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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>Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management</strong> -
<div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Background: The COVID-19 pandemic has caused disruptions to cancer care by delaying diagnoses and treatment, presenting challenges and uncertainties for both patients and physicians. We conducted a nationwide online survey to investigate the effects of the pandemic and capture modifications, prompted by pandemic-related control measures, on cervical cancer screening-related activities from mid-March to mid-August 2020, across Canada. Methods: The survey consisted of 61 questions related to the continuum of care in cervical cancer screening and treatment: appointment scheduling, tests, colposcopy, follow-up, treatment of pre-cancerous lesions/cancer, and telemedicine. We piloted the survey with 21 Canadian experts in cervical cancer prevention and care. We partnered with the Society of Canadian Colposcopists, Society of Gynecologic Oncology of Canada, Canadian Association of Pathologists, and Society of Obstetricians and Gynecologists of Canada, which distributed the survey to their members via email. We reached out to family physicians and nurse practitioners via MDBriefCase. The survey was also posted on McGill Channels (Department of Family Medicine News and Events) and social media platforms. The data were analyzed descriptively. Results: Unique responses were collected from 510 participants (16 November 2020 - 28 February 2021), representing 418 fully- and 92 partially- completed surveys. Responses were from Ontario (41.0%), British Columbia (21.0%), and Alberta (12.8%), and mostly comprised family physicians/general practitioners (43.7%), and gynecologist/obstetrician professionals (21.6%). Cancelled screening appointments were mainly reported by family physicians/general practitioners (28.3%), followed by gynecologist/obstetrician professionals (19.8%), and primarily occurred in private clinics (30.5%). Decreases in the number of screening Pap tests and colposcopy procedures were consistently observed across Canadian provinces. About 90% reported that their practice/institution adopted telemedicine to communicate with patients. Conclusions: The area most severely impacted by the pandemic was appointment scheduling, with an important level of cancellations reported. Survey results may inform resumptions of various fronts in cervical cancer screening and management.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22279458v1" target="_blank">Pan-Canadian survey on the impact of the COVID-19 pandemic on cervical cancer screening and management</a>
</div></li>
<li><strong>A machine learning approach identifies unresolving secondary pneumonia as a contributor to mortality in patients with severe pneumonia, including COVID-19</strong> -
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Background: Patients with severe SARS-CoV-2 pneumonia experience longer durations of critical illness yet similar mortality rates compared to patients with severe pneumonia secondary to other etiologies. As secondary bacterial infection is common in SARS-CoV-2 pneumonia, we hypothesized that unresolving ventilator-associated pneumonia (VAP) drives the apparent disconnect between length-of-stay and mortality rate among these patients. Methods: We analyzed VAP in a prospective single-center observational study of 585 mechanically ventilated patients with suspected pneumonia, including 190 patients with severe SARS-CoV-2 pneumonia. We developed CarpeDiem, a novel machine learning approach based on the practice of daily ICU team rounds to identify clinical states for each of the 12,495 ICU patient-days in the cohort. We used the CarpeDiem approach to evaluate the effect of VAP and its resolution on clinical trajectories. Findings: Patients underwent a median [IQR] of 4 [2,7] transitions between 14 clinical states during their ICU stays. Clinical states were associated with differential hospital mortality. The long length-of-stay among patients with severe SARS-CoV-2 pneumonia was associated with prolonged stays in clinical states defined by severe respiratory failure and with a lower frequency of transitions between clinical states. In all patients, including those with COVID-19, unresolving VAP episodes were associated with transitions to unfavorable states and hospital mortality. Interpretation: CarpeDiem offers a machine learning approach to examine the effect of VAP on clinical outcomes. Our findings suggest an underappreciated contribution of unresolving secondary bacterial pneumonia to outcomes in mechanically ventilated patients with pneumonia, including due to SARS-CoV-2.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22280118v1" target="_blank">A machine learning approach identifies unresolving secondary pneumonia as a contributor to mortality in patients with severe pneumonia, including COVID-19</a>
</div></li>
<li><strong>Healthcare system overstretch and in-hospital mortality of intubated COVID-19 patients in Greece: an updated analysis, September 2020 to April 2022</strong> -
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Background: Our previous analysis showed how in-hospital mortality of intubated COVID-19 patients in Greece is adversely affected by patient load and regional disparities. We aimed to update this analysis to include the large “delta” and “omicron” waves that affected Greece during 2021-2022, while also considering the effect of vaccination. Methods: Anonymized surveillance data were analyzed from all COVID-19 patients in Greece intubated between 1 September 2020 and 4 April 2022, and followed up until 17 May 2022. Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates. Results: Mortality was significantly higher above 400 patients, with an adjusted Hazard Ratio of 1.22, 95% CI: 1.09-1.38), rising progressively up to 1.48 (95% CI: 1.31-1.69) for 800+ patients. Hospitalization away from Attica region was also independently associated with increased mortality, as was hospitalization after 1 September 2021 (HR=1.21, 95% CI: 1.09-1.36). Vaccination did not affect the mortality of these already severely ill patients. Conclusion: Our results confirm that in-hospital mortality of severely ill COVID-19 patients is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after 1 September especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of healthcare services in Greece, ensuring equitable and high-quality care for all.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.25.22280326v1" target="_blank">Healthcare system overstretch and in-hospital mortality of intubated COVID-19 patients in Greece: an updated analysis, September 2020 to April 2022</a>
</div></li>
<li><strong>The impact of COVID-19 vaccination in the US: averted burden of SARS-COV-2-related cases, hospitalizations and deaths</strong> -
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By August 1, 2022, the SARS-CoV-2 virus had caused over 90 million cases of COVID-19 and one million deaths in the United States.  Since December 2020, SARS-CoV-2 vaccines have been a key component of US pandemic response; however, the impacts of vaccination are not easily quantified.  Here, we use a dynamic county-scale metapopulation model to estimate the number of cases, hospitalizations, and deaths averted due to vaccination during the first six months of vaccine availability.  We estimate that COVID-19 vaccination was associated with over 8 million fewer confirmed cases, over 120 thousand fewer deaths, and 700 thousand fewer hospitalizations during the first six months of the campaign.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22280281v1" target="_blank">The impact of COVID-19 vaccination in the US: averted burden of SARS-COV-2-related cases, hospitalizations and deaths</a>
</div></li>
<li><strong>Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: a cross sectional study</strong> -
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Objective: To examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men. Design, setting , and participants: We conducted a cross-sectional study of adults living in Ecuador between July and October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status. Results: 1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27–44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with severe depression, COVID-19 infection, and chronic diseases. For women, and self-employment, having cohabitants requiring care, having COVID-19 and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor self-reported health status was associated with perceived poor or inadequate housing and depression. Conclusion: Being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22280279v1" target="_blank">Determinants of self-reported health status during COVID-19 lockdown among surveyed Ecuadorian population: a cross sectional study</a>
</div></li>
<li><strong>Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial</strong> -
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Background: Dimethyl fumarate (DMF) is an anti-inflammatory drug that has been proposed as a treatment for patients hospitalised with COVID-19. Methods: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised for COVID-19. In this initial assessment of DMF, performed at 27 UK hospitals, eligible and consenting adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF 120mg twice daily for 2 days followed by 240mg twice daily for 8 days, or until discharge if sooner. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale, assessed using a proportional odds model. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. The trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936). Findings: Between 2 March 2021 and 18 November 2021, 713 patients were enrolled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients were receiving corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.85-1.46; p=0.42). There was no significant effect of DMF on any secondary outcome. As expected, DMF caused flushing and gastrointestinal symptoms, each in around 6% of patients, but no new adverse effects were identified. Interpretation: In adults hospitalised with COVID-19, DMF was not associated with an improvement in clinical outcomes.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22280285v1" target="_blank">Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial</a>
</div></li>
<li><strong>When should healthcare workers with COVID-19 return to work? An analysis of follow-up antigen test results after a positive COVID test</strong> -
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Background: Under CDCs guidance for mitigating healthcare worker (HCW) staffing shortages, COVID-positive HCW may return to work as early as five days after their initial positive test without a negative antigen test, if symptoms are improving. Recent studies suggest a robust correlation between a positive COVID-19 antigen test and infectiousness. Methods: From January to June 2022, HCW employed by a large health system who tested positive for COVID on a PCR test were instructed to isolate and return for a rapid antigen test on day 5 or later if they had been fever-free for 24 hours and their symptoms were improving. We conducted chi-squared tests and a multivariate logistic regression to assess the association between demographic characteristics, vaccination status, and days from the initial positive PCR test on RTW antigen test results. Results: Compared to day 5, HCW had a lower odds of a positive antigen result on day 7 (OR: 0.39, p&lt;0.0001) and after at least 8 days (OR: 0.16, p&lt;0.0001). Unexpectedly, a positive antigen result was more likely among HCW who were vaccinated (OR: 1.41, p &lt;0.05), boosted for more than 90 days prior (OR: 2.21, p&lt;0.0001), and boosted within 90 days (OR: 2.08, p &lt; 0.01) compared to not being vaccinated. Conclusions: Our findings suggest that HCW returning to work before day 7 following a positive PCR test may still be infectious and future guidelines addressing contingency staffing should reflect these findings in order to minimize possible transmission in the healthcare setting. The finding that boosted individuals had over twice the odds of returning positive on the follow up antigen test compared to unvaccinated HCWs merits additional research.
</p>
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.24.22280327v1" target="_blank">When should healthcare workers with COVID-19 return to work? An analysis of follow-up antigen test results after a positive COVID test</a>
</div></li>
<li><strong>Development of Q-LAAD, an allonamer-based antigen test for the rapid detection of SARS-CoV-2</strong> -
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The SARS-CoV-2 virus has spread globally causing coronavirus disease 2019 (COVID-19). Rapidly and accurately identifying viral infections is an ongoing necessity. We used the systematic evolution of ligands by exponential enrichment (SELEX) technique to produce a DNA allonamer with two distinct binding domains made allosteric through a linker section; one domain binds SARS-CoV-2 spike (S) protein, inducing a conformational change that allows the reporter domain to bind a fluorescent reporter molecule. We used bead-based fluorescence and immunofluorescence assays to confirm the allonamer9s affinity and specificity for S-protein and confirmed that the allonamer can bind to S-proteins with mutations corresponding to those of the alpha, beta, gamma, and delta variants. We then developed the allonamer-based Quantum-Logic Aptamer Analyte Detection (Q-LAAD) test, a rapid, high-throughput antigen test for qualitative detection of SARS-CoV-2 in clinical settings. We validated Q-LAAD against retrospective and prospective clinical anterior nasal swab samples collected from symptomatic patients suspected of having COVID-19. Q-LAAD showed 97% sensitivity and 100% specificity compared to the RT-qPCR assay. Q-LAAD has a limit of detection (LOD) of 1.88 TCID50/mL, is cost-effective and convenient, and requires only a common fluorescence plate reader. Q-LAAD may be a useful clinical diagnostic tool in the fight against SARS-CoV-2.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.23.22280297v1" target="_blank">Development of Q-LAAD, an allonamer-based antigen test for the rapid detection of SARS-CoV-2</a>
</div></li>
<li><strong>Pandemic Fatigue: Measurement, Correlates, and Consequences</strong> -
<div>
The existence and potential consequences of pandemic fatigue have been debated fiercely. We introduce a theoretical conceptualization and brief measure of this much debated construct. Using this measure across two large repeated cross-sectional surveys in Denmark and Germany and one panel survey in Denmark (overall N = 34,582), we provide evidence for the existence of and changes in pandemic fatigue between October 2020 and September 2021 during the COVID-19 pandemic. We also identify its correlates and its relation to self-reported adherence to recommended health-protective behaviors. Finally, we explore the causal impact of pandemic fatigue on people’s intention to adhere to different health-protective behaviors in a well-powered preregistered online experiment with U.S. participants (N = 1,584). Overall, our results provide crucial evidence concerning not only the existence and nature of pandemic fatigue, but also people’s psychological and behavioral responses in the face of a pandemic.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://psyarxiv.com/2xvbr/" target="_blank">Pandemic Fatigue: Measurement, Correlates, and Consequences</a>
</div></li>
<li><strong>Crosstalk among COVID-19, STRA6, Retinol, and G protein-coupled receptor may explain the novel hypothesis of Retinol depletion and retinoid signaling disorder of COVID-19 pathogenesis</strong> -
<div>
