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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>In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission</strong> -
<div>
Many hospitals have stopped or are considering stopping universal admission testing for SARS-CoV-2. We discuss reasons why admission testing should still be part of a layered system to prevent hospital-acquired SARS-CoV-2 infections during times of significant community transmission. These include the morbidity of SARS-CoV-2 in vulnerable patients, the predominant contribution of presymptomatic and asymptomatic people to transmission, the high rate of transmission between patients in shared rooms, and the data suggesting surveillance testing is associated with fewer nosocomial infections. Preferences of diverse patient populations, particularly the hardest hit communities, should be surveyed and used to inform prevention measures. Hospitals’ ethical responsibility to protect patients from serious infections should predominate over concerns about costs, labor, and inconvenience. We call for more rigorous data on the incidence and morbidity of nosocomial SARS-CoV-2 infections and more research to help determine when to start, stop, and restart universal admission testing and other prevention measures.
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🖺 Full Text HTML: <a href="https://osf.io/unfz7/" target="_blank">In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission</a>
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<li><strong>Cell-attribute aware community detection improves differential abundance testing from single-cell RNA-Seq data</strong> -
<div>
Variations of cell-type proportions within tissues could be informative of biological aging and disease risk. Single-cell RNA-sequencing offers the opportunity to detect such differential abundance (DA) patterns, yet this task can be statistically challenging due to the noise in single-cell data, inter-sample variability and because DA patterns are often of small effect size. Here we present a DA-testing paradigm called ELVAR that uses cell attribute aware clustering when inferring differentially enriched communities within the single-cell manifold. Using simulated and real single-cell and single-nucleus RNA-Seq datasets, we benchmark ELVAR against an analogous DA algorithm that uses Louvain for clustering, as well as local neighborhood-based DA-testing methods, demonstrating that ELVAR improves the sensitivity to detect DA-shifts in relation to aging, precancerous states and Covid-19 phenotypes. In effect, leveraging cell attribute information when inferring cell communities can denoise single-cell data, avoid the need for batch correction and help retrieve more robust cell states for subsequent DA-testing. ELVAR is available as an open-source R-package.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.04.28.538653v1" target="_blank">Cell-attribute aware community detection improves differential abundance testing from single-cell RNA-Seq data</a>
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<li><strong>Cohort Profile: A longitudinal Victorian COVID-19 cohort (COVID PROFILE)</strong> -
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Purpose: The COVID PROFILE cohort is a longitudinal clinical study based in Victoria Australia, which was established to understand immunity to SARS-CoV-2 in a low transmission population setting and to identify immunological markers of long-term immunity and immune-dysregulation after both infection and vaccination. Additionally, this cohort was established as a biobank resource for researchers to address other health-related immunological questions. Participants: We enrolled 178 adult community members, including household contacts, who had either recovered from a SARS-CoV-2 infection or were SARS-CoV-2 naive. Only participants 18 years of age or older and, in the case of female participants, non-pregnant women at the time of enrollment were included in the study. Detailed COVID-19 clinical data, vaccination status, medical history and demographics was collected. Findings to date: At enrollment, we found that 87.8% of COVID-19 recovered individuals were seropositive with detectable levels of anti-SARS-CoV-2 IgG antibodies. Seronegative COVID-19 recovered individuals included asymptomatic individuals or participants that were enrolled more than 12 months after their COVID-19 diagnosis. Except for one individual who was seropositive at baseline despite a previous SARS-CoV-2 PCR negative diagnosis, all household contacts and other community members enrolled as SARS-CoV-2 PCR negative, were seronegative for all SARS-CoV-2-specific antibodies tested. The infection rate (re-infection or new infection) during 24 months of the study was 42.7%, as determined by either rapid antigen tests, PCRs or serology screens. Of the SARS-CoV-2 recovered participants, 32.6% reported ongoing symptoms at enrollment of which 47% had already experienced ongoing symptoms for more than 12 weeks. Future Plans: COVID PROFILE will be used to comprehensively understand temporal immunity to SARS-CoV-2 and COVID-19 vaccines and to understand the impact of host immunological composition on such immunity and symptom severity. Additionally, studies focusing on understanding immunity following breakthrough infections and immunological risk factors that contribute towards development of long COVID are planned.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.27.23289157v1" target="_blank">Cohort Profile: A longitudinal Victorian COVID-19 cohort (COVID PROFILE)</a>
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<li><strong>Population immunity of natural infection, primary-series vaccination, and booster vaccination in Qatar during the COVID-19 pandemic: An observational study</strong> -
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Background: Waning of natural infection protection and vaccine protection highlight the need to evaluate changes in population immunity over time. Population immunity of previous SARS-CoV-2 infection or of COVID-19 vaccination are defined, respectively, as the overall protection against reinfection or against breakthrough infection at a given point in time in a given population. Methods: We estimated these population immunities in Qatar population between July 1, 2020 and November 30, 2022, to discern generic features of the epidemiology of SARS-CoV-2. Effectiveness of previous infection, mRNA primary-series vaccination, and mRNA booster (third-dose) vaccination in preventing infection were estimated, month by month, using matched, test-negative, case-control studies. Findings: Previous-infection effectiveness against reinfection was strong before emergence of Omicron, but declined with time after a wave and rebounded after a new wave. Effectiveness dropped immediately after Omicron emergence from 88.3% (95% CI: 84.8-91.0%) in November 2021 to 51.0% (95% CI: 48.3-53.6%) in December 2021. Primary-series effectiveness against infection was 84.0% (95% CI: 83.0-85.0%) in April 2021, soon after introduction of vaccination, before waning gradually to 52.7% (95% CI: 46.5-58.2%) by November of 2021. Effectiveness declined linearly by ~1 percentage point every 5 days. After Omicron emergence, effectiveness dropped suddenly from 52.7% (95% CI: 46.5-58.2%) in November 2021 to negligible levels in December 2021. Booster effectiveness dropped immediately after Omicron emergence from 83.0% (95% CI: 65.6 -91.6%) in November 2021 to 32.9% (95% CI: 26.7-38.5%) in December 2021, and continued to decline thereafter. Effectiveness of previous infection and vaccination against severe, critical, or fatal COVID-19 were generally &gt;80% throughout the study duration. Interpretation: High population immunity may not be sustained beyond a year. This creates fertile grounds for repeated waves of infection to occur, but these waves may increasingly exhibit a benign pattern of infection. Funding: The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.
</p>
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.28.23289254v1" target="_blank">Population immunity of natural infection, primary-series vaccination, and booster vaccination in Qatar during the COVID-19 pandemic: An observational study</a>
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<li><strong>The epidemiological impact of digital and manual contact tracing on the SARS-CoV-2 epidemic in the Netherlands: empirical evidence.</strong> -
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Background. The Dutch government introduced the CoronaMelder smartphone application for digital contact tracing (DCT) to complement manual contact tracing (MCT) by Public Health Services (PHS) during the 2020-2022 SARS-CoV-2 epidemic. Modelling studies showed great potential but empirical evidence of DCT and MCT impact is scarce. Methods. We determined reasons for testing, and mean exposure-testing intervals by reason for testing, using routine data from PHS Amsterdam (1 December 2020 to 31 May 2021) and data from two SARS-CoV-2 rapid diagnostic test accuracy studies at other PHS sites in the Netherlands (14 December 2020 to 18 June 2021). Throughout the study periods, notification of DCT-identified contacts was via PHS contact-tracers, and self-testing was not yet widely available. Results. The most commonly reported reason for testing was having symptoms. In asymptomatic individuals, it was having been warned by an index case. Only around 2% and 2-5% of all tests took place after DCT or MCT notification, respectively. About 20-36% of those who had received a DCT or MCT notification had symptoms at the time of test request. Test positivity after a DCT notification was significantly lower, and exposure-test intervals after a DCT or MCT notification were longer, than for the above-mentioned other reasons for testing. Conclusions. Our data suggest that the impact of DCT and MCT on the SARS-CoV-2 epidemic in the Netherlands was limited. However, DCT impact might be enlarged if app use coverage is improved, contact-tracers are eliminated from the digital notification process to minimise delays, and DCT is combined with self-testing.
</p>
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.27.23289149v1" target="_blank">The epidemiological impact of digital and manual contact tracing on the SARS-CoV-2 epidemic in the Netherlands: empirical evidence.</a>
</div></li>
<li><strong>Migrant healthcare workers experiences and mobility patterns in a global health crisis: a qualitative study with Romania physicians working in Germany</strong> -
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Introduction. Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers experiences and explores mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective equitable healthcare workforce policy. Methods. Romanian physicians in Germany served as an empirical case study. We applied a qualitative explorative approach; interviews (n=21) were collected from mid of September to early November 2022 and content analysis was performed. Results. Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Conclusions. Health policy must establish systematic monitoring of the migrant HCWF including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.
