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<title>04 January, 2024</title>
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<h1 data-aos="fade-down" id="covid-19-sentry">Covid-19 Sentry</h1>
<h1 data-aos="fade-right" data-aos-anchor-placement="top-bottom" id="contents">Contents</h1>
<ul>
<li><a href="#from-preprints">From Preprints</a></li>
<li><a href="#from-clinical-trials">From Clinical Trials</a></li>
<li><a href="#from-pubmed">From PubMed</a></li>
<li><a href="#from-patent-search">From Patent Search</a></li>
</ul>
<h1 data-aos="fade-right" id="from-preprints">From Preprints</h1>
<ul>
<li><strong>BCG activation of trained immunity is associated with induction of cross reactive COVID-19 antibodies in a BCG vaccinated population.</strong> -
<div>
Background: During the current COVID 19 pandemic, the rate of morbidity and mortality was considerably lower in BCG vaccinated countries like Pakistan. BCG has been shown to provide cross protection to both disseminated TB as well as non related viral infections in BCG vaccinated children which is consistent with COVID 19 morbidity in the younger age group. Recently, this cross protection was attributed to trained immunity (TI) associated with BCG recall responses in the innate arm of the immune system. Little is known about the longevity of BCG Trained Immunity (TI) beyond early childhood. Objective: To assess the BCG induced recall responses in healthy individuals by cytokines secreted from the TI network and its potential role in providing cross protection against COVID 19 and other viral infections. Study Design: In this cross sectional study, healthy young adults and adolescents (n=20) were recruited from 16-40 years of age, with no prior history of TB treatment, autoimmune, or chronic inflammatory condition. Methods: BCG induced cytokine responses were assessed using prototypic markers for cells of the TI network macrophages [M1 (TNF alpha, IFN gamma), M2 (IL10)], NK (IL2), Gamma delta (gamma delta]) T (IL17, IL4)} and SARS CoV2 IgG antibodies against RBD using short term (12 hours) cultures assay. Results: Significant differences were observed in the magnitude of recall responses to BCG with macrophage cytokines showing the highest mean levels of TNF alpha (9148 pg/ml) followed by IL10 (488 pg/ml) and IFN gamma(355 pg/ml). The ratio of unstimulated vs BCG stimulated cytokines was 132 fold higher for TNF alpha, 40 fold for IL10, and 27 fold for IFN gamma. Furthermore, SARS-CoV-2 antibodies were also detected in unstimulated plasma which showed cross reactivity with BCG. Conclusion: The presence of cross reactive antibodies to SARS-CoV-2 and the relative ratio of pro and anti inflammatory cytokines secreted by activated TI cellular network may play a pivotal role in protection in the early stages of infection as observed during the COVID 19 pandemic in the younger age groups resulting in lower morbidity and mortality.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.01.02.573408v1" target="_blank">BCG activation of trained immunity is associated with induction of cross reactive COVID-19 antibodies in a BCG vaccinated population.</a>
</div></li>
<li><strong>VLP-Based Model for Study of Airborne Viral Pathogens</strong> -
<div>
The recent COVID-19 pandemic has underscored the danger of airborne viral pathogens. The lack of model systems to study airborne pathogens limits the understanding of airborne pathogen distribution, as well as potential surveillance and mitigation strategies. In this work, we develop a novel model system to study airborne pathogens using virus like particles (VLP). Specifically, we demonstrate the ability to aerosolize VLP and detect and quantify aerosolized VLP RNA by Reverse Transcription-Loop-Mediated Isothermal Amplification (RT-LAMP) in real-time fluorescent and colorimetric assays. Importantly, the VLP model presents many advantages for the study of airborne viral pathogens: (i) similarity in size and surface components; (ii) ease of generation and noninfectious nature enabling study of BSL3 and BSL4 viruses; (iii) facile characterization of aerosolization parameters; (iv) ability to adapt the system to other viral envelope proteins including those of newly discovered pathogens and mutant variants; (v) the ability to introduce viral sequences to develop nucleic acid amplification assays.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.01.03.574055v1" target="_blank">VLP-Based Model for Study of Airborne Viral Pathogens</a>
</div></li>
<li><strong>Antigen non-specific CD8+ T cells accelerate cognitive decline in aged mice following respiratory coronavirus infection</strong> -
<div>
Primarily a respiratory infection, numerous patients infected with SARS-CoV-2 present with neurologic symptoms, some continuing long after viral clearance as a persistent symptomatic phase termed long COVID. Advanced age increases the risk of severe disease, as well as incidence of long COVID. We hypothesized that perturbations in the aged immune response predispose elderly individuals to severe coronavirus infection and post-infectious sequelae. Using a murine model of respiratory coronavirus, mouse hepatitis virus strain A59 (MHV-A59), we found that aging increased clinical illness and lethality to MHV infection, with aged animals harboring increased virus in the brain during acute infection. This was coupled with an unexpected increase in activated CD8+ T cells within the brains of aged animals but reduced antigen specificity of those CD8+ T cells. Aged animals demonstrated spatial learning impairment following MHV infection, which correlated with increased neuronal cell death and reduced neuronal regeneration in aged hippocampus. Using primary cell culture, we demonstrated that activated CD8+ T cells induce neuronal death, independent of antigen-specificity. Specifically, higher levels of CD8+ T cell-derived IFN-{gamma} correlated with neuronal death. These results support the evidence that CD8+ T cells in the brain directly contribute to cognitive dysfunction following coronavirus infection in aged individuals.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2024.01.02.573675v1" target="_blank">Antigen non-specific CD8+ T cells accelerate cognitive decline in aged mice following respiratory coronavirus infection</a>
</div></li>
<li><strong>Four Years of COVID-19: Saudi Arabia, Egypt and Pakistan Have the Highest Research Growth Rates From 2020-2023</strong> -
<div>
We tried to assess the global research scholarly output after COVID-19 (from 2020 to 2023). Based on Scopus record, the world has produced 15, 041, 579 publications with 86, 165, 933 citations. We analyzed those countries, which have published at least 150, 000 research papers. For each country, we retrieved total number of publications, % growth rate, total citations, citations per paper, Field Weighted Citation Impact (FWCI), and % international collaboration. Twenty-seven (n=27) countries were found to be highly productive, with China leading the way in number of publications. Citation metrics are dominated by the USA, China, and European countries. Specifically, Switzerland, Netherlands, and Australia are notable for their high impact and influence. Saudi Arabia achieved the highest growth rate of 53.5%, and highest international collaboration (76.5%). Infact Saudi Arabia also attained high citations per article (8.8), and an FWCI of 1.63. While, Pakistan exhibited an 8.4 citations per article, FWCI of 1.54, growth rate of 34.9%, and collaborative percentage of 64.9%. Egypt also attained the 2nd highest growth rate (n=36.1). Based on four (n=4) distinct performance metrics, Pakistan and Saudi Arabia were in the top ten group.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.31.573759v1" target="_blank">Four Years of COVID-19: Saudi Arabia, Egypt and Pakistan Have the Highest Research Growth Rates From 2020-2023</a>
</div></li>
<li><strong>Complex changes in serum protein levels in COVID-19 convalescents</strong> -
<div>
The COVID-19 pandemic, triggered by severe acute respiratory syndrome coronavirus 2, has affected millions of people worldwide. Much research has been dedicated to our understanding of COVID-19 disease heterogeneity and severity, but less is known about recovery associated changes. To address this gap in knowledge, we quantified the proteome from serum samples from 29 COVID-19 convalescents and 29 age-, race-, and sex-matched healthy controls. Samples were acquired within the first months of the pandemic. Many proteins from pathways known to change during acute COVID-19 illness, such as from the complement cascade, coagulation system, inflammation and adaptive immune system, had returned to levels seen in healthy controls. In comparison, we identified 22 and 15 proteins with significantly elevated and lowered levels, respectively, amongst COVID-19 convalescents compared to healthy controls. Some of the changes were similar to those observed for the acute phase of the disease, i.e. elevated levels of proteins from hemolysis, the adaptive immune systems, and inflammation. In contrast, some alterations opposed those in the acute phase, e.g. elevated levels of CETP and APOA1 which function in lipid/cholesterol metabolism, and decreased levels of proteins from the complement cascade (e.g. C1R, C1S, and VWF), the coagulation system (e.g. THBS1 and VWF), and the regulation of the actin cytoskeleton (e.g. PFN1 and CFL1) amongst COVID-19 convalescents. We speculate that some of these shifts might originate from a transient decrease in platelet counts upon recovery from the disease. Finally, we observed race-specific changes, e.g. with respect to immunoglobulins and proteins related to cholesterol metabolism.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2022.10.26.513886v2" target="_blank">Complex changes in serum protein levels in COVID-19 convalescents</a>
</div></li>
<li><strong>Rapid and specific detection of single nanoparticles and viruses in microfluidic laminar flow via confocal fluorescence microscopy</strong> -
<div>
Mainstream virus detection relies on the specific amplification of nucleic acids via polymerase chain reaction, a process that is slow and requires extensive laboratory expertise and equipment. Other modalities, such as antigen-based tests, allow much faster virus detection but have reduced sensitivity. In this study, we report the development of a flow virometer for the specific and rapid detection of single nanoparticles based on confocal microscopy. The combination of laminar flow and multiple dyes enable the detection of correlated fluorescence signals, providing information on nanoparticle volumes and specific chemical composition properties, such as viral envelope proteins. We evaluated and validated the assay using fluorescent beads and viruses, including SARS-CoV-2. Additionally, we demonstrate how hydrodynamic focusing enhances the assay sensitivity for detecting clinically-relevant virus loads. Based on our results, we envision the use of this technology for clinically relevant bio-nanoparticles, supported by the implementation of the assay in a portable and user-friendly setup.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.31.573251v1" target="_blank">Rapid and specific detection of single nanoparticles and viruses in microfluidic laminar flow via confocal fluorescence microscopy</a>
</div></li>
<li><strong>DNA origami vaccine (DoriVac) nanoparticles improve both humoral and cellular immune responses to infectious diseases</strong> -
<div>
Current SARS-CoV-2 vaccines have demonstrated robust induction of neutralizing antibodies and CD4+ T cell activation, however CD8+ responses are variable, and the duration of immunity and protection against variants are limited. Here we repurposed our DNA origami vaccine platform, DoriVac, for targeting infectious viruses, namely SARS-CoV-2, HIV, and Ebola. The DNA origami nanoparticle, conjugated with infectious-disease-specific HR2 peptides, which act as highly conserved antigens, and CpG adjuvant at precise nanoscale spacing, induced neutralizing antibodies, Th1 CD4+ T cells, and CD8+ T cells in naive mice, with significant improvement over a bolus control. Pre-clinical studies using lymph-node-on-a-chip systems validated that DoriVac, when conjugated with antigenic peptides or proteins, induced promising cellular immune responses in human cells. These results suggest that DoriVac holds potential as a versatile, modular vaccine platform, capable of inducing both humoral and cellular immunities. The programmability of this platform underscores its potential utility in addressing future pandemics.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.29.573647v1" target="_blank">DNA origami vaccine (DoriVac) nanoparticles improve both humoral and cellular immune responses to infectious diseases</a>
</div></li>
<li><strong>Major role of S-glycoprotein in providing immunogenicity and protective immunity in mRNA lipid nanoparticle vaccines based on SARS-CoV-2 structural proteins</strong> -
<div>
Recently we have developed an mRNA lipid nanoparticle (mRNA-LNP) platform providing efficient long-term expression of an encoded gene in vivo after both intramuscular and intravenous application. Based on this platform, we have generated mRNA-LNP coding SARS-CoV-2 structural proteins M, N, S from different virus variants and studied their immunogenicity separately or in combinations in vivo. As a result, all candidate vaccine compositions coding S and N proteins induced excellent anti-RBD and N titers of binding antibodies. T cell responses mainly represented specific CD4+ T cell lymphocyte producing IL-2 and TNF-. mRNA-LNP coding M protein did not show high immunogenicity. High neutralizing activity was detected in sera of mice vaccinated with mRNA-LNP coding S protein (alone or in combinations) against closely related strains but was not detectable or significantly lower against an evolutionarily distant variant. Our data showed that the addition of mRNAs encoding S and M antigens to the mRNA-N in the vaccine composition enhanced immunogenicity of mRNA-N inducing more robust immune response to the N protein. Based on our results, we suggested that the S protein plays a key role in enhancement of immune response to the N protein in the mRNA-LNP vaccine.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.30.573713v1" target="_blank">Major role of S-glycoprotein in providing immunogenicity and protective immunity in mRNA lipid nanoparticle vaccines based on SARS-CoV-2 structural proteins</a>