More than two years have passed since the pandemic and despite all the efforts of researchers, the pathogenesis of COVID-19 has not yet been resolved. Multisystem involvement, neuroendocrine involvement, and pathophysiological changes caused by SARS-CoV-2 in peripheral organs have been shown in many studies. However, the molecular mechanism of these pathophysiological changes caused by COVID-19 has not been elucidated. The frequent mutations of SARS-CoV-2 and the change in the interaction of the virus with host cells have further complicated the pathogenetic mechanism in COVID-19. Unfortunately, the mechanism determined at the beginning of the pandemic and based on the single receptor tropism of ACE2 was insufficient to explain the pathogenesis of COVID-19. It is known that SARS-CoV-2 causes retinoid signaling defects and chemosensory receptor disorders and exerts its pathogenic effects through these mechanisms. Multisystem involvement and different clinical presentations in COVID-19 suggest that virus-host interaction develops through multiple receptors and signaling pathways. The previous mechanism described via ACE2, based on single-receptor tropism, was insufficient to elucidate the pathogenesis of COVID-19 due to the absence of ACE2 receptors in most of the affected organs. In addition, there is no satisfactory explanation for the mechanism by which ACE2-free organs are affected in COVID-19. In this regard, we think that ACE2 is not a true binding receptor for the SARS-CoV-2 spike protein. With our recent molecular docking studies, STRA6 and its GPCRs were identified as new binding receptors of the SARS-CoV-2 spike protein. These studies have brought a multi-receptor mechanism to the pathogenesis of COVID-19. The multi-receptor mechanism clearly illuminates the complex pathogenesis of retinoid signaling disorder, systemic organ involvement, neuroendocrine involvement, loss of smell and taste, and many other peripheral symptoms and signs, which are considered an enigma in the pathogenesis of COVID-19. Therefore, we suggest retinoid signaling defect as the main pathogenetic disorder in COVID-19 and STRA6 and GPCRs as the main binding receptors of SARS-CoV-2 spike protein. This new mechanism also clarifies the changing symptoms and findings in COVID-19 with each new variant. Moreover, these studies have explained the novel hypothesis for COVID-19 pathogenesis: Retinol depletion and retinoid signaling disorder and have revealed new drug targets for the treatment and prophylaxis of COVID-19.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/a6r3g/" target="_blank">Crosstalk among COVID-19, STRA6, Retinol, and G protein-coupled receptor may explain the novel hypothesis of Retinol depletion and retinoid signaling disorder of COVID-19 pathogenesis</a>
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<li><strong>Does polyethylene glycol, used as an excipient at mRNA-based (Moderna, Pfizer) vaccines, cause an increase in the frequency of epilepsy in PWE?</strong> -
<div>
PEGs, also known as polyethylene glycol, are hydrophilic polymers of various diameters made up of repeated (-CH2-CH2-O-) units and are frequently used in commercial and medical applications like cosmetics, and pharmaceutical preparations and now increase in drug development but the concern about antibodies against PEGs is producing (1) PEGs (PEGs2000) are used as excipients in mRNA-based vaccines like Moderna and Pfizer (2) it is utilized in these vaccines to encapsulate the SLNPs, polyethylene glycol (PEG), which has been identified as the main culprit for this anaphylactic reactions4,5. PEG is used in a wide variety of additional products6, including cosmetics, meals, and pharmaceutical preparations. Its action is essential for preserving the colloidal stability of nanoparticles in biological fluids as well as for lowering the amount of uptake by filter organs, which increases the effectiveness and safety of the particles after vaccination. (3). One of the most prevalent neurological conditions, epilepsy is linked to higher morbidity and mortality rates. PWE who aspirate during seizures have a higher chance of developing pneumonia, and infections can make their PWE’s seizure symptoms worse. Patients with particular epilepsy syndromes who take immunosuppressive medications (such as those with tuberous sclerosis complex or autoimmune encephalitis) must also be regarded as “at risk.” PWE is also more likely to have comorbid conditions, which increases their chance of developing a severe SARS-CoV-2 infection. (4). In a study for colonoscopic screening using PEG as safe more than sodium, the study reported 2 cases of increased frequency of epilepsy attacks on two women who were admitted with generalized tonic-clonic seizures induced by precolonoscopic PEG preparation because of PEG effect on fluids and hyponatremia-induced epilepsy, Electrolyte solutions containing PEG have been linked to seizure activity and/or unconsciousness. Low serum osmolality and irregular electrolytes were linked to the seizure cases. Patients having a history of seizures or a tendency toward them, as well as those with known or suspected hyponatremia, should receive therapy with these drugs with caution (5) Numerous research and evaluations found no evidence linking vaccines to afebrile seizures, and they concluded that immunizations do not cause the beginning of epilepsy [6]. In patients in our cohort who grew more prone to seizures post vaccination but did not have a simultaneous fever, this finding raises doubts about the direct impact of immunization, even though these patients had more serious epilepsy with less control than our multivariate analysis did confirm that seizures frequency is only influenced by one component. The frequency pattern of pre-vaccine seizures was getting worse consequently, it is conceivable to imagine that immunization was an immediate contributing factor in altering seizure frequency, in actuality, the patients who deteriorated were affected by epilepsy that is more severe and poorly controlled. (7) According to several observational studies, individuals with epilepsy (PWE) experienced worsening seizure control during the COVID-19 pandemic. (8-13) An observational study by Isabel Martinez-Fernandez shows Seizure frequency increased after vaccination in 6.2% of people with epilepsy. 6.2% of PWE saw a meaningful increase in seizure frequency after receiving the covid-19 vaccine and in 61.5% of these cases, other probable causes were also present, the causes of worsening seizures are distinct from immunization were identifiable, and patients with a higher risk of seizures and those who had an aggravation after receiving the covid-19 immunization monthly epilepsy. (14) Understanding that PEG is immunogenic and antigenic is important. More thorough investigations are necessary to thoroughly assess the effect of anti-PEG antibodies on PEG conjugates. The chance of experiencing potential adverse effects is increased by the growing usage of PEG and PEGylated therapeutic proteins. First off, side products created during polymer production can indirectly cause hypersensitivity. Second, the pharmacokinetic behavior of the PEGylated medicines exhibits some undesirable modifications. Furthermore, there are certain unanticipated impacts of the leftovers because PEG is not biodegradable. (15) Finally, this letter to the editor gives alarming about the immune response in form of anti-PEGs antibodies as a concern in the future as PEGs are included in drug development as nanoparticles and protein bindings to decrease the clearance of these compounds. And many cases of epilepsy were reported as increasing the frequency after covid-19 vaccinations.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/p8kxj/" target="_blank">Does polyethylene glycol, used as an excipient at mRNA-based (Moderna, Pfizer) vaccines, cause an increase in the frequency of epilepsy in PWE?</a>
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<li><strong>Can long-term post-COVID-19 fainting syndrome explain why a US artist swimmer Anita Alvarez has recurrent fainting attacks after diving during a swimming competition? Does interleukin-6 play a role?</strong> -
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At the 19th FINA (Fédération Internationale De Natation.) World Aquatic Championships were held in Budapest, Hungary, American swimmer Anita Alvarez lost consciousness, experienced recurrent fainting attacks after diving during a swimming competition, and had to be pulled from the bottom of the pool by her coach. And this happens for the second time (1) Five (0.6%) of the 789 elite athletes in an observational study who tested positive for COVID-19 had CMR evidence of inflammatory cardiac disease (myocarditis or pericarditis) (2) Concern has been expressed by a number of authors on the effect of neurologic and neuromuscular problems on return to play. As they recover from COVID19 disease, athletes may experience tiredness, decreased neuromuscular function, and decreased muscle strength. Several additional COVIDrelated problems, such as general weariness, cognitive impairment, and coagulopathy, can occur in recovering athletes. (3)(4) The most common chronic cardiovascular dysautonomia in young and middle-aged people, primarily women, is postural orthostatic tachycardia syndrome (POTS). Chronic orthostatic intolerance, an abnormal increase in heart rate (HR) upon standing, and deconditioning are its defining characteristics. Post-viral autoimmune activation has been proposed as a potential cause of the condition (5) Interleukin-6 is crucial for athletes, particularly after arduous activity and after submerging in cold water. Immersion in cold water is linked to a little increase in IL-6 levels from post-exercise values. (6) Two studies described a syncopal episode in COVID-19 survivors 3 to 4 weeks after diagnosis, at the post-acute COVID-19 stage. This increases the likelihood that syncope had a role, not just during the illness’s acute stage but also as a long-term consequence. Patients in both of these cases underwent analysis for postural orthostatic tachycardia disorder, a part of the autonomic dysfunctions. As previously stated, unexplained pre/syncope accounted for 87.9% (531/604) of the detailed scenes and was the most frequent cause of the temporary loss of awareness. Reflex pre/syncope occurred 7.8% of the time overall (47/604). Orthostatic hypotension made up 2.2 percent (13/604) of the cases, and 2.2 percent (13/604) of the cases likely had cardiac pre/syncope. (7,8) Interleukin-6 (IL-6) is a localized energy sensor that is supplied to active skeletal muscle and can explain why there is an increase in plasma IL-6 during exercise. The length and intensity of the workout have an impact on the creation of IL-6, and moo muscle glycogen material supports this production. The discovery of abnormally elevated levels of IL-6 following arduous exercise has consistently been observed in several studies. After 6 minutes of vigorous exercise, a 2-fold increase in plasma IL-6 was seen. After 30 minutes of running by the treadmill, the blood level of IL-6 had significantly increased, reaching its peak after 2.5 hours. In other studies, when IL-6 levels weren’t monitored during the running workout but rather a few hours later, peak IL-6 levels were discovered right away after the workout, followed by a rapid decline. In this manner, maximal IL-6 levels (100-fold increment) were assessed immediately following the 3-3.5 h race. (9) Peak IL-6 levels are attained at the conclusion of the workout or soon after. Chronic IL-6 elevations cause hyperinsulinemia, lower body mass, and impaired insulin control of skeletal muscle glucose absorption. The level of circulating IL-6 is two to three times higher in senior patients with type 2 DM than it is in younger, healthy people. (10) As stated by NICE (National Institute for Health and Care Excellence), A significant proportion of acute COVID-19 survivors experience long-term physical and neuropsychiatric symptoms, which are categorized as “ongoing symptomatic COVID-19” (symptoms that continue for 4 to 12 weeks after the onset of the illness) and “post-COVID-19 syndrome” or “long COVID” (symptoms that continue for more than 12 weeks). We hypothesize that inflammatory cytokines like interleukin-6 may be involved in the neuro-immune cross-talk that results in these chronic COVID-19 symptoms (IL-6). This hypothesis is supported by a number of research lines, including population-based cohort and genetic Mendelian Randomization studies, which suggest that inflammation and weariness are related and that IL-6 may play a causal role in both symptoms. In particular, clinical epidemiology studies are necessary to determine whether IL-6 and/or other inflammatory cytokine levels are elevated. (11) Finally, this letter of the editor is an alarming pill for saving athletes all over the world and evaluating recurrent attacks of syncopal or cardiac arrest or other cardiovascular problems nowadays post covid-19 pandemic long-term sequelae, and more clinical studies are needed.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/4vn7e/" target="_blank">Can long-term post-COVID-19 fainting syndrome explain why a US artist swimmer Anita Alvarez has recurrent fainting attacks after diving during a swimming competition? Does interleukin-6 play a role?</a>
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<li><strong>Intensity of sample processing methods impacts wastewater SARS-CoV-2 whole genome amplicon sequencing outcomes</strong> -
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Wastewater SARS-CoV-2 surveillance has been deployed since the beginning of the COVID-19 pandemic to monitor dynamics in virus burden in local communities. Genomic surveillance of SARS-CoV-2 in wastewater, particularly the efforts for whole genome sequencing for variant tracking or identification, are comparatively challenging due to low target concentration, complex microbial and chemical background, and lack of robust nucleic acid recovery experimental procedures. The intrinsic sample limitations are inherent to wastewater. In this study, we evaluated impacts from sample types, certain sample intrinsic features, and processing and sequencing methods on sequencing outcomes with a specific focus on the breadth of genome coverage. We collected 184 composite and grab wastewater samples from the Chicago area between March to October 2021 for SARS-CoV-2 quantification and genomic surveillance. Samples were processed using a mixture of processing methods reflecting different homogenization intensities (HA+Zymo beads, HA+glass beads, and Nanotrap), and were sequenced using two sequencing library preparation kits (the Illumina COVIDseq kit and the QIAseq DIRECT kit). A synthetic SARS-CoV-2 RNA experiment was performed to validate the potential impacts of processing methods on sequencing outcomes. Our findings suggested that 1) SARS-CoV-2 whole genome sequencing outcomes were associated with sample types and processing methods 2) in less intensive method processed samples (HA+glass beads), higher genome breadth of coverage in sequencing (over 80%) was associated with N1 concentration &gt; 105 cp/L, while in intensive method (HA+Zymo beads), qPCR results were inconsistent with sequencing outcomes, and 3) sample processing methods and sequencing kits, rather than the extraction methods or intrinsic features of wastewater samples, played important roles in wastewater SARS-CoV-2 amplicon sequencing. Overall, extra attention should be paid to wastewater sample processing (e.g., concentration and homogenization) for sufficient, good quality RNA yield for downstream sequencing.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.22.22280217v1" target="_blank">Intensity of sample processing methods impacts wastewater SARS-CoV-2 whole genome amplicon sequencing outcomes</a>
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<li><strong>Effects of SARS-CoV-2 Infection on Attention, Memory, and Sensorimotor Performance</strong> -