</p>
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.29.23289300v1" target="_blank">Migrant healthcare workers experiences and mobility patterns in a global health crisis: a qualitative study with Romania physicians working in Germany</a>
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<li><strong>Mortality Classification of Hospitalized COVID-19 Patients in Zambia Using Machine Learning</strong> -
<div>
The Corona Virus Disease 2019 (COVID-19) has wreaked havoc globally, resulting in millions of cases and deaths. The objective of this study was to predict mortality in hospitalized COVID-19 patients in Zambia using machine learning (ML) methods based on factors that have been shown to be predictive of mortality and thereby improve pandemic preparedness. This research employed seven powerful ML models that included: decision tree (DT), random forest (RF), support vector machines (SVM), logistic regression (LR), naïve bayes (NB), gradient boosting (GB), and XGBoost (XGB). These classifiers were trained on 1,433 hospitalized COVID-19 patients from various health facilities in Zambia. The performances achieved by these models were checked using accuracy, recall, F1-Score, area under the receiver operating characteristic curve (ROC_AUC), area under the precision-recall curve (PRC_AUC), and other metrics. The best performing model was the XGB which had accuracy of 92.3%, recall of 94.2%, F1-Score of 92.4%, and ROC_AUC of 97.5%. The pairwise Mann-Whitney U-test analysis showed that the second-best model (GB) and the third-best model (RF) did not perform significantly worse than the best model (XGB) and had the following: GB had accuracy of 91.7%, recall of 94.2%, F1-Score of 91.9%, and ROC_AUC of 97.1%. RF had accuracy of 90.8%, recall of 93.6%, F1-Score of 91.0%, and ROC_AUC of 96.8%. Other models showed similar results for the same metrics checked. The study successfully derived and validated the selected ML models and predicted mortality effectively with reasonably high performance in the stated metrics. The feature importance analysis found that knowledge of underlying health conditions about patients’ hospital length of stay (LOS), white blood cell count, age, and other factors can help healthcare providers offer lifesaving services on time, improve pandemic preparedness and decongest health facilities in Zambia and other countries with similar settings.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/africarxiv/98wvg/" target="_blank">Mortality Classification of Hospitalized COVID-19 Patients in Zambia Using Machine Learning</a>
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<li><strong>Discovery of GS-5245 (Obeldesivir), an Oral Prodrug of Nucleoside GS-441524 that Exhibits Antiviral Efficacy in SARS-CoV-2 Infected African Green Monkeys</strong> -
<div>
Remdesivir 1 is an amidate prodrug that releases the monophosphate of nucleoside GS-441524 (2) into lung cells thereby forming the bioactive triphosphate 2-NTP. 2-NTP, an analog of ATP, inhibits the SARS-CoV-2 RNA-dependent RNA polymerase replication and transcription of viral RNA. Strong clinical results for 1 have prompted interest in oral approaches to generate 2-NTP. Here we describe the discovery of a 5’-isobutyryl ester prodrug of 2 (GS-5245, Obeldesivir, 3) that has low cellular cytotoxicity and three to seven-fold improved oral delivery of 2 in monkeys. Prodrug 3 is cleaved pre-systemically to provide high systemic exposures of 2 that overcome its less efficient metabolism to 2-NTP leading to strong SARS-CoV-2 antiviral efficacy in an African green monkey infection model. Exposure-based SARS-CoV-2 efficacy relationships resulted in an estimated clinical dose of 350-400 mg twice-daily. Importantly, all SARS-CoV-2 variants remain susceptible to 2 which supports development of 3 as a promising COVID-19 treatment.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.04.28.538473v1" target="_blank">Discovery of GS-5245 (Obeldesivir), an Oral Prodrug of Nucleoside GS-441524 that Exhibits Antiviral Efficacy in SARS-CoV-2 Infected African Green Monkeys</a>
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<li><strong>Impact of the COVID-19 Pandemic, Stratified by Transfer and COVID-19 Infection Status, on Inpatient Mortality in ST-Elevation Myocardial Infarction Patients, Using a Nationally Representative Database</strong> -
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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted various aspects of healthcare, including the management of ST-elevation myocardial infarction (STEMI) patients. Our study investigates the in-hospital outcomes and the impact of transfer and COVID-19 infection status on mortality in STEMI patients. Methods: We conducted a retrospective cohort study to compare the inpatient outcomes of STEMI patients in 2020 with STEMI patients from 2016 to 2019 using the National Inpatient Sample database. We performed 1:1 greedy nearest neighbor matching and utilized logistic regression to compare mortality. Results: In our matched cohort, there was no difference in overall mortality between STEMI patients in 2020 and those from 2016 to 2019 (OR 1.00, 95% CI: 0.94-1.05; p = 0.87). When stratified by COVID-19 infection status, regularly admitted STEMI patients with concurrent COVID-19 infection in 2020 had 2.11 times higher odds of inpatient mortality compared to regularly admitted STEMI patients from 2016 to 2019 (OR 2.11, 95% CI: 1.55-2.87; p &lt; 0.001). STEMI acute care transfers with concurrent COVID-19 infection in 2020 had 3.17 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 3.17, 95% CI: 1.83-5.50; p &lt; 0.001). STEMI non-acute care transfers with concurrent COVID-19 infection in 2020 had 5.13 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 5.13, 95% CI: 1.87-14.06; p = 0.001). Conclusion: The COVID-19 pandemic exacerbated many longstanding disparities within our healthcare system. Moving forward, it is crucial to engage in further discussions addressing the national physician shortage, the patient transfer system and healthcare in underserved regions.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.27.23289238v1" target="_blank">Impact of the COVID-19 Pandemic, Stratified by Transfer and COVID-19 Infection Status, on Inpatient Mortality in ST-Elevation Myocardial Infarction Patients, Using a Nationally Representative Database</a>
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<li><strong>Quantifying the Risk of General Health and Early COVID-19 Spread in Residential Buildings with Deep Learning and Expert-augmented Machine Learning</strong> -
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Buildings9 built environment has been linked to their occupants9 health. It remains unclear whether those elements that predisposed its residents to poor general health before the two SARS pandemics also put residents at risk of contracting COVID-19 during early outbreaks. Relevant research to uncover the associations is essential, but there lacks a systematic examination of the relative contributions of different elements in one9s built environment and other non-environmental factors, singly or jointly. Hence, the current study developed a deep-learning approach with multiple input channels to capture the hierarchical relationships among an individual9s socioecology9s demographical, medical, behavioral, psychosocial, and built-environment levels. Our findings supported that 1) deep-learning models whose inputs were structured according to the hierarchy of one9s socioecology outperformed plain models with one-layered input in predicting one9s general health outcomes, with the model whose hierarchically structured input layers included one9s built environment performed best; 2) built-environment features were more important to general health compared to features of one9s sociodemographic and their health-related quality of life, behaviors, and service utilization; 3) a composite score representing built-environment features9 statistical importance to general health significantly predicted building-level COVID-19 case counts; and 4) building configurations derived from the expert-augmented learning of granular built-environment features that were of high importance to the general health were also linked to building-level COVID-19 case counts of external samples. Specific built environments put residents at risk for poor general health and COVID-19 infections. Our machine-learning approach can benefit future quantitative research on sick buildings, health surveillance, and housing design.
</p>
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.25.23289115v1" target="_blank">Quantifying the Risk of General Health and Early COVID-19 Spread in Residential Buildings with Deep Learning and Expert-augmented Machine Learning</a>
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<li><strong>Inequalities in Healthcare Use during the COVID-19 Pandemic</strong> -
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The COVID-19 pandemic has led to severe reductions in non-COVID related healthcare use, but little is known whether this burden is shared equally across the population. This study investigates whether the reduction in administered care disproportionately affected certain sociodemographic strata, in particular marginalised groups. Using detailed medical claims data from the Dutch universal health care system and rich registry data that cover all residents in The Netherlands, we predict expected healthcare use based on pre-pandemic trends (2017- Feb 2020) and compare these expectations with observed healthcare use in 2020. Our findings reveal a substantial 10% decline in the number of weekly treated patients in 2020 relative to prior years. Furthermore, declines in healthcare use are unequally distributed and are more pronounced for individuals below the poverty line, females, the elderly, and foreign-born individuals, with cumulative relative risk ratios ranging from 1.09 to 1.22 higher than individuals above the poverty line, males, young, and native-born. These inequalities stem predominantly from declines in middle and low urgency procedures, and indicate that the pandemic has not only had an unequal toll in terms of the direct health burden of the pandemic, but has also had a differential impact on the use of non-COVID healthcare.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.26.23289095v1" target="_blank">Inequalities in Healthcare Use during the COVID-19 Pandemic</a>
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<li><strong>Evaluation of the Pilot Wastewater Surveillance for SARS-CoV-2 in Norway, June 2022 - March 2023</strong> -
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Background: During the COVID-19 pandemic, wastewater-based surveillance gained great international interest as an additional tool to monitor SARS-CoV-2. In autumn 2021, the Norwegian Institute of Public Health decided to pilot a national wastewater surveillance (WS) system for SARS-CoV-2 and its variants between June 2022 and March 2023. We evaluated the system to assess if it met its objectives and its attribute-based performance. Methods: We adapted the available guidelines for evaluation of surveillance systems. The evaluation was carried out as a descriptive analysis and consisted of the following three steps: (i) description of the WS system, (ii) identification of users and stakeholders, and (iii) analysis of the system attributes and performance including sensitivity, specificity, timeliness, usefulness, representativeness, simplicity, flexibility, stability, and communication. Cross-correlation analysis was performed to assess the system ability to provide early warning signal of new wave of infections. Results: The pilot WS system was a national surveillance system using existing wastewater infrastructures from the largest Norwegian municipalities. We found that the system was sensitive, timely, useful, representative, simple, flexible, acceptable, and stable to follow the general trend of infection. Preliminary results indicate that the system could provide an early signal of changes in variant distribution. However, challenges may arise with: (i) specificity due to temporary fluctuations of RNA levels in wastewater, (ii) representativeness when downscaling, and (iii) flexibility and acceptability when upscaling the system due to limited resources and/or capacity. Conclusions: Our results showed that the pilot WS system met most of its surveillance objectives. The system was able to provide an early warning signal of 1-2 weeks, and the system was useful to monitor infections at population level and complement routine surveillance when individual testing activity was low. However, temporary fluctuations of WS values need to be carefully interpreted. To improve quality and efficiency, we recommend to standardise and validate methods for assessing trends of new waves of infection and variants, evaluate the WS system using a longer operational period particularly for new variants, and conduct prevalence studies in the population to calibrate the system and improve data interpretation.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.27.23289199v1" target="_blank">Evaluation of the Pilot Wastewater Surveillance for SARS-CoV-2 in Norway, June 2022 - March 2023</a>
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<li><strong>Demographic Influence on the Effectiveness of England’s SARS-CoV-2 Policies</strong> -
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Health data is key for the development of medicinal drugs, treatments, and policy-planning to control the spread of infectious diseases. However, the collection, curation, and interpretation of health data is often biased. This paper discusses England-wide impact of public policies to control the spread of SARS-CoV-2 (Covid-19) infections, based on the recorded per-capita infection cases between July 2020 to January 2023. The analysis presented herewith highlights the disparities across the upper local tier authorities, in the number of Covid-19 cases recorded in response to the policies. This paper further presents the correlation between the Covid-19 cases count and demographic factors, thus highlighting the key factors determining the effectiveness of the NHS policies, and therefore the need for incorporating demographic imbalance in the policy planning process. It is concluded that the upper local tier authorities comprise of three clusters of low, mid, and high prevalence of Covid-19 infections. Where the regions with high prevalence of Covid-19 cases are also the ones with higher proportions of Black/ Mixed racial groups, amongst a mid-range and low internal Migrations.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.25.23288871v1" target="_blank">Demographic Influence on the Effectiveness of England’s SARS-CoV-2 Policies</a>
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<li><strong>The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study</strong> -
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Background: The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories. Methods: Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of regular transfers between pairs of wards with shared specialities, atypical transfers between pairs of wards with no shared specialities and site transfers between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three interviews with site nurse practitioners and bed managers within the same hospital network. Results: We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95%CI: 2.56-3.12), compared to regular transfers, 1.92 days (95%CI: 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents. Conclusion: Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
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🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.26.23289016v1" target="_blank">The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study</a>
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<li><strong>Improving capacity for advanced training in obstetric surgery: Evaluation of a blended learning approach</strong> -
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Introduction Significant differences in outcomes for mothers and babies following obstetric surgical interventions between low- and middle-income countries and high-income settings have demonstrated a need for improvements in quality of care and training of obstetric surgical and anaesthetic providers. To address this a five-day face-to-face training intervention was developed. When the COVID-19 pandemic interrupted its roll-out, the course was redesigned for delivery by blended learning. Methods This 3-part blended-learning course (part-1: 15 hours self-directed online learning, part-2: 13 hours facilitated virtual workshops and part-3: 10 hours face-to-face delivery), was conducted in Kenya. We assessed the completion rate of part-1 (21 assignments), participation rate in parts 2 and 3, participant satisfaction, change in knowledge and skills and compared the cost of the blended delivery compared to the 5-day face-to-face delivery, in GB Pounds.   Results 65 doctors took part in part 1, 53 completing at least 90% of the assignments. 60 doctors participated in part 2, and 53 participated in part 3. Participants completing an evaluation reported (n=53) attending the training was a good use of their time (each of parts-1 and 3: 98%, part-2: 94%) and would recommend this to other colleagues (part-1 and 3: 98%, part-2: 90%). Mean (SD) knowledge score improved from 64% (7%) to 80% (8%) and practical skills from 44% (14%) to 87% (7%). The blended course achieved a cost-saving of £207 per participant compared to the 5-day face-to-face delivery approach. Conclusion We have demonstrated that a blended learning approach to clinical training in a low resource setting is feasible, acceptable and more cost effective. More studies are required to investigate the effectiveness of this approach on health outcomes.
