise, alone or in combination with certain foods or medications (food-dependent EIA, or FDEIA). Therapy is identical to that of any immunoglobulin E-mediated allergic reaction. Objectives: This case is reported to increase awareness among emergency physicians of EIA and FDEIA. Case Report: A 57-year-old man was found with a diffuse erythematous rash after eating a wheat bagel and walking up five flights of stairs. Emergency medical services found him hypotensive and combative. In the Emergency Department, the patient's blood pressure was 72/27 mm Hg, with an oxygen saturation of 97% on non-rebreather mask. The physical examination was notable for bilateral inspiratory crackles in the lower one-third of the lungs. He received intravenous (i.v.) diphenhydramine 25 mg, i.v. methylprednisolone 125 mg, and 1 L of normal saline, after which his blood pressure improved to 110/54 mm Hg. He was admitted to the hospital where his recovery was uneventful. Conclusion: EIA and FDEIA are uncommon forms of physical allergy, but they represent important entities for emergency physicians to consider. Recognition of the association with exercise is key, as recurrences can be prevented by avoiding triggers. Copyright © 2012 Elsevier Inc. Source


Weitzman E.R.,Childrens Hospital Informatics Program
BMC medical informatics and decision making | Year: 2012

Data stored in personally controlled health records (PCHRs) may hold value for clinicians and public health entities, if patients and their families will share them. We sought to characterize consumer willingness and unwillingness (reticence) to share PCHR data across health topics, and with different stakeholders, to advance understanding of this issue. Cross-sectional 2009 Web survey of repeat PCHR users who were patients over 18 years old or parents of patients, to assess willingness to share their PCHR data with an-out-of-hospital provider to support care, and the state/local public health authority to support monitoring; the odds of reticence to share PCHR information about ten exemplary health topics were estimated using a repeated measures approach. Of 261 respondents (56% response rate), more reported they would share all information with the state/local public health authority (63.3%) than with an out-of-hospital provider (54.1%) (OR 1.5, 95% CI 1.1, 1.9; p = .005); few would not share any information with these parties (respectively, 7.9% and 5.2%). For public health sharing, reticence was higher for most topics compared to contagious illness (ORs 4.9 to 1.4, all p-values < .05), and reflected concern about anonymity (47.2%), government insensitivity (41.5%), discrimination (24%). For provider sharing, reticence was higher for all topics compared to contagious illness (ORs 6.3 to 1.5, all p-values < .05), and reflected concern for relevance (52%), disclosure to insurance (47.6%) and/or family (20.5%). Pediatric patients and their families are often willing to share electronic health information to support health improvement, but remain cautious. Robust trust models for PCHR sharing are needed. Source


Agarwal S.,University of Wisconsin - Milwaukee | Yu H.,University of Wisconsin - Milwaukee | Kohane I.,Childrens Hospital Informatics Program
BMC Bioinformatics | Year: 2011

Background: Negated biomedical events are often ignored by text-mining applications; however, such events carry scientific significance. We report on the development of BioN∅T, a database of negated sentences that can be used to extract such negated events.Description: Currently BioN∅T incorporates ≈32 million negated sentences, extracted from over 336 million biomedical sentences from three resources: ≈2 million full-text biomedical articles in Elsevier and the PubMed Central, as well as ≈20 million abstracts in PubMed. We evaluated BioN∅T on three important genetic disorders: autism, Alzheimer's disease and Parkinson's disease, and found that BioN∅T is able to capture negated events that may be ignored by experts.Conclusions: The BioN∅T database can be a useful resource for biomedical researchers. BioN∅T is freely available at http://bionot.askhermes.org/. In future work, we will develop semantic web related technologies to enrich BioN∅T. © 2011 Agarwal et al; licensee BioMed Central Ltd. Source


Wilson K.,Ottawa Health Research Institute | Brownstein J.S.,Childrens Hospital Informatics Program | Brownstein J.S.,Harvard University | Fidler D.P.,Indiana University Bloomington
Health Policy and Planning | Year: 2010

The International Health Regulations (2005) [IHR(2005)] represent a potentially revolutionary change in global health governance. The use of the regulations by the World Health Organization (WHO) to respond to the outbreak of pandemic influenza A 2009-H1N1 highlights the importance of the regulations to protecting global health security. As the 2009-H1N1 pandemic illustrated, the IHR(2005) have provided a more robust framework for responding to public health emergencies of international concern (PHEICs), through requiring reporting of serious disease events, strengthening how countries and WHO communicate concerning health threats, empowering the WHO Director-General to declare the existence of PHEICs and to issue temporary recommendations for responding to them, and requiring countries not to implement measures that unnecessarily restrict trade and travel or infringe on human rights. However, limitations to the effectiveness of the IHR(2005) revealed in the 2009-H1N1 pandemic include continuing inadequacies in surveillance and response capacities within some countries, violations of IHR(2005) rules and a potentially narrowing scope of application only to influenza-like pandemic events. These limitations could undermine the IHR(2005)'s potential to contribute to national and global efforts to detect and mitigate future public health emergencies. Support for the IHR(2005) should be broadened and deepened to improve their utility as a tool to strengthen global health security. © The Author 2010; all rights reserved. Source


Nsoesie E.O.,Childrens Hospital Informatics Program | Nsoesie E.O.,Harvard University | Kluberg S.A.,Childrens Hospital Informatics Program | Brownstein J.S.,Childrens Hospital Informatics Program | And 2 more authors.
Preventive Medicine | Year: 2014

Objective: Traditional surveillance systems capture only a fraction of the estimated 48. million yearly cases of foodborne illness in the United States. We assessed whether foodservice reviews on Yelp.com (a business review site) can be used to support foodborne illness surveillance efforts. Methods: We obtained reviews from 2005 to 2012 of 5824 foodservice businesses closest to 29 colleges. After extracting recent reviews describing episodes of foodborne illness, we compared implicated foods to foods in outbreak reports from the U.S. Centers for Disease Control and Prevention (CDC). Results: Broadly, the distribution of implicated foods across five categories was as follows: aquatic (16% Yelp, 12% CDC), dairy-eggs (23% Yelp, 23% CDC), fruits-nuts (7% Yelp, 7% CDC), meat-poultry (32% Yelp, 33% CDC), and vegetables (22% Yelp, 25% CDC). The distribution of foods across 19 more specific food categories was also similar, with Spearman correlations ranging from 0.60 to 0.85 for 2006-2011. The most implicated food categories in both Yelp and CDC were beef, dairy, grains-beans, poultry and vine-stalk. Conclusions: Based on observations in this study and the increased usage of social media, we posit that online illness reports could complement traditional surveillance systems by providing near real-time information on foodborne illnesses, implicated foods and locations. © 2014. Source

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