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<title>12 May, 2023</title>
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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>Biorefinery Innovation in Increasing the Effectiveness of COVID-19 Vaccine Production</strong> -
<div>
The COVID-19 pandemic has highlighted the importance of innovation in the fight against infectious diseases. Biorefinery offers a promising platform for the production of vaccines that is more cost-effective, efficient, and scalable than traditional methods. By using advanced fermentation and purification techniques and genetic engineering, biorefinery can improve the efficacy of vaccines and enable their production on a large scale. While there are challenges that need to be addressed, biorefinery has the potential to revolutionize the way we produce vaccines and other bioproducts, and contribute to a more sustainable and resilient future.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/6tuh7/" target="_blank">Biorefinery Innovation in Increasing the Effectiveness of COVID-19 Vaccine Production</a>
</div></li>
<li><strong>Metabolic alterations unravel the materno fetal immune responses with disease severity in pregnant women infected with SARS-CoV-2</strong> -
<div>
Background: Pregnancy being immune compromised state, COVID-19 disease poses a high risk of premature delivery and threat to fetus. Plasma metabolome regulates immune cellular responses and we aimed to analyze the plasma secretome, metabolome, and immune cells in COVID-19-positive pregnant mothers and cord blood. Methods: COVID-19 RT-PCR positive pregnant females (n=112) asymptomatic (n=82), or with mild (n=21) or moderate (n=9) disease and control healthy pregnant (n=10) females were included. Mothers blood and cord blood (n=80) was analyzed for untargeted metabolome profiling and plasma cytokines by high-resolution mass spectrometry (MS) and multiplex cytokine bead array. Immune scan in mothers was done using flow cytometry. Results: In asymptomatic SARS-CoV-2 infection, the amino acid metabolic pathways such as glycine, serine, L-lactate, and threonine metabolism was upregulated, riboflavin and tyrosine metabolism, downregulated. In mild to moderate disease, the pyruvate and NAD+ metabolism (energy metabolic pathways) were mostly altered. In addition to raised TNF-alpha, IFN-alpha, IFN-gamma, IL-6 cytokine storm, IL-9 was increased in both mothers and neonates. Pyruvate and NAD+ metabolic pathways along with IL-9 and IFN-gamma had an impact on non-classical monocytes, increased CD4 T cells and B cells but depleted CD8+ T cells. Cord blood mimicked the mothers metabolomic profiles by showing altered valine, leucine, isoleucine, glycine, serine, threonine in asymptomatic and NAD+ and riboflavin metabolism in mild and moderate disease subjects. Conclusions: Our results demonstrate a graduated immune-metabolomic interplay in mother and fetus in pregnant females with different degrees of severity of COVID-19 disease. IL-9 and IFN- gamma regulated pyruvate, lactate TCA metabolism, and riboflavin metabolism with context to disease severity are hallmarks of this materno-fetal metabolome.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.05.10.540101v1" target="_blank">Metabolic alterations unravel the materno fetal immune responses with disease severity in pregnant women infected with SARS-CoV-2</a>
</div></li>
<li><strong>D614G and Omicron SARS-CoV-2 variant spike proteins differ in the effects of N-glycan modifications on spike expression, virus infectivity, and neutralization by some therapeutic antibodies</strong> -
<div>
The SARS-CoV-2 spike glycoprotein has 22 potential N-linked glycosylation sites per monomer that are highly conserved among diverse variants, but how individual glycans affect virus entry and neutralization of Omicron variants has not been extensively characterized. Here we compared the effects of specific glycan deletions or modifications in the Omicron BA.1 and D614G spikes on spike expression, processing, and incorporation into pseudoviruses, as well as on virus infectivity and neutralization by therapeutic antibodies. We found that loss of potential glycans at spike residues N717 and N801 each conferred a loss of pseudovirus infectivity for Omicron but not for D614G or Delta variants. This decrease in infectivity correlated with decreased spike processing and incorporation into Omicron pseudoviruses. Oligomannose-enriched Omicron pseudoviruses generated in GnTI- cells or in the presence of kifunensine were non-infectious, whereas D614G or Delta pseudoviruses generated under similar conditions remained infectious. Similarly, authentic SARS-CoV-2 grown in the presence of kifunensine decreased titers more for the BA.1.1 variant than Delta or D614G variants relative to their respective, untreated controls. Finally, we found that loss of some N-glycans, including N343 and N234, increased the maximum percent neutralization by the class 3 S309 monoclonal antibody against D614G but not BA.1 variants, while these glycan deletions altered the neutralization potency of the class 1 COV2-2196 and Etesevimab monoclonal antibodies without affecting maximum percent neutralization. The maximum neutralization by some antibodies also varied with the glycan composition, with oligomannose-enriched pseudoviruses conferring the highest percent neutralization. These results highlight differences in the interactions between spike glycans and residues among SARS-CoV-2 variants that can affect spike expression, virus infectivity, and susceptibility of variants to antibody neutralization.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.05.10.540228v1" target="_blank">D614G and Omicron SARS-CoV-2 variant spike proteins differ in the effects of N-glycan modifications on spike expression, virus infectivity, and neutralization by some therapeutic antibodies</a>
</div></li>
<li><strong>Mild/Asymptomatic Maternal SARS-CoV-2 Infection Leads to Immune Paralysis in Fetal Circulation and Immune Dysregulation in Fetal-Placental Tissues</strong> -
<div>
Few studies have addressed the impact of maternal mild/asymptomatic SARS-CoV-2 infection on the developing neonatal immune system. In this study, we analyzed umbilical cord blood and placental chorionic villi from newborns of unvaccinated mothers with mild/asymptomatic SARS-CoV-2 infection during pregnancy using flow cytometry, single-cell transcriptomics, and functional assays. Despite the lack of vertical transmission, levels of inflammatory mediators were altered in cord blood. Maternal infection was also associated with increased memory T, B cells, and non-classical monocytes as well as increased activation. However, ex vivo responses to stimulation were attenuated. Finally, within the placental villi, we report an expansion of fetal Hofbauer cells and infiltrating maternal macrophages and rewiring towards a heightened inflammatory state. In contrast to cord blood monocytes, placental myeloid cells were primed for heightened antiviral responses. Taken together, this study highlights dysregulated fetal immune cell responses in response to mild maternal SARS-CoV-2 infection during pregnancy.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.05.10.540233v1" target="_blank">Mild/Asymptomatic Maternal SARS-CoV-2 Infection Leads to Immune Paralysis in Fetal Circulation and Immune Dysregulation in Fetal-Placental Tissues</a>
</div></li>
<li><strong>Factors associated with the near miss of pregnant and postpartum women hospitalized by Covid-19</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Objective To analyze the factors associated with maternal near miss due to Covid-19 in Brazil. Method cross-sectional study that assessed the cases of pregnant and postpartum women hospitalized with SARS due to Covid-19, aged between 10 and 49 years and from March 2020 to March 2022. Secondary data available in the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) were used. Data were analyzed using SPSS statistical software, with univariate analysis followed by logistic regression. Results the significant independent factors associated with near miss in pregnant postpartum women due to Covid-19 were black/brown race, O2 saturation &lt;95%, dyspnea, comorbidities, need for invasive and non-invasive ventilatory support. Conclusion the factors associated with near misses in pregnant and postpartum women with covid-19 reveal characteristics and risks inherent to the pathophysiology of the disease that contribute to worsening the condition.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.10.23289809v1" target="_blank">Factors associated with the near miss of pregnant and postpartum women hospitalized by Covid-19</a>
</div></li>
<li><strong>Reconciling the efficacy and effectiveness of masking on epidemic outcomes</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Mask wearing in public settings has been broadly implemented as a means to mitigate the COVID-19 pandemic. However, the reported effectiveness of masking has been much lower than laboratory measures of efficacy, and this large discrepancy has cast doubt on the utility of masking. Here, we develop an agent-based model that comprehensively accounts for individual masking behaviors and infectious disease dynamics, and test the impact of masking on epidemic outcomes. Using realistic inputs of mask efficacy and contact data at the individual level, the model reproduces the lower effectiveness as reported in randomized controlled trials. Model results demonstrate that transmission within households, where masks are rarely used, can substantially lower effectiveness, and reveal the interaction of nonlinear epidemic dynamics, control measures (e.g., masking and social distancing), and potential measurement biases. Overall, model results show that, at the individual level, consistent masking can reduce the risk of first infection, and, over time, reduce the frequency of repeated infection. At the population level, masking can provide direct protection to mask wearers, as well as indirect protection to non-wearers, collectively reducing epidemic intensity. These findings suggest it is prudent for individuals to use masks during an epidemic, and for policy makers to recognize the less-than-ideal effectiveness of masking when devising public health interventions.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.10.23289803v1" target="_blank">Reconciling the efficacy and effectiveness of masking on epidemic outcomes</a>
</div></li>
<li><strong>Retrospective Analysis of Equity-Based Optimization for COVID-19 Vaccine Allocation</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Marginalized racial and ethnic groups in the United States were disproportionally affected by the COVID-19 pandemic. To study these disparities, we construct an age-and-race-stratified mathematical model of SARS-CoV-2 transmission fitted to age-and-race-stratified data from 2020 in Oregon and analyze counterfactual vaccination strategies in early 2021. We consider two racial groups: non-Hispanic White persons and persons belonging to BIPOC groups (including non-Hispanic Black persons, non-Hispanic Asian persons, non-Hispanic American Indian or Alaska Native persons, and Hispanic or Latino persons). We allocate a limited amount of vaccine to minimize overall disease burden (deaths or years of life lost), inequity in disease outcomes between racial groups (measured with five different metrics), or both. We find that, when allocating small amounts of vaccine (10% coverage), there is a trade-off between minimizing disease burden and minimizing inequity. Older age groups, who are at a greater risk of severe disease and death, are prioritized when minimizing measures of disease burden, and younger BIPOC groups, who face the most inequities, are prioritized when minimizing measures of inequity. The allocation strategies that minimize combinations of measures can produce middle-ground solutions that similarly improve both disease burden and inequity, but the trade-off can only be mitigated by increasing the vaccine supply. With enough resources to vaccinate 20% of the population the trade-off lessens, and with 30% coverage, we can optimize both equity and mortality. Our goal is to provide a race-conscious framework to quantify and minimize inequity that can be used for future pandemics and other public health interventions.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.08.23289679v1" target="_blank">Retrospective Analysis of Equity-Based Optimization for COVID-19 Vaccine Allocation</a>
</div></li>
