Rapid progression of orbital abscess requiring lateral canthotomy in a pediatric patient.

Subperiosteal abscess (SPA) is a rare complication of acute sinusitis in children that may develop rapidly. In this case report, we describe an 11 year-old boy who presented with a large SPA 2 days after being diagnosed with conjunctivitis. The patient required emergent lateral canthotomy and cantholysis (LCC), IV antibiotics, and emergent surgery. It is crucial that emergency physicians be able to identify and treat this vision-threatening complication.

Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples.

BACKGROUND: Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). METHODS: Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. RESULTS: Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005). CONCLUSIONS: Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.

Transition bandwidths for stimuli with sparse spectral densities (L).

Transition bandwidths, observed as peaks in threshold functions in band-widening discrimination experiments, exhibit a number of notable features, such as a tenfold range of individual differences. The transition from a discrimination process based on temporal features to a process akin to profile analysis occurs automatically when the stimulus becomes wide enough to support across channel comparisons. A challenging finding is that transition bandwidths are unaffected by spectral density, tolerating frequency differences between spectral components as great as 400 Hz. Theoretical considerations based on this fact favor distinguishing between spectral and temporal processes as early as the initial stage of peripheral filtering.

Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder.

Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 U.S. military veterans (two females: 28-55 years old) were investigated to determine how subjective appraisals of morally injurious events measured by Moral Injury Event Scale (MIES) and PTSD symptoms are differentially related to spontaneous fluctuations indexed by amplitude of low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging scanning. ALFF in the left inferior parietal lobule (L-IPL) was positively associated with MIES subscores of transgressions, negatively associated with subscores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L-IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with MIES total scores. Our results provide the first evidence that morally injurious events and PTSD symptoms have dissociable neural underpinnings, and behaviorally distinct subcomponents of morally injurious events are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted by moral injury.

Quality control for community-based sea-ice model development.

A new collaborative organization for sea-ice model development, the CICE Consortium, has devised quality control procedures to maintain the integrity of its numerical codes' physical representations, enabling broad participation from the scientific community in the Consortium's open software development environment. Using output from five coupled and uncoupled configurations of the Los Alamos Sea Ice Model, CICE, we formulate quality control methods that exploit common statistical properties of sea-ice thickness, and test for significant changes in model results in a computationally efficient manner. New additions and changes to CICE are graded into four categories, ranging from bit-for-bit amendments to significant, answer-changing upgrades. These modifications are assessed using criteria that account for the high level of autocorrelation in sea-ice time series, along with a quadratic skill metric that searches for hemispheric changes in model answers across an array of different CICE configurations. These metrics also provide objective guidance for assessing new physical representations and code functionality.This article is part of the theme issue 'Modelling of sea-ice phenomena'.

SchizConnect: Mediating neuroimaging databases on schizophrenia and related disorders for large-scale integration.

SchizConnect (www.schizconnect.org) is built to address the issues of multiple data repositories in schizophrenia neuroimaging studies. It includes a level of mediation--translating across data sources--so that the user can place one query, e.g. for diffusion images from male individuals with schizophrenia, and find out from across participating data sources how many datasets there are, as well as downloading the imaging and related data. The current version handles the Data Usage Agreements across different studies, as well as interpreting database-specific terminologies into a common framework. New data repositories can also be mediated to bring immediate access to existing datasets. Compared with centralized, upload data sharing models, SchizConnect is a unique, virtual database with a focus on schizophrenia and related disorders that can mediate live data as information is being updated at each data source. It is our hope that SchizConnect can facilitate testing new hypotheses through aggregated datasets, promoting discovery related to the mechanisms underlying schizophrenic dysfunction.

Differences between magnitudes and health impacts of BC emissions across the United States using 12 km scale seasonal source apportionment.

Recent assessments have analyzed the health impacts of PM2.5 from emissions from different locations and sectors using simplified or reduced-form air quality models. Here we present an alternative approach using the adjoint of the Community Multiscale Air Quality (CMAQ) model, which provides source-receptor relationships at highly resolved sectoral, spatial, and temporal scales. While damage resulting from anthropogenic emissions of BC is strongly correlated with population and premature death, we found little correlation between damage and emission magnitude, suggesting that controls on the largest emissions may not be the most efficient means of reducing damage resulting from anthropogenic BC emissions. Rather, the best proxy for locations with damaging BC emissions is locations where premature deaths occur. Onroad diesel and nonroad vehicle emissions are the largest contributors to premature deaths attributed to exposure to BC, while onroad gasoline emissions cause the highest deaths per amount emitted. Emissions in fall and winter contribute to more premature deaths (and more per amount emitted) than emissions in spring and summer. Overall, these results show the value of the high-resolution source attribution for determining the locations, seasons, and sectors for which BC emission controls have the most effective health benefits.