</div></li>
<li><strong>An ATP-Binding Cassette Transporter Gene Links Innate and Adaptive Immune Responses</strong> -
<div>
Positive-strand RNA viruses and DNA viruses generate double-stranded RNA (dsRNA) during their replication processes and innate immune responses against viral infections are orchestrated by numerous interferon-stimulating genes, yet the detailed coordination of downstream signaling of anti-viral immune responses is not fully understood. Recent studies suggest 2’-5’-Oligoadenylate Synthetase 1 (OAS1) may have a protective role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections; however, the mechanism regulating OAS1 remains uninvestigated. Our aim is to understand the regulation of OAS1 and its modulation of RNaseL activity, as this has significant implications for responses to RNA viruses, including Vesicular stomatitis virus (VSV) and SARS-CoV-2. We explore the hypothesis that ABCF1 an ATP-binding cassette family member protein, a key regulator of innate immune responses and macrophage polarization and cytokine storm, play a role in regulating the antiviral responses and downstream dsRNA signaling revealed by measuring responses to the synthetic dsRNA analog termed poly (I:C). We utilize ABCF1 haplo-insufficient mice to discover that ABCF1 modulates the amplitude and frequency of VSV-specific Cytolytic T lymphocyte in anti-viral immune responses and suggests that innate immune responses underpin this process. To understand this mechanism, we describe that ABCF1 interacts with 2’-5’-oligoadenylate synthetase 1 (OAS1) which in turn modulates essential proteins that leads to the modulation of RNaseL activity via ABCE1. Furthermore, we find that ABCF1, possibly acting through IRF3 phosphorylation and dimerization, also influences the production of interferon-alpha (IFN-a) and interferon-beta (IFN-b) in bone marrow-derived macrophages. Overall, we unexpectedly discovered that ABCF1 acts as a crucial link between innate and adaptive immunity, regulating the development of adaptive Cytolytic T lymphocyte responses and interacting with OAS1, a key regulator of innate immune responses against viral infections. Exploring pharmacological agents that target ABCE1 or ABCF1 may lead to the discovery of novel modalities for countering SARS CoV-2 and other viruses where OAS1 is a crucial innate immune response gene.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.31.573785v1" target="_blank">An ATP-Binding Cassette Transporter Gene Links Innate and Adaptive Immune Responses</a>
</div></li>
<li><strong>Identifying Best Practices for Future Pandemic Preparedness: A Comparative Policy Analysis</strong> -
<div>
Background: This comparative policy analysis studies government responses to the COVID-19 pandemic, with a focus on countries severely impacted by the virus. The study aims to assess the impact of various confounding variables, including GDP, healthcare spending per capita, poverty rate, and population density, on the effectiveness of pandemic response policies. Methods: The data obtained for the policies employs a multifaceted approach that incorporates both economic and non-economic policies. The analysis includes fiscal policies encompassing healthcare and economic sectors, adaptability in policy adjustments, and non-economic measures. The study also utilizes a principal component analysis (PCA) to identify similarities and differences among countries with varying levels of success. Results: Key findings indicate that successful countries adopted proactive fiscal policies addressing healthcare and economic challenges simultaneously. Flexibility and adaptability in policy adjustments emerged as significant traits among effective responses. Stricter non-economic policies were generally associated with improved pandemic outcomes. Additionally, effective contact tracing played a pivotal role in case identification and isolation. Conclusions: This research underscores the importance of a comprehensive and adaptable approach to pandemic response, considering economic, healthcare, and social factors. The study’s insights offer valuable guidance to governments and policymakers seeking to enhance preparedness plans for future global health crises. As the world continues to grapple with ongoing and evolving pandemic challenges, the lessons drawn from the pandemic can be used as a model of future success.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/preprints/socarxiv/7mwbj/" target="_blank">Identifying Best Practices for Future Pandemic Preparedness: A Comparative Policy Analysis</a>
</div></li>
<li><strong>Assessing the differentiated impacts of COVID-19 on the immigration flows to Europe</strong> -
<div>
The immediate effects of COVID-19 on mortality, fertility, and internal and international migration have been widely studied. Particularly, immigration to high-income countries declined in 2020. However, the persistence of these declines, and the extent to which they have impacted different migration corridors are yet to be established. Drawing on immigration flows from Eurostat and ARIMA time-series models, we assess the impact of COVID-19 on different immigration streams to seven European countries. We forecast counterfactual levels of immigration in 2020 and 2021 assuming no pandemic, and compare these estimates with actual immigration counts. We use regression modelling to explore the role of immigrants´ origin, distance, stringency measures and GDP trends at origins and destinations as potential driving forces of changes in immigration during COVID-19. Our results show that, while there was a general decline in immigration during 2020, inflows returned to expected levels in 2021, except for Spain. However, immigration corridors originating from outside the Schengen Area were still hardly affected in 2021. Immigrant´s origin emerged as the main factor modulating immigration changes during the pandemic, and to a lesser extent stringency measures and GDP trends in destination countries. Contextual factors at origin seem to have been less important.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/bsezk/" target="_blank">Assessing the differentiated impacts of COVID-19 on the immigration flows to Europe</a>
</div></li>
<li><strong>Saponin Nanoparticle Adjuvants Incorporating Toll-Like Receptor Agonists Improve Vaccine Immunomodulation</strong> -
<div>
Over the past few decades, the development of potent and safe immune-activating adjuvant technologies has become the heart of intensive research in the constant fight against highly mutative and immune evasive viruses such as influenza, SARS-CoV-2, and HIV. Herein, we developed a highly modular saponin-based nanoparticle platform incorporating toll-like receptor agonists (TLRas) including TLR1/2a, TLR4a, TLR7/8a adjuvants and their mixtures. These various TLRa-SNP adjuvant constructs induce unique acute cytokine and immune-signaling profiles, leading to specific Th-responses that could be of interest depending on the target disease for prevention. In a murine vaccine study, the adjuvants greatly improved the potency, durability, breadth, and neutralization of both COVID-19 and HIV vaccine candidates, suggesting the potential broad application of these adjuvant constructs to a range of different antigens. Overall, this work demonstrates a modular TLRa-SNP adjuvant platform which could improve the design of vaccines for and dramatically impact modern vaccine development.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.07.16.549249v2" target="_blank">Saponin Nanoparticle Adjuvants Incorporating Toll-Like Receptor Agonists Improve Vaccine Immunomodulation</a>
</div></li>
<li><strong>The Double-Edged Sword Mediatized Integration Processes during the COVID-19 Pandemic</strong> -
<div>
The issue of media appropriation by refugees experienced a boom in 2015, but since then the topic has received less attention over the years. In addition, refugees have faced significant challenges since the appearance of COVID-19. In this paper, I discuss how Syrian migrants and refugees who have lived in Germany for at least four years used media technologies during COVID-19. I present findings from twelve guided interviews conducted in a northern German city. In summary, media use in general has increased, as has that of the majority society. On the other hand, media use during the pandemic has proven to be a double-edged sword: Some refugees had great(er) problems coping with the situation, while others gained self-empowerment and agency through using media during the pandemic.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://osf.io/yjt23/" target="_blank">The Double-Edged Sword Mediatized Integration Processes during the COVID-19 Pandemic</a>
</div></li>
<li><strong>Trivalent mRNA vaccine-candidate against seasonal flu with cross-specific humoral immune response</strong> -
<div>
Seasonal influenza remains a serious global health problem, leading to high mortality rates among the elderly and individuals with comorbidities. It also imposes a substantial economic burden through increased absenteeism during periods of active pathogen circulation. Vaccination is generally accepted as the most effective strategy for influenza prevention. As both influenza A and B viruses circulate and cause seasonal epidemics, vaccines need to include multiple antigens derived from different viral subtypes. While current influenza vaccines are effective, they still have limitations, including narrow specificity for certain serological variants, which may result in a mismatch between vaccine antigens and circulating strains. Additionally, the rapid variability of the virus poses challenges in providing extended protection beyond a single season. Therefore, mRNA technology is particularly promising for influenza prevention, as it enables the rapid development of multivalent vaccines and allows for quick updates of their antigenic composition. mRNA vaccines have already proven successful in preventing COVID-19 by eliciting rapid cellular and humoral immune responses. In this study, we present the development of a trivalent mRNA vaccine candidates, evaluate its immunogenicity using the hemagglutination inhibition assay, and assess its efficacy in animals. We demonstrate the higher immunogenicity of the mRNA vaccine candidates compared to the inactivated split influenza vaccine and its enhanced ability to generate a cross-specific humoral immune response. These findings highlight the potential mRNA technology in overcoming current limitations of influenza vaccines and hold promise for ensuring greater efficacy in preventing seasonal influenza outbreaks.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.30.573722v1" target="_blank">Trivalent mRNA vaccine-candidate against seasonal flu with cross-specific humoral immune response</a>
</div></li>
<li><strong>Tying the Knot: Unraveling the Intricacies of the Coronavirus Frameshift Pseudoknot</strong> -
<div>
Understanding and targeting functional RNA structures towards treatment of coronavirus infection can help us to prepare for novel variants of SARS-CoV-2 (the virus causing COVID-19), and any other coronaviruses that could emerge via human-to-human transmission or potential zoonotic (inter-species) events. Leveraging the fact that all coronaviruses use a mechanism known as -1 programmed ribosomal frameshifting (-1 PRF) to replicate, we apply algorithms to predict the most energetically favourable secondary structures (each nucleotide involved in at most one pairing) that may be involved in regulating the -1 PRF event in coronaviruses, especially SARS-CoV-2. We compute previously unknown most stable structure predictions for the frameshift site of coronaviruses via hierarchical folding, a biologically motivated framework where initial non-crossing structure folds first, followed by subsequent, possibly crossing (pseudoknotted), structures. Using mutual information from 181 coronavirus sequences, in conjunction with the algorithm KnotAli, we compute secondary structure predictions for the frameshift site of different coronaviruses. We then utilize the Shapify algorithm to obtain most stable SARS-CoV-2 secondary structure predictions guided by frameshift sequence-specific and genome-wide experimental data. We build on our previous secondary structure investigation of the singular SARS-CoV-2 68 nt frameshift element sequence, by using Shapify to obtain predictions for 132 extended sequences and including covariation information. Previous investigations have not applied hierarchical folding to extended length SARS-CoV-2 frameshift sequences. By doing so, we simulate the effects of ribosome interaction with the frameshift site, providing insight to biological function. We contribute in-depth discussion to contextualize secondary structure dual-graph motifs for SARS-CoV-2, highlighting the energetic stability of the previously identified 3_8 motif alongside the known dominant 3_3 and 3_6 (native-type) -1 PRF structures. Integrating experimental data within minimum free energy (MFE) hierarchical folding algorithms provides novel structure predictions to distill the relationship between RNA structure and function. In particular, fully categorizing most stable secondary structure predictions via hierarchical folding supports our identification of motif transitions and critical site targets for future therapeutic research.