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<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.medrxiv.org/content/10.1101/2023.04.25.23289116v1" target="_blank">Improving capacity for advanced training in obstetric surgery: Evaluation of a blended learning approach</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>A Study of mRNA-1283.222 Injection Compared With mRNA-1273.222 Injection in Participants ≥12 Years of Age to Prevent COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Biological: mRNA-1283.222;   Biological: mRNA-1273.222<br/><b>Sponsor</b>:   ModernaTX, 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>Evaluation of the RD-X19 Treatment Device in Individuals With Mild COVID-19</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Device: RD-X19;   Device: Sham<br/><b>Sponsor</b>:   EmitBio 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>Postoperative Sugammadex After COVID-19</strong> - <b>Conditions</b>:   General Anesthesia;   COVID-19<br/><b>Interventions</b>:   Drug: Sugammadex Sodium;   Drug: neostigmine 50µg/kg + glycopyrollate 0.01mg/kg<br/><b>Sponsor</b>:   Korea University Ansan 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>A Randomized, Double-Blind, Placebo-Controlled Phase 2/3 Study to Determine the Safety and Effectiveness of Azeliragon in the Treatment of Patients Hospitalized for Coronavirus Disease 2019 (COVID-19)</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: Azeliragon;   Drug: Placebo<br/><b>Sponsor</b>:   Salim S. Hayek<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>Cognitive-behavioral Therapy for Mental Disorder in COVID-19 Survivors</strong> - <b>Condition</b>:   Post Acute COVID-19 Syndrome<br/><b>Intervention</b>:   Behavioral: mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT)<br/><b>Sponsor</b>:   Azienda Socio Sanitaria Territoriale di Lecco<br/><b>Recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A Coping and Resilience Intervention for Adolescents</strong> - <b>Condition</b>:   COVID-19 Pandemic<br/><b>Interventions</b>:   Behavioral: Coping and Resilience Intervention for Adolescents;   Other: Printing materials of Coping and Resilience Intervention for Adolescents<br/><b>Sponsor</b>:   Taipei Medical University<br/><b>Enrolling by invitation</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effectiveness of Modified Diaphragmatic Training for Gastroesophageal Reflux Disease Post Covid-19</strong> - <b>Conditions</b>:   GERD;   Post COVID-19 Condition;   Diaphragm Issues<br/><b>Interventions</b>:   Other: modified diaphragmatic training;   Other: standard diaphragmatic training<br/><b>Sponsor</b>:   Indonesia University<br/><b>Completed</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Effect of Telerehabilitation Practice in Long COVID-19 Patients</strong> - <b>Conditions</b>:   Long COVID-19;   Long COVID;   Post COVID-19 Condition;   Post-COVID-19 Syndrome;   Post-COVID Syndrome<br/><b>Interventions</b>:   Behavioral: Telerehabilitation;   Behavioral: Standard rehabilitation care<br/><b>Sponsor</b>:   Indonesia University<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 Safety, Tolerability and Pharmacokinetics Study of RAY1216 in Healthy Adult Participants</strong> - <b>Condition</b>:   COVID-19 (Coronavirus Disease 2019)<br/><b>Interventions</b>:   Drug: RAY1216 dose 1;   Drug: RAY1216 dose 2;   Drug: RAY1216 dose 3;   Drug: RAY1216 dose 4 &amp;ritonavir   Drug: RAY1216 dose 5;   Drug: RAY1216 dose 6;   Drug: RAY1216 dose 7;   Drug: RAY1216 dose 8;   Drug: RAY1216 dose 9;   Drug: RAY1216 dose 10<br/><b>Sponsor</b>:   Guangdong Raynovent Biotech 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>Computerized Training of Attention and Working Memory in Post COVID-19 Patients With Cognitive Complaints</strong> - <b>Conditions</b>:   COVID-19;   Cognitive Impairment;   Cognition Disorder;   Memory Disorders;   Attention Deficit;   Memory Impairment;   Memory Loss;   Attention Impaired<br/><b>Intervention</b>:   Device: RehaCom<br/><b>Sponsor</b>:   Erasmus Medical 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>Strategies and Treatments for Respiratory Infections &amp;Amp; Viral Emergencies (STRIVE): Immune Modulation Strategy Trial</strong> - <b>Condition</b>:   COVID-19<br/><b>Interventions</b>:   Drug: abatacept infusion;   Drug: Placebo group<br/><b>Sponsor</b>:   University of Minnesota<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>A Study of Silmitasertib (CX-4945) in Healthy Subject</strong> - <b>Condition</b>:   COVID-19<br/><b>Intervention</b>:   Drug: CX-4945<br/><b>Sponsor</b>:   Senhwa Biosciences, Inc.<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>Evaluation of the Efficacy and Safety of Nano-S1</strong> - <b>Condition</b>:   COVID-19 Pneumonia<br/><b>Intervention</b>:   Drug: NANOS1 , argent colloïdal ,<br/><b>Sponsor</b>:   General Administration of Military Health, Tunisia<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>Digital Mental Health Care for COVID-19 High-Risk Populations - Phase 2</strong> - <b>Conditions</b>:   Stigma, Social;   Help-Seeking Behavior<br/><b>Interventions</b>:   Other: Adjusted Content Intervention;   Other: Non-Adjusted Intervention Video<br/><b>Sponsors</b>:   Research Foundation for Mental Hygiene, Inc.;   Columbia 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>Research of the Long-COVID-19 Syndrome in the Children</strong> - <b>Condition</b>:   Long COVID<br/><b>Intervention</b>:   Other: Device<br/><b>Sponsor</b>:   Samara State Medical University<br/><b>Enrolling by invitation</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>SNAP@CQD as a promising therapeutic vehicle against HCoVs: an overview</strong> - This report discusses potential therapies for treating human coronaviruses (HCoVs) and their economic impact. Specifically, we explore therapeutics that can support the body’s immune response, including immunoglobulin (Ig)A, IgG and T-cell responses, to inhibit the viral replication cycle and improve respiratory function. We hypothesize that carbon quantum dots conjugated with S-nitroso-N-acetylpenicillamine (SNAP) could be a synergistic alternative cure for treating respiratory injuries caused…</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>GMI, a fungal immunomodulatory protein, ameliorates SARS-CoV-2 envelope protein-induced inflammation in macrophages via inhibition of MAPK pathway</strong> - Clinically, COVID-19 is often accompanied by a severe immune response (cytokine storm) which produces a large number of cytokines, such as TNF-α, IL-6 and IL-12, and consequently causes acute respiratory distress syndrome (ARDS). GMI is a type of fungal immunomodulatory protein that is cloned from Ganoderma microsporum and acts as modulating immunocyte for various inflammatory diseases. This study identifies GMI as a potential anti-inflammatory agent and determines the effects of GMI on 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>Innate immune pathway modulator screen identifies STING pathway activation as a strategy to inhibit multiple families of arbo and respiratory viruses</strong> - RNA viruses continue to remain a threat for potential pandemics due to their rapid evolution. Potentiating host antiviral pathways to prevent or limit viral infections is a promising strategy. Thus, by testing a library of innate immune agonists targeting pathogen recognition receptors, we observe that Toll-like receptor 3 (TLR3), stimulator of interferon genes (STING), TLR8, and Dectin-1 ligands inhibit arboviruses, Chikungunya virus (CHIKV), West Nile virus, and Zika virus to varying degrees….</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>Robust SARS-CoV-2-specific and heterologous immune responses in vaccine-naïve residents of long-term care facilities who survive natural infection</strong> - We studied humoral and cellular immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 152 long-term care facility staff and 124 residents over a prospective 4-month period shortly after the first wave of infection in England. We show that residents of long-term care facilities developed high and stable levels of antibodies against spike protein and receptor-binding domain. Nucleocapsid-specific responses were also elevated but waned over time. Antibodies showed stable…</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>Sulfated endospermic nanocellulose crystals prevent the transmission of SARS-CoV-2 and HIV-1</strong> - Biomaterials with antimicrobial activity are gaining attention due to their biodegradability and efficacy in interacting with a wide range of microorganisms. A new cellulose nano-biomaterial, endospermic nanocellulose crystals (ENC) obtained from parenchymal tissue of ivory nut endosperm, has a natural capacity as a universal binder. This feature is enhanced when it is chemically functionalized, and can be exploited in the fight against microbes. We tested the ability of sulfated ENC in aqueous…</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>MasitinibL shows promise as a drug-like analog of masitinib that elicits comparable SARS-Cov-2 3CLpro inhibition with low kinase preference</strong> - SARS-CoV-2 infection has led to several million deaths worldwide and ravaged the economies of many countries. Hence, developing therapeutics against SARS-CoV-2 remains a core priority in the fight against COVID-19. Most of the drugs that have received emergency use authorization for treating SARS-CoV-2 infection exhibit a number of limitations, including side effects and questionable efficacy. This challenge is further compounded by reinfection after vaccination and the high likelihood 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>Recuperative herbal formula Jing Si maintains vasculature permeability balance, regulates inflammation and assuages concomitants of “Long-Covid”</strong> - Coronavirus disease 2019 (COVID-19) is a worldwide health threat that has long-term effects on the patients and there is currently no efficient cure prescribed for the treatment and the prolonging effects. Traditional Chinese medicines (TCMs) have been reported to exert therapeutic effect against COVID-19. In this study, the therapeutic effects of Jing Si herbal tea (JSHT) against COVID-19 infection and associated long-term effects were evaluated in different in vitro and in vivo models. 