iiinova — where your digital self keeps evolving

John Ross @johnrossmd.bsky.social · 11/10/2026

Dumbass Northern flicker (possibly drunk on nearby crabapples) crashed through my window screen and got stuck between the screen and the window. Even after I enlarged the opening, it still took him a while to get out (he’s fine now btw).

Northern flicker, a large woodpeckerish guy, caught in a situation of his own making

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John Ross @johnrossmd.bsky.social · 07/10/2026

The annual curve of flu cases is starting to rise sharply in the US. This would be a great week to get vaccinated, if you haven't already

Influenza Positive Tests Reported to CDC by Clinical Laboratories,
National Summary, 2025-26 Season, week ending Sep 26, 2026. From: https://www.cdc.gov/fluview/surveillance/2026-week-38.html

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John Ross @johnrossmd.bsky.social · 03/10/2026

"Stew" was also Elizabethan slang for "brothel," which may refer to the sweating tub treatment for syphilis. This combined exposure to fumes of cinnabar, or mercuric sulfide (bad, useless) and exposure to extreme heat (actually therapeutic! Treponema pallidum lacks heat shock proteins).

The engraved titlepage of a Latin comedy, Cornelianum Dolium, by "T. R." published in 1638, shows a man standing in a sweating tub; the fumes of cinnabar or mercuric sulphide were thought to cure venereal disease. The top inscription reads: "Farewell, O Venus and Cupids"; the lower, "I sit on the throne of Venus, I suffer in the tub."

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John Ross @johnrossmd.bsky.social · 30/09/2026

Classic "orange on stilts" appearance of Cushing syndrome: central obesity with pendulous abdomen, thin arms and legs, buffalo hump

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John Ross @johnrossmd.bsky.social · 17/09/2026

I have seen too much cefepime delirium/encephalopathy in the hospitalized elderly, so I try to avoid it unless it’s absolutely necessary. New study shows cefepime is associated with higher all-cause mortality vs comparator antibiotics #IDSky jamanetwork.com/journals/jam...

The posterior probability that cefepime was associated with increased mortality was 99.3% vs ceftazidime (OR, 1.30; 95% Crl, 1.06-1.62), 94.7% vs carbapenem (OR, 1.26; 95% Crl, 0.95-1.66), and 77.6% vs piperacillin-tazobactam (OR, 1.09; 95% CrI, 0.87-1.34).

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John Ross @johnrossmd.bsky.social · 14/09/2026

Cychlorphine, a new synthetic opioid, is 10 times as potent as fentanyl, not detected by standard lab tests, and may be less susceptible to reversal by naloxone. Use of *multiple doses* of Narcan is advised cychlorphine OD is suspected

Critically, respiratory depression assayed by non-invasive plethysmography was most pronounced for fluorphine, chlorphine, and brorphine; and, concerningly, for some compounds, pre-treatment with naloxone (6 mg/kg i.p.) only partially reversed respiratory depression, indicating possible non-opioid contributions to toxicity or receptor kinetics that differ from classical opioids.6 Similarly partial naloxone reversal of cardiorespiratory impairment induced by these analogs in vivo was reported.6 The preclinical findings, extrapolated to the N-propionitrile modification in cychlorphine, suggest a drug with extremely potent MOR agonism, pronounced respiratory depressant capacity, and potentially complex naloxone reversal dynamics in overdose scenarios.

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John Ross @johnrossmd.bsky.social · 10/09/2026

Sorry, the mystery Walter Reed visit was in 2019, prompting this later denial in September 2020

Trump tweet Sept 1, 2020: “It never ends! Now they are trying to say that your favorite President, me, went to Walter Reed Medical Center, having suffered a series of mini-strokes. Never happened to THIS candidate - FAKE NEWS. Perhaps they are referring to another candidate from another Party!”

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John Ross @johnrossmd.bsky.social · 10/09/2026

This is the Rood Approach, a sensory stimulation technique used to activate weak muscles after stroke. Trump has had a wonky right leg since his mystery visit to Walter Reed in September 2020. This 2020 clip shows circumduction gait, in which the weak leg is dragged in a semicircle after a stroke.