<li><strong>Contact patterns of frail and non-frail elderly persons in the Netherlands during the COVID-19 pandemic</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background During the COVID-19 pandemic social distancing measures were imposed to protect the population from exposure, especially elderly and frail persons who have the highest risk for severe outcomes. These restrictions greatly reduced contacts in the general population, but little is known about behaviour changes among elderly and frail persons themselves. Our aim was to quantify how COVID-19 measures affected contact behaviour of elderly and how this differed between frail and non-frail elderly. Methods In 2021 a contact survey was carried out among persons aged 70 years and older in the Netherlands. A random sample of persons per age group (70-74, 75-79, 80-84, 85-89, 90+) and gender was invited to participate, either during a period with stringent (April 2021) or moderate (October 2021) measures. Participants provided general information on themselves including their frailty, and reported characteristics of all persons with whom they had face-to-face contact on a given day, over the course of a full week. Results In total 720 community-dwelling elderly persons were included (overall response rate of 15%), who reported 16,505 contacts. During the survey period with moderate measures, non-frail participants had significantly more contacts outside their household than frail participants. Especially for women, frailty was a more informative predictor for number of contacts than age. During the survey period with stringent measures, frail and non-frail participants had significantly lower numbers of contacts compared to the survey period with moderate measures. The reduction of number of contacts was largest for the eldest non-frail participants. As they likely interact closely with highly aged and highly frail persons, this reduction of number of contacts indirectly protects frail elderly from SARS-CoV-2 exposure. Conclusions The results of this study reveal that social distancing measures during the COVID-19 pandemic differentially affected the contact patterns of frail and non-frail elderly. The reduction of contacts may have led to direct protection of elderly persons in general but also to indirect protection of frail elderly.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.09.23289550v1" target="_blank">Contact patterns of frail and non-frail elderly persons in the Netherlands during the COVID-19 pandemic</a>
</div></li>
<li><strong>Immunogenicity of NVX-CoV2373 in PREVENT-19: A Phase 3, Randomized, Placebo-Controlled Trial in Adults in the United States and Mexico</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background. NVX-CoV2373, an adjuvanted, recombinant SARS-CoV-2 spike (rS) protein vaccine, consistently demonstrated protective efficacy against COVID-19 in clinical trials and has received regulatory authorizations or approvals worldwide. Methods. PREVENT-19 (NCT04611802) is a phase 3, randomized, observer-blinded, placebo-controlled trial evaluating safety, immunogenicity, and efficacy of NVX-CoV2373 in ≈30 000 participants ≥18 years in the United States and Mexico. Vaccine humoral immune response (ie, serum immunoglobulin [IgG] antibodies, hACE2 receptor binding inhibition antibodies, and neutralizing antibodies to SARS-CoV-2) (ancestral strain) was assessed in 1200 participants randomly selected and equally divided between participants 18-64 and ≥65 years. Results. In the per protocol analysis, NVX-CoV2373 induced vigorous serum antibody responses among the 1063 analyzed participants who were SARS-CoV-2 seronegative at baseline, received both doses of study treatment, and had serology results available 2 weeks after dose 2. Geometric mean (GM) responses in both younger and older adults were higher among recipients of vaccine versus placebo for IgG (64 259 vs 121 and 37 750 vs 133 ELISA units, respectively), hACE2 receptor binding inhibition GM titers (GMTs) (222 vs 5 and 136 vs 5, respectively), and neutralizing antibody GMTs (1303 vs 11 and 900 vs 11, respectively). Humoral responses were 30-40% lower in participants ≥65 years or HIV-positive; however, seroconversion rates were high and comparable between the age cohorts, regardless of HIV serostatus. Conclusions. NVX-CoV2373 elicited robust humoral immune responses against ancestral SARS-CoV-2 virus 2 weeks following the second vaccination in adult PREVENT-19 participants, consistent with previously reported high vaccine efficacy.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.08.23289670v1" target="_blank">Immunogenicity of NVX-CoV2373 in PREVENT-19: A Phase 3, Randomized, Placebo-Controlled Trial in Adults in the United States and Mexico</a>
</div></li>
<li><strong>The Heterogeneous Effects of Lockdown Policies on Air Pollution</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
While a sharp decline in air pollution has been documented during early Covid-19 lockdown periods, the stability and homogeneity of this effect are still under debate. Building on pollution data with a very high level of resolution, this paper estimates the impact of lockdown policies on PM2.5 exposure in France over the whole year 2020. Our analyses highlight a surprising and undocumented increase in exposure to particulate pollution during lockdown periods. This result is observed during both lockdown periods, in early spring and late fall, and is robust to several identification strategies and model specifications. Combining administrative datasets with machine learning techniques, this paper also highlights strong spatial heterogeneity in lockdown effects, especially according to long-term pollution exposure.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.11.23289832v1" target="_blank">The Heterogeneous Effects of Lockdown Policies on Air Pollution</a>
</div></li>
<li><strong>Cohort Profile: Post-hospitalisation COVID-19 study (PHOSP-COVID)</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Abstract ● PHOSP-COVID is a national UK multi-centre cohort study of patients who were hospitalised for COVID-19 and subsequently discharged. ● PHOSP-COVID was established to investigate the medium- and long-term sequelae of severe COVID-19 requiring hospitalisation, understand the underlying mechanisms of these sequelae, evaluate the medium- and long-term effects of COVID-19 treatments, and to serve as a platform to enable future studies, including clinical trials. ● Data collected covered a wide range of physical measures, biological samples, and Patient Reported Outcome Measures (PROMs). ● Participants could join the cohort either in Tier 1 only with remote data collection using hospital records, a PROMs app and postal saliva sample for DNA, or in Tier 2 where they were invited to attend two specific research visits for further data collection and biological research sampling. These research visits occurred at five (range 2-7) months and 12 (range 10-14) months post-discharge. Participants could also participate in specific nested studies (Tier 3) at selected sites. ● All participants were asked to consent to further follow-up for 25 years via linkage to their electronic healthcare records and to be re-contacted for further research. ● In total, 7935 participants were recruited from 83 UK sites: 5238 to Tier 1 and 2697 to Tier 2, between August 2020 and March 2022. ● Cohort data are held in a Trusted Research Environment and samples stored in a central biobank. Data and samples can be accessed upon request and subject to approvals.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.08.23289442v1" target="_blank">Cohort Profile: Post-hospitalisation COVID-19 study (PHOSP-COVID)</a>
</div></li>
<li><strong>Living with Long COVID: Implementing a living approach to the NICE guideline on managing the long-term effects of COVID-19</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Objectives The aim of this paper is to describe the development and implementation of a flexible living approach to maintaining the currency of NICE′s long-term effects of COVID-19 (LTE) guideline and monitoring the uncertain evidence base of this condition. Study Design and Setting The NICE COVID-19 team reviewed its practical experiences of establishing a living approach to developing and maintaining the LTE guideline, including initial development, maintenance and eventual transition to a lower intensity model. The methods and processes were described narratively over the first 2 years of the guideline′s lifespan. This was combined with quantitative data on emerging and cumulative evidence over the period to chart the evidence landscape. Results Following publication, the initial timepoint-based update process evolved into a flexible living approach with remote topic expert engagement. Experts engaged with the new process with a 64% response rate to the online surveys. Emerging evidence increased rapidly following publication [11,405 studies assessed in 2021 and 13,181 in 2022] and was captured by continuous surveillance. There were no urgent triggers for updating from the studies identified in 2022 via the living approach, saving considerable resources over the timepoint based approach which would commit resources to planning and convening expert panel meetings. A total of 184 studies with a potential future impact were summarised to capture the cumulative evidence base. Experts highlighted ongoing research and implementation issues which have further informed surveillance of the guideline. After a sustained period without triggers for updating, the living approach was restricted to the highest priority areas with surveillance of ongoing studies. Conclusion This paper illustrates a flexible living approach taken to a novel condition with an evolving evidence landscape. Currency of some living guidelines can be maintained without the need for frequent updating.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.09.23289572v1" target="_blank">Living with Long COVID: Implementing a living approach to the NICE guideline on managing the long-term effects of COVID-19</a>
</div></li>
<li><strong>Interaction quality among children, staff and parents in German ECEC centres in the COVID-19 pandemic - Results from a longitudinal study</strong> -
<div>
Early Education and Care (ECEC) centres had implemented a variety of protective and hygiene measures during the COVID-19 pandemic. Some of these measures temporarily restricted the behaviour of pedagogical staff, children and parents, for example keeping distance from each other or wearing face masks. This may have made it difficult for staff to offer high quality interactions with a positive, sensitive attitude towards children and parents, as would be important for good pedagogical work. Long-term effects of these distance measures on the quality of daily interactions in ECEC centres are largely unexplored. Based on a panel survey among German ECEC centre leaders over a period of one and a half years, we provide a long-term assessment of the impact of specific protective measures on different levels of interactions within ECEC centres, namely on staff-child interactions, interactions of children with each other and the cooperation between staff and parents. We found child-child interaction largely unaffected by the measures, while staff-parent interaction suffered the most. Communication with parents and regular implementation of pedagogical practices have a stabilizing effect, while keeping distance from children, face masks and (pandemic-related) staff shortages worsen staff-child interactions.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/63xm5/" target="_blank">Interaction quality among children, staff and parents in German ECEC centres in the COVID-19 pandemic - Results from a longitudinal study</a>
</div></li>
<li><strong>Emotional Responses to a Global Stressor: Average Patterns and Individual Differences</strong> -
<div>