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>Fourteen immunomodulatory alkaloids and two prenylated phenylpropanoids with dual therapeutic approach for COVID-19: molecular docking and dynamics studies</strong> - The pandemic outbreak of COVID-19 caused by the new severe acute respiratory syndrome coronavirus (SARS-CoV-2) is a global health burden. To date, there is no highly effective antiviral therapy to eradicate the virus; as a result, researchers are racing to introduce new potential therapeutic agents. Alternatively, traditional immunity boosters and symptomatic treatment based on natural bioactive compounds are also an option. The 3-chymotrypsin-like protease (3CL^(pro)) crystal structure, 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>Protecting the public interest while regulating health professionals providing virtual care: A scoping review</strong> - Technology is transforming service delivery in many health professions, particularly with the rapid shift to virtual care during the COVID-19 pandemic. Health profession regulators must navigate legal and ethical complexities to facilitate virtual care while upholding their mandate to protect the public interest. The objectives of this scoping review were to examine how the public interest is protected when regulating health professionals who provide virtual care, discuss policy and practice…</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>Anti-spike protein to determine SARS-CoV-2 antibody levels: Is there a specific threshold conferring protection in immunocompromised patients?</strong> - CONCLUSION: We suggest specific adjusted thresholds (BAU/ml) for the four commercial antibody assays that are used to assess pre-exposure prophylaxis in immunocompromised patients.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>MicroRNA-598 inhibition ameliorates LPS-induced acute lung injury in mice through upregulating Ebf1 expression</strong> - Acute lung injury is a critical acute respiratory distress syndrome (ARDS) with high morbidity and mortality. MicroRNAs (miRNAs) have been demonstrated to play important roles regulating acute lung injury development. In this study, we found that the expression of miR-598 was significantly upregulated in the lung tissues of mice with lipopolysaccharide (LPS)-induced acute lung injury. Both loss-of-function and gain-of-function studies were performed to evaluate the function of miR-598 in acute…</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>Regulatory approval pathway for COVID-19 vaccine in USA, Europe and India</strong> - The coronavirus disease-2019 (COVID-19) outbreak has confused everyone, including healthcare experts, physicians and frontline workers. Monoclonal antibodies, anticoagulants and immunomodulatory therapy were initially used to treat COVID-19. However, they can only inhibit the virus from replicating, which is not enough to provide a lasting cure. As each month passes, a growing number of companies are working on vaccinations that will aid in the development of resistance against the corona virus….</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>Discovery of Highly Potent Small Molecule Pan-Coronavirus Fusion Inhibitors</strong> - The unprecedented pandemic of COVID-19, caused by a novel coronavirus, SARS-CoV-2, and its highly transmissible variants, led to massive human suffering, death, and economic devastation worldwide. Recently, antibody-evasive SARS-CoV-2 subvariants, BQ and XBB, have been reported. Therefore, the continued development of novel drugs with pan-coronavirus inhibition is critical to treat and prevent infection of COVID-19 and any new pandemics that may emerge. We report the discovery of several highly…</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 Flavonoid Cyanidin Shows Immunomodulatory and Broad-Spectrum Antiviral Properties, Including SARS-CoV-2</strong> - New antiviral treatments are needed to deal with the unpredictable emergence of viruses. Furthermore, vaccines and antivirals are only available for just a few viral infections, and antiviral drug resistance is an increasing concern. Cyanidin (a natural product also called A18), a key flavonoid that is present in red berries and other fruits, attenuates the development of several diseases, through its anti-inflammatory effects. Regarding its mechanism of action, A18 was identified as an IL-17A…</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Efficacy of Plant-Made Human Recombinant ACE2 against COVID-19 in a Golden Syrian Hamster Model</strong> - Coronavirus disease 2019 (COVID-19) is a novel infectious respiratory disease caused by SARS-CoV-2. We evaluated the efficacy of a plant-based human recombinant angiotensin-converting enzyme 2 (hrACE2) and hrACE2-foldon (hrACE2-Fd) protein against COVID-19. In addition, we analyzed the antiviral activity of hrACE2 and hrACE2-Fd against SARS-CoV-2 using real-time reverse-transcription PCR and plaque assays. The therapeutic efficacy was detected using the Golden Syrian hamster model infected with…</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>A Security Camera for the Planet</strong> - A new satellite, funded by a nonprofit, aims to pinpoint emissions of methane—a gas that plays a major role in global warming. - <a href="https://www.newyorker.com/news/annals-of-climate-action/a-security-camera-for-the-planet">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Week the Biden-Trump Rematch Got Real</strong> - One difference from 2020: the Republican attacks on the President’s even more unpopular Veep. - <a href="https://www.newyorker.com/news/letter-from-bidens-washington/the-week-the-biden-trump-rematch-got-real">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Climate Crisis Gives Sailing Ships a Second Wind</strong> - Cargo vessels are some of the dirtiest vehicles in existence. Can a centuries-old technology help to clean them up? - <a href="https://www.newyorker.com/news/annals-of-a-warming-planet/the-climate-crisis-gives-sailing-ships-a-second-wind">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Curious Side Effects of Medical Transparency</strong> - When we peer into our patient portals, we don’t always see ourselves more clearly. - <a href="https://www.newyorker.com/news/essay/the-curious-side-effects-of-medical-transparency">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The Risky Gamble of Kevin McCarthy’s Debt-Ceiling Strategy</strong> - In the face of a catastrophic default, the House Speaker has pitted his most extreme members against the President. - <a href="https://www.newyorker.com/news/the-political-scene/the-risky-gamble-of-kevin-mccarthys-debt-ceiling-strategy">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>7 burning questions about sunscreen, answered</strong> -
<figure>
<img alt="Three tubes of sunscreen with abstracted flames surrounding." src="https://cdn.vox-cdn.com/thumbor/Mm-lLvjUfnGUtCCxeHxh_rB4bdc=/237x0:1677x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72235014/Final_SunscreenStory.0.jpg"/>
<figcaption>
Paige Vickers/Vox; Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Yes, you need to wear it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5iPCOH">
Anyone who’s suffered the torment of a sunburn can tell you how they wished they’d done a better job protecting their skin. Sunscreen, one of the tools in the sun-protective tool belt, is non-negotiable, regardless of the weather or your skin type. Any dermatologist will say so; they’re likely to recommend everyone include it in their daily skin-care regimen. Even so, many American adults aren’t great about wearing sunscreen: Only 12 percent of men and 29 percent of women reported always using sunscreen when outside on a sunny day for an hour or more, according to a <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7122a5.htm">2020 National Health Interview Survey</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DZvxxd">
Sunscreen — which works by blocking ultraviolet radiation from the sun — <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759112/">has been shown</a> to prevent skin cancer, wrinkles, pigmentation, and sunburn. Taken together with other smart sun practices, like wearing sunglasses and a hat that covers the face and ears and seeking shade, regular sunscreen use can lower your risk of skin cancers, both among lighter-skinned people (who are <a href="https://www.medicalnewstoday.com/articles/skin-cancer-by-race">more susceptible to skin cancer</a>) and people of color, who are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454668/">more likely to die from skin cancer</a> due to a delay in detection.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nbXkI5">
Not all sunscreens available in the US (and elsewhere) are built alike. In the European Union, for instance, sunscreen is regulated as a cosmetic product so new ingredients have been introduced into their formulas, compared to the US where new ingredients haven’t been approved in over two decades. Some sunscreens leave a ghostly cast; others can exceed $50 for just a few ounces of product. To help guide you toward the sunscreen of your dreams, experts provide clarity on common questions about the product.