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John Ross @johnrossmd.bsky.social · 05/09/2026

“these results imply that other furin cleavage sites, such as the one in SARS-CoV-2, may be acquired in bats through recombination or insertion mutations”

Given the importance of a the furin cleavage site in determining host range, infectivity, and cross-species transmission2627, this finding provides important insights into the evolutionary processes that shape coronavirus genomes. More broadly, these results imply that other furin cleavage sites, such as the one in SARS-CoV-2, may be acquired in bats through recombination or insertion mutations, further highlighting bats' role as potential reservoirs of genetic innovations relevant to zoonotic

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John Ross @johnrossmd.bsky.social · 28/08/2026

Over half of children with measles have enlarged spleens (Am J Dis Child 1926;31:26-30)

Graph showing over 50% of kids with measles have palpable spleens by the 3rd day of rash

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John Ross @johnrossmd.bsky.social · 28/08/2026

Measles infection in pregnancy increases the risk of intrauterine death nine-fold and maternal mortality ten-fold

Clin Infect Dis 2014 Apr;58(8):1086-92
Of 55 pregnant women with measles, 53 (96%) were hospitalized; measles-related complications included diarrhea (60%), pneumonia (40%), and encephalitis (5%). Among pregnant women with known human immunodeficiency virus (HIV) status, 15% of those without measles and 19% of those with measles were HIV positive. Of 42 measles-related pregnancies with known outcomes, 25 (60%) had ≥1 adverse maternal, fetal, or neonatal outcome and 5 women (12%) died. Compared with 172 pregnancies without measles, after adjusting for age, pregnancies with measles carried significantly increased risks for neonatal low birth weight (adjusted relative risk [aRR] = 3.5; 95% confidence interval [CI], 1.5–8.2), spontaneous abortion (aRR = 5.9; 95% CI, 1.8–19.7), intrauterine fetal death (aRR = 9.0; 95% CI, 1.2–65.5), and maternal death (aRR = 9.6; 95% CI, 1.3–70.0).

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John Ross @johnrossmd.bsky.social · 27/08/2026

While rats and rat fleas seem to be of primary importance in infection in densely populated urban settings, spread of fleas by opossums, cats, and dogs may also play a role

Map of flea-borne typhus in Texas in 2008-25; most typhus cases in Texas occur in South Texas from Nueces County south to the Rio Grande Valley. In the past couple of decades, new areas of endemicity have emerged in the Dallas-Fort Worth metroplex, Greater Houston area, Bexar, Travis, and other Texas counties

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John Ross @johnrossmd.bsky.social · 18/08/2026

The United States has a long history of blaming epidemics on stigmatized and marginalized groups, such as vampires, witches, the Irish, gays, and NIH career scientists

The New England vampire panic was the reaction to an outbreak of tuberculosis in the late 18th and 19th centuries throughout Rhode Island, eastern Connecticut, southern Massachusetts, Vermont, and other areas of the New England states.[1] Consumption (tuberculosis) was thought to be caused by the deceased consuming the life of their surviving relatives.[2] Bodies were exhumed and internal organs ritually burned to stop the deceased "vampire" from attacking the local population and to prevent the spread of the disease. Notable cases provoked national attention and comment, such as those of Mercy Brown in Rhode Island and Frederick Ransom in Vermont.

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John Ross @johnrossmd.bsky.social · 17/08/2026

Wage theft and ICE go together like MAHA and measles

When one worker confronted his employer over text, saying he would file a report alleging wage theft, the employer wielded a threat that immigrant advocates say has become increasingly common since the Trump administration’s immigration crackdown started.

“You can file whatever you like,” the employer wrote, in messages viewed by the Globe. “I will not pay you nothing because you threaten me [sic] now [expletive] off or I will get ICE and the police to your house to bring you back to the dusty taco eating place you come from … I know where you live.” (Boston Globe, August 17, 2026)

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John Ross @johnrossmd.bsky.social · 05/08/2026

Remember that godawful screwworm infecting cattle in Texas and New Mexico because the Trump administration defunded the control program? Well, there were at least 202 human cases in Mexico in the past year too

Figure 1. Confirmed human New World screwworm myiasis cases resulting from reemergence of Cochliomyia hominivorax screwworm, by epidemiologic week and cumulative, Mexico, April 13, 2025–March 14, 2026. Data were obtained from official epidemiologic bulletins of the Directorate General of Epidemiology, Ministry of Health (14–16). Link to paper: https://wwwnc.cdc.gov/eid/article/32/10/26-1235_article

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John Ross @johnrossmd.bsky.social · 03/08/2026

Thugamar cuairt ar Éirinn an samhradh seo agus thugamar cuairt ar Ráth Chruacháin, teach na Banríona Maeve. Anseo le mo mhac in Oweynagat (Uaimh na gCat)