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Background: Recovery after SARS-CoV-2 infection is extremely variable, with some individuals recovering quickly, and others experiencing persistent long-term symptoms or developing new symptoms after the acute phase of infection, including fatigue, poor concentration, impaired attention, or memory deficits. Many existing studies reporting cognitive deficits associated with SARS-CoV-2 infection are limited by the exclusive use of self-reported measures or a lack of adequate comparison groups. Methods: Forty-five participants, ages 18-70, (11 Long-COVID, 14 COVID, and 20 No-COVID) underwent behavioral testing with the NIH Toolbox Neuro-Quality of Life survey and selected psychometric tests, including a flanker interference task and the d2 Test of Attention. Results: We found greater self-reported anxiety, apathy, fatigue, emotional dyscontrol, sleep disturbance and cognitive dysfunction in COVID compared No-COVID groups. After categorizing COVID patients according to self-reported concentration problems, we observed declining performance patterns in multiple attention measures across No-COVID controls, COVID and Long-COVID groups. COVID participants, compared to No-COVID controls, exhibited worse performance on NIH Toolbox assessments, including the Eriksen Flanker, Nine-Hole Pegboard and Auditory Verbal Learning tests. Conclusion: This study provides convergent evidence that previous SARS-CoV-2 infection is associated with impairments in sustained attention, processing speed, self-reported fatigue and concentration. The finding that some patients have cognitive and visuomotor dysfunction in the absence of self-reported problems suggests that SARS-CoV-2 infection can have unexpected and persistent subclinical consequences.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.22.22280222v1" target="_blank">Effects of SARS-CoV-2 Infection on Attention, Memory, and Sensorimotor Performance</a>
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<li><strong>Higher risk of SARS-CoV-2 Omicron BA.4/5 infection than of BA.2 infection after previous BA.1 infection, the Netherlands, 2 May to 24 July 2022</strong> -
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We investigate differences in protection from previous infection and/or vaccination against infection with Omicron BA.4/5 or BA.2. We observed a higher percentage of registered previous SARS-CoV-2 infections among 19836 persons infected with Omicron BA.4/5 compared to 7052 persons infected with BA.2 (31.3% vs. 20.0%) between 2 May and 24 July 2022 (adjusted odds ratio (aOR) for testing week, age group and sex: 1.4 (95%CI: 1.3-1.5)). No difference was observed in the distribution of vaccination status between BA.2 and BA.4/5 cases (aOR: 1.1 for primary and booster vaccination). Among reinfections, those newly infected with BA4/5 had a shorter interval between infections and the previous infection was more often caused by BA.1, compared to those newly infected with BA.2 (aOR: 1.9 (1.5-2.6). This suggests immunity induced by BA.1 is less effective against a BA.4/5 infection than against a BA.2 infection.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2022.09.21.22280189v1" target="_blank">Higher risk of SARS-CoV-2 Omicron BA.4/5 infection than of BA.2 infection after previous BA.1 infection, the Netherlands, 2 May to 24 July 2022</a>
</div></li>
</ul>
<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>Association Between Smell Training and Quality of Life in Patients With Impaired Sense of Smell Following COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Other: Olfactory training with essential oils;   Other: Olfactory training with fragrance-free oils<br/><b>Sponsor</b>:   Ditte Gertz Mogensen<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>The Efficacy and Safety of TADIOS as an Adjuvant Therapy in Patients Diagnosed With Mild to Moderate COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: TADIOS;   Drug: Placebo<br/><b>Sponsor</b>:   Helixmith Co., Ltd.<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 Fourth Dose Study in Australia</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: Tozinameran;   Biological: Elasomeran;   Biological: Bivalent Pfizer-BioNTech;   Biological: Bivalent Moderna<br/><b>Sponsors</b>:   Murdoch Childrens Research Institute;   Coalition for Epidemic Preparedness Innovations;   The Peter Doherty Institute for Infection and Immunity<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 and Effects of an Investigational COVID-19 Vaccine as a Booster in Healthy People</strong> - <b>Conditions</b>:   SARS-CoV-2 Infection;   COVID-19<br/><b>Interventions</b>:   Biological: BNT162b5 Bivalent or BNT162b2 Bivalent 30 µg;   Biological: BNT162b4 5 µg;   Biological: BNT162b4 10 µg;   Biological: BNT162b4 15 µg<br/><b>Sponsors</b>:   BioNTech SE;   Pfizer<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>Trial of 2nd Booster Dose of COVID-19 Vaccine</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Other: Invitation to get a 2nd booster dose of COVID-19 vaccine<br/><b>Sponsor</b>:   Norwegian Institute of Public Health<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>PBI-0451 Phase 2 Study in Nonhospitalized Symptomatic Adults With COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: PBI-0451;   Drug: Placebo<br/><b>Sponsor</b>:   Pardes Biosciences, Inc.<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>Evaluating the Safety and Efficacy of AD17002 Intranasal Spray in Treating Participants With Mild to Moderate COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: AD17002 + Formulation buffer;   Biological: Placebo<br/><b>Sponsors</b>:   Advagene Biopharma Co. Ltd.;   Gadjah Mada 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>Community-Based Health Education Programs for the Early Detection of, and Vaccination Against, COVID-19 and the Adoption of Self-Protective Measures of Hong Kong Residents</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Behavioral: Community-based Health Education based on core intervention package;   Behavioral: Health Information Sharing Group<br/><b>Sponsors</b>:   The Hong Kong Polytechnic University;   Food and Health Bureau, Hong Kong<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>Simvastatin Nasal Rinses for the Treatment of COVID-19 Mediated Dysomsia</strong> - <b>Conditions</b>:   Olfactory Disorder;   COVID-19<br/><b>Intervention</b>:   Drug: Simvastatin<br/><b>Sponsors</b>:   Washington University School of Medicine;   Duke 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>Cardiopulmonary Rehabilitation in Post-acute COVID-19 Syndrome</strong> - <b>Condition</b>:   Post Acute COVID-19 Syndrome<br/><b>Interventions</b>:   Other: Cardiopulmonary rehabilitation;   Other: Health education<br/><b>Sponsor</b>:   Taipei Medical University Shuang Ho 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>Engaging Church Health Ministries to Decrease Coronavirus Disease-19 Vaccine Hesitancy in Underserved Populations</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Behavioral: Active Intervention Group<br/><b>Sponsor</b>:   Pennington Biomedical Research 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>Evaluation of the Efficacy of Mouth Rinses With Commercial Mouthwashes to Decrease Viral Load in Saliva in COVID-19 Patients</strong> - <b>Condition</b>:   covid19<br/><b>Interventions</b>:   Drug: Lacer Clorhexidina Colutorio;   Drug: Lacer Clorhexidine 0.20% Colutorio;   Drug: Gingilacer Encías Delicadas Colutorio;   Drug: Distilled water<br/><b>Sponsors</b>:   Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana;   Hospital Universitario Fundación Jiménez Díaz;   Hospital Universitario Infanta Elena<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>Hydrogen-Oxygen Generator With Nebulizer for Adjuvant Treatment of COVID-19 Positive Patients</strong> - <b>Conditions</b>:   Covid19;   Hydrogen-oxygen Gas;   AMS-H-03<br/><b>Interventions</b>:   Device: Hydrogen-Oxygen Generator with Nebulizer, AMS-H-03;   Device: the hospital routine oxygen supply equipment (wall oxygen or cylinder oxygen)<br/><b>Sponsor</b>:   Ruijin Hospital<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>Safety and Immunogenicity of COVID-19 Vaccine in Population Aged 18 Years and Above</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: low-dose LYB001;   Biological: Recombinant COVID-19 Vaccine (CHO Cell);   Biological: high-dose LYB001<br/><b>Sponsors</b>:   Guangzhou Patronus Biotech Co., Ltd.;   Yantai Patronus Biotech Co., Ltd.<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>Long COVID-19 Syndrome in Primary Care: A Novel Protocol of Exercise Intervention “CON-VIDA Clinical Trial”</strong> - <b>Conditions</b>:   COVID-19;   Long COVID;   Post-COVID-19 Syndrome<br/><b>Intervention</b>:   Behavioral: EXERCISE<br/><b>Sponsor</b>:   Universidad San Jorge<br/><b>Active, not 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>COVID-19, Overzealous Sanitizer Use, and Hair Discoloration: Case Reports</strong> - Proper hand hygiene is one of the top preventive measures against the Coronavirus Disease 2019 (COVID-19). In this study, we report the cases of four patients who presented with blonde discoloration of hair of the dorsal hands and distal forearms during the COVID-19 pandemic. The mean age of participants was 41.25±4.35 years, and 75% percent of them were men. Three patients were medical staff who had to use antiseptics frequently, and one of them was a housewife. In all participants, the primary…</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>Pathogen-Host Adhesion between SARS-CoV-2 Spike Proteins from Different Variants and Human ACE2 Studied at Single-Molecule and Single-Cell Levels</strong> - The binding of the receptor binding domain (RBD) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein onto human angiotensin-converting enzyme 2 (ACE2) is considered as the first step for the virus to adhere onto the host cells during the infection. Here, we investigated the adhesion of spike proteins from different variants and ACE2 using single-molecule and single-cell force spectroscopy. We found that the unbinding force and binding probability of the spike 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>MERS-CoV nsp1 regulates autophagic flux via mTOR signaling and dysfunctional lysosomes</strong> - Autophagy, a cellular surveillance mechanism, plays an important role in combating invading pathogens. However, viruses have evolved various strategies to disrupt autophagy and even hijack it for replication and release. Here, we demonstrated that Middle East respiratory syndrome coronavirus (MERS-CoV) non-structural protein 1(nsp1) induces autophagy but inhibits autophagic activity. MERS-CoV nsp1 expression increased ROS and reduced ATP levels in cells, which activated AMPK and inhibited the…</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>Seroprevalence of influenza viruses in Shandong, Northern China during the COVID-19 pandemic</strong> - Nonpharmaceutical interventions (NPIs) have been commonly deployed to prevent and control the spread of the coronavirus disease 2019 (COVID-19), resulting in a worldwide decline in influenza prevalence. However, the influenza risk in China warrants cautious assessment. We conducted a cross-sectional, seroepidemiological study in Shandong Province, Northern China in mid-2021. Hemagglutination inhibition was performed to test antibodies against four influenza vaccine strains. A combination of…</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 Delta and Omicron variants evade population antibody response by mutations in a single spike epitope</strong> - Population antibody response is thought to be important in selection of virus variants. We report that SARS-CoV-2 infection elicits a population immune response that is mediated by a lineage of VH1-69 germline antibodies. A representative antibody R1-32 from this lineage was isolated. By cryo-EM, we show that it targets a semi-cryptic epitope in the spike receptor-binding domain. Binding to this non-ACE2 competing epitope results in spike destruction, thereby inhibiting virus entry. On the basis…</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>Pediatric Residency Training amid the COVID-19 Pandemic: Exploring the Impact of Supervision and Clinical Practice Guidelines on Clinical and Financial Outcomes</strong> - CONCLUSION: Direct supervision inhibited the negative impact of the COVID-19 pandemic on both clinical and financial outcomes of non-COVID-19 inpatient care by pediatric residents, while CPG only inhibited the negative impact on financial outcomes. Implication of This Study. In a disaster, the availability of CPG and direct supervision makes AMC hospitals able to inhibit the negative impact of disasters on clinical and financial outcomes.</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>Jian-Ti-Kang-Yi decoction alleviates poly(I:C)-induced pneumonia by inhibiting inflammatory response, reducing oxidative stress, and modulating host metabolism</strong> - Jian-Ti-Kang-Yi decoction (JTKY) is widely used in the treatment of COVID-19. However, the protective mechanisms of JTKY against pneumonia remain unknown. In this study, polyinosinic-polycytidylic acid (poly(I:C)), a mimic of viral dsRNA, was used to induce pneumonia in mice; the therapeutic effects of JTKY on poly(I:C)-induced pneumonia model mice were evaluated. In addition, the anti-inflammatory and anti-oxidative potentials of JTKY were also investigated. Lastly, the metabolic regulatory…</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 Basis for the Inhibition of Coronaviral Main Proteases by a Benzothiazole-Based Inhibitor</strong> - The ongoing spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused hundreds of millions of cases and millions of victims worldwide with serious consequences to global health and economies. Although many vaccines protecting against SARS-CoV-2 are currently available, constantly emerging new variants necessitate the development of alternative strategies for prevention and treatment of COVID-19. Inhibitors that target the main protease (M^(pro)) of SARS-CoV-2, an…</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>Chemically Modified Bovine β-Lactoglobulin as a Broad-Spectrum Influenza Virus Entry Inhibitor with the Potential to Combat Influenza Outbreaks</strong> - Frequent outbreaks of the highly pathogenic influenza A virus (AIV) infection, together with the lack of broad-spectrum influenza vaccines, call for the development of broad-spectrum prophylactic agents. Previously, 3-hydroxyphthalic anhydride-modified bovine β-lactoglobulin (3HP-β-LG) was proven to be effective against human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it has also been used in the clinical control of cervical human…</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>The Bovine Seminal Plasma Protein PDC-109 Possesses Pan-Antiviral Activity</strong> - Mammalian seminal plasma contains a multitude of bioactive components, including lipids, glucose, mineral elements, metabolites, proteins, cytokines, and growth factors, with various functions during insemination and fertilization. The seminal plasma protein PDC-109 is one of the major soluble components of the bovine ejaculate and is crucially important for sperm motility, capacitation, and acrosome reaction. A hitherto underappreciated function of seminal plasma is its anti-microbial 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>SARS-CoV-2 RBD-Specific Antibodies Induced Early in the Pandemic by Natural Infection and Vaccination Display Cross-Variant Binding and Inhibition</strong> - The development of vaccine candidates for COVID-19 has been rapid, and those that are currently approved display high efficacy against the original circulating strains. However, recently, new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged with increased transmission rates and less susceptibility to vaccine induced immunity. A greater understanding of protection mechanisms, including antibody longevity and cross-reactivity towards the variants of concern…</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>Broad-Spectrum Small-Molecule Inhibitors of the SARS-CoV-2 Spike-ACE2 Protein-Protein Interaction from a Chemical Space of Privileged Protein Binders</strong> - Therapeutically useful small-molecule inhibitors (SMIs) of protein-protein interactions (PPIs) initiating the cell attachment and entry of viruses could provide novel alternative antivirals that act via mechanisms similar to that of neutralizing antibodies but retain the advantages of small-molecule drugs such as oral bioavailability and low likelihood of immunogenicity. From screening our library, which is focused around the chemical space of organic dyes to provide good protein binders, we…</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>Bacteriophage-Derived Double-Stranded RNA Exerts Anti-SARS-CoV-2 Activity In Vitro and in Golden Syrian Hamsters In Vivo</strong> - Bacteriophage-derived dsRNA, known as Larifan, is a nationally well-known broad-spectrum antiviral medication. This study aimed to ascertain the antiviral activity of Larifan against the novel SARS-CoV-2 virus. Larifan’s effect against SARS-CoV-2 