"Mesmerizing and Terrifying": Senusret III's Unique Macrotia.

The ancient Egyptian pharaoh Senusret III was a legend to both his contemporaries and his descendants: an ideal of kingly power whose legacy of control and intimidation was remembered for centuries. Of particular note is the unique macrotia that the king's statues display. In this paper, we discuss possible etiologies of Senusret's unique presentation and ultimately conclude that Senusret's immortalized features were likely rooted in propaganda rather than a medical cause.

Civilian Moral Injury and Amygdala Functional Connectivity During Attention to Threat.

BACKGROUND: Moral injury references emotional and spiritual/existential suffering that may emerge following psychological trauma. Despite being linked to adverse mental health outcomes, little is known about the neurophysiological mechanisms of this phenomenon. In this study, we examined neural correlates of moral injury exposure and distress using the Moral Injury Exposure and Symptom Scale for Civilians. We also examined potential moderation of these effects by race (Black vs. White individuals) given the likely intersection of race-related stress with moral injury. METHODS: Forty-eight adults ages 18 to 65 years (mean age = 30.56, SD = 11.93) completed the Moral Injury Exposure and Symptom Scale for Civilians and an affective attentional control measure, the affective Stroop task (AS), during functional magnetic resonance imaging; the AS includes presentation of threat-relevant and neutral distractor stimuli. Voxelwise functional connectivity of the bilateral amygdala was examined in response to threat-relevant versus neutral AS distractor trials. RESULTS: Functional connectivity between the right amygdala and left postcentral gyrus/primary somatosensory cortex was positively correlated with the Moral Injury Exposure and Symptom Scale for Civilians exposure score (voxelwise p < .001, cluster false discovery rate-corrected p < .05) in response to threat versus neutral AS distractor trials. Follow-up analyses revealed significant effects of race; Black but not White participants demonstrated this significant pattern of amygdala-left somatosensory cortex connectivity. CONCLUSIONS: Increased exposure to potentially morally injurious events may lead to emotion-somatosensory pathway disruptions during attention to threat-relevant stimuli. These effects may be most potent for individuals who have experienced multilayered exposure to morally injurious events, including racial trauma. Moral injury appears to have a distinct neurobiological signature that involves abnormalities in connectivity of emotion-somatosensory paths, which may be amplified by race-related stress.

"A Profound, Abiding Hatred": An Analysis of Hermann Goering's Alleged Morphine Addiction.

Hermann Goering, one of the most prominent members of the Nazi Party and for many years the presumed heir to Adolf Hitler, had a well-known history of morphine addiction. By the last days of the Second World War, he was widely considered by his contemporaries to have been completely incapacitated by his addiction. In this article, we argue that Goering's addiction, while possibly present, was purposefully exaggerated by his rivals for political purposes. His habit of ingesting paracodeine pills may have been a crude form of opioid maintenance therapy, similar to that of methadone today. Ultimately, his history of substance abuse had no significant impact on his capacity, ruthlessness, and leading role in Nazi crimes.

Two God-Kings, Two Skulls: Artificial Cranial Deformation in Akhenaten of Egypt and Khingila of the Huns.

Separated by half a continent and over 1800 years, Akhenaten, the "Heretic Pharaoh" of Egypt, and Khingila, "The God-King" of the Alchon Huns, had a great deal in common. Both rulers laid claim to divinity, labeling themselves as gods amongst men, and both are represented in their official imagery with unusually shaped skulls consistent in appearance with artificial cranial deformation (ACD) performed upon them soon after birth. This article compares the evidence - including the KV55 mummy, likely the remains of Akhenaten himself - between the two God-Kings and determines that Khingila almost certainly possessed an annular erect ACD consistent with the wider Hun culture. Akhenaten's ACD in his state-sponsored imagery was likely solely an artistic choice meant to emphasize his oneness with the divine. In both men, their represented ACD was ultimately intended to solidify their power through two different avenues. For Khingila, it was to emphasize a common ethnic and cultural heritage with his subjects. For Akhenaten, it was meant to set the pharaoh even further apart from the rest of humanity.

"Forbidden Fish": Did King Henry I Die of Lamprey Poisoning?