</div>
<div class="article-link article-html-link">
🖺 Full Text HTML: <a href="https://www.biorxiv.org/content/10.1101/2023.12.28.573501v1" target="_blank">Tying the Knot: Unraveling the Intricacies of the Coronavirus Frameshift Pseudoknot</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>Long COVID Ultrasound Trial</strong> - <b>Conditions</b>: Long Covid <br/><b>Interventions</b>: Device: Splenic Ultrasound <br/><b>Sponsors</b>: SecondWave Systems Inc.; University of Minnesota; MCDC (United States Department of Defense) <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>Immunogenicity After COVID-19 Vaccines in Adapted Schedules</strong> - <b>Conditions</b>: Coronavirus Disease 2019; COVID-19 <br/><b>Interventions</b>: Drug: BNT162b2 30µg; Drug: BNT162b2 20µg; Drug: BNT162b2 6µg; Drug: mRNA-1273 100µg; Drug: mRNA-1273 50µg; Drug: ChAdOx1-S [Recombinant] <br/><b>Sponsors</b>: Universiteit Antwerpen <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>Could Wearing Face Mask Have Affected Demodex Parasite</strong> - <b>Conditions</b>: Pandemic, COVID-19; Demodex Infestation <br/><b>Interventions</b>: Diagnostic Test: standard superficial skin biopsy (SSSB) <br/><b>Sponsors</b>: Nurhan Döner Aktaş <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>TDCS Stimulation After Covid-19 Infection</strong> - <b>Conditions</b>: COVID-19 <br/><b>Interventions</b>: Procedure: Transcranial Direct Stimulation <br/><b>Sponsors</b>: Istanbul Medipol University Hospital; Alanya Alaaddin Keykubat 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>Safety and Immunogenicity of a Booster Vaccination With an Adapted Vaccine</strong> - <b>Conditions</b>: SARS-CoV2 Infection <br/><b>Interventions</b>: Biological: PHH-1V81; Biological: Comirnaty Omicron XBB1.5 <br/><b>Sponsors</b>: Hipra Scientific, S.L.U <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>A Study to Evaluate the Safety, Tolerability, and Immunogenicity of a Combined Modified RNA Vaccine Candidate Against COVID-19 and Influenza.</strong> - <b>Conditions</b>: Influenza; COVID-19 <br/><b>Interventions</b>: Biological: Influenza and COVID-19 Combination A; Biological: Licensed influenza vaccine; Biological: COVID-19 Vaccine; Biological: Influenza and COVID-19 Combination B; Biological: Placebo <br/><b>Sponsors</b>: BioNTech SE; Pfizer <br/><b>Not yet recruiting</b></p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Transcranial Pulse Stimulation (TPS) in Post-COVID-19</strong> - <b>Conditions</b>: Post-COVID-19 Syndrome; Fatigue <br/><b>Interventions</b>: Device: Transcranial pulse stimulation Verum; Device: Transcranial pulse stimulation Sham <br/><b>Sponsors</b>: Medical University of Vienna; Campus Bio-Medico University <br/><b>Not yet recruiting</b></p></li>
</ul>
<h1 data-aos="fade-right" id="from-pubmed">From PubMed</h1>
<ul>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Plant extracts modulate cellular stress to inhibit replication of mouse Coronavirus MHV-A59</strong> - The Covid-19 infection outbreak led to a global epidemic, and although several vaccines have been developed, the appearance of mutations has allowed the virus to evade the immune response. Added to this is the existing risk of the appearance of new emerging viruses. Therefore, it is necessary to explore novel antiviral therapies. Here, we investigate the potential in vitro of plant extracts to modulate cellular stress and inhibit murine hepatitis virus (MHV)-A59 replication. L929 cells were…</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 trial of an inhibitor of plasminogen activator inhibitor-1 (TM5614) in mild to moderate COVID-19</strong> - An inhibitor of plasminogen activator inhibitor (PAI)-1, TM5614, inhibited thrombosis, inflammation, and fibrosis in several experimental mouse models. To evaluate the efficacy and safety of TM5614 in human COVID-19 pneumonia, phase IIa and IIb trials were conducted. In an open-label, single-arm trial, 26 Japanese COVID-19 patients with mild to moderate pneumonia were treated with 120-180 mg of TM5614 daily, and all were discharged without any notable side effects. Then, a randomized,…</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>Antiviral effect of palmatine against infectious bronchitis virus through regulation of NF-κB/IRF7/JAK-STAT signalling pathway and apoptosis</strong> - 1. Infectious bronchitis virus (IBV), a gamma-coronavirus, can infect chickens of all ages and leads to an acute contact respiratory infection. This study evaluated the anti-viral activity of palmatine, a natural non-flavonoid alkaloid, against IBV in chicken embryo kidney (CEK) cells.2. The half toxic concentration (CC(50)) of palmatine was 672.92 μM, the half inhibitory concentration (IC(50)) of palmatine against IBV was 7.76 μM and the selection index (SI) was 86.74.3. Mode of action assay…</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>One-step silver coating of polypropylene surgical mask with antibacterial and antiviral properties</strong> - Face masks can filter droplets containing viruses and bacteria minimizing the transmission and spread of respiratory pathogens but are also an indirect source of microbes transmission. A novel antibacterial and antiviral Ag-coated polypropylene surgical mask obtained through the in situ and one-step deposition of metallic silver nanoparticles, synthesized by silver mirror reaction combined with sonication or agitation methods, is proposed in this study. SEM analysis shows Ag nanoparticles fused…</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 novel inhibitor of SARS-CoV infection: Lactulose octasulfate interferes with ACE2-Spike protein binding</strong> - The ongoing challenge of managing coronaviruses, particularly SARS-CoV-2, necessitates the development of effective antiviral agents. This study introduces Lactulose octasulfate (LOS), a sulfated disaccharide, demonstrating significant antiviral activity against key coronaviruses including SARS-CoV-2, SARS-CoV, and MERS-CoV. We hypothesize LOS operates extracellularly, targeting the ACE2-S-protein axis, due to its low cellular permeability. Our investigation combines biolayer interferometry…</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>IFN-γ-mediated control of SARS-CoV-2 infection through nitric oxide</strong> - INTRODUCTION: The COVID-19 pandemic has highlighted the need to identify mechanisms of antiviral host defense against SARS-CoV-2. One such mediator is interferon-g (IFN-γ), which, when administered to infected patients, is reported to result in viral clearance and resolution of pulmonary symptoms. IFN-γ treatment of a human lung epithelial cell line triggered an antiviral activity against SARS-CoV-2, yet the mechanism for this antiviral response was not identified.</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>HDAC1-3 inhibition increases SARS-CoV-2 replication and productive infection in lung mesothelial and epithelial cells</strong> - CONCLUSION: This study highlights a previously unrecognized effect of HDAC1-3 inhibition in increasing SARS-CoV-2 cell entry, replication and productive infection correlating with increased expression of ACE2 and TMPRSS2. These data, while adding basic insight into COVID-19 pathogenesis, warn for the use of HDAC inhibitors in SARS-CoV-2 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>Should Virtual Objective Structured Clinical Examination (OSCE) Teaching Replace or Complement Face-to-Face Teaching in the Post-COVID-19 Educational Environment: An Evaluation of an Innovative National COVID-19 Teaching Programme</strong> - Background The COVID-19 pandemic brought about drastic changes to medical education and examinations, with a shift to online lectures and webinars. Additionally, social restrictions in the United Kingdom (UK) inhibited students’ ability to practice for objective structured clinical examination (OSCE) with their peers. Methods The Virtual OSCE buddy scheme (VOBS) provided a means to practice OSCE skills virtually by linking groups of 2-6 final-year medical students with a junior doctor who had…</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>Valorizing pomegranate wastes by producing functional silver nanoparticles with antioxidant, anticancer, antiviral, and antimicrobial activities and its potential in food preservation</strong> - The food sector generates massive amounts of waste, which are rich in active compounds, especially polyphenols; therefore, valorizing these wastes is a global trend. In this study, we produce silver nanoparticles from pomegranate wastes, characterized by enhanced antioxidant, anticancer, antiviral, and antimicrobial properties and investigated their potential to maintain the fruit quality for sixty days in market. The pomegranate waste-mediated silver nanoparticles (PPAgNPs) were spherical shape…</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>Antibody-Conjugated Magnetic Nanoparticle Therapy for Inhibiting T-Cell Mediated Inflammation</strong> - Tolerance induction is critical for mitigating T cell-mediated inflammation. Treatments based on anti-CD3 monoclonal antibody (mAb) play a pivotal role in inducing such tolerance. Anti-CD3 mAb conjugated with dextran-coated magnetic nanoparticles (MNPs) may induce inflammatory tolerance is posited. MNPs conjugated with anti-CD3 mAb (Ab-MNPs) are characterized using transmission and scanning electron microscopy, and their distribution is assessed using a nanoparticle tracking analyzer. Compared…</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>Optimization of the 5-plex digital PCR workflow for simultaneous monitoring of SARS-CoV-2 and other pathogenic viruses in wastewater</strong> - Wastewater-based epidemiology is a valuable tool for monitoring pathogenic viruses in the environment, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19). While quantitative polymerase chain reaction (qPCR) is widely used for pathogen