in vitro was measured in human lung adenocarcinoma (Calu3) and primary human small airway epithelial cells (HSAEC), and in vivo in the SARS-CoV-2 infection model in golden Syrian hamsters. Larifan inhibited SARS-CoV-2 replication both in vitro and in…</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>Quercetin in the Prevention and Treatment of Coronavirus Infections: A Focus on SARS-CoV-2</strong> - The COVID-19 outbreak seems to be the most dangerous challenge of the third millennium due to its highly contagious nature. Amongst natural molecules for COVID-19 treatment, the flavonoid molecule quercetin (QR) is currently considered one of the most promising. QR is an active agent against SARS and MERS due to its antimicrobial, antiviral, anti-inflammatory, antioxidant, and some other beneficial effects. QR may hold therapeutic potential against SARS-CoV-2 due to its inhibitory effects on…</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>Plant Metabolites as SARS-CoV-2 Inhibitors Candidates: In Silico and In Vitro Studies</strong> - Since it acquired pandemic status, SARS-CoV-2 has been causing all kinds of damage all over the world. More than 6.3 million people have died, and many cases of sequelae are in survivors. Currently, the only products available to most of the world’s population to fight the pandemic are vaccines, which still need improvement since the number of new cases, admissions into intensive care units, and deaths are again reaching worrying rates, which makes it essential to compounds that can be used…</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>What Putin’s Mobilization Means for the War in Ukraine</strong> - The Kremlin announced a draft to dramatically increase its fighting force. Will the Russian public fight back? - <a href="https://www.newyorker.com/news/q-and-a/what-putins-mobilization-means-for-the-war-in-ukraine">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Breaking Down New York’s Long-Awaited Fraud Lawsuit Against Donald Trump</strong> - Letitia James, the New York attorney general, claims that the Trump Organization illegally obtained hundreds of millions of dollars by systematically exaggerating the value of its properties. - <a href="https://www.newyorker.com/news/our-columnists/breaking-down-new-yorks-long-awaited-fraud-lawsuit-against-donald-trump">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why Ron DeSantis Thinks Weaponizing Asylum Seekers Is a Winning Strategy</strong> - The Florida Governor’s political stunt rests on the cynical assumption that no one actually wants to offer refuge to people fleeing adversity. - <a href="https://www.newyorker.com/news/our-columnists/why-ron-desantis-thinks-weaponizing-asylum-seekers-is-a-winning-strategy">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Nicole Krauss Reads “Shelter”</strong> - The author reads her story from the October 3, 2022, issue of the magazine. - <a href="https://www.newyorker.com/podcast/the-writers-voice/nicole-krauss-reads-shelter">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Iran’s Ferocious Return to the Belligerent Policies of the Revolution’s Early Days</strong> - The country’s new President, Ebrahim Raisi, is cracking down on women, arming Russia, and playing hardball with the U.S. on nuclear diplomacy. - <a href="https://www.newyorker.com/news/daily-comment/irans-ferocious-return-to-the-belligerent-policies-of-the-revolutions-early-days">link</a></p></li>
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<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>How — and why — to take the train across the country</strong> -
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<img alt="" src="https://cdn.vox-cdn.com/thumbor/tazio4hWpsaU8lk6dRoiH1d7Ujw=/273x0:4818x3409/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71415942/GettyImages_97231375.0.jpg"/>
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Getty Images/CSA Images RF
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Long-distance trains in the US are very slow, but it’s much more environmentally friendly and rewarding.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ygqmmI">
Last year, I took the Amtrak from Chicago to San Francisco in coach, and loved it so much that I did it again. So this summer, I decided to take four more long-distance trains: <a href="https://twitter.com/SioBhanBhan/status/1555598049639931904">San Francisco to Seattle</a>, <a href="https://twitter.com/SioBhanBhan/status/1557137441181548545">Seattle to Chicago</a>, <a href="https://twitter.com/SioBhanBhan/status/1558547743492161536">Chicago to New Orleans</a>, and <a href="https://twitter.com/SioBhanBhan/status/1559599608774373376">New Orleans to Los Angeles</a>. (I flew from Los Angeles home to San Francisco because of timing issues, which is a big problem with US rail — something we’ll get into later.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="aFzkuY">
Along the way, I learned about America. I saw the quaint lakes of the Upper Midwest, the humid clouds of the Mississippi Delta, the breathtaking mountains of Montana, and the endless hills of West Texas. I saw beautiful sunsets in northern Washington and Chicago and the Arizona desert. Most of all, I met people with wildly different life experiences from me — people rebuilding their homes after Hurricane Ida, blues musicians from Chicago, overnight commuters through the Great Plains for work, people talking about their experiences in the military, or farming, or being grandparents.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6aXpAy">
Taking the train is not only more scenic, but is much more environmentally friendly than either <a href="https://ourworldindata.org/travel-carbon-footprint">driving</a> or <a href="https://www.vox.com/2019/2/8/18215774/green-new-deal-high-speed-train-air-travel">flying</a>. UK data shows taking even a less-efficient train <a href="https://ourworldindata.org/travel-carbon-footprint">has about</a> one-sixth to one-fourth of the carbon footprint of flying, and about one-fourth of the carbon footprint of driving a non-electric car. <a href="https://www.vox.com/2019/2/8/18215774/green-new-deal-high-speed-train-air-travel">An analysis</a> from areas of Europe with <a href="https://www.hindawi.com/journals/jat/2018/6205714/">more environmentally friendly</a> trains found the environmental benefits to be even higher. It can also be inexpensive: I did this all with a flat-rate rail pass, which allowed me to take a certain number of segments within a set time period — more on that later, too.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WKjP96">
Despite all its positives, rail in America has serious issues. Long-distance trains in the US are abysmally slow, and until (unless?) we get high-speed rail it’s an inefficient and sometimes frustrating way to travel. But if you’re willing to put up with the delays, it’s also (in my opinion) the most rewarding way to travel around the country, with beautiful views you can’t see anywhere else, more comfort than a car or plane, and the opportunity to meet people from all over the US — and world. So if you’re thinking of making the journey, here’s what to expect, and how to make the most of your trip.
</p>
<h3 id="a0BLog">
Long-distance trains in the US are very, very slow
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Kyr4mh">
A hundred years ago, the US was a rail innovation leader. Unfortunately, things haven’t improved much since then. Passenger rail is actually <a href="https://slate.com/human-interest/2009/05/why-trains-run-slower-now-than-they-did-in-the-1920s.html">slower</a> now than it was in the 1920s.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EwBeTB">
The reasons for the decline of rail are many: fewer tracks paired with the rise of freight trains, the rise of <a href="https://mpra.ub.uni-muenchen.de/17495/1/MPRA_paper_17495.pdf">highways</a> as cost-effective competitors, and most simply and most crucially, the fact that new rail <a href="https://www.cnet.com/culture/are-us-trains-really-that-bad-its-complicated/">isn’t being built</a>.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KZgrgo">
It doesn’t seem like high-speed — or any speed — rail will be able to be built at scale any time soon. Rail projects in the US face a lack of <a href="https://www.greenbiz.com/article/why-us-needs-get-track-high-speed-rail">federal investment</a> — recently, the Inflation Reduction Act focused <a href="https://www.politico.com/news/2022/07/28/transit-democrats-car-climate-deal-00048599">$50 billion</a> on cars and only a few billion dollars on any transit alternatives; and the US funds only <a href="https://www.cfr.org/backgrounder/state-us-infrastructure">25 percent</a> of infrastructure at a federal level, much less than many European countries — and also a lack of state-level support, in part due to <a href="https://www.vox.com/2015/6/12/8764819/why-american-trains-are-bad">high cost</a> of land and <a href="https://qz.com/1761495/this-is-why-the-us-still-doesnt-have-high-speed-trains/">construction</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ecLgsH">
This <a href="https://www.vox.com/videos/2022/7/29/23283654/california-high-speed-rail-palmdale-warning">Vox video</a> gives some reasons California’s high-speed rail is “<a href="https://www.vox.com/videos/2022/7/29/23283654/california-high-speed-rail-palmdale-warning">decades late and way over budget</a>”: Local politicians want it to run through their towns, which continually delays the project and makes the train slower and less efficient; people misuse environmental reviews to stop trains from coming to their neighborhoods, which creates legal costs for the government; and the government, in contrast to Europe, hires more expensive consultants instead of full-time engineering experts.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4dlSzj">
Adding to the slowness, freight rail, which transports cargo, not people — and which came to national attention in the <a href="https://www.vox.com/policy-and-politics/2022/9/14/23353627/railroad-strike-updates-2022-amtrak-unions-congress">narrowly averted rail strike</a> in September 2022 over working conditions — owns the tracks in all of the US outside the <a href="https://www.amtrak.com/about-amtrak/northeast-corridor.html">Northeast Corridor</a> from Washington, DC to Boston. This means passenger rail will often stop, sometimes for hours at end, for freight; and is a major reason that <a href="https://www.bts.gov/content/amtrak-time-performance-trends-and-hours-delay-cause">over 40 percent</a> of long-haul Amtrak trains arrive behind schedule. In the Northeast Corridor, performance is much better.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GPGhDC">
While the US has regressed, other countries have progressed. Even lower-speed regional rail and streetcars, common in other parts of the world and the <a href="https://www.vox.com/2015/5/7/8562007/streetcar-history-demise">US past</a>, are missing in much of the US due to disinvestment in favor of cars; and high-speed rail is essentially nonexistent. Critics of rail argue that the US is too big to feasibly have high-speed rail outside of population centers, <a href="https://www.vox.com/2019/2/8/18215774/green-new-deal-high-speed-train-air-travel">but China does</a>. The fastest rail lines in Europe and Asia travel on average <a href="https://www.weforum.org/agenda/2019/07/worlds-high-speed-trains-railways/">upwards of 150 mph</a> — and have capacity to go even faster — while the only classified high-speed rail in the US (the Amtrak Acela, which goes up to 150 mph and travels at about an average of 67 mph) travels at less than half that speed.
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<div id="Ika3PN">
<blockquote class="twitter-tweet">
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Next month I am traveling from NYC to Chicago, the 3rd busiest air route in the country, which takes 19.5 hours via Amtrak on a daily train. This is the same distance as Beijing to Shanghai, which takes only 4.3 hours and leaves every 20 minutes. This country can do better. <a href="https://t.co/bfV0pGG5Vg">pic.twitter.com/bfV0pGG5Vg</a>
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— Hayden Clarkin (<span class="citation" data-cites="the_transit_guy">@the_transit_guy</span>) <a href="https://twitter.com/the_transit_guy/status/1559942910015062018?ref_src=twsrc%5Etfw">August 17, 2022</a>
</blockquote></div></li>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dysbio">
Because we don’t have high-speed rail, the major downside of rail travel is speed. Outside of the Northeast Corridor, flying — even with all the time you have to spend getting to airports far outside the city center — is much faster. It’ll take you a couple days to get from Chicago to any West Coast city via train, and even regional travel such as Chicago to Minneapolis takes about 8 hours — a trip that would take <a href="https://www.weforum.org/agenda/2019/07/worlds-high-speed-trains-railways/">between 2-3 hours</a> in many European or Asian countries.
</p>
<h3 id="nqIaQv">
How to take the train
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GMOAhV">
If you have the time, there are many reasons worth looking into taking the train for long-distance trips. On the train, you don’t have to worry about driving your car or paying for gas or stopping for food. In sleeper trains, meals are included with the price; in coach you have access to a cafe car with limited food offerings — I usually choose to bring my own food.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rYT0RD">
Trains in coach are often cheaper than air travel, particularly during times of high demand. I couldn’t have afforded to fly to Seattle, Chicago, New Orleans, and LA during this summer of high prices — and I did this all using the $499 <a href="https://www.amtrak.com/deals-discounts/multi-ride-rail-passes.html">USA Rail Pass</a>, which allows you to take 10 trips of any length (as long as you don’t transfer trains) in a 30 day period. I would’ve been able to travel to New York, San Diego, and any of the cities along those routes at no extra cost. If you’re transporting a lot of luggage, it’s also a potentially budget-friendly option. Last year, I had to figure out how to get my bike from Chicago to San Francisco, and I was able to take it on the California Zephyr for only $20. You also get two 50-pound suitcases for free.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DJY9Ks">
There are downsides to coach. It has no showers and the bathrooms aren’t great, although in certain models of car the bathrooms are more spacious and give you more room. The only food offered is for purchase in the cafe car and has limited selection, so I’d recommend bringing your own food. But coach is, unfortunately, probably the only truly affordable way to take the long-distance train.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0jHhzk">
If you have the money, there are multiple <a href="https://www.amtrak.com/sleeper-car-accommodations">types of sleeper cars</a>, the most common of which are roomettes — the cheaper option with your own space and shared restroom and shower — and bedrooms, which are larger and have their own bathroom and shower. Roomettes start at just under $700 per person for the long-haul (2-day) trains, while bedrooms will run you over $1,000. There are also accessible bedrooms and family bedrooms. Traveling with kids can obviously be a barrier in terms of time and cost, but for those who can afford it, it’s easier for families to travel in roomettes or sleeper cars for long-haul trains, and kids under 2 travel for free. A friend with a baby recently booked a Chicago-Seattle roomette for his family around Christmas and said that even with the cost, it was cheaper than flying that season.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kXqkjZ">
A final thing to watch out for is the train might make you or your traveling companions motion sick. After I finished my journey, I got land-sickness for a couple of nights after being on the train for so long — I’d wake up and feel like I was still on the train, which was somewhat unpleasant. In general, if you’re traveling in coach you’ll want to pack a blanket and pillow, and whether you’re in coach or sleeper I’d recommend motion sickness medicine and slip-on shoes to walk around the train.