Two guys in Oweynagat (Uaimh na gCat), Cave of the Cats, Rathcroghan, County Roscommon. A portal to the Underworld and the supposed origin site of Halloween (Samhain)

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John Ross @johnrossmd.bsky.social · 02/08/2026

"Each time he shears a sheep he sees/Some bloated plutocrat who ought to freeze" has lived in my mind rent-free for decades

Now that's grand stuff. There is no doubt of it. There's a wonderful movement and force to it. You can almost see it move, it goes so fast. But the modern reader can't get it. It won't mean to him what it meant to the early Greek. The setting, the costume, the scene has all got to be changed in order to let the reader have a real equivalent to judge just how good the Greek verse is. In my translation I alter it just a little, not much but just enough to give the passage a form that reproduces the proper literary value of the verses, without losing anything of the majesty. It describes, I may say, the Directors of the American Industrial Stocks rushing into the Balkan War Cloud.--

Then there came rushing to the shock of war
Mr. McNicoll of the C. P. R.
He wore suspenders and about his throat
High rose the collar of a sealskin coat.
He had on gaiters and he wore a tie,
He had his trousers buttoned good and high;
About his waist a woollen undervest
Bought from a sad-eyed farmer of the West.
(And every time he clips a sheep he sees
Some bloated plutocrat who ought to freeze),
Thus in the Stock Exchange he burst to view,
Leaped to the post, and shouted, "Ninety-two!"

There! That's Homer, the real thing! Just as it sounded to the rude crowd of Greek peasants who sat in a ring and guffawed at the rhymes and watched the minstrel stamp it out into "feet" as he recited it!

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John Ross @johnrossmd.bsky.social · 02/08/2026

Odyssey discourse reminds me of Stephen Leacock's funny and mean-spirited essay "Homer and Humbug," which asserts that "The classics are only primitive literature. They belong in the same class as primitive machinery and primitive music and primitive medicine"

Or let me take another example from the so-called Catalogue of the Ships that fills up nearly an entire book of Homer. This famous passage names all the ships, one by one, and names the chiefs who sailed on them, and names the particular town or hill or valley that they came from. It has been much admired. It has that same majesty of style that has been brought to an even loftier pitch in the New York Business Directory and the City Telephone Book. It runs along, as I recall it, something like this,--

"And first, indeed, oh yes, was the ship of Homistogetes the Spartan, long and swift, having both its masts covered with cowhide and two rows of oars. And he, Homistogetes, was born of Hermogenes and Ophthalmia and was at home in Syncope beside the fast flowing Paresis. And after him came the ship of Preposterus the Eurasian, son of Oasis and Hyteria," . . . and so on endlessly.

Instead of this I substitute, with the permission of the New York Central Railway, the official catalogue of their locomotives taken almost word for word from the list compiled by their superintendent of works. I admit that he wrote in hot weather. Part of it runs:--

Out in the yard and steaming in the sun
Stands locomotive engine number forty-one;
Seated beside the windows of the cab
Are Pat McGaw and Peter James McNab.
Pat comes from Troy and Peter from Cohoes,
And when they pull the throttle off she goes;
And as she vanishes there comes to view
Steam locomotive engine number forty-two.
Observe her mighty wheels, her easy roll,
With William J. Macarthy in control.
They say her engineer some time ago
Lived on a farm outside of Buffalo
Whereas his fireman, Henry Edward Foy,
Attended School in Springfield, Illinois.
Thus does the race of man decay or rot--
Some men can hold their jobs and some can not.

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John Ross @johnrossmd.bsky.social · 20/07/2026

Screenshot, in case this disappears from the CDC website

On July 17, 2026, Taylor Farms de Mexico recalled all iceberg lettuces sourced from central Mexico.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are continuing to collect different types of data to investigate a multistate outbreak of Cyclospora infections.

Epidemiologic and traceback data show that iceberg lettuce from Taylor Farms de Mexico is contaminated with Cyclospora and is making people sick.

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John Ross @johnrossmd.bsky.social · 20/07/2026

TIL there was a lost sequel to the Odyssey called the Telegony, in which Telegonus, Odysseus’s son by Circe, accidentally kills his old man with a stingray spine. In a weirdly incestuous turn of events, Telegonus marries the newly widowed Penelope, while his half-brother Telemachus marries Circe

Shipwrecked on Ithaca by a storm, Telegonus believed mistakenly that he had made landfall on Corcyra (Corfu) and, assailed by hunger, began plundering the island. Odysseus and his oldest son, Telemachus, defended their city and, in the ensuing melée, Telegonus accidentally killed his father with a lance tipped with the venomous spine of a stingray. Telemachus married Telegonus' mother, the enchantress Circe, while Telegonus took to wife Odysseus' widow Penelope.