</p>
<h3 id="e13gB9">
What are UV rays in the first place?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zPkhh9">
The sun emits <a href="https://www.epa.gov/radtown/ultraviolet-uv-radiation-and-sun-exposure">ultraviolet — or UV — rays</a> that can damage the skin. Two types of UV rays cause sunburns: UVA and UVB. UVA rays penetrate the skin more deeply and are a greater contributor to skin cancer, says <a href="https://scholars.utoledo.edu/display/person-kelly-dobos">Kelly Dobos</a>, a cosmetic chemist and professor of cosmetic science at the University of Cincinnati and the University of Toledo. When sunscreen was <a href="https://www.nytimes.com/2010/06/24/fashion/24skinside.html">first regulated by the Food and Drug Administration in the 1970s</a>, “our understanding of damage from the sun was really limited to UVB,” Dobos says. “As our knowledge about the damage from the sun grew to incorporate deeper penetrating UVA rays, we now have broad-spectrum sunscreens that cover UVB and UVA.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nCUvgf">
UVA rays are what Hope Mitchell, a dermatologist and founder of <a href="https://www.mitchellderm.com/">Mitchell Dermatology</a>, calls “aging rays.” They can pass through windows and glass and prematurely age your skin, causing wrinkles and age spots, Mitchell says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="C7Bkg5">
You’ll want a sunscreen that protects against both UVA and UVB rays, referred to as broad spectrum, so make sure “broad spectrum” or other verbiage that mentions protection against both UVA and UVB rays is referenced on the label.
</p>
<h3 id="fPUxta">
What ingredients do I want in sunscreen?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ofmrvD">
Sunscreens fall under one of two consumer categories: chemical and mineral sunscreens. However, from a chemistry perspective, both types of sunscreens are made of chemicals, Dobos says. Don’t be fooled: She often encounters people who believe mineral sunscreens are “natural.” They’re not — the ingredients used in those sunscreens aren’t extracted from the ground and ready for use in a cosmetic product.
</p>
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Mineral sunscreens work by creating a barrier on the skin that reflects UV rays. The main ingredients in these sunscreens are <a href="https://www.healthline.com/health/beauty-skin-care/best-sunscreen-ingredients#zinc-oxide">titanium dioxide and zinc oxide</a>, which can leave a white or ashy cast on the skin. Chemical sunscreens get absorbed into the skin and “help create chemical reactions that lead to repelling the UV rays,” says <a href="https://connects.catalyst.harvard.edu/Profiles/display/Person/87938">Rachel Reynolds</a>, interim chair of dermatology at Beth Israel Deaconess Medical Center and assistant professor of dermatology at Harvard Medical School. <a href="https://health.clevelandclinic.org/how-to-choose-the-best-sunscreen-for-your-skin/">Ingredients in chemical sunscreens</a> include avobenzone, homosalate, octocrylene, octinoxate, octisalate, and oxybenzone. These sunscreens can feel greasy.
</p>
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“There’s pros and cons to each type,” Dobos says. (More on this shortly.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wqlsV9">
In 2019, the FDA announced two ingredients — <a href="https://www.cnn.com/2019/02/21/health/fda-proposed-regulations-sunscreen/index.html">PABA and trolamine salicylate</a> — were not safe and effective and are no longer permitted in sunscreens, says dermatologist <a href="https://www.monhealth.com/main/find-a-physician/hall-mary-j-md-11">Mary Hall</a>, a spokesperson for <a href="https://www.skincancer.org/">The Skin Cancer Foundation</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7tskKq">
Regardless of what type of sunscreen you prefer, make sure it’s water and sweat resistant, Hall says.
</p>
<h3 id="ghNplo">
How can I find a sunscreen that looks and feels nice on my skin and still protects me from UV rays?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1aa7zB">
One of the biggest obstacles to regular sunscreen use is finding one you’ll actually want to apply every day. The chalky residue from mineral sunscreens isn’t an ideal look for most people, especially those with darker skin types. Oily chemical sunscreens or sunblocks with irritating fragrances can also be annoying for those with sensitive skin or allergies.
</p>
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Each brand of sunscreen has a different formula — and many of these have improved recently to address consumer pain points. Dobos is a fan of <a href="https://supergoop.com/">Supergoop</a> sunscreens; these are primarily chemical sunscreen products, but without the oily feel typical of these sunscreens. “They have great formulas that work with makeup when you apply it,” Dobos says. She’s also a fan of <a href="https://www.neutrogena.com/sun">Neutrogena sunscreens</a> — the brand offers both chemical and mineral formulas — which come in lotions, sprays, and sticks. The Skin Cancer Foundation has a <a href="https://www.skincancer.org/recommended-products/">database of sunscreens the organization recommends</a>, including <a href="https://www.cerave.com/sunscreen/face/hydrating-mineral-sunscreen-spf-30-face-sheer-tint">CeraVe Hydrating Sunscreen Face Sheer Tint</a> and <a href="https://www.laroche-posay.us/our-products/sun/face-sunscreen/anthelios-mineral-zinc-oxide-sunscreen-spf-50-883140000907.html">La Roche-Posay Anthelios Face Mineral Sunscreen</a>.
</p>
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To address the white residue left by mineral sunscreens, some manufacturers have begun offering tinted sunscreen. “They typically contain iron oxide,” says <a href="https://med.umn.edu/bio/ronda-farah">Ronda Farah</a>, an associate professor of dermatology at the University of Minnesota. “That’s what I use because my skin tone is olive.” Other options for non-streaky screens include <a href="https://www.thecut.com/2016/07/best-gel-sunscreens-review.html">chemical-based gel sunscreens</a>, which are clear when applied, or sunscreens with a yellow tone, Farah says.
</p>
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For those with sensitive skin or allergies, Farah recommends mineral sunscreens — those with titanium dioxide and zinc oxide ingredients. One of the most common sources of allergy in cosmetic products is fragrance, Dobos says, so opt for a fragrance-free sunscreen. Mitchell recommends <a href="https://www.neutrogena.com/products/sun/sheer-zinc-face-dry-touch-sunscreen-broad-spectrum-spf-50-for-sensitive-skin/6811081.html">Neutrogena Sheer Zinc Face Mineral Sunscreen SPF 50</a> and <a href="https://www.neostrata.com/products/sheer-physical-protection/F30164U.html">Neostrata Sheer Physical Protection</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ZtXrM6">
Reynolds recommends mineral sunscreens for children <a href="https://www.healthline.com/health/childrens-health/best-sunscreen-for-kids#what-to-look-for">since they’re less irritating</a>. The <a href="https://www.fda.gov/consumers/consumer-updates/should-you-put-sunscreen-infants-not-usually">FDA does not recommend sunscreen for infants under 6 months</a> since they may be susceptible to rashes; instead, keep them out of direct sunlight and keep them covered up with long sleeve shirts, pants, and hats.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="yQUZoF">
Because there are so many sunscreen options, Farah says to buy three, and be prepared to only like one of them for everyday use on the face. “The other two,” she says, “demote to the body.” Don’t spend a ton of money here — you can get an effective sunscreen that feels great for a low cost.
</p>
<h3 id="LhXsMt">
How much should I spend on sunscreen?
</h3>
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Some manufacturers and beauty stores stock sunscreens that can run up to $60 for a wee bottle. “You don’t have to buy expensive fancy sunscreens,” Farah says. “You can buy stuff from Target or Walmart as long as it has that sun protective factor and it’s not irritating skin.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qsVkKW">
While higher-end sunscreens can feel a little nicer or contain tints and makeup, it doesn’t materially change the efficacy of the sunscreen. If you prefer your sunscreen lightweight, matte, or want it to double as makeup, it may be worth it to spend a little more. “I typically say spend the money on the fancy one for your face and neck,” Farah says, “and the cheaper sunscreens on the body.”
</p>
<h3 id="FsE9GR">
How much SPF do I need?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SjZXI4">
Sun protection factor — also known as SPF — refers to the amount of time you could stay out in the sun without burning compared to if you weren’t wearing any sunscreen at all. “So an SPF of 30 would mean that you could stay out in the sun 30 times longer with this sunscreen on and not burn relative to having no sunscreen at all,” Reynolds says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ikcXTY">
Experts recommend wearing sunscreen with SPF 30 or higher. Beyond SPF 50, any additional protection is negligible since the UV rays are already effectively blocked. “The difference between an SPF of 15 and 30 in terms of the overall efficacy is going to be greater than if you’re jumping from an SPF 30 to an SPF 50,” Reynolds says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="X6Py3c">
Pay attention to the expiration date on the bottle, too. Hall recommends people purchase a new bottle of sunscreen at least once a year.
</p>
<h3 id="42FKBF">
What is the correct way to apply sunscreen?
</h3>
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There are a few rules of thumb regarding when and how much sunscreen you should use. Timing-wise, apply sunscreen 30 minutes before going outside, Hall says. As far as quantity, experts recommend a shot glass sized amount of sunscreen for the entire body and a nickel-sized amount for your face. “A thicker layer will protect better than a thin layer,” Reynolds says. Applying too thin a layer of sunscreen will result in less SPF protection than what’s labeled on the bottle.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1Ra18F">
The best way to ensure you’re applying enough sunscreen is to use a cream-based sunscreen, Reynolds says. Spray sunscreens provide a thinner coating, and are therefore offering less protection. However, spray sunscreens are convenient for use on the scalp, Reynolds says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="orWunX">
Keep in mind that the best sunscreen option is one that you’ll readily use. So if spray options are your preference, they’re better than nothing. Farah also uses stick-based sunscreens for her children since they’re easier to apply.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="S2OkUn">
One application isn’t enough if you’re spending extended time outdoors. Reapply every two to four hours if you’re in the sun, experts say.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3WADUg">
Regardless of whether you’re soaking up the sun, wear sunscreen on your face and neck every day, Farah says, as UV rays can penetrate windows in your home and car.