</p>
<h3 id="xsNc95">
People and places
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LFzv5T">
The best things about the train are the scenery and the people. There’s no better way to see the scope of America. One of the most incredible experiences of my life was waking up in the middle of Glacier National Park in Montana; I saw the sun rise and set on Mount Shasta, the Great Plains, the deserts of Arizona and Utah, and the mountains towering over California’s Inland Empire cities. The scenery in Colorado, Washington, and Montana is the most spectacular, but I also loved the quiet beauty of Mississippi’s wetlands and Wisconsin’s lakes. Slow travel is an almost meditative experience, with nowhere to go or be except to watch the world pass by.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uty9CV">
The train is one of the few places in American public life where people really want to talk to each other. It’s also one of the few places where you meet people with a diversity of life experiences (excepting public transit, though most people on the subway and bus don’t want to talk). People who take the train, particularly in coach, are pretty representative of the US.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9y7ALk">
I had incredible conversations on the train, from learning about the Great Migration and Chicago’s transformation over the last 50 years from a couple who’d experienced it, to hearing about flooding and community in Louisiana from the mostly local passengers and crew on the train to New Orleans, to discussing moving to California by train with a young couple and their kids. Meeting such a diverse group of people and traveling through less-traveled areas of the US was also a sobering experience — the train stops not only in big cities, but in small towns with high poverty and infrastructure in ruins, and regional passengers are often from areas that the United States’ vast wealth has left behind.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YWnb7s">
Be sure to spend time in the observation car and talk to people — I also talked to people in the coach car, but the observation car is specifically set up for being social.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5ucP81">
The train isn’t viable for every journey, but it is a wonderful way to see and learn about all sides of America: the good and the bad, the strange and the beautiful. Long-distance rail may change the way you see the country — I know it did for me.
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<ul>
<li><strong>The Supreme Court’s new term could be even more consequential than its last one</strong> -
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<img alt="An illustration shows the US Supreme Court building, overshadowed by a hand with a judge’s gavel, and surrounded by blue, white, and red shapes suggesting pieces of the American flag." src="https://cdn.vox-cdn.com/thumbor/JiCMK6GvZkNuXBHga2Z84rFVVnE=/225x0:1576x1013/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71415568/moore_scotus_board_2b.0.jpg"/>
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Christina Animashaun/Vox
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Republican justices who overruled Roe v. Wade are only getting started.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IAlVHn">
The headline of this piece is likely to turn a few heads. The Supreme Court’s last term, after all, was <a href="https://www.vox.com/23180634/supreme-court-rule-of-law-abortion-voting-rights-guns-epa">an orgy of conservative excess</a> unlike any since the Court’s <a href="https://www.vox.com/21497317/originalism-amy-coney-barrett-constitution-supreme-court">Great Depression-era attacks on the New Deal</a>. And it culminated in the demise of <em>Roe v. Wade</em>, arguably the most closely watched Supreme Court decision since the justices declared school segregation unconstitutional in 1954.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Yk34BX">
But this term, a potentially even more consequential issue than the right to an abortion is on the Court’s docket: <a href="https://www.vox.com/23161254/supreme-court-threat-democracy-january-6">democracy itself</a>. A single case, <a href="https://www.scotusblog.com/case-files/cases/moore-v-harper-2/"><em>Moore v. Harper</em></a>, threatens to fundamentally rewrite the rules governing federal elections, potentially giving state legislatures (some of which are highly gerrymandered themselves) nearly limitless power to skew those elections.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XDpG9V">
A second case in the Court’s new term — which officially opens on Monday, October 3 — also places free and fair elections in the United States in grave peril. That case, <a href="https://www.scotusblog.com/case-files/cases/merrill-v-milligan-2/"><em>Merrill v. Milligan</em></a>, could usher in a new era of racial gerrymandering where states have <a href="https://www.vox.com/23180634/supreme-court-rule-of-law-abortion-voting-rights-guns-epa">more freedom to undercut Black and brown political power</a> than they’ve had since President Lyndon Johnson signed the Voting Rights Act in 1965 — a law that the Roberts Court has <a href="https://www.vox.com/22575435/voting-rights-supreme-court-john-roberts-shelby-county-constitution-brnovich-elena-kagan">spent the last decade dismantling piece by piece</a>.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V9TchB">
If both these cases go badly, it’s not that America will stop having elections. But the power to decide how elections are conducted — which ballots are counted, where district lines are drawn, and potentially even who is certified as the winner of an election — could rest with increasingly partisan officials, including the justices themselves.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dTqQeP">
And even if the Court were not hearing what could be two of the most significant election cases of the modern era, this would still be a term with enormous policy stakes.
</p>
<div class="c-wide-block">
<figure class="e-image">
<img alt="A protester holds a sign that reads “YOUR VOTE IS YOUR VOICE - DON’T LET THEM SILENCE YOU.” The Capitol dome is in the background." src="https://cdn.vox-cdn.com/thumbor/bnJPD702nQ-qU8Tmu-mxHL40zAM=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24048605/GettyImages_1237853180t.jpg"/> <cite>Tom Williams/CQ-Roll Call via Getty Images</cite>
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A protester holds a sign at a rally outside the US Capitol to urge the Senate to pass voting rights legislation on January 19, 2022.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BOg90V">
Just in October, the Court plans to hear <a href="https://www.scotusblog.com/case-files/cases/sackett-v-environmental-protection-agency/">two</a> different <a href="https://www.scotusblog.com/case-files/cases/national-pork-producers-council-v-ross/">cases</a> that could significantly undercut US efforts to protect the environment — building on a decision from last June that <a href="https://www.vox.com/2022/6/30/23189610/supreme-court-epa-west-virginia-clean-power-plan-major-questions-john-roberts">weakened the EPA’s power to fight climate change</a>. In its November session, the Court will hear a pair of cases that are widely expected to <a href="https://www.scotusblog.com/case-files/cases/students-for-fair-admissions-inc-v-president-fellows-of-harvard-college/">forbid universities from considering race</a> when deciding which students to admit, effectively ending race-based affirmative action programs at those schools.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zUoSMV">
Other cases on the Court’s docket could <a href="https://www.scotusblog.com/case-files/cases/health-and-hospital-corporation-of-marion-county-indiana-v-talevski/">undercut Medicaid</a> and erase legal safeguards intended to halt the <a href="https://www.scotusblog.com/case-files/cases/haaland-v-brackeen/">cultural genocide of Indigenous people</a>.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="71rb5z">
Bear in mind, moreover, that the Court has only begun to fill up its docket for the upcoming term. As the year progresses, the Court will agree to hear additional cases, some of which could be no less harrowing for liberal democracy than <em>Moore</em>, <em>Merrill</em>, and others that the justices have already agreed to take up.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NysK01">
With that said, here are nine cases that are already on the Court’s docket, and that could each shift US policy dramatically to the right.
</p>
<h3 id="3LpqGj">
<ol type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">The single biggest threat to US democracy since the January 6 attack
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hS7jRi">
It’s difficult to exaggerate the stakes in <em>Moore</em>, which could neutralize the parts of state constitutions that protect the right to vote and give an unprecedented amount of power to state legislatures, some of which are <a href="https://www.vox.com/22632427/redistricting-gerrymandering-house-republicans">heavily gerrymandered</a>.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sqtqZ7">
<em>Moore</em> involves the “<a href="https://www.vox.com/22958543/supreme-court-gerrymandering-redistricting-north-carolina-pennsylvania-moore-toth-amy-coney-barrett">independent state legislature doctrine</a>,” a theory that the Supreme Court has rejected many times over the course of more than a century, but that at least four members of the current Court have signed on to in one form or another.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VcG75n">
Two provisions of the Constitution state that the rules governing federal elections shall be determined by each state’s “legislature.” For more than a century, the Court has understood this word, at least when used in this context, to refer to <a href="https://www.vox.com/23161254/supreme-court-threat-democracy-january-6">whatever body within that state has the power to make laws</a> — what the Court has referred to as the “legislative power.” So if a state ordinarily permits its governor to veto legislation, or if the people of a state can ordinarily enact laws via a ballot initiative, state laws governing federal elections are made in the same way.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dgINoy">
Under the independent state legislature theory, however, the word “legislature” must be understood to mean the body of elected representatives which make up a state’s legislative branch of government. Indeed, under the strongest version of this theory, state governors are forbidden from vetoing bills governing federal elections (because the governor is not the “legislature”). And state courts are forbidden from striking down election laws that violate the state constitution (because courts are not the “legislature”).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zDrxlP">
It’s unclear if the Court will go that far, but even a less aggressive decision in <em>Moore</em> would fundamentally alter the balance of power between the states and the Supreme Court, and potentially give the Court’s GOP-appointed majority an <a href="https://www.vox.com/23161254/supreme-court-threat-democracy-january-6">unprecedented amount of say over how federal elections are conducted</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j2i0iy">
The ultimate power to interpret a state law, for example, rests with state courts, not federal judges. But even a relatively narrow reading of the independent state legislature doctrine would give the same Supreme Court that’s recently <a href="https://www.vox.com/22575435/voting-rights-supreme-court-john-roberts-shelby-county-constitution-brnovich-elena-kagan">shown such hostility to voting rights laws</a> the power to overrule a state supreme court’s interpretation of that state’s election law — on the theory that the state supreme court somehow misinterpreted an act of the state legislature, and this error must be corrected by the US Supreme Court.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="baMLbD">
Even if the Court does not issue a maximalist decision in <em>Moore</em>, in other words, it could still centralize authority over all presidential and congressional elections within itself — empowering the justices to read state election laws in ways that benefit their preferred party or candidates.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E5oCA9">
And, in the worst-case scenario for democracy, Republicans in key swing states <a href="https://www.vox.com/22958543/supreme-court-gerrymandering-redistricting-north-carolina-pennsylvania-moore-toth-amy-coney-barrett">like Michigan, Pennsylvania, and Wisconsin</a>, where the GOP controls highly gerrymandered state legislatures, could gain an unlimited ability to decide how congressional elections are conducted, and who wins their state’s electoral votes.
</p>
<h3 id="FUOBA2">
<ol start="2" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">A new age of racial gerrymandering
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qI6tpU">
Last year, Alabama’s Republican legislature enacted congressional maps that give Black Alabamans <a href="https://www.vox.com/2022/2/1/22910909/supreme-court-racial-gerrymander-alabama-merrill-singleton-milligan">far less US House representation</a> than their numbers suggest they should receive.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UEQFin">
African Americans <a href="https://www.census.gov/quickfacts/AL">make up about 27 percent of Alabama’s population</a>. But, under the gerrymandered maps, Black voters only have a real shot of electing their candidate of choice in one of the state’s seven congressional districts — so Black voters will only control 14 percent of the state’s congressional delegation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kYnpUO">
A panel of three federal judges — <a href="https://www.vox.com/2022/2/8/22922774/supreme-court-merrill-milligan-alabama-brett-kavanaugh-racial-gerrymandering-voting-rights-act">two appointed by former President Donald Trump</a> — ordered the state to redraw the maps, arguing that they violate the Voting Rights Act, the landmark 1965 law prohibiting race discrimination in elections.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Fj8QKR">
Nevertheless, the Court voted 5-4 last February to reinstate Alabama’s map, at least for the 2022 election cycle. And, in <em>Merrill v. Milligan</em>, the Court will decide whether to make that decision permanent, effectively permitting the maps to remain in effect until the next redistricting cycle in 2031.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="mtWdCr">
In fairness, the mere fact that Alabama’s maps give Black voters significantly less representation than their share of the state’s population suggests that they should have is not sufficient for the <em>Merrill </em>plaintiffs to prevail. Rather, under the Supreme Court’s decision in <a href="https://caselaw.findlaw.com/us-supreme-court/478/30.html"><em>Thornburg v. Gingles</em></a> (1986), these plaintiffs have to demonstrate that other factors are present; among other things, they need to show that enough Black voters live in close enough proximity that it would be possible to draw a second majority-Black district, and that white Alabamans tend to vote as a bloc for candidates opposed by Black voters.
</p>
<div>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/2SsNZwss1i1sPJssHBUCLcnxVjA=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24048815/GettyImages_1383620702t.jpg"/> <cite>Brandon Bell/Getty Images</cite>
<figcaption>
Marchers dance and gather during the Black Voters Matter’s 57th Selma to Montgomery March, on March 9, 2022.
</figcaption>
</figure>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/A9s73DcxJJ1vM2y4HG0jBjCJpwA=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24048826/GettyImages_1384346860t.jpg"/> <cite>Brandon Bell/Getty Images</cite>
<figcaption>
People and social justice organizations marched in 2022 to commemorate “Bloody Sunday,” when Rep. John Lewis and other civil rights leaders marched 11 miles on March 7, 1965, during the height of the civil rights movement.
</figcaption>
</figure></div></li>
</ul>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NjvC5u">
The lower court found that these factors were met in <em>Merrill, </em>although Alabama makes a plausible argument in its brief that Black voters in Alabama <a href="https://www.supremecourt.gov/DocketPDF/21/21-1086/221827/20220425152045101_Milligan%20-%20Merits%20Br%20FINAL%204-25.pdf">may not live sufficiently close together</a> to justify a second majority-Black district.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HAoCn0">
But Alabama’s brief does not so much seek a narrow decision holding that it complied with <em>Gingles,</em> as it asks the Court to overrule <em>Gingles</em> and replace it with a new rule that would make it virtually impossible for voting rights plaintiffs to challenge any racial gerrymander. Under Alabama’s proposed test, a map may be struck down only if its configuration “<a href="https://www.supremecourt.gov/DocketPDF/21/21-1086/221827/20220425152045101_Milligan%20-%20Merits%20Br%20FINAL%204-25.pdf">can be explained only by racial discrimination</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZrZbVS">
But that is not what <em>Gingles</em> held, and it is <a href="https://www.vox.com/22575435/voting-rights-supreme-court-john-roberts-shelby-county-constitution-brnovich-elena-kagan">not what the text of the Voting Rights Act provides</a> — the Act provides that any state law that “results in a denial or abridgement of the right of any citizen of the United States to vote on account of race or color” is illegal, even if the law was not motivated by racist intent.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="g3sDK4">
But, given this Court’s long record of hostility to voting rights plaintiffs, there is a very real risk that its Republican-appointed majority will accept Alabama’s proposal to effectively legalize most racial gerrymanders.