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John Ross @johnrossmd.bsky.social · 14/07/2026

Plus the whole guns and cars thing

The US has 11 motor vehicle crash deaths per 100,000 of population, about double the average in wealthy countries

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John Ross @johnrossmd.bsky.social · 12/07/2026

Live look at the 2nd Session of the 119th United States Congress

Genevieve Bujold walking through a roomful of patients on life support artfully suspended from the ceiling in the 1978 thriller Coma

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John Ross @johnrossmd.bsky.social · 12/07/2026

Cyclospora is a difficult diagnosis. PCR is best; microscopy sucks. In the pre-PCR era, we would often just treat empirically with TMP-SMX if the diagnostic suspicion was high (eg. ongoing outbreak, onset of illness in summer, subacute diarrhea with weight loss over weeks). #IDSky

843 cases of cyclosporiasis so far this summer in the US; this is almost certainly a gross undercount due to public health underfunding and the low diagnostic sensitivity of microscopy

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John Ross @johnrossmd.bsky.social · 27/06/2026

Hockey News had him 13th overall

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John Ross @johnrossmd.bsky.social · 22/06/2026

Uriah Heep looks like Victorian Beavis

Engraving of Uriah Heep by Harry Furniss, from an early edition of David Copperfield by Charles Dickens

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John Ross @johnrossmd.bsky.social · 20/06/2026

Bell was at first flattered by the attention he garnered as “the real-life Sherlock Holmes,” but soon came to regret it, especially after Conan Doyle doxxed him in the dedication to The Adventures of Sherlock Holmes

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John Ross @johnrossmd.bsky.social · 20/06/2026

Conan Doyle, who was Bell’s ward clerk as a medical student, used chunks of Bell’s deductions about patients more or less verbatim in the Holmes stories. He would later press Bell for story ideas, although it is not clear whether Doyle actually used them or not

Bell, anticipating Kahneman’s Thinking Fast and Slow: “The experienced physician and the trained surgeon every day, in their examinations of the humblest patient, have to go through a similar process of reasoning, quick or slow according to the personal equations of each, almost automatic in the experienced man, laboured and often erratic in the tyro, yet requiring just the same simple requisites, senses to notice facts, and education and intelligence to apply them," he noted. With proper training, anyone could become a Sherlock Holmes.

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John Ross @johnrossmd.bsky.social · 20/06/2026

Really enjoyed Sleuth-Hound by @drlindseyfitz.bsky.social, about Joseph Bell, the physician who was the real-life model for Sherlock Holmes, the golden age of Victorian murder, and the birth of forensic medicine. It uncovers a lost chapter in medical history, and it’s great grisly fun to boot!

Advance copy of Sleuth-Hound: The Case of the Real Sherlock Holmes, by Lindsey Fitzharris

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John Ross @johnrossmd.bsky.social · 07/06/2026

Martha’s Vineyard Hospital, which has 25 beds, had over 700 positive tests for alpha-gal allergy last year. If you live in Massachusetts, best to get your fill of red meat now

Four years ago, when the InterIsland Public Health Excellence Collaboration hired Roden-Reynolds, he found lone star ticks mostly in the island’s less populous southern stretches. Now they’re everywhere. In 2021, Martha’s Vineyard Hospital ran 78 tests for alpha gal. Last year, the number topped 1,600; about 44 percent were positive.

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John Ross @johnrossmd.bsky.social · 29/05/2026

This reads like an Alan Dean Foster novelization of the DSM-III (complimentary)

Paperback edition of Play It As It Lays, by Joan Didion

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John Ross @johnrossmd.bsky.social · 27/05/2026

Splenunculus, or accessory spleen. Present in 20% of people. Can take over the immune function of the spleen if it is damaged by trauma and has to be surgically removed, as happened to this patient.

Coronal image from CT scan of abdomen, showing accessory spleen (splenunculus)

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John Ross @johnrossmd.bsky.social · 19/05/2026

He is not aging well. He has a diagonal earlobe crease (Frank sign), which is associated with coronary disease and shortened telomeres

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John Ross @johnrossmd.bsky.social · 08/05/2026

Hey, remember the "don't worry your pretty little head about coronavirus" discourse?