</p>
<h3 id="VqaKxE">
I heard French and Korean sunscreens are better than American ones, is that true?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="pCUBPh">
In the United States, sunscreens are considered an over-the-counter drug and are regulated by the FDA. Therefore, ingredients in sunscreen must be deemed safe and effective by the FDA. In places like the European Union, sunscreens are still regulated, but they’re <a href="https://single-market-economy.ec.europa.eu/sectors/cosmetics/cosmetic-products-specific-topics/sunscreen-products_en">considered cosmetics</a>, “and it’s easier to get a new active ingredient approved,” Dobos says. No new sunscreen ingredients <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.29001">have been approved by the FDA since 2000</a>. Elsewhere in the world, sunscreens contain newer ingredients, like bemotrizinol, which could potentially be approved by the FDA by 2025, Dobos says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="svZxyq">
By skirting drugstores and ordering international sunscreens online, consumers can get their hands on newer formulations, but ones that are not approved in the US. While some experts find no reason to import sunscreen from beyond American shores, if you are looking to try something different, Dobos advises caution: Only purchase from a reputable company (manufacturers with global operations like L’Oreal, Unilever, Johnson and Johnson are best) and check to see if the <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/compliance-actions-and-activities/warning-letters">FDA sent a warning letter to the company</a> for not being safe or effective. “A few years ago, there were some Korean sunscreens that a company had tested by an independent laboratory and it <a href="https://nymag.com/strategist/2020/12/what-went-wrong-with-puritos-sunscreen.html">did not perform up to the label claim of the SPF</a>,” Dobos says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jCnmik">
Finding the perfect sunscreen may require some trial and error, but regular use is crucial, no matter your age or skin type. It’s never too late to start a healthy skin habit — and keep wrinkles, sun spots, and, most importantly, skin cancer, at bay.
</p></li>
<li><strong>Will having the world’s biggest population make this the “Indian Century”?</strong> -
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/edLbuyIa1keorriXmujA8KRWhxs=/146x0:2465x1739/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72234886/GettyImages_1252220416.0.jpg"/>
<figcaption>
Pedestrians walk past a population clock board displayed outside the International Institute for Population Sciences in Mumbai on April 27, 2023. | AFP via Getty Images
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</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Why numbers can only go so far for the world’s new most populous nation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="YdFhu8">
China has officially been the world’s most populous country <a href="https://ourworldindata.org/explorers/population-and-demography?facet=none&amp;country=CHN~IND~USA~IDN~PAK&amp;hideControls=false&amp;Metric=Population&amp;Sex=Both+sexes&amp;Age+group=Total&amp;Projection+Scenario=None">since 1950</a>, when the United Nations began keeping statistics. But it’s almost certainly had the most people <a href="https://ourworldindata.org/world-population-growth#population-growth-by-country">for centuries</a>, if not far longer. China was the first country to pass 1 billion, <a href="https://www.washingtonpost.com/archive/politics/1982/10/28/chinas-population-passes-1-billion-in-latest-census/f3b0e967-6dbd-4ca0-9f63-e125e980e0ab/">in 1982</a>, and with an <a href="https://www.wsj.com/articles/u-n-confirms-indias-population-is-overtaking-chinas-8e5b2c8e">estimated 1.426 billion people</a> in 2022 — more than four times the numbers and population density of the US — it’s at the top of the global table.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fSwPDI">
But not anymore. According to UN demographers, this month India <a href="https://www.un.org/en/desa/india-overtake-china-world-most-populous-country-april-2023-united-nations-projects">will have matched and then will surpass</a> China in total population, most likely by the time you read this. This isn’t precisely a surprise — India’s <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=IN-CN">fertility rate has been above China’s</a> since years before the latter country implemented its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116810/#:~:text=China's%20one%20child%20family%20policy%2C%20which%20was%20first%20announced%20in,over%20the%20past%20two%20decades.">one-child policy in 1979</a>, and demographers have long projected that it was only a matter of time before India caught up. But that day was <a href="https://apnews.com/article/china-india-world-population-census-fertility-193b45b5ae69e7ce9f870f5ce60909d9">still expected to be years later</a> — not right now.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jQavVg">
What does this mean? Beyond forcing a generation of schoolchildren to remake their mental map about world population, not much for the moment. Both countries are still massive, home to nearly three out of every eight people on the planet.
</p>
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In China, decades of the world’s most aggressive and coercive population controls have <a href="https://www.vox.com/future-perfect/23558772/china-population-overpopulation-one-child-policy-demographics-aging-beijing-xi-jinping">arguably worked too well</a>. Its fertility rate — the number of expected births per woman over the course of their reproductive lives — <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=CN">is just 1.3</a>, among the <a href="https://worldpopulationreview.com/country-rankings/total-fertility-rate">lowest levels in the world</a>, and it’s been below the 2.1 rate needed for a country to replace its population through births alone since the early 1990s.
</p>
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Decades of depressed fertility means the country’s population — <a href="https://www.cnn.com/2023/01/18/china/china-population-drop-explainer-intl-hnk/index.html">which is already declining</a> — will continue to age, putting serious economic constraints on an economy that has long been boosted by the <a href="https://chinapower.csis.org/china-demographics-challenges/">world’s largest pool of young laborers</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EP2Qp7">
India, by contrast, has seen its fertility rate <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=IN">slide much more gradually</a>, from the nearly six children per woman it experienced in the population bomb 1960s to around 2.1 today. That has both fueled India’s continual population growth — which is projected to <a href="https://www.pewresearch.org/short-reads/2023/02/09/key-facts-as-india-surpasses-china-as-the-worlds-most-populous-country/#:~:text=The%20UN's%20%E2%80%9Clow%20variant%E2%80%9D%20scenario,1%20billion%20people%20by%202100.">peak at 1.7 billion in 2064</a>, according to the UN’s middle-of-the-road estimate — and kept it younger overall, meaning India won’t just be larger than China but will also have <a href="https://theprint.in/india/imminent-end-of-demographic-dividend-share-of-indias-working-age-population-set-to-fall-by-2036/1451773/#:~:text=A%20deeper%20look%20at%20the,India's%20total%20population%20than%20before.">far more young, potentially productive workers</a>.
</p>
<h3 id="ajTipj">
Demography is not destiny
</h3>
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Historically, that kind of population distribution has been a recipe for economic success. East Asian nations like Japan and South Korea — and later China, for that matter — <a href="https://www.wilsoncenter.org/event/the-demographic-dividend-economic-growth-changing-age-structures#:~:text=Twitter%20LinkedIn%20Email-,The%20Demographic%20Dividend%3A%20Economic%20Growth%20With%20Changing%20Age%20Structures,known%20as%20the%20demographic%20dividend.">cashed in on a demographic dividend</a> in the second half of the 20th century, as rapid drops in fertility meant lots of workers with fewer children to support, which helped make those workers more productive. Based on raw demography alone, India is poised to reap the same advantages, which has led some forecasters to <a href="https://www.outlookindia.com/business/it-s-not-india-s-decade-it-s-india-s-century-mckinsey-s-sternfels-news-220635">herald the “Indian Century.”</a>
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BGoNdt">
But remember how I said that demography <em>is not </em>destiny? A huge surplus of young workers is a great thing, but only if a country can grow fast enough to find productive work for all of them — and while India has made <a href="https://www.hindustantimes.com/world-news/india-has-almost-wiped-out-extreme-poverty-imf-101649311909782.html">enormous strides</a> in reducing extreme poverty, that’s something the country <a href="https://www.nytimes.com/interactive/2023/04/19/world/asia/india-china-population.html">still struggles with</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XJAjut">
If you can’t find work for your citizens, population can go from boon to bomb. And while India’s fertility transition looks like a smooth bunny slope at the national level, those numbers <a href="https://www.pewresearch.org/short-reads/2021/12/13/key-facts-about-the-religiously-and-demographically-diverse-states-of-india/">conceal huge differences regionally</a>. India’s population is growing most rapidly in poorer states in the north, while in the developed south, population has already peaked and low fertility rates look closer to China’s.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="2weJkZ">
For India to make the most out of its favorable demographic position, it will need to take some pages from China’s book, beginning with female empowerment. Only about one out of every five women in India <a href="https://www.npr.org/sections/goatsandsoda/2023/01/04/1146953384/why-women-in-india-are-dropping-out-the-workforce-even-as-the-economy-grows">have formal employment</a>, barely more than half the rate in China. That means fighting ingrained gender discrimination in India and ensuring access to both family planning, which varies widely in the country, and access to education.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="JDX5CQ">
India also faces a very different political landscape than China. The world’s most populous country is also the world’s largest democracy. That, too, can be a strength, but at the moment India is experiencing <a href="https://www.vox.com/2023/3/24/23654832/rahul-gandhi-expelled-lok-sabha-narendra-modi">marked democratic backsliding</a>, as Prime Minister Narendra Modi <a href="https://www.ft.com/content/28c89610-503c-11e9-b401-8d9ef1626294">rewrites electoral rules</a>, <a href="https://www.cbsnews.com/news/india-citizenship-bill-muslim-violent-protests-assam-vow-of-court-challenge-today-2019-12-12/">attacks Muslim minorities</a>, and <a href="https://rsf.org/en/ndtv-takeover-signals-end-pluralism-india-s-leading-media">stifles the press</a>. The apparently politically motivated <a href="https://www.newyorker.com/news/q-and-a/has-modi-pushed-indian-democracy-past-its-breaking-point#:~:text=In%20India%2C%20we%20have%20a,It%20has%20changed%20a%20lot.">disqualification</a> in March of Modi’s main political rival, Congress Party leader Rahul Gandhi, is another low point for a country that the NGO Freedom House now only rates as “<a href="https://freedomhouse.org/country/india/freedom-world/2023">partly free.</a>”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="H9q4fD">
The simple fact that China is no longer the world’s most populous country underscores the fact that we are entering entirely new demographic territory. Barring radical change, our children will live to see <a href="https://www.weforum.org/agenda/2022/11/world-population-passes-8-billion-what-you-need-to-know/">global population peak and begin to shrink</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7ijwzP">
For the world to continue to grow economically in the decades ahead, we’ll need to get far more out of every worker. And India, which likely <a href="https://www.nytimes.com/interactive/2023/04/19/world/asia/india-china-population.html">can’t fully depend</a> on the kind of export-driven manufacturing growth that has lifted almost every other country out of extreme poverty, will need to chart its own path into the future.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="U0EHeN">