Major stressors often challenge emotional well-being—increasing negative emotions and decreasing positive emotions. But how long do these emotional hits last? Prior theory and research contain conflicting views. Some research suggests that most individuals’ emotional well-being will return to, or even surpass, baseline levels relatively quickly. Others have challenged this view, arguing that this type of resilient response is uncommon. The present research provides a strong test of resilience theory by examining emotional trajectories over the first six months of the COVID-19 pandemic. In two pre-registered longitudinal studies (total N =1,147), we examined average emotional trajectories and predictors of individual differences in emotional trajectories across 13 waves of data from February through September 2020. The pandemic had immediate detrimental effects on average emotional well-being. Across the next six months, average negative emotions returned to baseline levels with the greatest improvements occurring almost immediately. Yet, positive emotions remained depleted relative to baseline levels, illustrating the limits of typical resilience. Individuals differed substantially around these average emotional trajectories and these individual differences were predicted by socio-demographic characteristics and stressor exposure. We discuss theoretical implications of these findings that we hope will contribute to more nuanced approaches to studying, understanding, and improving emotional well-being following major stressors.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/g3jr7/" target="_blank">Emotional Responses to a Global Stressor: Average Patterns and Individual Differences</a>
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<li><strong>Healthcare resource utilisation and costs of hospitalisation and primary care among adults with COVID-19 in England: a population-based cohort study</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Objectives To quantify healthcare resource utilisation (HCRU) and costs to the National Health Service (NHS) associated with acute COVID-19 in adults in England. Design Population-based retrospective cohort study, using Clinical Practice Research Datalink (CPRD) Aurum primary care electronic medical records linked when available to Hospital Episode Statistics (HES) secondary care administrative data. Setting Patients registered to primary care practices in England. Population 1,706,368 adults with a positive SARS-CoV-2 PCR or antigen test from August 2020 to January 2022 were included; 13,105 within the hospitalised cohort indexed between August 2020 and March 2021, and 1,693,263 within the primary care cohort indexed between August 2020 and January 2022. Main outcome measures Primary and secondary care HCRU and associated costs during the acute phase of COVID-19 (≤4 weeks following positive test), stratified by age group, risk of severe COVID-19 and immunocompromised status. Results Among the hospitalised cohort, average total length of stay, as well as in critical care wards, was longer in older adults. Median healthcare cost per hospitalisation was higher in those aged 75 - 84 (£8,942) and ≥85 years (£8,835) than in those aged &lt;50 years (£7,703). Whilst few (6.0%) patients in critical care required mechanical ventilation, its use was higher in older adults (50 - 74 years: 8.3%; &lt;50 years: 4.3%). HCRU and associated costs were often greater in those at higher risk of severe COVID-19 when compared to the overall cohort, although minimal differences in HCRU were found across the three different high-risk definitions implemented. Among the primary care cohort, GP or nurse consultations were more frequent among older adults and the immunocompromised. Conclusions COVID-19 related hospitalisations in older adults, particularly critical care admissions, were the primary drivers of high resource use of COVID-19 in England. These findings may inform health policy decisions and resource allocation in the prevention and management of COVID-19.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.05.10.23289557v1" target="_blank">Healthcare resource utilisation and costs of hospitalisation and primary care among adults with COVID-19 in England: a population-based cohort study</a>
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<h1 data-aos="fade-right" id="from-clinical-trials">From Clinical Trials</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Standard of Care Combined With Glucocorticoid in Elderly People With Mild or Moderate COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Drug: Glucocorticoid<br/><b>Sponsor</b>:   Huashan Hospital<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Arginine Replacement Therapy in COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Drug: Arginine Hydrochloride<br/><b>Sponsor</b>:   Emory University<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effectiveness of a Second COVID-19 Vaccine Booster in Chinese Adults</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: Intramuscularly administered Ad5-nCoV vaccine;   Biological: Aerosolized Ad5-nCoV;   Biological: DelNS1-2019-nCoV-RBD-OPT1;   Biological: SYS6006<br/><b>Sponsor</b>:   Jiangsu Province Centers for Disease Control and Prevention<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Long COVID-19 Syndrome Lifestyle Intervention Study</strong> - <b>Condition</b>:   Long COVID-19 Syndrome<br/><b>Intervention</b>:   Dietary Supplement: Low carbohydrate diet intervention<br/><b>Sponsor</b>:   University of Southern California<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>PAxlovid loNg cOvid-19 pRevention triAl With recruitMent In the Community in Norway</strong> - <b>Conditions</b>:   Post COVID-19 Condition, Unspecified;   SARS-CoV2 Infection;   COVID-19<br/><b>Interventions</b>:   Drug: Nirmatrelvir/ritonavir;   Drug: Placebo<br/><b>Sponsors</b>:   Haukeland University Hospital;   University of Bergen<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Working Towards Empowered Community-driven Approaches to Increase Vaccination and Preventive Care Engagement</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Other: mHealth Outreach;   Other: Care Coordination<br/><b>Sponsors</b>:   University of California, San Diego;   San Ysidro Health Center<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Safety, Tolerability and Immunogenicity of Alveavax-v1.2, a BA.2/Omicron-optimized, DNA Vaccine for COVID-19 Prevention</strong> - <b>Condition</b>:   Sars-CoV-2 Infection<br/><b>Interventions</b>:   Drug: Alveavax-v1.2;   Drug: Janssen Ad26.COV2.S<br/><b>Sponsor</b>:   Alvea Holdings, LLC<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Role of Anthropometric Indices and Vit-D Supplementation on BioNTech, Pfizer Vaccine Side Effect and Immunoglobulin G Response Against SARS-CoV-2 in Individuals Infected With COVID-19; A Randomized Control Trial</strong> - <b>Condition</b>:   Role of Anthropometric Indices and Vit-D Supplementation on BioNTech, Pfizer Vaccine Side Effect and IgG Response Against SARS-CoV-2<br/><b>Intervention</b>:   Combination Product: Vitamin-D<br/><b>Sponsor</b>:   Sulaimany Polytechnic university<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>COVID-19 Vaccination Detoxification in LDL-C</strong> - <b>Conditions</b>:   COVID-19 Stress Syndrome;   COVID-19 Vaccine Adverse Reaction;   COVID-19-Associated Thromboembolism;   COVID-19 Post-Intensive Care Syndrome;   COVID-19-Associated Stroke;   COVID-19 Respiratory Infection<br/><b>Intervention</b>:   Combination Product: Atorvastatin Calcium Tablets<br/><b>Sponsor</b>:   Yang I. Pachankis<br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Post Covid-19 Dysautonomia Rehabilitation Randomized Controlled Trial</strong> - <b>Conditions</b>:   Post-Acute COVID-19 Syndrome;   Dysautonomia<br/><b>Interventions</b>:   Procedure: Rehabilitation;   Procedure: Standard of Care<br/><b>Sponsors</b>:   Evangelismos Hospital;   National and Kapodistrian University of Athens;   LONG COVID GREECE;   414 Military Hospital of Special Diseases<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Exercise for Health in Patients With Post-acute Sequelae of COVID-19</strong> - <b>Condition</b>:   Long COVID<br/><b>Intervention</b>:   Other: Rehabilitation program<br/><b>Sponsors</b>:   Campus docent Sant Joan de Déu-Universitat de Barcelona;   Hospital de Mataró;   University of Barcelona<br/><b>Active, not recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Digital Multimodal Rehabilitation for People With Post-acute COVID-19 Syndrome.</strong> - <b>Condition</b>:   Post-COVID Syndrome<br/><b>Interventions</b>:   Behavioral: RehabCovid_Telematic;   Behavioral: RehabCovid_ImmersiveVR;   Behavioral: Control_Condition<br/><b>Sponsors</b>:   Consorci Sanitari de Terrassa;   University of Barcelona;   Universitat de Girona;   Unitat Assistencial i Preventiva de l’Esport- Centre d’Alt rendiment;   Politecnic University of Catalonia;   Corporación Fisiogestión<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Study in Healthy Volunteers to Evaluate the Safety, Tolerability, Pharmacokinetics, and Drug-Drug Interaction Potential of Single and Multiple Doses of ALG-097558</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: ALG-097558;   Drug: Placebo;   Drug: Midazolam;   Drug: Itraconazole;   Drug: Carbamazepine;   Drug: ALG-097558 in solution formulation;   Drug: ALG-097558 in tablet formulation<br/><b>Sponsor</b>:   Aligos Therapeutics<br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Immunoadsorption Study Mainz in Adults With Post-COVID Syndrome</strong> - <b>Conditions</b>:   Post-COVID-19 Syndrome;   Post-COVID Syndrome;   Post COVID-19 Condition<br/><b>Interventions</b>:   Device: Immunoadsorption;   Device: Sham-apheresis<br/><b>Sponsor</b>:   University Medical Center Mainz<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Efficacy and Safety of Auricular Acupuncture in Depression During the Covid 19 Pandemic</strong> - <b>Conditions</b>:   Depressive Symptoms;   Depression;   Anxiety;   Insomnia;   Quality of Life<br/><b>Intervention</b>:   Device: Auricular Acupuncture<br/><b>Sponsors</b>:   Universidade do Sul de Santa Catarina;   University of Sao Paulo<br/><b>Not yet recruiting</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Long-term consequences of COVID-19 on mental health and the impact of a physically active lifestyle: a narrative review</strong> - CONCLUSIONS: Preventive measures must be undertaken, such as the vaccination of the entire population, vaccination hesitancy discouragement by creating awareness among individuals, and people’s engagement in a physically active lifestyle, since being physically active is a low-cost and effective measure to restore or inhibit the negative outcomes from COVID-19 on mental health.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Cruciferous vegetable-derived indole-3-carbinol prevents coronavirus cell egression mechanisms in tracheal and intestinal 3D in vitro models</strong> - The potential antiviral effects of indole-3-carbinol (I3C), a phytochemical found in Cruciferous vegetables, were investigated. Fibroblasts and epithelial cells were co-cultured on Alvetex® scaffolds, to obtain ad hoc 3D in vitro platforms able to mimic the trachea and intestinal mucosae, which represent the primary structures involved in the coronavirus pathogenesis. The two barriers generated in vitro were treated with various concentrations of I3C for different incubation periods. A…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Structural requirements of Holothuria floridana fucosylated chondroitin sulfate oligosaccharides in anti-SARS-CoV-2 and anticoagulant activities</strong> - Fucosylated chondroitin sulfate (FucCS) is a unique glycosaminoglycan found primarily in sea cucumbers. This marine sulfated glycan is composed of a chondroitin sulfate backbone decorated with fucosyl branches attached to the glucuronic acid. FucCS exhibits potential biological actions including inhibition of blood clotting and severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. These biological effects have been attributed to certain structural features, including molecular…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Luteolin inhibits spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) binding to angiotensin-converting enzyme 2</strong> - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), a respiratory illness that poses a serious threat to global public health. In an essential step during infection, SARS-CoV-2 uses the receptor-binding domain (RBD) of the spike (S) protein to engage with angiotensin-converting enzyme 2 (ACE2) in host cells. Chinese herbal medicines and their active components exhibit antiviral activity, with luteolin being a flavonoid that can significantly…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Nature-inspired catalytic asymmetric rearrangement of cyclopropylcarbinyl cation</strong> - In nature, cyclopropylcarbinyl cation is often involved in cationic cascade reactions catalyzed by natural enzymes to produce a great number of structurally diverse natural substances. However, mimicking this natural process with artificial organic catalysts remains a daunting challenge in synthetic chemistry. We report a small molecule-catalyzed asymmetric rearrangement of cyclopropylcarbinyl cations, leading to a series of chiral homoallylic sulfide products with good to excellent yields and…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Designer DNA NanoGripper</strong> - DNA has shown great biocompatibility, programmable mechanical properties, and structural addressability at the nanometer scale, making it a versatile material for building high precision nanorobotics for biomedical applications. Herein, we present design principle, synthesis, and characterization of a DNA nanorobotic hand, called the “NanoGripper”, that contains a palm and four bendable fingers as inspired by human hands, bird claws, and bacteriophages evolved in nature. Each NanoGripper finger…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Transcriptome Analysis Reveals Organ-Specific Effects of 2-Deoxyglucose Treatment in Healthy Mice</strong> - CONCLUSIONS: These findings suggest that 2DG has a systemic impact that varies across organs, potentially affecting multiple pathways and functions. The study provides insights into the potential therapeutic benefits of 2DG across different diseases and highlights the importance of understanding its systemic effects for future research and clinical applications.