surveillance in wastewater, it can be affected by inhibition and is limited to relative quantification. Digital PCR (dPCR) offers potential solutions to these limitations. In this…</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>Porcine delta coronavirus inhibits NHE3 activity of porcine intestinal epithelial cells through miR-361-3p/NHE3 regulatory axis</strong> - Porcine deltacoronavirus (PDCoV) infection in piglets can cause small intestinal epithelial necrosis and atrophic enteritis, which leads to severe damages to host cells, and result in diarrhea. In this study, we investigated the relationship between miR-361, SLC9A3(Solute carrier family 9, subfamily A, member 3), and NHE3(sodium-hydrogen exchanger member 3) in in porcine intestinal epithelial cells (IPI-2I) cells after PDCoV infection. Our results showed that the ssc-miR-361-3p expression…</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><em>In silico</em> study of inhibition activity of boceprevir drug against 2019-nCoV main protease</strong> - Boceprevir drug is a ketoamide serine protease inhibitor with a linear peptidomimetic structure that exhibits inhibition activity against 2019-nCoV main protease. This paper reports electronic properties of boceprevir and its molecular docking as well as molecular dynamics simulation analysis with protein receptor. For this, the equilibrium structure of boceprevir has been obtained by DFT at B3LYP and ωB97XD levels with 6-311+G(d,p) basis set in gas and water mediums. HOMO-LUMO and absorption…</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>Novel sofosbuvir derivatives against SARS-CoV-2 RNA-dependent RNA polymerase: an in silico perspective</strong> - The human coronavirus, SARS-CoV-2, had a negative impact on both the economy and human health, and the emerging resistant variants are an ongoing threat. One essential protein to target to prevent virus replication is the viral RNA-dependent RNA polymerase (RdRp). Sofosbuvir, a uridine nucleotide analog that potently inhibits viral polymerase, has been found to help treat SARS-CoV-2 patients. This work combines molecular docking and dynamics simulation (MDS) to test 14 sofosbuvir-based…</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>Differential Roles of Interleukin-6 in Severe Acute Respiratory Syndrome-Coronavirus-2 Infection and Cardiometabolic Diseases</strong> - Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can lead to a cytokine storm, unleashed in part by pyroptosis of virus-infected macrophages and monocytes. Interleukin-6 (IL-6) has emerged as a key participant in this ominous complication of COVID-19. IL-6 antagonists have improved outcomes in patients with COVID-19 in some, but not all, studies. IL-6 signaling involves at least 3 distinct pathways, including classic-signaling, trans-signaling, and trans-presentation…</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>Gaza Is Starving</strong> - The chief economist of the World Food Program explains how the scarcity of food may tip the territory into famine. - <a href="https://www.newyorker.com/news/q-and-a/gaza-is-starving">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Why the Noise of L.A. Helicopters Never Stops</strong> - The L.A.P.D. says it has the largest local airborne law-enforcement unit in the world. A recent audit found little evidence that its choppers deter crime. - <a href="https://www.newyorker.com/news/letter-from-los-angeles/why-the-noise-of-la-helicopters-never-stops">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>When Americans Are the Threat at the Border</strong> - Many people charged with trafficking in Tucson are U.S. citizens, suffering from the same problems of poverty and addiction that plague the rest of the country. - <a href="https://www.newyorker.com/news/daily-comment/when-americans-are-the-threat-at-the-border">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>The California Town Owned by a New York Investment Firm</strong> - Scotia was created, a century and a half ago, so that lumberjacks could live near the trees they cut down. Its current owners have been trying for more than a decade to bring new residents to town. - <a href="https://www.newyorker.com/news/us-journal/scotia-the-california-town-owned-by-a-new-york-investment-firm">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Could a Trump Win Put His Running Mate in Office?</strong> - Senate Republicans’ brief in the Supreme Court surprisingly argues just that. - <a href="https://www.newyorker.com/news/daily-comment/could-a-trump-win-put-his-running-mate-in-office">link</a></p></li>
</ul>
<h1 data-aos="fade-right" id="from-vox">From Vox</h1>
<ul>
<li><strong>The Fifth Circuit just made it even more dangerous to be pregnant in a red state</strong> -
<figure>
<img alt="A person in a sun hat walks in a crowd waving a flag that reads “Bans off our bodies.”" src="https://cdn.vox-cdn.com/thumbor/Y1ok0oXBezaIKxBVZkfFJZW-GNA=/167x0:2834x2000/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73020400/1259022129.0.jpg"/>
<figcaption>
Abortion-rights activists march to the US Supreme Court on June 24, 2023, in Washington, DC. | Anna Rose Layden/Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Trumpiest court in America just tried to neutralize a federal law requiring most hospitals to provide medically necessary abortions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IiaWlL">
On Tuesday, a <a href="https://www.vox.com/policy-and-politics/2022/12/27/23496264/supreme-court-fifth-circuit-trump-court-immigration-housing-sexual-harrassment">notoriously right-wing federal appeals court</a> attempted to rewrite a federal law that, among other things, <a href="https://www.vox.com/scotus/2023/12/4/23984674/supreme-court-abortion-emtala-emergency-medically-necessary-idaho">requires most US hospitals</a> to provide abortions to patients who are experiencing a medical emergency if a doctor determines that an <a href="https://www.vox.com/abortion">abortion</a> will stabilize the patient.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="XsvjLU">
The case is <a href="https://www.ca5.uscourts.gov/opinions/pub/23/23-10246-CV0.pdf"><em>Texas v. Becerra</em></a>, and all three of the United States Court of Appeals for the Fifth Circuit’s judges who joined this opinion were appointed by Republicans. Two, including Kurt Engelhardt, the opinion’s author, were appointed by former <a href="https://www.vox.com/donald-trump">President Donald Trump</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="scmPi7">
The case involves the <a href="https://www.law.cornell.edu/uscode/text/42/1395dd">Emergency Medical Treatment and Labor Act</a> (EMTALA), a federal statute requiring hospitals that accept Medicare funds to provide “such treatment as may be required to stabilize the medical condition” of “any individual” who arrives at the hospital’s ER with an “emergency medical condition.” (In limited circumstances, the hospital may transfer the patient to a different facility that will provide this stabilizing treatment.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="TPRUYX">
EMTALA contains no carve-out for abortion. It simply states that, whenever any patient arrives at a Medicare-funded hospital with a medical emergency, the hospital must offer that patient whatever treatment is necessary to “stabilize the medical condition” that caused the emergency. So, if a patient’s emergency condition can only be stabilized by an abortion, federal law requires nearly all hospitals to provide that treatment. (Hospitals can opt out of EMTALA by not taking Medicare funds but, because Medicare funds <a href="https://www.vox.com/health-care">health care</a> for elderly Americans, very few hospitals do opt out.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7CL2D2">
This federal law, moreover, also states that it overrides (or “preempts,” to use the appropriate legal term) state and local laws “<a href="https://www.law.cornell.edu/uscode/text/42/1395dd">to the extent that the [state law] directly conflicts with a requirement of this section</a>.” So, in states with sweeping abortion bans that prohibit some or all medically necessary abortions, the state law must give way to EMTALA’s requirement that all patients must be offered whatever treatment is necessary to stabilize their condition.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="M0gk2m">
It is important to emphasize just how little EMTALA has to say about abortion. EMTALA does not protect healthy women who wish to terminate their pregnancies. Nor does it preempt any state regulations of abortion, except when a patient is experiencing a medical emergency and their doctors determine that an abortion is the appropriate treatment.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="tTHGIr">
But when an emergency room patient presents with a life-threatening illness or condition — or, in the words of the EMTALA statute, that patient has a condition that places their health “in serious jeopardy,” that threatens “serious impairment to bodily functions,” or “serious dysfunction of any bodily organ or part” — then Medicare-funded hospitals must provide whatever treatment is necessary.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7YMlft">
The <em>Texas </em>case, in other words, asks whether a state government can force a woman to die, or suffer lasting injury to her uterus or other reproductive organs, because the state’s lawmakers are so opposed to abortion that they will not permit it, even when such an abortion is required by federal law.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1tQ38g">
And yet, despite the fact that the EMTALA statute is unambiguous, and despite the fact that this case only involves patients whose life or health is threatened by a pregnancy, three Fifth Circuit judges told those patients that they have no right to potentially lifesaving medical care.