</p>
<h3 id="JvXPID">
<ol start="3" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">The end of affirmative action in university admissions
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nDpjmv">
As a general rule, race-conscious policies are not allowed. The Constitution places strict limits on the government’s ability to consider race, and federal anti-discrimination laws impose similar restrictions on private universities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EyY5rU">
In <a href="https://www.law.cornell.edu/supct/html/02-241.ZO.html"><em>Grutter v. Bollinger</em></a> (2003), however, the Court held that universities may take limited account of race when deciding which students to admit, because ignoring racial diversity would lead to an inferior educational experience for all students. “Numerous studies show that student body diversity promotes learning outcomes, and ‘better prepares students for an increasingly diverse workforce and society, and better prepares them as professionals,’” the Court explained in <em>Grutter</em>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8aX68Q">
Nevertheless, two closely related cases — <a href="https://www.scotusblog.com/case-files/cases/students-for-fair-admissions-inc-v-president-fellows-of-harvard-college/"><em>Students for Fair Admissions v. President &amp; Fellows of Harvard College</em></a>, and <a href="https://www.scotusblog.com/case-files/cases/students-for-fair-admissions-inc-v-university-of-north-carolina/"><em>Students for Fair Admissions v. University of North Carolina</em></a> — are widely expected to overrule <em>Grutter</em> and forbid universities from considering race even if that will lead to worse outcomes for all of the university’s students.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AbgTVs">
Affirmative action has already had one close call before the Supreme Court and survived. In <a href="https://www.supremecourt.gov/opinions/15pdf/14-981_4g15.PDF"><em>Fisher v. University of Texas</em></a> (2016), Justice Anthony Kennedy, who dissented in <em>Grutter</em>, surprised most Court observers by voting to weaken <em>Grutter</em>, but not to overrule it altogether.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tWZsXt">
But <em>Grutter</em> was decided by just one vote, and Kennedy and liberal Justice Ruth Bader Ginsburg have since been replaced by archconservative justices appointed by Trump. So the likelihood that <em>Grutter</em> will survive contact with the current Court is quite small.
</p>
<h3 id="SIaxi8">
<ol start="4" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">Gutting protections for Medicaid patients
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CQJ1XU">
Current Medicaid law offers states a bargain. The federal government picks up a significant share of the cost of providing health care to poor people. In return, states and health providers that participate in state Medicaid programs must comply with certain rules intended to protect patients the federal government is helping pay for. State Medicaid plans, for example, <a href="https://khn.org/news/block-grants-medicaid-faq/">must provide coverage to certain individuals</a>, including children and pregnant patients who meet certain income criteria.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ENTl1s">
That brings us to <a href="https://www.scotusblog.com/case-files/cases/health-and-hospital-corporation-of-marion-county-indiana-v-talevski/"><em>Health and Hospital Corporation of Marion County, Indiana v. Talevski</em></a>, a lawsuit that could render much of this bargain unenforceable.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Amy7tQ">
Under current law, the rules governing when individual plaintiffs may sue to enforce federal Medicaid law are quite complicated, but such suits are allowed when states and health providers violate at least some of Medicaid’s requirements. The defendants in <em>Talevski</em> ask the Court to overrule longstanding precedents that permit these suits. If this position prevails, many of these rules could cease to function in Republican presidential administrations, as the federal government would become the only body capable of enforcing them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MIMOey">
Even in Democratic administrations, moreover, the government would likely struggle to keep Medicaid operating as it currently does, because the federal government only has limited resources to police violations of federal Medicaid law. And the ordinary remedy when a state does not comply with the conditions attached to a federal grant is to cut off those funds — something that a pro-Medicaid administration would be reluctant to do because it would mean punishing low-income patients for the sins of a state or health provider.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Rbf89v">
In a post-<em>Talevski</em> world, in other words, the only way to enforce Medicaid law may be to cut off federal health care funds to the states — which would lead to even more people losing health coverage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="HjsHei">
It’s worth noting the immediate stakes in <em>Talevski</em> as well. The plaintiff alleges that her husband, who had dementia, experienced horrid abuse while he was living in a nursing home. Among other things, she claims that the home violated a federal law that prohibited this home from giving her husband “<a href="https://casetext.com/case/talevski-v-health-and-hospital-corporation-of-marion-county">powerful and unnecessary psychotropic medications for purposes of chemical restraint</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NAPlJ9">
Now, however, the Supreme Court could render this federal law and many others a virtual nullity. And even if the Court finds a middle ground that only neutralizes some of these lawsuits, that would still mean many Americans would be helpless if they are denied care, or given care that falls far below the standard set by federal law.
</p>
<h3 id="dRa4sS">
<ol start="5" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">Who is in charge of ICE?
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XMyaKh">
Federal law provides that the secretary of Homeland Security — currently Alejandro Mayorkas — “shall be responsible” for “<a href="https://www.law.cornell.edu/uscode/text/6/202">establishing national immigration enforcement policies and priorities</a>.” Under this authority, Mayorkas <a href="https://www.ice.gov/doclib/news/guidelines-civilimmigrationlaw.pdf">issued a memo</a> instructing Immigration and Customs Enforcement (ICE) agents to prioritize enforcement efforts against removable immigrants who “pose a threat to national security, public safety, and border security and thus threaten America’s well-being” — and, implicitly, to give a lower priority to enforcement against other immigrants.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UCD0uG">
Nevertheless, Judge Drew Tipton, a <a href="https://www.vox.com/23204150/supreme-court-ice-texas-united-states-drew-tipton-immigration">Trump appointee</a> with a history of handing down legally dubious orders undercutting the Biden administration’s immigration policies, declared this memo unlawful. Tipton’s order is <a href="https://www.vox.com/23204150/supreme-court-ice-texas-united-states-drew-tipton-immigration">at odds with the text of federal law</a>, with Supreme Court decisions giving immigration officials broad authority to decide when to enforce the law, and with the basic liberal democratic notion that law enforcement must be under the command and control of political officials who are themselves accountable to someone who is elected.
</p>
<div>
<figure class="e-image">
<img alt="The US Department of Homeland Security on a window in which is reflected a crowd of protesters." src="https://cdn.vox-cdn.com/thumbor/VkgmlJgEbCvMlw2tz9bP7XDMkas=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24049297/GettyImages_988413630t.jpg"/> <cite>Bastiaan Slabbers/NurPhoto via Getty Images</cite>
<figcaption>
A view of the Department of Homeland Security Immigration Field Office, in Philadelphia, in June 2018.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MZL0Rc">
In July, the Supreme Court announced that it would nonetheless permit Tipton’s order to remain in effect while the justices consider the case.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FrKQ6V">
If the Court acts <a href="https://www.vox.com/2022/6/30/23189965/supreme-court-biden-texas-remain-in-mexico-john-roberts">as it did in another recent immigration case</a>, it’s likely a majority of justices will eventually reverse Tipton and restore Mayorkas’s lawful authority over immigration enforcement. But a decision in this case, <a href="https://www.supremecourt.gov/DocketPDF/22/22A17/229661/20220708124118756_Texas%20Stay%20Application%20-%20Final.pdf"><em>United States v. Texas</em></a>, may not come until late June of 2023.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="8YwiFy">
In other words, Tipton is still likely to unlawfully wield many of the powers of the Secretary of Homeland Security for nearly a year.
</p>
<h3 id="qGzCnq">
<ol start="6" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">New limits on the federal government’s power to fight water pollution
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DR9zfC">
The Clean Water Act is not the most precisely drafted statute. It prohibits anyone from discharging a wide range of pollutants into the “<a href="https://casetext.com/case/sackett-v-us-envtl-prot-agency-1">waters of the United States</a>,” but does not define what this term means.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="L4ps5a">
While there is broad consensus that oceans, rivers, and lakes qualify, what of creeks or human-made drainage ditches that empty into major waterways? What of wetlands that border a river or lake, or that might be connected to one via creeks or drainage ditches? The Clean Water Act has long been understood to cover at least some of these relatively minor bodies of water, because of the reality that toxic chemicals dumped into a wetland miles away from a navigable waterway do not become less toxic simply because they take some time to make their way into that waterway.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SCr4nf">
<a href="https://www.scotusblog.com/case-files/cases/sackett-v-environmental-protection-agency/"><em>Sackett v. EPA</em></a> involves a difficult question of whether a wetland, which drains into a tributary, which itself drains into a creek, which in turn empties into a lake, is subject to the Clean Water Act. And it is likely that this Supreme Court will use <em>Sackett</em> to significantly reduce that act’s scope.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="E6oq9r">
The last time the Supreme Court considered which waters constitute “waters of the United States,” in <a href="https://www.law.cornell.edu/supct/html/04-1034.ZO.html"><em>Rapanos v. United States</em></a> (2006), the Court’s conservative bloc split on how best to define that term, and the Court as a whole split 4-1-4 on how to resolve the case — there was no majority opinion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TVx4Ua">
Justice Antonin Scalia wrote an opinion for the four most conservative justices, claiming that the phrase “does not include channels through which water flows intermittently or ephemerally, or channels that periodically provide drainage for rainfall.” Scalia added that wetlands are only subject to the act if they have a “continuous surface connection” with a “relatively permanent body of water” that makes it “difficult to determine where the ‘water’ ends and the ‘wetland’ begins.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WL0pzl">
Justice Kennedy applied a different test, arguing that wetlands can qualify as “waters of the United States” if they “significantly affect the chemical, physical, and biological integrity of other covered waters more readily understood as ‘navigable.’” The federal appeals court that heard <em>Sackett </em>determined that it should apply Kennedy’s test, rather than Scalia’s.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MdcHnV">
Since <em>Rapanos</em>, however, both Scalia and Kennedy have been replaced by more conservative Trump appointees — as was Justice Ruth Bader Ginsburg, who joined a more liberal dissent in <em>Rapanos</em>. It is fairly likely, in other words, that whatever emerges from this Court in <em>Sackett</em> will be at least as restrictive as the test Scalia announced in <em>Rapanos</em>.
</p>
<h3 id="bzlkpQ">
<ol start="7" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">The fight over whether religious conservatives have a constitutional right to discriminate
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QfAAHd">
Religious conservatives have twice sought a sweeping decision from the Supreme Court, holding that they have a constitutional right to discriminate against LGBTQ people. They’ve thus far had mixed success. While the Court has twice ruled in favor of conservative litigants claiming a right to discriminate, it has <a href="http://vox.com/2021/6/17/22538645/supreme-court-fulton-philadelphia-lgbtq-catholic-social-services-foster-care-john-roberts-religion">done so</a> on <a href="https://www.vox.com/identities/2018/6/4/17425294/supreme-court-masterpiece-cakeshop-gay-wedding-cake-baker-ruling">narrow grounds</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J2nXST">
One problem with these litigants’ previous lawsuits is that they presented difficult line-drawing problems. In <a href="https://casetext.com/case/masterpiece-cakeshop-ltd-v-colo-civil-rights-commn-3"><em>Masterpiece Cakeshop v. Colorado Civil Rights Commission</em></a> (2018), for example, the plaintiffs’ lawyers tried to reframe a baker who refused to bake a cake for a same-sex couple as an “<a href="https://www.scotusblog.com/wp-content/uploads/2017/09/16-111-ts.pdf">artist</a>” who was dragooned into producing a work of art celebrating a marriage he rejects on religious grounds.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J3QJJU">
Ultimately, the Supreme Court dodged this question, with Justice Elena Kagan noting that this same argument that “artists” have a right to discriminate could <a href="https://www.oyez.org/cases/2017/16-111">permit discrimination by hairstylists, makeup artists, jewelers</a>, and, indeed, pretty much anyone whose job requires a degree of creativity.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7TtvT6">
Which brings us to <a href="https://www.scotusblog.com/case-files/cases/303-creative-llc-v-elenis/"><em>303 Creative v. Elenis</em></a>, the case currently before the Supreme Court. Unlike a baker, who can only make a tenuous claim that they are engaged in First Amendment protected speech when they bake a wedding cake, <em>303 Creative</em> involves someone who wishes to design wedding websites — <a href="https://casetext.com/case/303-creative-llc-v-elenis-3">but only for straight couples</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FaGo5W">
While the exact details of 303 Creative’s website design process might affect how this case should be decided, generally, a website is a medium that uses words to convey meaning, and thus the plaintiffs in <em>303 Creative</em> present a much stronger case that their business is engaged in First Amendment protected speech than the plaintiffs in <em>Masterpiece Cakeshop</em>. Moreover, the current Court, with its 6-3 Republican-appointed majority, <a href="https://www.vox.com/22889417/supreme-court-religious-liberty-christian-right-revolution-amy-coney-barrett">rarely rules against religious conservatives</a> — even when they present much weaker arguments than the ones presented by the <em>303 Creative</em> plaintiffs. So it’s not hard to guess who will prevail in this case.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gOJn8i">
A more uncertain question is whether the Court will hand down a sweeping decision giving many religious conservatives a broad right to discriminate, or whether the Court’s decision will be more limited to the facts of this particular case.