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>90K/LGALS3BP expression is upregulated in COVID-19 but may not restrict SARS-CoV-2 infection</strong> - Glycoprotein 90K, encoded by the interferon-stimulated gene LGALS3BP, displays broad antiviral activity. It reduces HIV-1 infectivity by interfering with Env maturation and virion incorporation, and increases survival of Influenza A virus-infected mice via antiviral innate immune signaling. Its antiviral potential in SARS-CoV-2 infection remains largely unknown. Here, we analyzed the expression of 90K/LGALS3BP in 44 hospitalized COVID-19 patients at multiple levels. We quantified 90K protein…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>SARS-CoV-2 S1 Subunit Booster Vaccination Elicits Robust Humoral Immune Responses in Aged Mice</strong> - The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has raised concerns about reduced vaccine effectiveness and the increased risk of infection, and while repeated homologous booster shots are recommended for elderly and immunocompromised individuals, they cannot completely protect against breakthrough infections. In our previous study, we assessed the immunogenicity of an adenovirus-based vaccine expressing SARS-CoV-2 S1 (Ad5.S1) in mice, which induced robust…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Frontline Worker Safety in the Age of COVID-19: A Global Perspective</strong> - The third annual Health Watch USAsm webinar conference assembled 16 speakers from 4 continents who shared information regarding frontline worker safety in the age of COVID-19. The U.S. Bureau of Labor Statistics reported a nearly 4000% increase in workplace illness in 2020 compared with 2019. It is estimated that 2% of the U.S. workforce is not working because of long COVID. In addition, the impact is growing with each surge. After the acute illness, patients are often described as recovered,…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Reparixin improves survival in critically ill and transplant patients: A meta-analysis</strong> - CONCLUSIONS: The findings of this meta-analysis indicate that reparixin, an anti-inflammatory drug, improved survival in critically ill or transplant patients (including both COVID-19 and non-COVID-19 patients) without increasing the risk of infection.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Bioinformatics approach to analyse COVID-19 biomarkers accountable for generation of intracranial aneurysm in COVID-19 patients</strong> - COVID-19 became a health emergency on January 30, 2020. SARS-CoV-2 is the causative agent of the coronavirus disease known as COVID-19 and can develop cardiometabolic and neurological disorders. Intracranial aneurysm (IA) is considered the most significant reason for hemorrhagic stroke,and it accounts for approximately 85% of all subarachnoid hemorrhages (SAH). Retinoid signaling abnormalities may explain COVID-19’s pathogenesis with inhibition of AEH2, from which COVID-19 infection may enhance…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials</strong> - CONCLUSION: Although some observational studies found improved outcomes in patients using lipid-lowering agents, our study found no benefit in adding statins, fenofibrate, or nicotinamide to COVID-19 treatment. On the other hand, PCSK9 inhibitors can be a good candidate for further assessment. Finally, there are major limitations in the use of omega-3 supplements in treating COVID-19 and more trials are warranted to evaluate this efficacy.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>SARS-CoV-2 envelope protein triggers depression-like behaviors and dysosmia via TLR2-mediated neuroinflammation in mice</strong> - CONCLUSIONS: Our study demonstrates that envelope protein could directly induce depression-like behaviors, dysosmia, and obvious neuroinflammation in CNS. TLR2 mediated depression-like behaviors and dysosmia induced by envelope protein, which could serve as a promising therapeutic target for neurological manifestation in COVID-19 patients.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Eight-Month Follow-up After the Third Dose of BNT162b2 Vaccine in Healthcare Workers: The Question of a Fourth Dose</strong> - CONCLUSION: For HCWs who had coronavirus disease 2019 infection after completing a third vaccination, a sufficient antibody response was maintained until eight months after the third dose. The recommendation of the fourth dose may not be prioritized in subjects with hybrid immunity.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-patent-search">From Patent Search</h1>
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<h1 data-aos="fade-down" id="daily-dose">Daily-Dose</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-new-yorker">From New Yorker</a></li>
<li><a href="#from-vox">From Vox</a></li>
<li><a href="#from-the-hindu-sports">From The Hindu: Sports</a></li>
<li><a href="#from-the-hindu-national-news">From The Hindu: National News</a></li>
<li><a href="#from-bbc-europe">From BBC: Europe</a></li>
<li><a href="#from-ars-technica">From Ars Technica</a></li>
<li><a href="#from-jokes-subreddit">From Jokes Subreddit</a></li>
</ul>
<h1 data-aos="fade-right" id="from-new-yorker">From New Yorker</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Parents Who Fight the City for a “Free Appropriate Public Education”</strong> - Children with disabilities have a constitutional right to accommodation in public schools. Securing those rights can bring their families to a breaking point. - <a href="https://www.newyorker.com/news/annals-of-education/the-parents-who-fight-the-city-for-a-free-appropriate-public-education">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Don’t Say You Haven’t Been Warned About Trump and 2024</strong> - CNN’s awful town hall with the former President heralds a disastrous election year to come. - <a href="https://www.newyorker.com/news/letter-from-bidens-washington/dont-say-you-havent-been-warned-about-trump-and-2024">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Supreme Court Ruling the Fossil-Fuel Industry Doesn’t Like</strong> - Communities can now sue in state courts for compensation for the costs of climate change—something oil companies have fought against for years. - <a href="https://www.newyorker.com/news/daily-comment/a-supreme-court-ruling-the-fossil-fuel-industry-doesnt-like">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Vindication of E. Jean Carroll</strong> - In response to a writer’s accusation of sexual assault, nine jurors in Manhattan finally held Donald Trump accountable. - <a href="https://www.newyorker.com/news/our-local-correspondents/the-vindication-of-e-jean-carroll">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Zooey Zephyr and the Illiberal Decorum of Montana’s Christian Right</strong> - In a state that once considered itself a political outlier, the legislature barred a transgender representative from its floor. Will encroaching extremism seize the last best place? - <a href="https://www.newyorker.com/news/news-desk/zooey-zephyr-and-the-illiberal-decorum-of-montanas-christian-right">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>Democrats have a huge opportunity to win back rural voters</strong> -
<figure>
<img alt="A large red and blue Biden-Harris sign sits on the side of a dirt road in Iowa, with farm fields stretching out behind it." src="https://cdn.vox-cdn.com/thumbor/6pHYTLgs0IAzKKkmhFge932w8IQ=/0x0:4948x3711/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72273487/1229137815.0.jpg"/>
<figcaption>
Signs for Joe Biden and Kamala Harris in Union County, Iowa, on October 9, 2020. | Christopher Smith/Washington Post via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
For the first time in decades, Democrats are making gains in areas that have some of Trump’s most reliable voters.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kRnBZp">
In last year’s midterms, when Democrats narrowly held on to control of the Senate and won crucial elections in battleground states, they did so in part by reversing one of Donald Trump’s biggest 2020 accomplishments: They won more voters from rural and exurban communities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kXmQ3s">
From Arizona and Nevada, across the Midwest, and into North Carolina and Pennsylvania, Democratic Senate and gubernatorial candidates improved on President Joe Biden’s 2020 showing among this swath of the electorate, and persuaded tens of thousands of rural voters who voted for Trump to switch parties.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JmpuV0">
Now, as the 2024 campaign map begins to take shape, Democratic candidates, the state and national parties, and their outside partners will have to make a choice about how seriously to invest in outreach and persuasion operations in these communities. Democrats have long struggled in rural communities, but their decline in support has only accelerated in recent years, cementing the idea for many that the party caters to highly educated and primarily urban voters. That narrative has only entrenched itself since the ’90s, when former President Bill Clinton <a href="https://timesmachine.nytimes.com/timesmachine/1996/11/10/issue.html">essentially</a> split rural voters with his Republican opponents in his two presidential campaigns and won over 1,100 rural counties in 1996. Since then, Democratic presidential candidates have <a href="https://www.nbcnews.com/meet-the-press/what-remaking-american-politics-looks-1996-n1295000">endured dramatic losses</a> in rural areas: in 2008, Barack Obama won 455 rural counties; in 2020, Joe Biden won only 194.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Cvhk3T">
That crumbling of rural support has led some in the party to write off this section of voters entirely. Biden’s 2020 victory is illustrative of this dynamic: He won the presidency despite winning just 33 percent of rural voters. (Trump won 65 percent, <a href="https://www.pewresearch.org/politics/2021/06/30/behind-bidens-2020-victory/">up from the 59 percent</a> he won in 2016.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dYMyVz">
But the 2022 midterms reversed that slide.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uifj9j">
If Democrats decide to take these communities more seriously this cycle, activists, strategists, and former candidates say the party stands to shore up its margins in battleground states and make up for any possible loss in support from the suburbs. If candidates and their campaigns show up and work with the right local partners, they might have a better chance of replicating some of the rural progress they made in 2022. At the very least, they can “lose less badly,” as former Montana Gov. Steve Bullock, a Democrat, told me. “Far too often in exurban areas, Democrats over the last decade have just been ceding these areas to Republicans.” Bullock is now advising rural voter outreach efforts for the Democratic-aligned American Bridge 21st Century, a political advertising and opposition research group that is already spending money to promote Biden and Democrats’ record.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="I3awnc">
“What we need to do is, show up, listen, assume we share the same values, and demonstrate that we’re fighting for them,” Bullock said. “You’re not always going to win all these areas, but if you don’t show up, both in-person and on the airwaves, there’s gonna be a vacuum there.”