</p>
<h3 id="SLavTq">
The Fifth Circuit had no business hearing this case in the first place
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KNQX31">
This case never should have been heard by any federal court. That’s because it involves a fake dispute over a nonbinding document produced by the <a href="https://www.vox.com/joe-biden">Biden administration</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5uDyEc">
Federal agencies sometimes issue binding regulations, which have the force of law, often impose new legal restrictions on private parties, and may be challenged in federal court.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4edPSl">
The government also sometimes releases a nonbinding document, often referred to as a “guidance,” which explains how the federal government understands a particular law. One important difference between these nonbinding guidances and more formal announcements of new regulations is that a guidance does not impose any new legal obligations on individuals or businesses.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="q5vAyr">
In 2022, the Department of Health and Human Services <a href="https://www.cms.gov/files/document/qso-22-22-hospitals.pdf">issued such a document</a> “to restate existing guidance for hospital staff and physicians regarding their obligations under the Emergency Medical Treatment and Labor Act (EMTALA), in light of new state laws prohibiting or restricting access to abortion.” This guidance explained that EMTALA still requires most hospitals to provide patients experiencing a medical emergency with “stabilizing treatment within the capability of the hospital” — including, in appropriate cases, an abortion.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="BLmvG7">
As the Fifth Circuit has acknowledged in the past, “an agency’s actions are not reviewable” by a federal court “<a href="https://scholar.google.com/scholar_case?case=4003887446881112013&amp;hl=en&amp;as_sdt=6&amp;as_vis=1&amp;oi=scholarr">when they merely reiterate what has already been established</a>.” Similarly, the Fifth Circuit has also conceded, in cases that don’t involve abortion, that federal courts typically may not hear a lawsuit challenging a federal agency’s action when the agency “<a href="https://casetext.com/case/belle-co-v-us-army-corps-of-engrs">merely expresses its view of what the law requires of a party</a>, even if that view is adverse to the party.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ctr18k">
So, when Texas and two anti-abortion groups filed this lawsuit, which challenges HHS’s 2022 guidance, the case should have immediately been tossed out.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IqNHQE">
Nevertheless, Engelhardt and his fellow Fifth Circuit judges used this fake dispute over a nonbinding document as an excuse not just to hear the <em>Texas</em> case, but to declare that HHS’s reading of EMTALA is wrong and that the statute must be read to exclude abortions. This error alone is sufficient reason for the <a href="https://www.vox.com/scotus">Supreme Court</a> to step in and toss Engelhardt’s decision in the garbage.
</p>
<h3 id="mdasGy">
How Engelhardt justified rewriting EMTALA
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MoEaUX">
Engelhardt’s <a href="https://www.ca5.uscourts.gov/opinions/pub/23/23-10246-CV0.pdf">opinion</a> is surprisingly brief for such a consequential decision, and for one that reads a straightforward federal law in such a counterintuitive way. The section of the opinion laying out Engelhardt’s unusual reading of this federal law is only about eight pages long — yet it contains at least three separate legal errors.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="qpXir8">
For starters, Engelhardt places an enormous amount of weight on his claim that the EMTALA statute “did not explicitly address whether physicians must provide abortions.” He is correct that the word “abortion” does not appear in the EMTALA statute, but so what? Rather than itemizing every possible medical procedure that a doctor may need to perform during a medical emergency, EMTALA contains a blanket statement that hospitals must provide “such treatment as may be required to stabilize the medical condition” that caused a patient’s emergency.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="870GZU">
The EMTALA statute also does not use words like “appendectomy” or “bowel resection.” That doesn’t mean that a patient who needs their appendix removed to treat a medical emergency or whose life is threatened by an intestinal blockage must simply lie in their hospital bed and suffer until they die.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="DbHYdE">
Similarly, Engelhardt relies on a provision of federal Medicare law that says EMTALA should not be read “to authorize any Federal officer or employee to <a href="https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html/USCODE-2011-title42-chap7-subchapXVIII.htm">exercise any supervision or control over the practice of medicine</a> or the manner in which medical services are provided.” But there are two problems with reading this provision to create an abortion exception to EMTALA.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KJZZYw">
One is that this provision only applies to “any Federal officer or employee.” But, as the Justice Department <a href="https://www.supremecourt.gov/DocketPDF/23/23A470/291907/20231130143432646_23A469%20and%2023A470%20Response.pdf">explained in a recent brief to the Supreme Court</a>, “EMTALA’s stabilization obligation was enacted by <a href="https://www.vox.com/congress">Congress</a>, not imposed by a ‘Federal officer or employee.’”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fWzhUJ">
The purpose of this provision is to prevent federal officials from second-guessing medical decisions made by doctors and their patients. But neither the text of EMTALA itself nor HHS’s guidance document interpreting EMTALA claims that doctors must perform abortions when they deem those abortions unnecessary. The law simply provides that, when a doctor does<em> </em>determine that an abortion is medically necessary and the patient consents to that treatment, then the hospital must provide it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cHt5cr">
Engelhardt also points to a few provisions of EMTALA that require hospitals to stabilize a pregnant patient’s “unborn child” if the fetus is also experiencing a medical emergency. He claims that this language “requires hospitals to stabilize both the pregnant woman and her unborn child,” thus precluding an abortion. (Engelhardt does not appear to recognize that there are some cases where a patient cannot be saved unless their pregnancy is terminated.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="M3zRMK">
In any event, this apparent tension between a pregnant patient’s survival and that of the fetus is resolved by a provision that lays out hospitals’ precise obligations under EMTALA. A hospital is not required to perform an abortion against a patient’s wishes. Nor does it require the hospital to choose who lives and who dies in a sad case where one will die no matter what.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="vesgpW">
Instead, EMTALA states that a hospital <a href="https://www.law.cornell.edu/uscode/text/42/1395dd">meets its obligations if it “offers” the patient stabilizing treatment</a> and informs that patient “of the risks and benefits to the individual of such examination and treatment.” So, in a case where a patient is forced to choose between an abortion, which will stabilize their own condition, or a treatment that would save the fetus but leave the pregnant patient at risk, EMTALA requires a hospital to offer the patient either treatment and to explain the terrible choice facing them. And then it requires the hospital to honor the patient’s choice.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7cwWrD">
In any event, there are some signs that the Supreme Court, even the same Court that recently overruled <a href="https://www.vox.com/2022/5/3/23055125/roe-v-wade-abortion-rights-supreme-court-dobbs-v-jackson"><em>Roe v. Wade</em></a>, will reject Engelhardt’s twisted reading of the EMTALA statute. Last October, the Ninth Circuit left in place a trial court decision <a href="https://www.vox.com/scotus/2023/12/4/23984674/supreme-court-abortion-emtala-emergency-medically-necessary-idaho">holding that EMTALA means exactly what it says</a>, and thus hospitals in Idaho must provide emergency abortions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="PeG4b3">
The Ninth Circuit’s decision is currently before the Supreme Court on its “<a href="https://www.vox.com/2020/8/11/21356913/supreme-court-shadow-docket-jail-asylum-covid-immigrants-sonia-sotomayor-barnes-ahlman">shadow docket</a>,” but the justices have sat on the case without deciding it for more than a month. That’s a sign that the most stridently anti-abortion justices may not have the votes to rewrite the EMTALA statute to exclude abortions.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IUApoP">
Moreover, the fact that lower court judges disagree on whether EMTALA means what it says is a sign the Supreme Court is likely to review the Fifth Circuit’s decision. The justices frequently hear cases that divide lower courts, especially when two federal circuit courts disagree. So Engelhardt is unlikely to have the final word on whether states can ban medically necessary abortions.
</p></li>
<li><strong>Pregnancy care deserts are growing. Indigenous babies are at risk.</strong> -
<figure>
<img alt="Several exterior signs for Oyate Health Center next to a mobile health care unit bearing the health center’s logo under a blue sky." src="https://cdn.vox-cdn.com/thumbor/msICTrws9Z57ISYs1NgQh5f4_6c=/240x0:1680x1080/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73019720/Tara_Weston_final_17.0.jpg"/>
<figcaption>
A mobile health care unit outside Oyate Health Center, a tribally owned facility that provides prenatal care, in December 2023 in Rapid City, South Dakota. | Tara Rose Weston for Vox
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Solving the congenital syphilis crisis means investing in rural maternity care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="cprJ8J">
In mid-July, in the basement of Monument Health’s flagship hospital in Rapid City, South Dakota, neonatologist Kimberly Balay searches her phone for a photograph. The image is of a slide from a presentation she makes often, but wishes she didn’t have to: a graph that shows her hospital’s congenital syphilis cases rocketing up over just the past three years.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WkgVFz">
In 2018, Balay’s neonatal intensive care unit (NICU) saw its first case in 10 years. Then, it saw four cases a year in 2019 and 2020. Afterward, the curve shoots skyward. In 2021, there were 19 cases; in 2022, 32. “We pretty much constantly had somebody in our NICU” with the infection, she says.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="5tCN3N">
As medical director of one of only three NICUs in South Dakota, Balay knew this had to represent a much bigger problem. She talked about it to anyone who would listen — namely, other <a href="https://www.vox.com/health-care">health care</a> providers, city officials, tribal decision-makers. “People were always just like, yeah, I can’t believe that — syphilis? No, we got rid of that. And I’m like, no, no, it’s here. It’s in South Dakota. It’s affecting my babies,” she said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nU2Z3l">
Until the early 2010s, women only rarely got infected with syphilis. But in 2012, women’s infection rates began to tick upward, and rose more than 700 percent across the US according to estimates from the Centers for Disease Control and Prevention (CDC).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4fQUMR">
At the same time, congenital syphilis cases — in-utero infections that have high rates of disability and death — also began to lurch <a href="https://www.vox.com/23952456/syphilis-mortality-death-infant-newborn-congenital-babies-prenatal-maternity-pregnancy-desert">out of control</a> throughout the US. Transmission has been particularly intense in South Dakota. Last year, the state had the <a href="https://www.cdc.gov/std/statistics/2021/tables/13.htm">highest rate</a> of sexually transmitted syphilis infections, and the <a href="https://www.cdc.gov/std/statistics/2021/tables/20.htm">seventh highest</a> congenital syphilis rate.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="oJQO6h">
Nationally, infections in both adults and infants have increased faster in Native Americans than in any other racial or ethnic group, especially over the course of the pandemic — a trend also mirrored in South Dakota. But the concentration of cases in this group “has nothing to do with the color of their skin or their race,” said Balay. “It’s a disease of access.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="901puC">
Many providers like Balay see an obvious link between rising congenital syphilis rates and sparse access to obstetric care (i.e., care for pregnant people, also called maternity or prenatal care). That’s largely because, historically, prenatal care is where syphilis transmission to a fetus has been interrupted. Testing is standard in prenatal care, and all but eight states <a href="https://www.cdc.gov/std/treatment/syphilis-screenings.htm">require syphilis testing during pregnancy</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Y4MJpU">
The problem is simple, as Balay explains. “There just is not enough obstetric care,” she said. And as prenatal care becomes increasingly scarce, so do opportunities to catch and treat syphilis.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="MuWHE6">
Balay is not alone in thinking that scarcity helps explain what’s happening with congenital syphilis, especially among Indigenous Americans.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="fQZdLA">
In a recent CDC <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7246e1.htm">report</a>, 37 percent of US babies with syphilis were born to parents who didn’t get timely syphilis testing during pregnancy. But that number was higher, 47 percent, when the parents were American Indian. And most of those parents who didn’t get timely testing didn’t get any prenatal care at all.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="sDEE5P">
In rural states, increasingly inadequate maternity care access is making intensified mother-to-child syphilis transmission all but inevitable. That puts Indigenous women and their newborns at especially high risk.