For centuries, the sudden and mysterious death of King Henry I has been attributed to a large meal of lampreys that accidentally poisoned the unfortunate monarch. In this article, we conclude that lampreys were likely not the cause of the king's illness, nor is it likely that he was deliberately poisoned. Although a wide variety of abdominal pathologies could have been responsible, we suggest that a sporadic central nervous system (CNS) infection of Listeria monocytogenes appears to be the most likely cause of Henry's death, correlating with both his symptoms and rapid decline.

Mad Honey and the Poisoner King: A Case of Mass Grayanotoxin Poisoning in the Roman Military.

We describe an episode of mass poisoning during the ancient Third Mithridatic War. In a brutal and well-planned ambush, forces from the Kingdom of Pontus destroyed a Roman column through the clever use of "mad honey." Incapacitated by the acute poisoning, the Romans were unable to hold off the Pontic forces. We conclude that the debilitating symptoms that the Roman soldiers experienced were due to the presence of grayanotoxins in the honey. Although they were likely self-limiting, developing these symptoms in an enemy ambush made a lethal combination. The "mad honey" environmental threat continues to persist in the Black Sea region to this day and is an etiology that modern physicians should be aware of.

Possible Causes of Hypertrophic Osteoarthropathy in the La Ferrassie 1 Neanderthal.

For over a century, researchers have been perplexed by the unique osteological findings on La Ferrassie 1 (LF1), one of the most complete Neanderthal remains ever found. In 1997, Fennel and Trinkaus proposed that LF1 suffered from hypertrophic osteoarthropathy (HOA), likely secondary to chronic thoracic infection or pulmonary malignancy. This disease process can have many etiologies, and no study has fully explored the possible origin of LF1's HOA. Ultimately, it is most likely that LF1's HOA etiology arose from one of the many infectious diseases that prehistoric Neanderthals were exposed to, specifically a chronic pulmonary RNA virus.

Tyrant's End: Did Joseph Stalin Die From Warfarin Poisoning?

One of the most brutal dictators in humanity's history, Joseph Stalin forged the Soviet Union into a massive superpower, crushing the lives of millions of his own citizens along the way. His sudden death in March 1953 from a stroke took the world by surprise and led to a frantic power struggle within the ranks of the Soviet government. In recent years, researchers have proposed that Stalin's stroke was not natural and was potentially caused by one of his lieutenants poisoning him with warfarin or a similar anticoagulant. After examining the evidence, this article concludes that both Stalin's disease course and the properties of warfarin make it highly unlikely that he was deliberately assassinated.

"The Most Gentle of Lethal Methods": The Question of Retained Consciousness Following Decapitation.

Since the development of the infamous guillotine in the French Revolution, physicians have debated how long consciousness persists in decapitated heads. Fueled by anecdotes of severed heads that blink, blush, and appear to retain intelligence, numerous experiments have investigated this macabre subject for nearly 250 years. In this paper, we examine the evidence, both historical and modern, and ultimately conclude that, while the truth may never be fully known, all evidence appears to indicate that loss of consciousness appears to occur within seconds of decapitation. The rumors that circulated through the European consciousness during the Terror of the French Revolution appear to be just that - curious urban legends from an awed and terrified public.

Fire and Brimstone: SO2 as a Chemical Weapon in History.

Sulfur dioxide (SO2), a chemical produced from the burning of sulfur-containing materials, has a long history in chemical warfare. While it was largely used during ancient sieges, there were numerous proposals to weaponize it for the open battlefield in the early modern age.

Failure to Plan: The Disease That Cost an American Empire.

In 1802, the deadliest recorded epidemic of yellow fever struck a French expeditionary force, permanently destroying Napoleon Bonaparte's ambition to re-conquer Haiti and secure a North American empire. Toussaint L'Ouverture, Haitian revolutionary, effectively used his medical experience to spread this disease among French troops.

Schistosomiasis: The Disease That Saved Taiwan.

From 1949 to 1950, an acute epidemic of schistosomiasis struck several elite units of the People's Liberation Army during the Chinese Civil War that were preparing for an amphibious invasion of Taiwan. The crucial delay brought by the sudden outbreak of the disease may have cost communist forces control of the strategic island, changing the geopolitical calculus of the Pacific in the decades since.

A Lesion on the "King of Kings": Neurofibromas in the Parthian Empire's Arsacid Dynasty.

Multiple kings of the Arsacid Dynasty of the ancient Parthian Empire are depicted on their coinage with a recurrent facial lesion, one that is found across multiple generations. Multiple theories have attempted to explain this phenomenon, from basal cell carcinoma to hereditary trichoepithelioma. In this paper, we suggest that these lesions are possibly a representation of the neurofibromas found in Neurofibromatosis 1, an autosomal dominant disease process.