</p>
<h3 id="pyRrhA">
The new rural Democratic hope of 2022
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cBKYeL">
Democrats’ performance in rural counties last year comes with one big caveat: They still trail Republicans in rural voter share. No one I spoke to in Democratic circles thinks the party can suddenly win a majority of rural voters; Trump’s hold on many voters in these communities is strong. But the GOP’s hold on rural regions is showing a few cracks, particularly in areas with Trumpian candidates: In almost all the 2022 cycle’s marquee statewide races, Democrats did better than Biden did two years before.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FUZlVi">
A <a href="https://www.axios.com/2022/12/11/democrats-rural-america-midterms">December Axios story featuring analysis</a> from the moderate Democratic group Third Way encapsulates those raw numbers. In most battleground states across the country, Democrats improved on Biden’s rural county vote share, from 1 percentage point in the Arizona gubernatorial contest to 15 percentage points in the Pennsylvania governor’s race. There may still be even more room to improve. Biden did worse among rural voters in 2020 than Hillary Clinton did in 2016.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Le6ag4">
The brightest spots for Democrats came in Michigan and Pennsylvania, where Gov. Gretchen Whitmer and Gov. Josh Shapiro, respectively, improved on Biden’s performance in rural counties by 10 and 15 percentage points. Candidates like Democratic Colorado Gov. Jared Polis, Sen. John Fetterman (D-PA), and Sen. Michael Bennet (D-CO) improved by more than 6 points — and even candidates who lost, like former Rep. Tim Ryan in Ohio’s Senate race, still improved on Biden’s numbers (winning 4 percent more support from these counties).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Mq4bAV">
Of course, the 2024 presidential electorate will be very different from the electorate that turned out for the midterms. In 2022, Democrats framed Trump-backed candidates as extremists, which helped Democrats overperform in suburban and urban areas that have drifted toward them while also persuading some rural voters to see Republican anti-abortion efforts as forms of overreach. That same strategy isn’t guaranteed to work in 2024. Trump’s presence on the 2024 ballot could also give other Republican candidates a boost, Lucas Holtz, a political analyst with Third Way, told me.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3NkFja">
But there’s another set of numbers from the 2022 midterms that provides even more hope for Democrats and that should force them to think seriously about the kind of presence they need to have in rural America: the number of Trump voters who flipped to Democrats during the midterms.
</p>
<figure class="e-image">
<img alt="A chart shows Democratic candidates who got large shares of rural voters in 2022, like Pennsylvania Gov. Josh Shapiro and Sen. Mark Kelly." src="https://cdn.vox-cdn.com/thumbor/txFZ3tJp8Qi_UYprY2eEUUvRpOY=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24651879/0.png"/> <cite>Lucas Holtz/Third Way</cite>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5PUoqN">
Holtz and the Third Way team looked at the raw data behind the Associated Press and NORC’s 2022 midterm exit polls (also known as AP VoteCast) and found that many of the statewide Democratic candidates who improved on Biden’s rural voter numbers did so by winning over significant chunks of rural voters who voted for Trump in 2020. For example, 15 percent of rural and exurban Trump voters ended up voting for Shapiro in Pennsylvania, and 12 percent of Trump 2020 voters cast ballots for Sen. Mark Kelly in Arizona.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E3Y4lA">
And again, candidates that didn’t win, like Democratic Senate candidates Cheri Beasley in North Carolina and Mandela Barnes in Wisconsin, still flipped about 4 and 3 percent of rural Trump voters each last year.
</p>
<h3 id="5oXwFc">
The 2024 rural opportunity
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6PKQBd">
Until 2022, it seemed to many rural Democrats and progressive activists that the Democratic Party leadership was content to abandon these communities to Republican dominance. Especially after Trump’s rural dominance in 2020, the narrative that Democrats had given up competing beyond the suburbs had solidified among many in the party. Rural Democratic politicians, like Bullock, who lost a Senate election in 2020, were beginning to sound the alarm ahead of the midterms.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YvM73C">
The former two-term governor now sounds a lot more optimistic when he talks about the future of rural Democrats. “We have a long way to go as a party, but I think that certainly we saw through the midterms that you can’t cede any parts of the country,” he said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="t1iZ09">
What is required to build on those 2022 gains, Democratic sources told Vox, looks a lot like a mix of economic populism, boots-on-the-ground local organizing, and pragmatic pitches that take into account the way rural voters think.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BRucnM">
Former Rep. Tim Ryan, who lost an Ohio Senate race to Republican venture capitalist J.D. Vance in 2022, sees this as a reframing of classic Democratic messaging. “Generally, I see a populism meaning that for most people, the economy is not working,” Ryan said. “You need to identify that, but there has to be an independent streak too. It’s not unique to rural voters, but it’s more pronounced in rural areas.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0nmi8i">
Ryan said the right appeal to rural voters emphasizes a kind of matter-of-fact attitude that doesn’t mean always defending national leaders. “It’s important as Democrats are going to campaign in rural areas to say, ‘Look, I have honest disagreements with Joe Biden, I have honest disagreements with Chuck Schumer, but I have completely honest disagreements with Donald Trump too. And I’m not going there to toe the line for anybody. I’m going to toe the line for you,’” he said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="o4YDDU">
Ryan, who is now on the Natural Allies Leadership Council, a natural gas advocacy group, said that pragmatism extends to topics of vital importance to the Democratic Party, like the way they talk about immigration, manufacturing, clean energy and climate change, free trade, and even the debt ceiling and the deficit.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7xNzEi">
Other Democratic strategists and progressive activists told me that how Democrats talk about their achievements also matters for rural voters. Melissa Morales, the founder and president of Somos Votantes, the Latino engagement group, told me that she and other rural Democratic advocates and strategists have a theory for how candidates should be talking about the economy. Called the “Winning Jobs Narrative Project,” the strategy calls on Democrats to center on working-class and rural voters first and find commonalities between their concerns and Democratic accomplishments.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VHVWzO">
Democratic candidates often pitch voters with a “long laundry list of things that they’re doing to help you out,” Morales said. Democratic messaging last year on the child tax credit, which used the tax code to dramatically slash child poverty, was a prime example. “We go in and talk about how it was a huge anti-poverty initiative, that we’re going to lift half of people out of poverty. But that turns out to be incredibly disempowering and comes from a place of pity and not respect.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="w6iCy1">
After years of polling and focus groups, Morales said, if you flip the framing to focus on how the tax credit will enable families to pay for child care and get parents back to work easier, the idea resonates better. In Nevada, Morales said, Sen. Catherine Cortez Masto won one of the tightest races in the country by talking about the economy and Democratic wins like this.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ytCguM">
And there’s also a way to talk about social issues that centers the libertarian and pragmatic streak that exists in a lot of rural communities, said Cody Lonning, a college instructor at Eastern Washington University and a co-founder of the Rural Urban Bridge Initiative, a think tank that develops messaging strategies for liberals and progressives. Abortion is an example of an issue where “there’s a sense of there needing to be a middle ground and neither party is really leaning into that idea, so when a candidate does talk in that way, there is a place of agreement.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WQ0CAW">
That means the candidates who can best connect with rural communities don’t necessarily get bogged down in policy specifics when talking to voters, but prioritize personality and earnestness. “A candidate does not have to agree with a voter on those issues. But they can’t just pivot and avoid those issues,” Lonning said. “A lot of times those questions are really sort of a voter exploring the cultural differences between them and a candidate, and trying to understand that candidate as a human being.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AoZhgU">
Republicans still have a tremendous advantage in base support, infrastructure, and candidate recruitment in rural communities. But making inroads and cutting down margins is the key to winning statewide elections — and that goal seems to be within reach for Democratic candidates this coming cycle.
</p></li>
<li><strong>The Republican plan to sneakily cut Medicaid, explained</strong> -
<figure>
<img alt="The caduceus — a staff with two snakes coiled around it and wings at the top, the symbol of medicine — is entangled in fraying strings." src="https://cdn.vox-cdn.com/thumbor/r3OIKC9-KwNKT2_xal39WVZmcBQ=/254x0:1694x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72273436/_PaigeVickers_Vox_WorkRequirements.0.jpg"/>
<figcaption>
Paige Vickers/Vox
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Medicaid work requirements are really just spending cuts in disguise.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xkHINv">
The Republican proposal to <a href="https://www.vox.com/policy/2023/4/25/23697375/medicaid-eligibility-work-requirements-debt-limit-bill">require people to work in order to receive Medicaid benefits</a> poses an existential question about the very nature of government assistance: Do you need to do something to earn it?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ibxNvW">
For years, the GOP’s answer has been yes, some people should. These days, they have <a href="https://www.vox.com/policy-and-politics/2018/8/24/17779338/voxcare-medicaid-expansion-success-charts">very specific people in mind</a>: The 19 million Americans, most of them childless and nondisabled adults, who were not eligible for Medicaid until the Affordable Care Act expanded eligibility a decade ago.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GprcMF">
House Republicans are so serious about imposing these new rules that they are trying to make them <a href="https://www.vox.com/policy/2023/4/19/23688022/debt-ceiling-2023-kevin-mccarthy-medicaid-work-requirement">a condition of lifting the federal debt limit</a> and averting an economic crisis. They don’t seem likely to succeed, <a href="https://www.vox.com/policy/2023/4/25/23697375/medicaid-eligibility-work-requirements-debt-limit-bill">given the Biden administration’s clear objections</a>, but the mere demand reveals that the party remains as serious as ever about shrinking the social safety net. They seek to do so by dividing the deserving — in the case of Medicaid, pregnant women, children, those who are elderly or disabled — from the undeserving, who have to work to earn benefits.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9eAcxJ">
“Assistance programs are supposed to be temporary, not permanent,” House Speaker Kevin McCarthy said in a speech on Wall Street outlining his party’s demands in the debt-limit talks. “A hand up, not a handout. A bridge to independence, not a barrier.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vva4NZ">
Work requirements for various social programs — housing assistance, food stamps, cash welfare, and Medicaid — have been a policy goal for Republicans since the 1980s. And they have succeeded, sometimes with the help of Democrats, in imposing them. SNAP, the food-stamp program, already has work requirements, which Republicans want to expand, in spite of <a href="https://ohiocapitaljournal.com/2021/06/08/study-work-requirements-for-snap-dont-increase-employment-numbers/">evidence</a> that they do not significantly increase employment.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HluRlx">
But Medicaid, by far the largest of these social programs, has long been the white whale for conservatives in their work requirement crusade. Twice as many people receive Medicaid benefits (about 90 million) as receive food stamps (about 42 million). Briefly, under President Donald Trump, Congress tried to implement them. But the results were disastrous and a federal judge blocked the requirements as counter to the purpose of the Medicaid program.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FG6eFK">
The entire debate rests on a core disagreement about the nature of Medicaid and, by extension, health insurance itself. Is it something you should have to work to earn, or a right to which Americans are entitled?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QPkTb8">
“In real life, what I think is most concerning is it will lead to losses of coverage, and that is not what the Medicaid program is supposed to be doing,” Cindy Mann, who oversaw Medicaid under President Barack Obama, <a href="https://www.vox.com/policy-and-politics/2018/3/5/17040424/trump-medicaid-cuts-explained">told me</a> about work requirements in 2018. “It’s supposed to be promoting coverage and promoting affordable coverage.”