</p>
<h3 id="u8DKJK">
Why maternal care access is worse for Indigenous mothers
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="CgVxL3">
All pregnant people in rural areas are at a geographical disadvantage when it comes to getting care. About <a href="https://www.chartis.com/sites/default/files/documents/rural_americas_ob_deserts_widen_in_fallout_from_pandemic_12-19-23.pdf">a quarter</a> of rural obstetric units have closed since 2011.<strong> </strong>According to a 2022 March of Dimes <a href="https://www.marchofdimes.org/maternity-care-deserts-report">report</a> on maternity care deserts — US counties without adequate obstetric providers or birth centers — two out of every three such deserts are rural.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VPOJHl">
Twenty-two percent of Indigenous Americans <a href="https://www.brookings.edu/wp-content/uploads/2022/09/GS_IOP_indigenous-rural-community.pdf">live in rural areas</a>, a higher proportion than any other racial or ethnic group. However, Indigenous Americans’ access to maternity care is often worse than that of other rural residents. In a <a href="https://www.sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/mrg_obstetrics_hung_forhp_8.8.22.pdf">study</a> conducted by researchers at the University of South Carolina’s Rural and Minority Health Research Center, rural Indigenous communities were farther from hospital-based obstetric units than any other rural communities. Additionally, more than half were at least 30 miles away from the nearest obstetric unit. (Although prenatal care often happens outside a hospital setting, providers are most likely to practice near an obstetric unit.)
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xOzN2G">
Amplifying that disadvantage is the fact rural Indigenous people are <a href="https://link.springer.com/article/10.1007/s11116-023-10429-6">less likely to own a vehicle</a> than other rural Americans, and are twice as likely to be carless as their white peers.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="KZ7alm">
Transportation is an immense and persistent problem for people trying to access prenatal care at the Kyle Health Center on the Pine Ridge reservation, said Dayle Knutson, a registered nurse who is the Indian Health Service’s (IHS) chief nurse officer for the Great Plains area. The reservation is vast, covering about <a href="https://www.bia.gov/regional-offices/great-plains/south-dakota/pine-ridge-agency">2.1 million acres</a> of land; Kyle is about 50 miles from the big IHS hospital in Pine Ridge. The clinic has a full-time midwife who provides obstetric care. However, many patients can’t physically get to the clinic due to a lack of <a href="https://www.vox.com/transportation">transportation</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IGwgwZ">
The risk to South Dakota’s mothers is concentrated in its rural areas, and especially on its reservations in the western part of the state. The March of Dimes defines a <a href="https://www.marchofdimes.org/peristats/reports/south-dakota/maternity-care-deserts">broad swath of counties statewide</a> as maternity care deserts. However, as can be seen in the below map, women in the western part of the state, especially those in <a href="https://sdtribalrelations.sd.gov/tribes/nine-tribes.aspx">counties containing reservations</a>, travel further to get care, partly due to less well-developed road systems.
</p>
<div class="c-float-right">
<figure class="e-image">
<img alt=" " src="https://cdn.vox-cdn.com/thumbor/khmm2SdpU6LNSVEVFhAxmJdl7pc=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25178719/Screenshot_2023_12_21_at_8.42.17_AM.png"/> <cite><a class="ql-link" href="https://www.marchofdimes.org/peristats/reports/south-dakota/maternity-care-deserts" target="_blank">March of Dimes</a></cite>
<figcaption>
In South Dakota, women in the western part of the state (especially those in counties containing reservations) travel further to get care.
</figcaption>
</figure>
</div>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="76Hnyh">
Although being able to physically access a prenatal care provider is an obvious barrier to getting prenatal care, another more subtle obstacle may also affect Indigenous Americans more than others. Substance use disorders have caused <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910676/">disproportionate</a> misery in America’s Indigenous communities, and many US states <a href="https://nida.nih.gov/about-nida/noras-blog/2023/02/pregnant-people-substance-use-disorders-need-treatment-not-criminalization">criminalize</a> drug use during pregnancy. This leads many of the women who’d most benefit from prenatal care to <a href="https://www.vox.com/health/23688319/syphilis-rates-women-rising-substance-use-health-care">avoid</a> it.
</p>
<h3 id="KxBVVk">
How sparse maternal care creates the conditions for syphilis
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zbUoWZ">
South Dakota offers a case study in how sparse maternal care creates challenges to stopping a congenital syphilis outbreak.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="4XHhEq">
The state lost many of its rural labor and delivery sites decades ago, as decreasing numbers of births in these areas meant these sites weren’t making enough money to stay open, said <a href="https://communityhealthcare.net/wp-content/uploads/2021/05/bio-ten-napel-1.pdf">Shelly Ten Napel</a>, CEO of the Community HealthCare Association of the Dakotas, a nonprofit organization representing primary care providers. “It’s just really hard to sustain [labor and delivery services] at a high quality level if you don’t have the volume,” said Ten Napel.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="3GjD6O">
At the same time, obstetric care became highly specialized, making it harder for the family care practitioners who used to deliver babies to stay up-to-date on current practices. As a result, many of these providers dropped pregnancy care from their repertoires.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="eD7RIX">
The <a href="https://www.vox.com/obamacare">Affordable Care Act</a>’s Medicaid expansion in 2010 made it <a href="https://www.kff.org/health-costs/issue-brief/rural-hospitals-face-renewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/">easier</a> for rural hospitals to stay open. But a lot of South Dakota’s hospital closures happened before its passage.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ww5sOh">
In her office across town from Balay’s NICU, OB-GYN <a href="https://www.rapidcityobgyn.com/medical-team">Rochelle Christensen</a> said the dearth of providers means her “patients drive three hours for their prenatal care sometimes.” There are now no labor and delivery services between the midpoint of the state and the hospital where she delivers babies in Rapid City, near the western edge of the state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Xu5Ec4">
Many Indigenous patients in the western part of the state used to get free obstetric care at IHS sites, located on or near reservations. (Free care was guaranteed to Indigenous people as a treaty right to compensate for centuries-old injustices.) But plagued by underfunding and difficulty recruiting providers, IHS facilities have progressively closed many of their childbirth services. In testimony provided during a 2021 <a href="https://www.usccr.gov/files/2021/07-14-Maternal-Mortality-and-Health-Disparities-of-American-Indian-Women-in-South-Dakota.pdf">federal inquiry</a> into South Dakota’s Indigenous maternal mortality crisis, tribal members described low standards of care in IHS maternity services, and closures or funding changes at IHS facilities that have forced local women to drive hundreds of miles to get routine prenatal care. Overall, according to <a href="https://www.usatoday.com/in-depth/news/health/2022/08/11/rural-native-americans-suffer-lack-maternal-health-care-access/10084897002/">reporting in USA Today</a>, only nine IHS facilities in six states offered childbirth services as of summer 2022.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AMIXoA">
Instead of going to IHS facilities, patients from reservations often come to Rapid City, said Balay, to get their prenatal care from a certified nurse midwife at the tribally owned <a href="https://www.oyatehealth.com/">Oyate Health Center</a>. But those providers are now themselves overloaded: In July, CDC epidemiologists investigating the state’s syphilis outbreak noted the health center’s two midwives were together caring for more than 200 patients, a heavy burden.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WT2lyC">
At the end of the CDC’s two-week investigation, its team <a href="https://www.greatplainstribalhealth.org/downloads/health-topics/tribal-epidemiology-center/sexual-health-education/180-gptlhb-epi-aid-syphilis-transmission-risk-factors-out-briefing-presentation-8-1-23/file.html">presented their findings</a> to more than 130 tribal and state <a href="https://www.vox.com/public-health">public health</a> staff. Among the most important drivers of the state’s syphilis outbreak were the scarcity of maternal health care and the lack of transportation, said the presenters.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="EL5Q46">
To overcome these barriers, the Kyle Health Center on the Pine Ridge Reservation employs public health nurses who see patients in their home or at their workplaces — “wherever they agree to” — for visits at least three times during their pregnancy, said Knutson. And just a few months ago, IHS implemented policies that permit those nurses to provide syphilis treatment with penicillin in the field. But even for them, it’s sometimes challenging to locate patients’ homes on the vast reservation.