</p>
<h3 id="vJzW4r">
<ol start="8" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">When can states pass laws that impact other states?
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NddAxw">
As a general rule, states may ban certain products within their borders, and different states can have different rules about which products are banned. Currently, <a href="https://www.businessinsider.com/legal-marijuana-states-2018-1">recreational marijuana</a> is legal in Virginia, but illegal just across the border in North Carolina. As a constitutional matter, that’s perfectly fine.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hkK83x">
In 2018, California’s voters enacted Proposition 12, which bans the sale of pork produced from hogs confined in a manner that the state law considers to be inhumane. On the surface, this is no different from North Carolina’s marijuana ban. California voters wished to prohibit a certain product from being sold within their state, and they did so.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9QHmht">
Nevertheless, in <a href="https://www.scotusblog.com/case-files/cases/national-pork-producers-council-v-ross/"><em>National Pork Producers v. Ross</em></a>, trade organizations representing the pork industry, allege that Prop 12 violates constitutional safeguards against state laws that burden commerce in other states. The idea is that pork producers in other states will have to either produce all pork in compliance with California’s standards, even if that pork will never enter California, or they will incur significant expense from segregating pork that is destined for the California market from the rest of their operation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="NN07yU">
Under existing precedents, a state law’s impact on other state markets needs to be pretty extreme before it becomes unconstitutional. Indeed, a right-leaning appeals court panel rejected the pork producers’ argument, explaining that “laws that increase compliance costs, without more, <a href="https://casetext.com/case/national-pork-producers-council-v-ross-1">do not constitute a significant burden on interstate commerce</a>.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5T2e65">
Should the Supreme Court disturb that holding, it could have sweeping implications not just for pork producers and consumers, but for many state laws that impose restrictions on commercial products that go beyond restrictions in other states.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CUTN7b">
As legal scholars Heather Gerken and James Dawson explained in a <a href="https://democracyjournal.org/magazine/36/living-under-someone-elses-law/">2015 article</a>, states frequently enact such laws. For example, Vermont “required food producers that use genetic modification to disclose this fact on the label of any food sold in that state, even if the producer has no facilities in Vermont. Minnesota has prohibited the purchase of electricity that was generated at new coal-fired power plants, even if those power plants are located outside Minnesota,” they wrote.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qvDiZM">
One surprising development in this case is that the Biden administration weighed in on the pork producers’ side — although they <a href="https://www.supremecourt.gov/DocketPDF/21/21-468/228387/20220617195711500_No.%2021-468%20Natl%20Pork%20Producers%20v.%20Ross%20Final.pdf">argue for a narrow ruling</a> that California’s pork law is unconstitutional because it “is aimed at ‘cruelty’ to animals that occurs entirely outside California and has no impact within California.” It’s possible that this is an effort to convince the Supreme Court not to hand down a more consequential decision.
</p>
<h3 id="qVnWMV">
<ol start="9" type="1">
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">A truly massive case about the legacy of cultural genocide against Native Americans
</li></ol></h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5zMtXH">
Finally, the Court will hear a case questioning several foundational principles of US law related to American Indians, and targeting a landmark law enacted in response to many decades of attacks on Indigenous culture.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WEiRYC">
Since the Washington administration, the Constitution has been understood to give the federal government authority over relations with American Indians. (Federal law and legal opinions often use the word “Indian” to refer to Indigenous nations and their citizens; this piece includes quotes using that terminology.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2fP2yJ">
For much of its history, the United States used this authority to, as one federal judge described it, “<a href="https://casetext.com/case/brackeen-v-haaland">‘Christianize’ the supposedly heathen Native peoples</a>.” Beginning in the 1800s, for example, the federal government <a href="https://www.vox.com/22956346/supreme-court-commerce-clause-native-american-indian-child-welfare-act-haaland-brackeen-texas">forcibly removed many American Indian children from their homes</a> and enrolled them in boarding schools intended to eradicate their connection to their culture.
</p>
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/VoRte-unZfA7Qp3k1tLbkqQVp18=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/24049414/GettyImages_514703982t.jpg"/> <cite>Bettmann Collection via Getty Images</cite>
<figcaption>
A group of Native Americans sits on the steps of the US Capitol in protest of discriminatory laws and inaction from Congress on July 17, 1978.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BIulyA">
To prevent this and similar attacks on tribal culture, Congress enacted the Indian Child Welfare Act (ICWA) in 1978. Among other things, this law says if a state court determines that a child who is either “<a href="https://www.vox.com/22956346/supreme-court-commerce-clause-native-american-indian-child-welfare-act-haaland-brackeen-texas">a member of an Indian tribe</a>” or “is eligible for membership in an Indian tribe and is the biological child of a member of an Indian tribe” must be removed from their home, that the child should be placed with an American Indian family — and, if possible, a member of the child’s extended family or, at least, their own tribe.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9YUL4M">
The plaintiffs in <a href="https://www.scotusblog.com/case-files/cases/haaland-v-brackeen/"><em>Haaland v. Brackeen</em></a> include non-Native American families who have adopted Native American children, and three red states that do not wish to comply with the ICWA’s requirements. They raise several constitutional challenges to the ICWA — challenges that call for a fundamental rethinking of the federal government’s relationship with tribes and with the states, and that could even potentially <a href="https://www.vox.com/22956346/supreme-court-commerce-clause-native-american-indian-child-welfare-act-haaland-brackeen-texas">undercut the government’s ability to regulate the national economy</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hm7Zqh">
All of these claims are at odds with existing law. Again, the ICWA was enacted in 1978, so it’s existed for more than four decades without falling to a constitutional challenge. But the Court’s current majority often <a href="https://www.vox.com/23180634/supreme-court-rule-of-law-abortion-voting-rights-guns-epa">treats following established precedents as merely optional</a>, so there’s no guarantee that the ICWA will survive past the end of the Supreme Court’s term next summer.
</p>
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</p>
<ul>
<li><strong>House of the Dragon gives us a time jump, a season reset, and two horrible childbirths</strong> -
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<img alt="" src="https://cdn.vox-cdn.com/thumbor/xW42Sve5Te4oqj3KEw2Zw3n8Gvk=/22x0:1729x1280/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/71415129/emma_d_arcy.0.jpg"/>
<figcaption>
Emma D’Arcy as an adult Rhaenyra. | Ollie Upton/HBO
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
If childbirth is a battle, then Targaryen mothers are war veterans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="X4uaD8">
Prior to the debut of <em>House of the Dragon</em>, co-showrunner Miguel Sapochnik <a href="https://www.hollywoodreporter.com/tv/tv-features/inside-house-of-the-dragon-trailer-cast-1235182776/">told</a> the Hollywood Reporter that the season would feature a number of childbirth scenes — all of which the creative team approached like “battles.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="J8kFqb">
By the time we reach episode six, “The Princess and the Queen,” said princess and said queen have each given birth at least three times. According to the show’s logic, then, Rhaenyra and Alicent are both war veterans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IZfCGY">
<em><strong>Note: This article contains spoilers for </strong></em><a href="http://voxmediapartner.go2cloud.org/aff_c?offer_id=2&amp;aff_id=1&amp;source=Vox&amp;aff_sub=HouseOfTheDragon2022&amp;aff_unique1=https://www.hbomax.com/series/urn:hbo:series:GYsYeoAxKH8LCwgEAAAOR"><strong>House of the Dragon</strong></a><em><strong>, Episode 6, “The Princess and the Queen.”</strong></em>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zSaV4e">
So far, <em>House of the Dragon</em> has played out less like a four-act opera than the overture before the show. We’ve gotten micro versions of the conflicts that will eventually erupt into full-blown civil war between our two main factions. We’ve greeted a steady stream of characters and learned all their secrets, foibles, and motivations as they carefully find their places on the great chess board. Many of them, especially in this episode, rotate into position only to be immediately dispatched through disgrace or death. The intermittent bursts of shocking violence have so far devastated only peripheral characters, never Rhaenyra or Alicent directly.
</p>
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<div id="5SCMhy">
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="l076U6">
The sole exception to this rule involves the type of violence that’s rarely framed as violence: childbirth. One of those brutal childbirth scenes formed the bloody core of <a href="https://www.vox.com/culture/23316570/house-of-the-dragon-heirs-review-recap-childbirth-scene">the show’s first episode</a>, with the death of Rhaenyra’s mother casting a long shadow over the Red Keep. Now, as the season makes its biggest time jump yet, we get a harrowing look at two more of those birth scenes — one with an outcome that suggests the show’s family ties are, themselves, acts of violence, and that each point on the dense Targaryen family tree is, in truth, a battle scar.
</p>
<h3 id="NkTNNL">
The magnificent Targaryens
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="w1XTGa">
The episode starts with a major skip some 10–15 years into the future and functions as a midpoint reset for the season. Accordingly, the show replaces its younger actors with adults. Fresh-faced Milly Alcock, who played a defiant but naive young Rhaenyra, becomes Emma D’Arcy, whose Rhaenyra is hardened and iron-willed but also perpetually exhausted. As Alicent, the wide-eyed, petrified Emily Carey, having gained some sentience through last week’s <a href="https://www.vox.com/culture/23356689/house-of-the-dragon-episode-5-alicent-dress-meaning-greens-and-blacks">green dress maneuver</a>, transitions seamlessly into the still-wide-eyed but constantly calculating, now permanently paranoid Olivia Cooke. Like father, like daughter.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7Hrs7F">
During the time we’ve skipped ahead, the major players of the Dance of Dragons (the coming civil war) have arrived on scene. (We go into more detail on the <a href="https://www.vox.com/culture/23312073/house-of-the-dragon-targaryen-family-tree-history-game-of-thrones">newly updated Targaryen family tree</a>.) In one corner, you’ve got the children of Alicent and Viserys: Aegon (Ty Tennant), a spoiled but typical teenage boy, his reticent younger sister Helaena (Evie Allen), and their weak but determined younger brother Aemond (Leo Ashton). The Targaryen children have grown up in a bubble of privilege that few things have managed to puncture. In a truly hilarious moment, Alicent tries to impress upon Aegon that his half-sister is going to claim the throne, and he mumbles, “So?” leaving her to spell out for him in capital letters the plot of this show.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GnQgec">
In the other corner are the children of Rhaenyra and her illicit lover, Harwin Strong (Ryan Corr): Jacaerys “Jace” Velaryon (Leo Hart), Lucerys “Luke” Velaryon (Harvey Sadler), and Joffrey Velaryon — whose birth we witness in a grueling opening scene. The boys all bear the name Velaryon despite being very obviously the offspring of Rhaenyra and her brown-haired beau, not Rhaenyra and her husband Laenor. (To give you an idea of how complicated the Velaryon family bonds are, Laenor insists on naming the newborn Joffrey after his own lost lover, Joffrey Lonmouth — the man who met a horrific end at the hands of Ser Criston Cole in the previous episode, breaking Laenor’s heart in the process.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pI1vpO">
The illegitimacy of the three Velaryon boys — don’t call them “Strongs”! — already looms over their childhoods and turns every conversation between Viserys (Paddy Considine) and his court into a series of entrapments. So far, the king has refused to acknowledge the reality in front of him: The questionable parentage of Rhaenyra’s children further undermines her claim to the throne. The birth of Rhaenyra’s third son, once again clearly not a black man with blond dreads, only increases the tension between Rhaenyra and Alicent. By the end of the episode, the encroaching monster of succession has started tangling its claws around each of their children as well.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="igsoCO">
But at what cost? The dual scenes of childbirth that feature prominently in this episode hint that <em>House of the Dragon</em> might be engaged in deconstructing the way <em>Game of Thrones</em> handled the question of power — by viscerally returning us to the roots of all power in Westeros: motherhood.