</p>
<h3 id="pr3Xwx">
What happened in Arkansas under Medicaid work requirements
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IoSZvU">
States are required to cover some people through Medicaid, such as pregnant women and the disabled, but they also have discretion about who is eligible for the program. Some states have used that discretion to expand coverage (in California, for example, Medicaid covers many undocumented immigrants) while others have kept their eligibility requirements much more stringent.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CPffrw">
The Affordable Care Act was a critical turning point for the program. Under the law, 40 states have expanded Medicaid eligibility to the childless, nondisabled adults living in or near poverty who historically have been excluded from the program. About 20 million Americans have been covered by Medicaid expansion in the past decade.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mfxOce">
But that has presented an ideological problem for conservatives. The bigger Medicaid grows, the more popular and therefore difficult to cut it becomes. An effort to repeal the Affordable Care Act failed. And so, with the Trump administration in power, Medicaid work requirements became their backdoor way to try to erode the gains of Medicaid expansion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="K7zVvS">
In early 2018, the Trump health department told states they would, for the first time, approve state proposals requiring work for some Medicaid beneficiaries. Several states lined up and two — Arkansas and Kentucky — had their plans approved.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NtIM5N">
The Kentucky version of Medicaid work requirements was never implemented due to a court order. But Arkansas did succeed in becoming the first state to ever impose Medicaid work requirements, mandating that some enrollees work or perform some kind of other work-related activity for 80 hours per month — and the result was a public policy disaster.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Yqz7Ch">
About 250,000 people were covered by Medicaid in Arkansas at the time of the work requirement’s approval. About 65,000 people were subject to the requirement; the rest were exempt. But only about 10 percent of people who needed to report their activities to the state actually did so. Ultimately, nearly 17,000 people lost health coverage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zf4xRz">
This had been one of the biggest fears for health advocates: that a lot of people would lose coverage not because they failed to comply but because they failed to report.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="isiGnC">
“The low level of reporting is a strong warning signal that the current process may not be structured in a way that provides individuals an opportunity to succeed, with high stakes for beneficiaries who fail,” wrote Penny Thompson, chairman of MACPAC, which was created by Congress to make policy recommendations for Medicaid, in a review of the Arkansas plan.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KH5Vdl">
Later evaluations of the Arkansas work requirement also found that the policy did not have the desired effect on employment. People fell off of the Medicaid rolls but didn’t seem to find more work.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zjklCy">
A <a href="https://www.nejm.org/doi/full/10.1056/nejmsr1901772">study</a> published in the <em>New England Journal of Medicine</em> found that Medicaid enrollment had fallen for working-age adults, the uninsured rate was rising in the state, and there had been little discernible effect on employment. The authors concluded that the work requirement “was associated with significant losses in health insurance coverage in the initial six months of the policy but no significant change in employment.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5F0hbn">
They also found that many people either were not aware of the reporting requirement or were confused by it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="52nZBa">
The study found that one-third of respondents in the age 30-49 range, the focus of their analysis because they were most likely to be expected to meet the requirement, had not heard anything about Arkansas’s new work requirements for Medicaid. Nearly half of those people, 44 percent, said they were unsure whether the requirements applied to them. A significant number of people said a lack of internet access (32 percent) had contributed to their decision not to report their relevant information to the state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Guil36">
Those findings provided support to the legal challenges to the Arkansas work requirement that ultimately brought an end to the policy. One of the plaintiffs, Adrian McGonigal, stated that he had not realized they needed to report their activities every month. He showed up at a pharmacy to fill prescriptions for two chronic health conditions and only learned then they were no longer covered by Medicaid; the bill would be $800. He couldn’t afford it, skipped his meds for a while, ended up unable to work because he was sick, and ultimately lost his job.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DhUYYa">
Citing such experiences and other evidence that work requirements were causing people to lose coverage without encouraging them to find more work, Judge James Boasberg ruled in 2019 that the proposals in Arkansas and Kentucky by the administration were “arbitrary and capricious” and ordered that the work requirements could not be allowed to remain in effect.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="y7rvKO">
“Weighing the harms these persons will suffer from leaving in place a legally deficient order against the disruptions to the State’s data-collection and education efforts due to vacatur renders a clear answer: the Arkansas Works Amendments cannot stand,” Boasberg wrote to conclude his ruling.
</p>
<h3 id="5jhlhD">
Who stands to lose under the House Republican plan
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FvvNye">
But the experience in Arkansas and Boasberg’s ruling haven’t stopped Republicans from continuing to pursue Medicaid work requirements as part of the debt-limit negotiations with Senate Democrats and the White House.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J45IUR">
The House’s work requirement proposal — dubbed a “community engagement” requirement in <a href="https://www.speaker.gov/wp-content/uploads/2023/04/LSGA_xml.pdf">the bill’s text</a> — would require many recipients to be working, looking for work, or participating in another kind of community service. Children under 18, adults over 56, people with mental or physical disabilities, and parents of dependent children would be exempted.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1vFJRW">
The Congressional Budget Office had previously <a href="https://www.cbo.gov/publication/58199">estimated</a> requiring nondisabled, non-elderly childless adults to work in order to receive Medicaid benefits would slash the program’s spending by $135 billion over 10 years — largely because more than 2 million people would lose coverage annually for failing to meet the work requirement.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HBncP5">
The same fundamental problem remains: There is little evidence of a large number of Medicaid enrollees who are avoiding work to stay on the program’s rolls. One study in Michigan, released while the Trump administration was pushing work requirements, is illustrative.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wDrYhl">
The research, published in <a href="http://jama.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2017.7055"><em>JAMA</em></a>, looked at the work status of people who enrolled in Medicaid after Michigan expanded the program under Obamacare. It stood out for being based on real interviews with Medicaid enrollees, rather than on administrative data or other information.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uMnk2c">
The big-picture takeaway was that most Medicaid enrollees in Michigan were working already, unable to work, or at a point in their lives where they would not work (retired or a student). Almost three-fourths of the people in the study fell into those categories. Only 28 percent were “out of work.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6XV4pK">
The authors broke down the “out of work” population and, rather than revealing a bunch of lazy hangers-on, they found people with real barriers to working — and who might benefit from having health insurance. Two-thirds said they had a chronic physical illness. More than a third said they had been diagnosed with a mental illness. One-quarter said they had a physical or mental condition that interfered with their ability to function at least half of the time.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NLLvs0">
Another analysis by the left-leaning Center on Budget and Policy Priorities (CBPP) examined the state proposals to require Medicaid to prove they are employed and <a href="https://www.cbpp.org/research/health/many-working-people-could-lose-health-coverage-due-to-medicaid-work-requirements">came to a startling conclusion</a>: Under those plans, even poorer people on Medicaid who already are working regularly might not meet the requirements and could suffer a lapse in health coverage as a result.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ks6Nhy">
That’s because people working lower-wage jobs are more likely to have irregular working hours or gaps in their employment. By CBPP’s estimate, one in four people who worked enough hours over the course of a year to meet Kentucky’s proposed work requirement would still have at least one month where they fall below the state’s 80-hour monthly requirement, and could therefore be at risk of losing coverage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="igyR9y">
Nationally, CBPP found, using census data, that two-thirds of people potentially subject to a work requirement were working, and 70 percent of those worked 1,000 hours over a year, or 80 hours a month, which would have met the Kentucky and Arkansas requirements. But nearly half of people (46 percent) who could be subject to a work requirement and were working had at least one month when they failed to clear the 80-hour bar.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="n2VTEW">
In other words: A Medicaid work requirement could force working people to lose their health insurance because it isn’t structured to reflect the realities of what work looks like for them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DDu5yO">
Lower-wage jobs tend to be more volatile, with fewer regular hours. Top industries for people who are likely to face a work requirement are food services, retail, and construction, according to CBPP — jobs that can be subject to seasonal and other shift changes.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="42dHj8">
Seven in 10 food service workers report that they work irregular hours, according to CBPP, along with 63 percent of retail workers and 54 percent of construction workers. All three industries have above-average rates of people quitting or being laid off; retail and food services have some of the shortest average job tenures.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TV0Yc1">
“Approved and pending state work requirement policies are based on the assumption that people who want to work can find steady employment at regular hours,” the CBPP authors wrote. “This assumption is out of step with the realities of the low-wage labor market.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3v5ogM">
Work requirements have also been proposed in such a way that could lead to serious racial discrimination.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1Sgnf0">
During the Trump administration, Michigan lawmakers pushed <a href="http://www.legislature.mi.gov/documents/2017-2018/billengrossed/Senate/pdf/2018-SEBS-0897.pdf">a plan</a> that would have required Medicaid recipients (with exceptions for the disabled, elderly, and a few other selected populations) to work or search for work at least 29 hours each week. If they fail to meet the work requirement, they could lose Medicaid coverage for a full year.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Z23dyP">
But the Michigan plan came with a twist: People who live in counties with unemployment rates above 8.5 percent were to be exempted from the requirement. In Michigan, the counties that meet that standard tend to be more rural, with a higher share of white residents. Meanwhile, that would likely lead in practice to rural whiter counties, where unemployment was higher, getting a break from these work requirements, while urban areas with a higher share of Black residents would still be subjected to them. That would have meant that Black Medicaid enrollees would be more likely to lose their health insurance.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PjHyyE">
George Washington University’s Sara Rosenbaum warned me at the time of “the potential for enormous discrimination, really racial redlining.” The Trump administration had explicitly said it would allow states to account for local conditions, such as high unemployment in certain areas or other factors, to provide exemptions from a work requirement.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MoUuHa">
“All of these things are potentially much harder to come by in rural areas,” Rosenbaum said. “Because of the demographics, you could have situations where the populations required to work are disproportionately African American.”