</p>
<h3 id="Gy8HOO">
What could help solve the maternal care crisis — and what stands in the way
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xdynQ2">
One of the most promising solutions to South Dakota’s maternal care scarcity problem got a boost last year when the state’s voters approved an initiative to expand Medicaid beginning in early 2023. The expansion means more than <a href="https://www.cms.gov/newsroom/press-releases/south-dakota-expands-medicaid-bringing-health-coverage-more-52000-state-residents#:~:text=South%20Dakota%20Expands%20Medicaid%20Bringing,than%2052%2C000%20State%20Residents%20%7C%20CMS">52,000</a> of the state’s residents are newly insured, which shifts the costs of their care from IHS to a better-funded federal program. It also means that hospitals caring for these patients will get paid more for the care they provide to the thousands of tribal residents newly covered by Medicaid. And most importantly to patients, expansion will make it more <a href="https://www.pbs.org/newshour/nation/how-south-dakota-voters-could-help-save-the-lives-of-uninsured-moms">financially feasible</a> to get the care they need.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AgSgMq">
All of that is good for improving IHS’s solvency because it increases what it recoups from insurance payments, said Ten Napel, which could eventually lead to broader maternity care availability in Indian Country.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V4wKlE">
While the birth rate is relatively low in most of the state, it is high on many of its reservations because their populations <a href="https://openprairie.sdstate.edu/cgi/viewcontent.cgi?article=1094&amp;context=sd_demography_conference#:~:text=state%20had%20an%20increase%20of,ranked%2015th%20in%20percent%20change).&amp;text=steadily%20in%20the%20past%2015,ranged%20from%200.3%20to%201.3).&amp;text=Of%20an%20increase%20of%2051%2C000,41%20percent%20were%20net%20migration.">skew younger</a>. If pregnant people are insured by Medicaid and they get care at IHS before, during, and after they give birth, IHS can collect payment from Medicaid for their care — which amounts to <a href="https://www.kff.org/medicaid/issue-brief/medicaid-and-american-indians-and-alaska-natives/">better compensation</a> than IHS would receive from the federal government for uninsured patients.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lysI46">
Compared with health facilities in other parts of the state with lower birth rates, facilities in South Dakota’s Indian Country stand to earn more from the maternity care they already provide. And those earnings would allow IHS to invest in providing even more maternity care.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="FVtw8z">
Still, other state policies may make it difficult to reexpand the state’s rural prenatal care availability. When the constitutional right to <a href="https://www.vox.com/abortion">abortion</a> was overturned nationally last June, South Dakota’s <a href="https://www.vox.com/2022/6/25/23182753/roe-overturned-abortion-access-reproductive-rights-trigger-laws">trigger law</a> banning abortion took effect immediately afterward. These types of laws threaten to widen maternity care deserts, said <a href="https://medicine.iu.edu/faculty/23603/wilkinson-tracey">Tracey Wilkinson</a>, a pediatrician who specializes in reproductive health issues at Indiana University’s medical school, by scaring away providers who fear being unable to practice the full scope of medical care. “We are seeing the experts in maternity care, such as OB-GYN and maternal-fetal medicine doctors, leave — they’re just leaving states,” she said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="6CY1Jf">
According to reporting by nonprofit news outlet South Dakota Searchlight, many of the state’s pregnancy care providers feel <a href="https://southdakotasearchlight.com/2023/05/13/sd-physicians-trapped-abortion-ban-trigger-law-health-life-mother-death/">trapped</a> by the law, and newly trained OB-GYNs say the restrictions have led them to <a href="https://southdakotasearchlight.com/2023/05/15/south-dakota-womens-health-care-shortage-abortion-ban-worsen-physicians-residents/">reconsider establishing practices</a> in the state.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="9VDdIp">
OB-GYN <a href="https://www.sanfordhealth.org/doctors/heather-spies">Heather Spies</a>, whose Sioux Falls practice is in the eastern part of South Dakota, pushed back against that idea, and said providers can work within the boundaries of the law to provide necessary care to pregnant people. So far, she said, she hasn’t seen anyone stop practicing in the state because of the restrictions. It’s as yet unclear what effects these changes will have on the state’s prenatal care deserts. And it also remains to be seen how improvement in care will impact syphilis transmission.
</p>
<h3 id="kJCtnf">
Tribes could mount a bigger response — but face roadblocks
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Amz1Ez">
During <a href="https://www.vox.com/2023/5/9/23715753/debt-ceiling-limit-default-deal-crisis">debt ceiling</a> negotiations earlier this year, <a href="https://www.vox.com/congress">Congress</a> <a href="https://www.cdc.gov/std/dstdp/dcl/2023-june-29-Mena-UpdateOnSTIPreventionFunding.htm">slashed</a> the last two years of a five-year grant that supports state disease intervention specialists. These employees are responsible for the bulk of South Dakota’s syphilis contact tracing, and defunding their work may mean less outbreak control, and more syphilis spread.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="GDQBVu">
Tribes themselves could play an important role in containing syphilis outbreaks on reservations. But they’re not able to because for years, the state has <a href="https://www.vox.com/24006120/south-dakota-syphilis-congenital-indigenous-tribal-native-american-meghan-oconnell-health-board">declined to tell tribal public health authorities</a> who in their communities needs treatment and contact tracing.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="rSmTIg">
There’s some hope in this regard: A state health department representative told Vox in December that the agency is in the process of negotiating a data-sharing agreement with tribal public health leadership. If this happens, tribes could potentially help transport pregnant people from remote areas to get testing and treatment, or could treat them in their homes, and could design programs to track and stop chains of transmission within tribal communities.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="B6mTbw">
Balay has other ideas for how South Dakota could address both maternal care scarcity and the need to stop syphilis spread: Mobile units, for example, could provide much-needed prenatal care and treatment for pregnant people with syphilis in the most isolated areas of the state. Support for that “could come from, I don’t know, a state with a surplus of $96.8 million this year,” she said, referring to an <a href="https://www.instagram.com/p/CuzgsFSrUls/">Instagram post</a> by Gov. Kristi Noem, which boasted of the surplus earlier this year.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="AZAmf8">
Whatever the details, urgently finding a solution aligns with both the priorities Balay feels the state should have, and the priorities its leaders says it has. “We are a state that prides itself on small government. However, the purpose of government is to protect its citizens,” she said.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="WGfqvz">
“We are a very pro-life state. This is a life-and-death matter.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="zfIQuf">
<em>This story was reported as part of an </em><a href="https://healthjournalism.org/"><em>Association of Health Care Journalists</em></a><em> fellowship, supported by the </em><a href="https://www.commonwealthfund.org/"><em>Commonwealth Fund</em></a><em>.</em>
</p></li>
<li><strong>Israel’s Supreme Court just overturned Netanyahu’s pre-war power grab</strong> -
<figure>
<img alt="Protesters hold signs and flags against a backdrop of lit-up office buildings at night, including a large sign reading “Help us keep our freedom.”" src="https://cdn.vox-cdn.com/thumbor/_-lKyMTpJydRcodmzBMBY0kb5U4=/234x0:3967x2800/1310x983/cdn.vox-cdn.com/uploads/chorus_image/image/73019192/1248039327.0.jpg"/>
<figcaption>
A protest against Netanyahu’s judicial overhaul in Tel Aviv on March 11, 2023. | Amir Levy/Getty Images
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The Court was acting to protect Israeli democracy. But it may also have sowed the seeds of a future crisis.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="meYyx0">
If it weren’t for the war, the latest ruling by Israel’s Supreme Court would be the biggest news in the country in quite some time.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dOIssd">
The ruling, released on New Year’s Day, annulled <a href="https://www.vox.com/2023/7/24/23805532/israel-judicial-overhaul-reasonableness">the single biggest piece of legislation</a> passed by Israeli Prime Minister <a href="https://www.vox.com/23910085/netanyahu-israel-right-hamas-gaza-war-history">Benjamin Netanyahu</a>’s far-right coalition. The Court’s reasoning fundamentally changes the balance of power in Israel’s democracy — so fundamentally, in fact, that some members of the elected government have vowed not to abide by it. If that happens, <a href="https://www.vox.com/israel">Israel</a> will be thrown into a full-blown constitutional crisis.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="jcZHZ7">
About a year ago, Netanyahu proposed a sweeping overhaul to Israel’s judiciary — one that would, in effect, put it under his personal thumb. Mass protests succeeded in blocking most of the overhaul. Only <a href="https://www.vox.com/2023/7/24/23805532/israel-judicial-overhaul-reasonableness">one plank</a> — curtailing the power of the courts to overturn government policy — actually became law, an amendment to Israel’s “Basic Laws,” the closest thing the country has to a constitution. This is the law that was just overturned by the Supreme Court.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="7MdpeE">
In doing so, the Court came to two key conclusions. First, that it has the general power to overturn Basic Laws — a power it had never deployed before. Second, that this new Basic Law was threatening enough to Israeli democracy that the court was justified in overruling it.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="IuMzaS">
In peacetime, a ruling this epochal would transform Israeli politics, reorienting everything around the question of the court’s new claim to power and (plausible) claim to be saving Israeli democracy.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="60P3sD">
But with the country enmeshed <a href="https://www.vox.com/2023/10/20/23919946/israel-hamas-war-gaza-palestine-ground-invasion-strategy">in an existential war in Gaza</a>, the domestic reaction to the court’s ruling is far less explosive than it would be otherwise. Whether this lasts — or whether Israel erupts into a domestic political crisis to match its current international peril — is far from clear.
</p>
<h3 id="BfK6PB">
Why Israel’s Supreme Court just made history
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ky3jOX">
At the beginning of 2023, Netanyahu had just returned to power after roughly one year in opposition. His new coalition, the most far-right in Israeli history, was united around one cause: reining in an independent Supreme Court that got in the way of their ambitions. In January, Justice Minister Yariv Levin unveiled a judicial reform package that would impose sweeping political controls on the judiciary — granting the Knesset, Israel’s parliament, new powers to appoint justices and even overrule Supreme Court decisions by a simple majority vote.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="Ab9tEf">
Leading <a href="https://en.idi.org.il/articles/50487">Israeli</a> and <a href="https://www.theglobeandmail.com/canada/article-israel-netanyahu-supreme-court/">international</a> legal observers saw the plan as a naked power grab. Ruling Israeli coalitions are already extremely powerful by international standards: the country lacks checks and balances like a formal constitution, a Senate-style upper house, a federal system, or a separately elected chief executive. The judiciary is pretty much the only check on what majorities do: if Netanyahu succeeded in neutering it, he would be free to pursue his <a href="https://www.vox.com/policy-and-politics/2020/2/27/21075868/israeli-democracy-war-netanyahu">demonstrably authoritarian political agenda</a> without constraint.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="wkBS8J">
In response, Israelis filled the streets in unprecedented numbers, protests that succeeded in blocking the initial push to overhaul the court in March. So Netanyahu turned to what scholars of democratic backsliding call “salami slicing”: splitting the bill into pieces and passing them in sequence rather than all at once.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="lgyfY3">
Ultimately, Netanyahu only managed to get one of these pieces passed before <a href="https://www.vox.com/2023/10/7/23907683/israel-hamas-war-news-updates-october-2023">the October 7 attack by Hamas</a> forced him to put off the push indefinitely — the Basic Law amendment that the Supreme Court just overturned.