February 4, 2020: Coronavirus ‘not something to panic about,’ says Berkeley health expert
Though cases in China may exceed current reports, infectious disease specialist John Swartzberg believes the United States is well equipped to face the outbreak

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John Ross @johnrossmd.bsky.social · 06/05/2026

R0 was 2.12. Not quite early COVID (3-4), but still impressive for a virus that we don’t usually associate with person-to-person spread

The median reproductive number (the number of secondary cases caused by an infected person during the infectious period) was 2.12 before the control measures were enforced and decreased to 0.96 after the measures were implemented.

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John Ross @johnrossmd.bsky.social · 05/05/2026

Andes virus, the hantavirus suspected in the cruise ship outbreak, may be transmitted person-to-person, plus the incubation period may be insanely long (up to 40 days). For infection control purposes, you need a literal quarantine

Humans usually become infected with hantaviruses through inhalation of aerosolized excreta produced by infected rodents. ANDV is the unique hantavirus capable of being transmitted from person-to-person (5–7). Infection by this route takes place during the early prodromal phase, and the incubation period ranges from 9 to 40 days (8).

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John Ross @johnrossmd.bsky.social · 27/04/2026

Me whenever a colleague raves about OpenEvidence AI

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John Ross @johnrossmd.bsky.social · 25/04/2026

Wastewater data suggests that measles cases are grossly undercounted in the US, perhaps because parents of unvaccinated kids are avoiding care (the confirmed US total for 2025 was 2,288)

Screenshot from https://www.cnn.com/2026/04/24/health/newer-testing-silent-spread-measles-elimination

A separate EIS investigation of measles in wastewater from Oregon found that the virus was detected 100 times between October and February, in 23 of 24 monitored counties. Oregon had six reported cases of measles during that time, but all of these were outside the areas that were being monitored for the virus.

“The number and spread of detection suggests measles is more widespread than the six reported cases that we have,” Dr. Jeffrey Tamucci, an EIS officer assigned to the Oregon Public Health Authority, said in a conference presentation.

“It begs the question, why are there missing clinical cases? Is it a sick person that does not seek care? A patient being diagnosed with other illnesses? Providers not testing those with clinically compatible symptoms? Or something else?” Tamucci said. “We don’t know for sure. We’re still trying to figure that out.”

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John Ross @johnrossmd.bsky.social · 15/04/2026

gouty arthritis among early modern aristocrats. Gout became a status symbol, suggesting noble blood. Montaigne even claimed that gout was an aphrodisiac of sorts: "[when the legs] do not receive the food that is their due … the genital parts … are fuller, better nourished, and more vigorous." 2/2

"Introduction of the Gout," George Cruikshank, 1818. A rich man gorges himself on food and drink (including a pineapple, a signifier of extreme luxury), while a demon applies a coal to his big toe (leading to inflammation of the 1st metatarsal joint, or podagra). A picture on the wall of Vesuvius erupting indicates that a gouty attack is imminent.

"An Exquisite Taste, an Enlarged Understanding," by George Hunt, 1830. Engraving of a gouty man savouring his feast; his left leg is wrapped in dressings and raised on a stand to alleviate his pain and swelling.

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John Ross @johnrossmd.bsky.social · 12/04/2026

Not an expert, but I think this is when the Indo-Europeans (or Proto-Indo-Europeans) started to show up. From Wikipedia:

According to evolutionary geneticist Eske Willerslev, "There was a heavy reduction of Neolithic DNA in temperate Europe, and a dramatic increase of the new Yamnaya genomic component that was only marginally present in Europe prior to 3000 BC."

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John Ross @johnrossmd.bsky.social · 11/04/2026

Mercenaries II (1979), Leon Golub, Musée des Beaux-Arts, Montréal

Grinning white men of indeterminate age wearing fatigues and holding automatic weapons, against a red oxide background reminiscent of the murals of Pompeii

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John Ross @johnrossmd.bsky.social · 05/04/2026

Did you do anything to get it to fruit? (I have a pineapple I've been growing indoors for a couple of years)

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John Ross @johnrossmd.bsky.social · 03/04/2026

Chick tracts were all over my rural Canadian high school, in which Catholics were a distinct minority. Always thought it was wild that Protestants would brag about their lack of obligation to perform good works!

Sinner at the throne of judgment: I spent my whole life doing good works!

God in the anti-Catholic Chick comic Last Rites: "By grace are ye saved...not of works"

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