</p>
<h3 id="g817RH">
America’s complicated relationship with work and welfare
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="f1g75Y">
House Republicans still think they can make a winning argument in favor of Medicaid work requirements — and they aren’t necessarily delusional to think so. But the politics of work requirements are complicated and also carry a substantial downside risk for the party proposing them, as Republicans should be well aware.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="H0OjAD">
The last time Republicans tried (and failed) to pass significant cuts to the Medicaid program, in the first year of the Trump presidency as part of their Affordable Care Act repeal plans, they paid the price during the 2018 midterm elections. That’s because Medicaid is popular. Over the past two decades, the health insurance program has become an increasingly crucial part of the safety net. Enrollment has roughly doubled from about <a href="https://www.statista.com/statistics/245347/total-medicaid-enrollment-since-1966/">46 million people in 2007</a> before the Great Recession to <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/">more than 92 million today</a>. More than 75 percent of the US public <a href="https://www.kff.org/medicaid/poll-finding/5-charts-about-public-opinion-on-medicaid/#:~:text=Large%20majorities%20of%20the%20public,they%20have%20an%20unfavorable%20view.">says</a> they have very or somewhat favorable views of the program. Two-thirds say they have some kind of connection to Medicaid, either because they themselves or a loved one was enrolled.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="heAhgl">
Two polls released while the Trump administration was moving full speed ahead on Medicaid work requirements reveal the paradox of American attitudes to requiring work in order to receive government support.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Gc74EW">
The Kaiser Family Foundation (KFF), the gold standard of health policy polling, <a href="http://voxcom.createsend1.com/t/d-l-oydhhut-l-d/">found</a> in June 2017 that 70 percent of respondents said that they would support a work requirement. But a Center for American Progress (CAP) poll released shortly after found that 57 percent said they opposed allowing states “to deny Medicaid health coverage to recipients ages 18 to 64 who do not have a job with a certain amount of hours and do not participate in state-approved work programs.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FlHD5q">
The wording of the questions may have played a role — and may hint at how Republicans and Democrats may frame the issue in the debate to come. KFF asked about allowing states to impose work requirements on people “in order to get health insurance through Medicaid.” CAP asked about denying people health insurance if they didn’t meet the requirements set by their state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ATtZVT">
This disparity — a huge majority supports work requirements if you frame them one way; a solid majority opposes them if you use a different frame — is telling in the odd relationship Americans have with the social safety net.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="n1p26q">
On the one hand, Americans believe in work — Max Weber’s Protestant work ethic is <a href="http://voxcom.createsend1.com/t/d-l-oydhhut-l-h/">crucial</a> to understanding the US psyche for good reason. Work is treated as an inherent good. That might help explain why we collectively are so susceptible to stories about people taking advantage of Medicaid or disability insurance. As Jack Meserve <a href="https://democracyjournal.org/magazine/our-welfare-puritanism/">wrote in Democracy in 2021</a> while Congress was debating another round of stimulus checks for most Americans due to the pandemic-driven economic downturn:
</p>
<blockquote>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9iDqel">
An insidious way that austerity has entrenched itself in the last four decades is by infusing every government program with suspicion and doubt toward the citizens it is supposed to help. That stance leaches into the populace, where soon average citizens look at their neighbors’ unemployment claims with skepticism, their fellow citizens’ need for help as an indication of sloth and greed. We now too often have a country of welfare puritans, all suffused with a haunting fear that someone, somewhere may be getting a benefit she doesn’t deserve.
</p>
</blockquote>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uE9GV5">
But on the other hand, Americans increasingly believe in an adequate social safety net. According to the CAP poll, more than 70 percent of people said they opposed cutting home heating assistance for low-income Americans, unemployment insurance, and affordable housing programs.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2Bx1W6">
Medicare and Social Security have long been third rails of American politics. In recent years, Medicaid may have joined them after Republicans proved unable to overhaul it during the Obamacare repeal debate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FFMyZ2">
So the way these issues are framed is key. Americans are okay with requiring work as a principle. But if you then explain the consequences in vivid terms, that people could be denied health insurance as a result, they’re less comfortable with it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pPVKKP">
If the actual result is funding and enrollment cuts — and people understand that — these proposals rapidly become much less popular.
</p></li>
<li><strong>Elon Musk says he’ll step down as Twitter CEO. But he’s not going anywhere.</strong> -
<figure>
<img alt="Elon Musk in a ball cap and T-shirt." src="https://cdn.vox-cdn.com/thumbor/4U2A7Lmb4KKboUWGYKgMR1AwpNs=/598x0:4179x2686/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72272004/GettyImages_1487983055.0.jpg"/>
<figcaption>
Clive Mason/Formula 1 via Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A new chief executive won’t change the fact that Musk still owns the company.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UOIdxb">
Elon Musk just announced that, in six weeks, he’s stepping down as the CEO of Twitter. But if you think that means the Elon-Twitter story is over, don’t hold your breath.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YpPNKq">
Musk <a href="https://twitter.com/elonmusk/status/1656748197308674048">announced on Thursday</a> that he has chosen his replacement as the chief executive of Twitter and its parent company, X, and that she will be starting in about six weeks. This is the most concrete timeline he’s made about his succession plan since December of last year when he first confirmed that he would <a href="https://www.npr.org/2022/12/20/1144182209/twitter-elon-musk-resigns">eventually step aside</a>. But Musk will still be the sole owner of Twitter, and unless he sells the company — or a controlling share of it — the billionaire is still in control.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BfI5ft">
We don’t know yet who will replace Musk. Some <a href="https://twitter.com/karaswisher/status/1656750984121446414">media insiders</a> have guessed it could be NBCUniversal advertising executive Linda Yaccarino, who has <a href="https://deadline.com/2022/11/elon-musk-twitter-nbcuniversal-sales-chief-linda-yaccarino-give-the-guy-a-minute-1235170436/">publicly defended Musk</a> and recently interviewed him at a <a href="https://possibleevent.com/twitters-elon-musk-to-join-nbcuniversals-linda-yaccarino-on-stage-at-possible/">major advertising conference</a>. Yaccarino did not respond to a request for comment. At this point, it’s still anyone’s guess.
</p>
<div id="2iP2CH">
<blockquote class="twitter-tweet">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" dir="ltr" lang="en">
Excited to announce that I’ve hired a new CEO for X/Twitter. She will be starting in ~6 weeks!<br/><br/>My role will transition to being exec chair &amp; CTO, overseeing product, software &amp; sysops.
</p>
— Elon Musk (<span class="citation" data-cites="elonmusk">@elonmusk</span>) <a href="https://twitter.com/elonmusk/status/1656748197308674048?ref_src=twsrc%5Etfw">May 11, 2023</a>
</blockquote></div></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YVCyzY">
Regardless of who replaces Musk, it’s not clear how much real power the new Twitter CEO could have. Even if he follows through with this plan and actually gives up his job as CEO — this is not at all guaranteed to happen until it happens — Musk’s ownership of Twitter means he can essentially hire or fire a new CEO as he pleases. Since Twitter is now a private company, Musk has virtually no outside accountability from an independent board of directors to question his decisions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UxWnyM">
In a tweet announcing the leadership change, Musk said he “will transition to being exec chair &amp; CTO, overseeing product, software &amp; sysops.” These roles still represent a major part of the business’s operations. So while Musk could decide to give a new CEO control over some parts of Twitter’s day-to-day business, just how much control he gives up is entirely at his discretion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="p2SyMq">
In other words, Musk’s critics may be celebrating at the prospect of a new person in charge at Twitter, but it’s not guaranteed that anything will change, even with someone new at the top.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E8svN9">
“He’s running product and technology for a 100% software company. What is the CEO in charge of: not paying the vendors?” Jason Goldman, Twitter’s former board member and first head of product, told Vox in a text.
</p>
<aside id="aYM598">
<div>
</div>
</aside>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YtrqIs">
In the past, Musk has been willing to give up some power at his other companies, including SpaceX and Tesla. Leaders like <a href="https://www.bloomberg.com/news/features/2018-07-26/she-launches-spaceships-sells-rockets-and-deals-with-elon-musk">Gwynne Shotwell, SpaceX’s COO</a>, run the business day to day.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2yck33">
But it may be easier for Musk to accept his limitations when it comes to handling the day to day of launching rockets into space or building cars than with Twitter. Musk has described running Twitter, while a <a href="https://apnews.com/article/elon-musk-twitter-social-media-c0addadac3226b016e14b835e3745e62">“painful experience,”</a> to be a relatively easier challenge — and one he thinks he can master by <a href="https://nypost.com/2022/04/22/elon-musk-plots-twitter-changes-defeat-the-spam-bots-or-die-trying/">eliminating bots</a>, adding <a href="https://www.vox.com/technology/2023/3/31/23664041/elon-musk-twitter-checkmark-pay-play-subscription-blue-doge-dog-dogecoin-shiba-logo">more paid content</a>, and allowing a <a href="https://www.vox.com/recode/2022/11/19/23468634/trump-twitter-elon-musk-ban-allowed-back-president-2024">wider range of voices</a> on the platform. And whether you agree with his “free speech extremist” <a href="https://www.vox.com/recode/23042878/elon-musk-twitter-free-speech">values</a> or not, it’s clear that Musk has strong opinions about how to run a social media company. Now, more than a year after <a href="https://www.vox.com/recode/2022/4/14/23024962/elon-musk-twitter-43-billion-private-analysis">his initial bid to buy Twitter</a>, Musk has given no indication that that’s changed.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="A6f9Li">
So if Musk isn’t ready to give up power at Twitter, why pick a new CEO?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yHcMZF">
One job responsibility Musk didn’t<em> </em>say he’d continue to lead is advertising — an <a href="https://www.vox.com/technology/2023/3/23/23651151/twitter-advertisers-elon-musk-brands-revenue-fleeing">area where he’s struggled</a> and where a seasoned ad executive, like Yaccarino, could help. A new CEO could help Twitter’s image with major advertisers, <a href="https://www.cnn.com/2023/02/10/tech/twitter-top-advertiser-decline/index.html">many of whom have quit or cut back</a> from the platform because of Musk’s perceived volatility.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V4vvVV">
A new CEO would put a new face to Twitter’s brand, and draw attention to someone besides Musk and his antics. But don’t expect Musk to quit Twitter anytime soon.