<em>A version of this story was initially published in the Future Perfect newsletter. </em><a href="https://confirmsubscription.com/h/d/A2BA26698741513A"><em><strong>Sign up here to subscribe!</strong></em></a>
</p></li>
<li><strong>In Nebraska, abortion rights are safe — for now</strong> -
<figure>
<img alt="" src="https://cdn.vox-cdn.com/thumbor/jnmGrK8d5So8wUXavr13mAtqSLc=/0x0:1024x768/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/72233231/AP23117806076149.0.jpg"/>
<figcaption>
Pat Neal, left, and Ann Fintell, both of Lincoln, celebrate in the Nebraska Capitol rotunda after the failure of a bill that would have banned abortion around the sixth week of pregnancy, Thursday, April 27, 2023. | AP Photo/Margery Beck
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Another measure that would have completely banned abortion in South Carolina also failed this week.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="b4qRcz">
The Nebraska legislature defeated a bill Thursday that would have restricted abortions in the state to six weeks after fertilization, protecting the right to abortion in a solidly Republican state. South Carolina, too, defeated a similarly restrictive piece of legislation Thursday, in another win for abortion rights in a red state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6o2HpQ">
As conservative states like Florida enact near-total abortion bans, the ongoing battles around abortion in states like South Carolina and Nebraska reinforce the complexities of legislating abortion access and force legislators to acknowledge the effect that limiting this access has on the lives of their constituents, outside of political tribalism.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5rsMDd">
In Nebraska, Gov. Jim Pillen, a Republican whose campaign website describes him as “<a href="https://www.jimpillen.com/issues/#:~:text=I%20am%20proudly%20prolife.&amp;text=I%20oppose%20taxpayer%20money%20funding,mothers%20and%20families%20in%20crisis.">proudly prolife</a>,” said after the vote that he was “profoundly disappointed” in the outcome, according to the <a href="https://www.nytimes.com/2023/04/27/us/abortion-bans-nebraska-south-carolina.html">New York Times.</a> Though Pillen supported the legislation, it will not come up again this year<strong> </strong>after its narrow defeat in Thursday’s cloture vote. Nebraska currently allows abortion up to 20 weeks of gestation.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0WffWJ">
State Sen. Joni Albrecht introduced the bill, called <a href="https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=50641">Nebraska Heartbeat Act</a> in January “to save the lives of unborn children,” according to <a href="https://nebraskalegislature.gov/FloorDocs/108/PDF/SI/LB626.pdf">a statement of intent</a>, and, “to encourage greater respect for human life in society and to preserve the integrity of Nebraska’s medical profession.” The bill mandates that doctors must test for fetal cardiac activity before performing an abortion and that performing an abortion if such activity is present would suspend the doctor’s medical license except in the case of rape, incest, or a medical emergency.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BlXvqJ">
The Nebraska Heartbeat Act failed in a cloture vote, which ends debate on a bill and bring it to the floor for a yes-or-no vote. In Nebraska’s nonpartisan unicameral legislature, it takes 33 votes to end debate and force a vote; only 32 senators voted in favor of cloture, with 15 voting against and two abstaining. Pillen later chastised the two senators who did not vote, Republican <a href="https://thehill.com/homenews/state-watch/3977744-nebraska-lawmakers-reject-six-week-abortion-ban/">Merv Riepe</a> and Democrat Justin Wayne, saying it was “unacceptable for senators to be present not voting on such a momentous vote.” <a href="https://nebraskapublicmedia.org/en/news/news-articles/bill-to-restrict-abortions-falls-one-vote-short/">The legislature’s policy</a> is to consider a bill dead for the rest of the session if it doesn’t pass the cloture vote.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="iTfv6Y">
Though Republican legislators had 33 votes to force cloture, Riepe’s abstention ended up being the decisive factor in the outcome. Riepe, a former hospital administrator representing a district in Omaha, <a href="https://thehill.com/homenews/state-watch/3977744-nebraska-lawmakers-reject-six-week-abortion-ban/">initially backed the bill</a>, though he later announced his intention to introduce an amendment allowing abortion up to 12 weeks of gestation, for fear that a six-week ban would amount to a “total ban” on the procedure.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gtbe68">
“At the end of the day, I need to look back and be able to say to myself, ‘Did you do the best?’” Riepe told the <a href="https://flatwaterfreepress.org/plot-twist-omaha-state-senator-wavers-puts-six-week-abortion-ban-in-jeopardy/">Flatwater Free Press </a>in March. “No group came to me, asking me to do this. This is of my own beliefs, my own commitments.”
</p>
<h3 id="gFjhq8">
Abortion is safe in Nebraska for now — but what about the future?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="SKV0Xz">
According to Sen. John Fredrickson, a Democrat representing an Omaha district, Thursday’s outcome is a testament to the fact “we still have thinking people” in the legislature, despite Nebraska’s deep-red bona fides.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sLPaTD">
“Just having very direct and frank conversations about the nuance, the reality of [abortion] and not falling into the traps of hyper-partisan framing or language about it — just coming to the table and having direct, frank conversations about what this actually means — that was our path to victory here,” he told Vox.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TpljLn">
Nebraska’s legislature is unicameral, so there’s no chance for the bill to be<strong> </strong>picked up<strong> </strong>in a different chamber, and it’s nonpartisan. Legislators don’t caucus with their parties, Fredrickson told Vox, so there’s not reliably a hard party-line vote, even on culture war issues like abortion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zDSP7r">
Just last year, the <a href="https://apnews.com/article/voting-rights-us-supreme-court-health-nebraska-legislature-0b8e1e93be48c9e3fd7264c94da7b786">legislature blocked a trigger law</a> that would have banned abortions when <em>Roe v. Wade </em>was overturned. In a similar maneuver to Thursday’s, a cloture vote prevented the bill from going to the floor.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VKBqEd">
Those two abortion rights victories, though, aren’t affirmative or definitive — they don’t explicitly uphold the right to an abortion either legislatively or in Nebraska’s constitution, and they won’t stop more legislation from coming forward in the future.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fzmaRE">
Though Fredrickson told Vox there was some organizing around a ballot measure protecting abortion rights, it’s challenging for abortion rights advocates in the legislature to explicitly protect that right. “From a legislative perspective, it’s very difficult for us to codify protections surrounding abortion, given the makeup of the [legislative] body, but we are able to play defense and protect against additional restrictions,” he said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="UzhWTf">
Riepe’s future 12-week ban could be the next challenge for Fredrickson and abortion rights proponents. Though <a href="https://nebraskalegislature.gov/FloorDocs/108/PDF/AM/AM1527.pdf">a proposed amendment</a> to the Albrecht bill contains exceptions for the life and health of the mother, fetal anomaly, rape, and incest, <a href="https://nebraskalegislature.gov/FloorDocs/108/PDF/AM/AM626.pdf">a previous iteration</a> of the twelve-week ban did not provide exceptions for rape and incest. Riepe <a href="https://flatwaterfreepress.org/plot-twist-omaha-state-senator-wavers-puts-six-week-abortion-ban-in-jeopardy/">previously expressed concern</a> that an exception for rape would unfairly target men and open them up to potential prosecution.
</p>
<h3 id="EylxjH">
South Carolina reaffirmed its stance on a harsh abortion ban
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="gd0f8f">
In another surprise, South Carolina’s senate failed to pass <a href="https://apnews.com/article/south-carolina-abortion-ban-legislature-8a3d4c18db8aabfc869b9466aa4f76aa">a total abortion ban on Thursday</a>, defeating the measure 22 to 21. Though abortion remains legal through 22 weeks of gestation in South Carolina, the legislature has repeatedly attempted to severely curtail or ban the procedure, or introduce draconian punishments for having an abortion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ErRtPH">
The chamber’s five women senators — three Republicans, one Democrat, and one Independent — held a multi-day filibuster against the bill, which would outlaw abortion at the point of conception.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RhK4lv">
“Abortion laws, each and every one of them, have been about control. It’s always about control, plain and simple. And in the senate, the males all have control. We, the women, have not asked for … nor do we want your protection. We don’t need it. There is not a single thing I can do when women such as me are insulted except make sure that you get an earful,” Republican <a href="https://www.npr.org/2023/04/28/1172840752/republican-abortion-ban-south-carolina-six-weeks-filibuster-sandy-senn-roe-wade">Sen. Sandy Senn</a>, who represents parts of Charleston and Dorchester counties, said to her colleagues on Thursday.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Idw89U">
The Senate in September <a href="https://www.vox.com/2022/9/10/23344663/south-carolina-gop-vote-legislation-abortion">defeated a similar measure</a>; it passed a separate abortion ban, which was then<a href="https://www.nytimes.com/2023/01/05/us/south-carolina-abortion-supreme-court.html"> declared unconstitutional by the South Carolina Supreme Court</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GfENrD">
The Court’s January ruling protecting the right to abortion isn’t absolute, however; according to the majority’s decision, that right “must be balanced against the State’s interest in protecting unborn life.” That opens the door for legislators to continue proposing abortion bans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="61DVr0">
<a href="https://www.scstatehouse.gov/sess125_2023-2024/bills/474.htm#:~:text=(B)%20Except%20as%20provided%20in,carrying%20has%20a%20detectable%20heartbeat.">In February, the Senate passed a bill</a> that would ban abortion after fetal cardiac activity. That bill is now in the state House, a staunchly hard-right chamber which includes the so-called “Freedom Caucus.” That group, <a href="https://www.npr.org/2023/04/28/1172840752/republican-abortion-ban-south-carolina-six-weeks-filibuster-sandy-senn-roe-wade">as Senn told NPR</a>, is “just hell-bent that it is going to be zero abortion or nothing, they say that they’re not going to go within six weeks, not going to go 12 weeks, it’s going to be zero or nothing.” Senate Minority Leader Brad Hutto echoed that sentiment, telling Vox that the February ban was unlikely to pass the House for that reason.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vMUIY5">
One member of the Freedom Caucus, Rep. Rob Harris, <a href="https://www.vox.com/2023/3/19/23647123/wyoming-abortion-pill-ban-south-carolina-texas">introduced a fetal personhood bill in March</a> that would make abortion punishable by life in prison or the death penalty. “Legislators in South Carolina have tried in every legislative session to introduce a fetal personhood bill” for the past two decades-plus, as Vicki Ringer, South Carolina director of public affairs for Planned Parenthood South Atlantic, told Vox at the time — but Harris’ legislation was “the craziest” she had seen in her career.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XeIG2y">
Thursday’s vote against the abortion ban is a step, but it’s not far enough, as Hutto told Vox. “If it were a permanent victory, it would be wonderful. But it’s just going to keep coming back and coming back, so we’re doing to it over and over again, and hopefully as we go along, educate more people and pick up more momentum.”