</p>
<h3 id="aXsEKB">
Every birth a battle
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jjyo1Y">
We’ve previously discussed the impact of <em>House of the Dragon</em>’s opening episode on our real-world understanding of childbirth in a post-<em>Roe</em> world; that is, such a world is brutal, unforgiving, dehumanizing, and arguably murderous. The two labor scenes in “The Princess and the Queen” each ask an inevitable follow-up question: What toll does giving birth in such a barbaric world exact on the women who have to exist in it?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rrKdAF">
And each scene gives us a dramatically different, but carefully linked, answer.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QBBaUq">
The opening scene of the episode is an excruciating, drawn-out birth scene, made all the more jarring because we’re also adjusting to our first sight of grown-up Rhaenyra. The camera lingers on her face throughout the ordeal as she struggles to successfully deliver her child. At last, she pops the baby out, and there’s a instant of respite for her and for us. But hardly has Rhaenyra collapsed back onto the bed than she gets a summons from the queen.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="36s6aw">
Alicent wants to see the newborn child herself, immediately. It’s a brazen form of rank-pulling and passive-aggression that tells us all we need to know about the direction Alicent’s character has evolved in the years since we last saw her. The camera darts over to Rhaenyra’s face, now marked with palpable fear: She doesn’t, perhaps can’t, trust Alicent to be alone with her vulnerable infant.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="b41QQQ">
Rhaenyra decides to call Alicent’s bluff: Though she can barely stand, she staggers to her feet, still passing afterbirth, and takes Joffrey to Alicent herself. A confused Laenor supports her as she limps through the castle, doing his best to crack jokes. At one point, he comically — but half-seriously — compares her unbearably painful ordeal to getting shot in the shoulder with a crossbow.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="82NE7K">
That he’s joking about this all while she’s still suffering, still bleeding, even, underscores the disconnect between the demands placed on the women of the court and the reality of carrying them out. The whole moment functions as a microcosmic illustration of Rhaenyra’s position in court: Even as the heir apparent, she’s expected mostly to be a whole, healthy incubator. Once she’s delivered her children, however, her role can be supplanted. A prior claim on her sons exists, and it’s not the claim of family or honor or any loftier ideal; it’s the claim of the court itself.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="hc32eX">
Rhaenyra, always insistent upon exerting whatever agency she has in a situation with no good options, chooses to take her subservience to that claim and use it to her advantage: While trekking through the castle she horrifies and impresses the court in equal measure. She is strong enough, barely, to make the long walk to see the queen, who makes a show of being duly astonished and concerned for her health. But the performance has its limits: Rhaenyra protects her child and scores a point against Alicent, but she knows she can’t protect him forever.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GR1IrQ">
Contrast this long, exhausting scene of labor and more labor with the brief and weirdly unintelligible birthing scene that comes near the end of the ep. Laena Velaryon (Nanna Blondell) has married Daemon (Matt Smith), who’s somehow managed to keep from murdering her long enough for them to raise two teenage twins, Rhaena and Baela. What we do see of Laena in this episode is a noble, proud Velaryon heir who’s riding the biggest dragon in the realm — Vhagar, once ridden by Aegon the Conqueror himself. She’s clearly come a long way from the halting child whose parents forced her to try and woo the 50-something King Viserys.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="QFKtMQ">
Yet none of Laena’s polish nor promise can save her from the terrible obligation of childbirth. While in labor with what would have been Daemon’s third child, Laena experiences complications that apparently stymie the physician. He declares that he’s done all he can do, the child won’t come. Echoing the choice Viserys faced in the first episode, the doctor offers to cut Laena’s womb in order to try to save the child — asking Daemon, of course, not Laena, who’s in agony in the background, unable to complete the delivery. Daemon refuses with a slight headshake, presumably signaling that they should simply let nature take its course.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lmS2Tf">
The scene then cuts to a shot of Laena, staggering alone down the beach to where Vhagar rests on the shore. Her dress is bloody but she’s still visibly pregnant. It’s unclear if Laena has miscarried, but signs point to yes; given the choice she makes next, the alternative is almost too horrible to contemplate. Laena, sobbing, orders Vhagar to immolate her. When the dragon resists, she begs him, and Vhagar sorrowfully burns her alive in a burst of flame while Daemon watches in stunned silence.
</p>
<h3 id="M86cDK">
What’s the show doing, burning through all these characters?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TVnD1H">
On its face, this entire sequence feels mishandled: It’s too brief, the events are confusing, and we’ve known Laena for too short a time for such an excruciating death scene to meaningfully impact our understanding of the show. For that matter, she isn’t the only character we’ve barely met who gets burned alive in this episode. (Harwin Strong, Lionel Strong, we hardly knew ye.) Throughout its middle episodes, <em>HotD</em> seems to be introducing us to new potential chess pieces, only to knock them off the board before the match has even begun. Is that the “point” of Laena Velaryon? Was she put into place only to be rendered expendable?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EYeqIU">
I think yes and no. While it’s true we’ve only seen her for a few moments throughout the show so far, we know several crucial things about her life — beginning and ending with her identity as a Velaryon. She seems to have wanted to wed Daemon, true, marriage itself was an inevitability, and she certainly never had the option to say no to motherhood. The psychological impact of being nearly trafficked into marriage at the age of 12, of having her wings clipped upon the advent of motherhood, of being confined into a static and limited role as wife and mother rather than powerful clan leader and noble dragonrider — she carries all of that with her down to the beach. Interestingly, in <em>Fire and Blood</em>, Martin’s version of this scene is different: He suggests, through the veil of legend and lore, that Laena walked down to the beach to attempt to ride her beloved dragon one last time, even while dying. The show’s version of Laena has more self-awareness and less hope.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="c6BHPx">
These childbirth scenes have drastically different outcomes, but both depict the act of childbirth in Westeros as a fundamentally torturous form of conscripted labor — “labor” used here in both senses. The duty of women in the Targaryen clan, above all else, is to give birth: to increase potential heirs so that the line of succession can continue and extend the greatness of the Targaryen dynasty. The family lineage of the Targaryen clan is its most important asset, but every point along that tree is the result of a woman risking her life and putting herself through untold hours of pain and physical toil, not to mention the many miscarriages she might have had in addition.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="73RaXZ">
At our point on the family tree, both Rhaenyra and Laena, even while debilitated from the effort and exhaustion of labor, remain defiant. Rhaenyra chooses to stagger through the castle, weaponizing her weakness and turning it into a show of strength. Laena chooses, on her own terms, to stop playing the game. She asserts her hold over the one thing she can still command: her dragon.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jMZ67w">
Inevitably, the grim nature of both birth scenes leaves us questioning the reason for all of this. Is securing all those points on the Targ tree even worth it? In this episode, we repeatedly see family bonds tested and proven to be thin as cobwebs. Alicent has to remind Aegon not to bully his own brother; Larys Strong burns his own father and brother alive for clout. Rhaenyra’s attempt to secure a lasting peace with Alicent through marriage fails completely due to her stepmother’s distrust. Being born into the Targaryen clan, or adjacent to it, might secure one a degree of power, but it also puts them at greater risk of being betrayed by those closest to them.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CKD920">
If that’s the best fate a woman can secure for her offspring in exchange for the excruciating pain of childbirth, it hardly seems worth the hardship. No matter, the choice isn’t hers; she has to avoid the chopping block herself, after all. It might be better to think of the Targaryen family tree less like a tree, then, and more like a vast machine, with cogs instead of people — a<em> </em><a href="https://www.youtube.com/watch?v=6n9ESFJTnHs"><em>Modern Times</em></a> for medieval times. The more cogs, the more an inherently violent system keeps functioning as intended, running on the strength and sacrifices of the women it immolates.
</p></li>
</ul>
<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>Dear Lady, Apsara Star and Angelino work well</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>Endeavour pleases</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>Memorable Time, Tiger Returns, Siege Perilous and Elite Agent shine</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>Kuldeep fights his way back to the top</strong> - Don’t have the fear of failure anymore, says wrist-spinner</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>Nations League: Portugal beats Czechs; Spain, England lose</strong> - While his Portugal rolled in Prague, Cristiano Ronaldo had a rough night, first enduring a nasty blow to his face that made his nose bleed and required a small bandage and then giving away a penalty that went unpunished</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>State’s tightrope walk in terms of finances continues</strong> - TS opted for special drawing facility on all days in July and WMA for 30 days</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>PM Modi to leave for Japan tonight for Shinzo Abe’s funeral</strong> - PM Modi to meet Japanese PM Kishida; no other bilateral meeting scheduled even as about 20 heads of state to travel to Tokyo</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>Mamata Banerjee ‘softening’ stand against RSS, PM Modi to salvage ‘corrupt-criminal syndicate’: CPI(M)</strong> - The latest editorial of People's Democracy has quoted Ms. Banerjee's statements at press conferences and said that she “has been making some new discoveries recently”.</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>Take out ‘Congress Jodo Yatra’ first: AAP's dig over Rajasthan political crisis</strong> - The Congress in Rajasthan plunged into a crisis as several MLAs loyal to Ashok Gehlot resigned over a possible move to appoint Sachin Pilot as Mr. Gehlot's successor</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>YSRCP, TDP have done injustice to Andhra Pradesh, alleges Sunil Deodhar</strong> - ‘Regional parties controlled by families can never ensure speedy development of State’</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>Giorgia Meloni: Italy’s far right on course to win election</strong> - Giorgia Meloni is set to lead a right-wing coalition as Italy’s first female PM, provisional results show.</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>Deadly gun attack at Russian school</strong> - Pupils are among at least 13 people killed and 21 wounded after a gunman opens fire at the school in Izhevsk.</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: Protests in Russia’s Dagestan region against new draft</strong> - Demonstrators clashed with security officials in a rare violent backlash against police.</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>People smuggler: I get clients to sign a waiver</strong> - A people smuggler lifts the lid on his trade to BBC Panorama’s Jane Corbin.</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: Ukraine will treat Russian deserters fairly, Zelensky vows</strong> - Ukraine says it will not force deserters to return to Russia where they would face prison.</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>Were your teen years exhausting? School schedules may be why</strong> - A new book traces how historical accidents left us pitting education against biology. - <a href="https://arstechnica.com/?p=1884031">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>iOS 16 review: Customization unlocked</strong> - The lock screen gets a major overhaul. - <a href="https://arstechnica.com/?p=1884255">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>NASA cancels Artemis I launch attempt but delays roll back decision</strong> - NASA is buying some time with this decision. - <a href="https://arstechnica.com/?p=1884337">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Music on the brain: Listening can influence our brain’s activity</strong> - The “Mozart effect” isn’t real—but music does affect our mental processes. - <a href="https://arstechnica.com/?p=1880612">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>GeForce GPUs are slowing down after installing the Windows 11 2022 Update</strong> - A new version of the GeForce Experience software will fix the issue. - <a href="https://arstechnica.com/?p=1884284">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
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<li><strong>I bought my daughter a refrigerator for her birthday</strong> - <!-- SC_OFF -->
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I can’t wait to see her face light up when she opens it.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/AutumnalAristocrat"> /u/AutumnalAristocrat </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/xo16sr/i_bought_my_daughter_a_refrigerator_for_her/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/xo16sr/i_bought_my_daughter_a_refrigerator_for_her/">[comments]</a></span></p></li>
<li><strong>I took a class recently on the history of food preservation.</strong> - <!-- SC_OFF -->
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In the early days, metal containers were the cheapest and easiest to make, so almost all food was stored in cans. Tin was a particularly soft and easy to mold/shape, and didn’t rust like other options, so most preserved food cans were made of tin.
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Things went great for a while, with some foods easily being shipped to places they previously wouldn’t have survived due to long journeys, and families could store food to eat when it wasn’t available fresh.
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However, reports of illness around certain foods started to become prevalent. Pickles foods would frequently “go bad” much sooner than other canned foods, and even though the food tasted the same, people would report illness very soon after eating older pickled products. After years of analyzing (crudely) samples of purportedly problematic pickles, scientists finally concluded the preserved foods themselves were fine—it was the cans that were the problem!
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They discovered certain food solutions—like pickle brine—could “leach” harmful chemicals from tin, much faster than non-brined foods. As an experiment, they started un-canning recently preserved pickles and putting pickled food in glass containers instead of tin. Jarred pickles tasted exactly the same and were preserved just as well as their canned counterparts, but nobody got sick!
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In the end, the conclusion was uncanny and jarring.
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. . . .
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Note: this is my first “original” joke (though inspired by lots of other variations). I wasn’t totally sure if the joke was better short and sweet, or if it was worth dragging out for the “I can’t believe I read that whole thing for a dad-joke level punchline” ending.
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I debated back and forth, and felt like no matter what I chose, some would like it and some would hate it.
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I guess you could say I was in a real pickle.
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Welcoming all criticism.
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<strong>EDIT: Because a few people have commented about “learning” from this joke, please note THIS IS ALL FICTION! Absolutely none of this is true as far as I know. Completely made up. Any factual truths are complete coincidences. Reader beware.</strong>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/somuchdanger"> /u/somuchdanger </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/xo1hz5/i_took_a_class_recently_on_the_history_of_food/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/xo1hz5/i_took_a_class_recently_on_the_history_of_food/">[comments]</a></span></p></li>
<li><strong>Superpu$$y!!!</strong> - <!-- SC_OFF -->
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There’s a crazy old lady in a nursing home. She goes up to the receptionist and tears open her robe, revealing her naked body. She yells, “SUPERPUSSY!” at the top of her lungs and walks away.
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Next the old lady goes into the rec room where other residents are basket-weaving, watching TV and reading… Again, the old lady tears open her robe and screams, “SUPERPUSSY!” at the top of her lungs and walks out of the room.
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Now the old lady goes into the cafeteria where a new resident is sitting by himself at a table. She rushes over to him, tears open her robe and yells, “SUPERPUSSY!” The new guy looks her up and down for a minute then says, “I’ll have the soup.”
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/revtim"> /u/revtim </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/xnpfs5/superpuy/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/xnpfs5/superpuy/">[comments]</a></span></p></li>
<li><strong>How do you find a velociraptor ?</strong> - <!-- SC_OFF -->
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You divide the distanceraptor by the timeraptor
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/AutomaticOcelot5194"> /u/AutomaticOcelot5194 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/xo6lwv/how_do_you_find_a_velociraptor/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/xo6lwv/how_do_you_find_a_velociraptor/">[comments]</a></span></p></li>
<li><strong>A lady approaches a priest and shyly tells him, “Father, I have a problem. I have these two talking female parrots but, they only know how to say one thing… they keep saying ‘Hi, we’re hot… do you want to <em>fuck us</em>?’</strong> - <!-- SC_OFF -->
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“That’s terrible!” says the priest. “But, I have a solution to your problem. Bring your two parrots over to my house tomorrow. I will put them with my two male talking parrots… to whom I’ve taught to pray and read the bible. My parrots will then teach your parrots to stop saying that terrible filth, and your female parrots will learn to pray and worship the good Lord.” So the next day, the lady brings her two female parrots to the priest’s house. The priest’s two male parrots are holding rosary beads and praying in their cage. The lady puts her female talking parrots in with the male talking Parrots, and the female parrots say, “Hi, we’re hot. Do you want to fuck us?” One male parrot looks over at the other male parrot and screams, “put the bible away you idiot, our prayers have been answered!”
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/IDCWhoIam"> /u/IDCWhoIam </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/xngv03/a_lady_approaches_a_priest_and_shyly_tells_him/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/xngv03/a_lady_approaches_a_priest_and_shyly_tells_him/">[comments]</a></span></p></li>
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