</p>
<h1 data-aos="fade-right" id="from-the-hindu-sports">From The Hindu: Sports</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Erling Haaland, Sam Kerr win Football Writers’ Association awards</strong> - Haaland has scored 51 goals in all competitions, while Kerr has scored 26 goals in 34 club appearances this season at Chelsea</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>‘Air’ movie review: Ben Affleck shoots Matt Damon into MVP territory</strong> - Armed with a phenomenal cast, Ben Affleck deftly directs this tale of Nike’s basketball division trying to sign a young Michael Jordan, in what would be a game-changing move for the worlds of sport, shoes and athletic marketing</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Erling Haaland, Sam Kerr win Football Writers’ Association awards</strong> - Erling Haaland beats his arsenal teammates Bukayo Saka and Martin Odegaard to win the title of “Footballer of the Year”</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Badminton World Federation hands interim ban on new ‘spin serve’</strong> - A new “unreturnable” spin-serve had caught the attention of the world’s top badminton players with even the Indian doubles shuttlers putting in the hard yards to master this latest skill</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Jaiswal swears by disciplined approach and attention to fitness</strong> - I do what I can outside cricket to keep myself fit and mentally strong, says RR opener</p></li>
</ul>
<h1 data-aos="fade-right" id="from-the-hindu-national-news">From The Hindu: National News</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>TS govt. planning to organise celebrations of 10th year of Telangana formation on a grand scale</strong> - Chief Minister conducted a series of meetings to discuss about the event</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Andhra Pradesh: YSRCP leaders should not interfere in affairs of Jana Sena Party, say party leaders</strong> - ‘Pawan Kalyan is keen on alliances with like-minded parties to defeat YSRCP in 2024 general elections’</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Electricity tariff hiked by 70 paise per unit for all LT &amp; HT categories in Karnataka</strong> - The overall increase of 8.31% is expected to bridge the approved revenue gap of ₹4,457.12 crore</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Application pending for years disposed of at adalats: Minister</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Disqualification of MLAs: Pressuring Speaker won’t be compatible with our free and fair legal process, says Fadnavis</strong> - “I don’t think the Speaker will give in to any kind of pressure,” he said.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine claims gains in Bakhmut after Russia denials</strong> - After months of slow Russian advances in the devastated city, the momentum seems to have shifted.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Pope Francis warns pets must not replace children in Italy</strong> - Pope Francis warns only the rich can afford to start a family, as Italy’s birth rate hits new low.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine war: WFP chief Cindy McCain says grain deal with Russia needed to feed world</strong> - Cindy McCain tells the BBC’s Sunday with Laura Kuenssberg programme the deal must be renewed by 18 May.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Wooing expat voters with post-Brexit woes in Spain</strong> - British candidates are canvassing UK expats in Spain’s first local polls since Brexit took effect.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>UK confirms supply of Storm Shadow long-range missiles in Ukraine</strong> - The Storm Shadow cruise missile will give Ukraine new capabilities in its conflict with Russia.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-ars-technica">From Ars Technica</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Rocket Report: SpaceX hits success milestone, Vulcan to resume testing</strong> - “If we’re going to have sovereign space capabilities … we need somewhere to launch from.” - <a href="https://arstechnica.com/?p=1938459">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Microsoft will take nearly a year to finish patching new 0-day Secure Boot bug</strong> - Fix will eventually render all kinds of older Windows boot media unbootable. - <a href="https://arstechnica.com/?p=1938719">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Chinese Mars rover sends back images of recent water-shaped crusts</strong> - Within the last million years or so, melted snow might have dampened Mars’ sands. - <a href="https://arstechnica.com/?p=1938794">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>OpenAI peeks into the “black box” of neural networks with new research</strong> - “We do not understand” how LLMs work, admits OpenAI in quest to make them interpretable. - <a href="https://arstechnica.com/?p=1937997">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Fairphone’s user-repairable headphones will offer spare parts through its app</strong> - But Fairphone doesn’t know how long it will stock spare parts. - <a href="https://arstechnica.com/?p=1938678">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>What’s the difference between a good lawyer and a great lawyer?</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A good lawyer knows the law. A great lawyer knows the judge.
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/EthanPaz26"> /u/EthanPaz26 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/13fb022/whats_the_difference_between_a_good_lawyer_and_a/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/13fb022/whats_the_difference_between_a_good_lawyer_and_a/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>“Do you want to hear a joke about the Russian Victory Day parade?”</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“No tanks.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Ovv_Topik"> /u/Ovv_Topik </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/13fg2p4/do_you_want_to_hear_a_joke_about_the_russian/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/13fg2p4/do_you_want_to_hear_a_joke_about_the_russian/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Iris‌‌h daughte‌‌r ha‌‌d no‌‌t bee‌‌n hom‌‌e fo‌‌r ove‌‌r ‌‌5 years‌‌. When she returned, he‌‌r Fathe‌‌r curse‌‌d he‌‌r heavily‌‌.</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Wher‌‌e hav‌‌e y‌‌e bee‌‌n al‌‌l thi‌‌s time‌‌, child‌‌? Wh‌‌y di‌‌d y‌‌e no‌‌t writ‌‌e t‌‌o us‌‌, no‌‌t eve‌‌n ‌‌a line‌‌? Wh‌‌y didn’‌‌t y‌‌e call‌‌? Ca‌‌n y‌‌e no‌‌t understan‌‌d wha‌‌t y‌‌e pu‌‌t ye‌‌r ol‌‌d Mothe‌‌r through?‌‌”<br/> ‌‌<br/> Th‌‌e girl‌‌, crying‌‌, replied‌‌, “Dad..‌‌. ‌‌I becam‌‌e ‌‌a prostitute.‌‌”<br/> ‌‌<br/> “Y‌‌e what!‌‌? Ge‌‌t ou‌‌t ‌‌a here‌‌, y‌‌e shameles‌‌s harlot‌‌! Sinner‌‌! You’r‌‌e ‌‌a disgrac‌‌e t‌‌o thi‌‌s Catholi‌‌c family.‌‌”<br/> ‌‌<br/> “OK‌‌, Dad..‌‌. a‌‌s y‌‌e wish‌‌. ‌‌I onl‌‌y cam‌‌e bac‌‌k t‌‌o giv‌‌e mu‌‌m thi‌‌s luxuriou‌‌s fu‌‌r coat‌‌, titl‌‌e dee‌‌d t‌‌o ‌‌a te‌‌n bedroo‌‌m mansion‌‌, plu‌‌s ‌‌a ‌‌5 millio‌‌n saving‌‌s certificate‌‌. Fo‌‌r m‌‌e littl‌‌e brother‌‌, thi‌‌s gol‌‌d Rolex‌‌. An‌‌d fo‌‌r y‌‌e Daddy‌‌, th‌‌e sparklin‌‌g ne‌‌w Mercede‌‌s limite‌‌d editio‌‌n convertibl‌‌e that’‌‌s parke‌‌d outsid‌‌e plu‌‌s ‌‌a membershi‌‌p t‌‌o th‌‌e countr‌‌y clu‌‌b ..‌‌. (take‌‌s ‌‌a breath‌‌) ..‌‌. an‌‌d a‌‌n invitatio‌‌n fo‌‌r y‌‌e al‌‌l t‌‌o spen‌‌d Ne‌‌w Year’‌‌s Ev‌‌e o‌‌n boar‌‌d m‌‌y ne‌‌w yach‌‌t i‌‌n th‌‌e Riviera.‌‌”<br/> ‌‌<br/> “Wha‌‌t wa‌‌s i‌‌t y‌‌e sai‌‌d y‌‌e ha‌‌d become?”‌‌, say‌‌s Dad‌‌.<br/> ‌‌<br/> Girl‌‌, cryin‌‌g again‌‌, “‌‌A prostitute‌‌, Daddy!‌‌”<br/> ‌‌<br/> “Oh‌‌! M‌‌y Goodness‌‌! Y‌‌e scare‌‌d m‌‌e hal‌‌f t‌‌o death‌‌, girl‌‌! ‌‌I though‌‌t y‌‌e sai‌‌d ‌‌a Protestant‌‌! Com‌‌e her‌‌e an‌‌d giv‌‌e ye‌‌r ol‌‌d Da‌‌d ‌‌a hug!‌‌”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/HelpingHandsUs"> /u/HelpingHandsUs </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/13enzba/irish_daughter_had_not_been_home_for_over_5_years/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/13enzba/irish_daughter_had_not_been_home_for_over_5_years/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A redneck’s father passed away in his sleep. So in the morning, he calls 911 to come pick up the body. The 911 operator told him that she would send someone out right away. “Where do you live?” asked the operator. He replied, “At the end of Eucalyptus Drive.”</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The operator asked, “Can you spell that for me? There was a long pause and finally he said,”How ’bout if I drag him over to Oak Street and you pick him up there?"
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/YZXFILE"> /u/YZXFILE </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/13expl0/a_rednecks_father_passed_away_in_his_sleep_so_in/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/13expl0/a_rednecks_father_passed_away_in_his_sleep_so_in/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Another oldie…</strong> - <!-- SC_OFF --></p>
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A man was getting a haircut prior to taking a trip to Rome. He mentioned the trip to the barber, who responded, “Why would you want to go there? It’s crowded and dirty — and full of Italians! You’re crazy to go to Rome!” “So, how are you getting there?” “We’re taking United,” was the reply. “We got a great rate!” “United!” exclaimed the barber. “That’s a terrible airline. Their planes are old, their flight attendants are ugly and they’re always late. “So, where are you staying in Rome?” “We’ll be at the downtown International Marriott.” “That dump! That’s the worst hotel in Rome. The rooms are small, the service is surly and they’re overpriced! “What are you going to do when you get there?” ”We’re going to go to see the Vatican, and we hope to see the Pope." “That’s rich,” laughed the barber. “You and a million other people trying to see him. He’ll look the size of an ant. Oh boy, good luck on this lousy trip of yours — you’re going to need it!”
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A month later, the man again came in for his regular haircut. The barber asked him about his trip to Rome.
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“It was wonderful,” explained the man. “Not only were we on time in one of United’s brand new planes, but it was overbooked and they bumped us up to first class. The food and wine were wonderful, and I had a beautiful young stewardess who waited on me hand and foot. And the hotel! Well, it was great! They’d just finished a $25 million remodeling job and now it’s the finest hotel in the city. They were overbooked too, so they apologized and gave us the presidential suite at no extra charge!”
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“Well,” muttered the barber. “I know you didn’t get to see the Pope.”
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“Actually, we were quite lucky, for as we toured the Vatican, a Swiss Guard tapped me on the shoulder and explained that the Pope likes to meet some of the visitors, and if I’d be so kind as to step into his private room and wait, the Pope would personally greet me. Sure enough, five minutes later, the Pope walked in. As I knelt down he spoke to me.”
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“What did he say?”
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“He said, ‘Where’d you get that shitty haircut?”
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Zulufepustampasic"> /u/Zulufepustampasic </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/13fbgfg/another_oldie/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/13fbgfg/another_oldie/">[comments]</a></span></p></li>
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