</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>Kochi Marathon today</strong> - Over 6000 runners to compete in four events</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>Backing of MS Dhoni has helped me lot as cricketer: CSK opener Devon Conway</strong> - Conway claimed that MS Dhoni is a highly composed and level-headed batter, and having his backing is really helpful for any cricket player</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>Watch out for the 1000th IPL match</strong> - It all started in 2008 after India’s success in the 2007 Twenty20 World Cup.</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>IPL 2023: CSK vs PBKS | Consistent Conway powers Chennai to competitive total against Punjab</strong> - Chennai are fielding the same playing XI while Punjab have brought in Harpreet Brar in place of Gurnoor Brar.</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>IPL 2023 | He’s grown as a leader: Mumbai Indian players and coaching staff pay tribute to Rohit Sharma’s captaincy</strong> - Rohit was handed the leadership role for the first time on April 24, 2013. He went on to guide the Mumbai Indians to titles in 2013, 2015, 2017, 2019 and 2020.</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>Data | World’s largest producer of milk hits a dry patch</strong> - Milk prices are ruling high as supply is constrained by lumpy skin disease and high fodder costs</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>T.N. council for higher education introduces new scheme for colleges</strong> - Govt. and aided colleges urged to conduct seminars and workshops</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>Why kingmaker? We want to emerge kings: H.D. Deve Gowda</strong> - The former PM denied that his party had any tacit understanding with the BJP or Congress, arguing that a regional party would prioritise Karnataka’s interests, and that the JD(S) could be trusted to keep its poll promises</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>Nitish Kumar sidesteps query on fighting 2024 Lok Sabha poll</strong> - The Bihar Chief Minister has previously stated he had “no ambitions” for himself</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>Watch | A tour of Bengaluru’s iconic college buildings</strong> - A video on Bengaluru’s oldest institutions, that have been providing education to students even to this day.</p></li>
</ul>
<h1 data-aos="fade-right" id="from-bbc-europe">From BBC: Europe</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine war: Crimea oil tank set ablaze by reported drone</strong> - Flames engulf the facility in Russian-held Sevastopol, a day after a wave of strikes across Ukraine.</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>Turkey’s President Erdogan back on campaign trail after illness</strong> - The Turkish leader holds a rally in the opposition stronghold of Izmir after falling ill on Tuesday.</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>Walrus Freya killed by Norway gets Oslo sculpture</strong> - The animal was a popular attraction, but euthanised in August out of public safety concerns.</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>What Europe’s royals could teach King Charles</strong> - A combative media, a colonial past and rebellious children. Can other royal families help the UK’s new monarch?</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>Barack Obama and friends surprise Barcelona restaurant</strong> - Bruce Springsteen and Steven Spielberg joined the ex-US president for dinner in the Catalan capital.</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>Driving across the American West in techno-excess with the BMW XM</strong> - “Hey Batman, turn on the seat massage.” - <a href="https://arstechnica.com/?p=1935214">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Curious about screen-based fitness machines? Here are the best we’ve found</strong> - We tried the most interesting devices on the market to see what’s worth your dollar. - <a href="https://arstechnica.com/?p=1934016">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>An ominous heating event is unfolding in the oceans</strong> - Average sea surface temperatures have soared to record highs—and stayed there. - <a href="https://arstechnica.com/?p=1935397">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Sensitive data is being leaked from servers running Salesforce software</strong> - There’s disagreement about how easy it is to configure Salesforce Community. - <a href="https://arstechnica.com/?p=1935543">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Report describes Apple’s “organizational dysfunction” and “lack of ambition” in AI</strong> - Sources say Apple’s conservative approach makes it less competitive. - <a href="https://arstechnica.com/?p=1935453">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-jokes-subreddit">From Jokes Subreddit</h1>
<ul>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Two Canadians End up in Hell…</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Two Canadians die and end up in Hell. Satan decides to pay them a visit, so he walks into their room and sees them talking and laughing. Confused, he asks them why they’re happy.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They tell him, “Well, we’re so sick of the cold where we’re from, and this place is nice and toasty.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Satan, annoyed, storms away and goes to Hell’s boiler room, where he turns up the temperature.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He goes back to the Canadians’ room, along the way being begged by all sorts of people to put the heating back down. He enters the room to see the Canadians having a barbecue. Furiously, he asks them what they’re doing.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Well, we can’t pass up this wonderful weather without getting out the barbecue!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Satan realizes he’s been doing the wrong thing. He goes to the boiler room and turns it down until it’s at a colder temperature than ever seen on earth.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He knows he’s won now, so he goes back to the Canadians’ room, only to see them jumping up and down in excitement. He shouts at them in fury, “WHY ARE YOU STILL HAPPY?!?!?!”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
They look at him and shout at the same time, “Hell froze over! That means the Leafs won!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/myaltaccount333"> /u/myaltaccount333 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/133h16k/two_canadians_end_up_in_hell/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/133h16k/two_canadians_end_up_in_hell/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Lying in bed, about ready to consummate their marriage, when the new bride says to her husband Johnny:</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“I have a confession to make, I’m not a virgin.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Johnny replies. “That’s no big thing in this day and age.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The wife continues. “Yeah, I’ve been with one other guy.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Oh yeah? Who was the guy?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Tiger Woods.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Tiger Woods, the golfer?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Yeah.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Well he’s rich, famous and handsome. I can see why you went to bed with him.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Then Johnny and his wife then make passionate love.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When they get done, Johnny gets up and walks to the telephone.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“What are you doing?” Says the wife.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Johnny says. “I’m hungry, I was going to call room service and get some food.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Tiger wouldn’t do that.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Oh yeah? What would Tiger do?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“He’d come back to bed and do it a second time.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Johnny puts down the phone and goes back to bed to make love with his wife a second time.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When they finish, he gets up and goes over to the phone.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“What are you doing?” She says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Johnny says. “I’m still hungry so I was going to get room service to get some food.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Tiger wouldn’t do that.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“Oh yeah? What would Tiger do?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“He’d come back to bed and do it one more time.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Johnny slams down the phone and goes back to bed and makes love to his wife one more time.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
When they finish he’s tired and beat.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He drags himself over to the phone and starts to dial.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The wife asks. “Are you calling room service?”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
“No! I’m calling Tiger Woods to find out what’s par for this hole.”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/orgasmic2021"> /u/orgasmic2021 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/132z9me/lying_in_bed_about_ready_to_consummate_their/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/132z9me/lying_in_bed_about_ready_to_consummate_their/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why do French people eat small breakfasts</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
One egg is an oeuf
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Fatbaldmanbaby"> /u/Fatbaldmanbaby </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/133iz52/why_do_french_people_eat_small_breakfasts/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/133iz52/why_do_french_people_eat_small_breakfasts/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A 7 year old &amp; 4 year old are in their bedroom. “You know what” says 7 year old “I think its time we started swearing…</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
A 7 year old &amp; 4 year old are in their bedroom. “You know what” says 7 year old “I think its time we started swearing. When we go downstairs for breakfast I’lI swear first then you”. “OK” says 4 year old. Mum asks 7 yr old what he wants for breakfast. “I’II have Coco pops, bitch”. WHACK, he flew out of his chair crying his eyes out. Mum looked at 4yr old &amp; said sternly “And what do you want?”. “Dunno but it won’t be fucking coco pops.”
</p>
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/No-Eye-9491"> /u/No-Eye-9491 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/132pv3u/a_7_year_old_4_year_old_are_in_their_bedroom_you/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/132pv3u/a_7_year_old_4_year_old_are_in_their_bedroom_you/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>I was down on my luck but got a date from a tinder profile with no pic.</strong> - <!-- SC_OFF --></p>
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I wasn’t expecting mych, probably 400lbs or professional. But i got to her door and low and behold a perky smile and strawberry blonde hair, all the right curves in all the right places. I couldn’t believe my luck. We exchanged names and i asked her what she did. She told me “sunday school teacher”. Now I ain’t never been with a Christian woman but I’m open minded about the whole thing, so i took her to dinner.
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We were driving to the nicest restaurant i could think of and i asked if she wanted to smoke a joint and get an appetite. She replied “heavens no, what would i tell my sunday school children.”
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I didn’t think much of it, weeds 50/50 some people do some people don’t.
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We got to the restaurant , nicest one i could think of, i ordered the steak and she got the lobster. I ordered the second most expensive bottle of wine yhey had. But when the waiter comes to pour she says she don’t drink!
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“You don’t drink?” I say. She replies “heavens no, what would i tell my Sunday school children?”
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I didn’t know what to do. Sure that super expensive dinner tastes great, and we talked and laughed all through it, i just didn’t know how to handle a woman who didn’t get high or drunk. The possibility never crossed my mind.
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So we’re driving home and pass a cheap motel, i figure what have i got to lose. I ask her“hey want to get a room and knock boots til the sun comes up?” She says “I thought you’d never ask!”
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I say " really? What will you tell your Sunday school children?"
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She says “The same thing i do every week, you don’t have to drink and smoke to have a good time.”
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A cake day reprint of my very first <a href="https://www.reddit.com/r/jokes">r/jokes</a> post.
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/KarmicComic12334"> /u/KarmicComic12334 </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/133ajgs/i_was_down_on_my_luck_but_got_a_date_from_a/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/133ajgs/i_was_down_on_my_luck_but_got_a_date_from_a/">[comments]</a></span></p></li>
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