</p>
<figure class="e-image">
<img alt="A sign pointing to the Supreme Court in Jerusalem is backdropped by dozens of people on the nearby sidewalks with banners and signs." src="https://cdn.vox-cdn.com/thumbor/E_skgpHporsDh5rHbPv-ZHkosEo=/800x0/filters:no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/25200880/1659540451.jpg"/> <cite>Mostafa Alkharouf/Anadolu Agency/Getty Images</cite>
<figcaption>
People gather outside Israel’s Supreme Court during a demonstration against the judicial overhaul on September 12, 2023.
</figcaption>
</figure>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dXcUzn">
This new law eliminated courts’ power to overturn decisions by Israel’s Cabinet or its ministers that they find to be “extremely unreasonable,” a vague-sounding standard that has a more technical meaning in Israeli law. In the simplest terms, the courts used this doctrine to block policies when the government can’t prove that its decisions were made according to some <a href="https://en.idi.org.il/articles/50104">basic standards of fair and just policymaking</a>.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LBQgf2">
To be clear, this “reasonableness” standard is not used to review legislation. It’s a principle of administrative law, meaning it’s used to assess policy decisions by members of the executive branch — primarily, the prime minister and Cabinet members. Last January, for example, the court ruled that it would be “extremely unreasonable” for Netanyahu to appoint <a href="https://www.jpost.com/israel-news/article-728898">Aryeh Deri</a>, a legislator convicted on tax fraud charges, to lead the interior and health ministries.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="uIU8zc">
Reasonableness is a <a href="https://www.nytimes.com/article/israel-judicial-overhaul-vote.html">relatively common judicial principle internationally</a>. It is especially useful in systems like Israel’s, that have few checks on arbitrary exercises of power by government officials. It is not without its flaws; the potential for judicial overreach is obvious. But instead of trying to limit reasonableness, the new Basic Law abolished it altogether — taking away one of the principal judicial tools for checking executive misconduct.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="ot2HpD">
According to Israel’s Supreme Court, the danger was so huge that it justified an unprecedented step: overturning a Basic Law by judicial fiat.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="j1RoRc">
“In rare cases in which the beating heart of the Israeli form of constitution is harmed, this court is authorized to declare the invalidation of a Basic Law that has in some way exceeded the Knesset’s authority,” former Israeli Supreme Court President Esther Hayut <a href="https://www.haaretz.com/israel-news/2024-01-01/ty-article/.premium/israels-high-court-set-to-release-ruling-on-netanyahu-govt-key-judicial-coup-law/0000018c-c01f-d3e0-abac-d8bf3c2d0000">wrote in her ruling</a> (despite having recently retired, Hayut heard the case and thus was empowered to rule on it).
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="kk0FNj">
This is hardly an obvious point. Typically, Basic Laws function like a constitution in Israel: when overturning legislation, the Court will frequently cite them as the legal foundation for their rulings. But in this case, 12 justices (out of 15) agreed that the Court can overturn them by appealing to Israel’s foundational identity as a Jewish and democratic state. If any law, even a Basic one, poses a serious enough threat to Israeli democracy, then the Court is justified in striking it down.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="1U17gX">
The justices were more split on whether the abolition of reasonableness was such a dire case, with a narrow 8-7 majority ruling that it was.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="c0REqh">
“In my view, it is not possible to square the amendment to the Basic Law on the Judiciary and the principle of the separation of powers and the principle of the rule of law, which are two of the most important characteristics of our democratic system,” Hayut wrote. “Such a violation at the very heart of our founding narrative cannot stand.”
</p>
<h3 id="cR5XtN">
Could Israel be heading for a second crisis?
</h3>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="LPGoLk">
With all that background in mind, you can see why this ruling is such a bombshell. The Court has just asserted a major new power and used it to rule against the government on the issue that dominated Israeli politics for the majority of last year. Under normal circumstances, this ruling would define the course of Israeli politics for the coming months.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="itCLbc">
But at the same time, there’s <a href="https://www.nytimes.com/2024/01/02/world/middleeast/israel-supreme-court-netanyahu.html">a general sense</a> that the government won’t do anything about it as long as the war is going on. The government’s rhetoric, while highly critical of the court, has (somewhat cynically) blamed the court for harming wartime unity rather than calling for an immediate policy response. Even the <a href="https://twitter.com/Yonatan_Touval/status/1742180889998606634">most extreme far-right responses</a>, such as a legislator’s tweet equating the Supreme Court to <a href="https://www.vox.com/politics/2023/10/10/23911661/hamas-israel-war-gaza-palestine-explainer">Hamas</a> and Hezbollah, called for action against the Court after wartime.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="V3jYGN">
What such action would look like is straightforward: a simple refusal to acknowledge the Court’s authority to overturn a Basic Law.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="VRtn7X">
When the Court first agreed to take up a challenge to the new Basic Law after its summer passage, Netanyahu suggested <a href="https://www.haaretz.com/israel-news/2023-07-27/ty-article/netanyahu-says-scrapping-reasonableness-clause-minor-correction-in-abc-news-interview/00000189-9773-d5eb-abcb-fff76d510000">he might not accept</a> the legitimacy of a ruling overturning their ban on reasonableness. After the decision on Monday, Justice Minister Levin warned that the Court’s ruling “<a href="https://www.timesofisrael.com/levin-declares-high-court-wont-stay-our-hand-after-justices-annul-overhaul-law/">would not stay our hand</a>” — seemingly a warning that his government would reject any court ruling that declares one of its future decisions as “unreasonable.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="RBs1KC">
This is the textbook definition of a constitutional crisis: a situation where two different legal authorities do not agree on what the law is or how to resolve their disagreement. Were it to happen, it would be an existential threat to the survival of Israel’s political system — a crisis the country might not be able to manage in peacetime, let alone during war.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="h2lwjs">
Luckily, there is a reasonable chance it may not come to that.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="0iqaIB">
The ban on reasonableness review, and the judicial overhaul in general, has <a href="https://en.idi.org.il/articles/50098">long been</a> unpopular. There is almost no chance the government will press the issue during the war with Hamas, and it may not be able to afterward. The Israeli public <a href="https://www.vox.com/23954323/return-of-liberal-zionism-israel">largely blames the government for failing to prevent Hamas’s attack on October 7</a>, and its poll numbers are plummeting. <a href="https://www.economist.com/middle-east-and-africa/2024/01/02/israels-supreme-court-strikes-back">The Economist</a> reports that, seeing this polling collapse, some members of Netanyahu’s Likud party are privately admitting that they no longer have the juice to pick a fight over the Supreme Court.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="xsrZpH">
Whether that will remain true, however, is an open question.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="nbVJcL">
The future of Israeli politics will depend heavily on how the war ends and what the world looks like afterward. With Israel settling in for extended fighting in <a href="https://www.vox.com/2018/11/20/18080046/gaza-palestine-israel">Gaza</a>, we can’t be sure what the political climate will look like in the coming months. Developments on the ground — not just on the war front, but also in <a href="https://www.cnn.com/2023/12/04/world/netanyahu-corruption-trial-resumes/index.html">Netanyahu’s ongoing corruption trial</a> — could well prompt the prime minister to return to his assault on the judiciary.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom" id="dh5Nf0">
Right now, all we can be sure of is that the Court has just fired a major volley in <a href="https://www.vox.com/policy-and-politics/2020/2/27/21075868/israeli-democracy-war-netanyahu">a long-running war over Israeli democracy</a> — one that will surely shape the future of that democracy for years to come.
</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>Daily Quiz | On Indian sportspersons</strong> - Here’s a quiz on some major records created by Indian sportspersons in 2023</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>IND vs SA second Test | India level series with seven-wicket win in two-day finish</strong> - A vintage Bumrah was in full bloom on a tailor-made surface.</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>WFI to challenge its suspension next week, calls EC meeting on January 16</strong> - The wrestling federation has maintained that it neither accepts the suspension nor does it recognise the ad-hoc panel that has been constituted by the IOA to manage the day-to-day affairs of the sport.</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>ICC amends stumping, concussion substitute rules</strong> - The modification has come into effect on December 12, 2023</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>Australia’s Usman Khawaja completes 7,000 international runs</strong> - In 69 Tests, Khawaja scored 5,224 runs in 122 innings at an average of 47.06</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>Six new COVID-19 cases in Telangana on January 3: MoHFW</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Here are the big stories from Karnataka today</strong> - Welcome to the Karnataka Today newsletter, your guide from The Hindu on the major news stories to follow today. Curated and written by Nalme Nachiyar.</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>ECI releases schedule for election to vacant MLC seats under MLA quota</strong> - Two seats fell vacant following resignation of BRS members Kadiam Srihari and Kaushik Reddy who were elected as MLAs</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. CM Stalin inaugurates women’s hostels, fisheries infrastructure</strong> -</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>BJP wants me arrested so I can’t campaign for LS polls: Kejriwal on ED summons</strong> - Kejriwal had skipped the Enforcement Directorate summons on Wednesday for the third time.</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>Swedish snow chaos leaves 1,000 vehicles trapped on main E22 road</strong> - The army is called in to help drivers in southern Sweden amid a big freeze across the Nordic countries.</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>Queen Margrethe II of Denmark embarks on final ride in gold carriage before abdication</strong> - Queen Margrethe II will formally step down next Sunday, after announcing her abdication last month.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine and Russia in ‘biggest prisoner swap’ so far</strong> - Both sides thanked the United Arab Emirates for mediating the deal.</p></li>
<li data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Ukraine war: What Russia’s escalating air attacks mean</strong> - In just five days, Russia has fired 500 missiles and drones at Ukraine. What does it mean for the war?</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>Mary, Crown Princess of Denmark: Australia celebrates an unexpected queen</strong> - Mary Donaldson met Crown Prince Frederik by chance in a Sydney bar - now she’s about to become queen of Denmark.</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>The Dell XPS laptop, as we know and love it, is no more</strong> - 2024 laptops all look like the XPS 13 Plus. XPS 15, 17, and 2-in-1 going away. - <a href="https://arstechnica.com/?p=1993478">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Microsoft is adding a new key to PC keyboards for the first time since 1994</strong> - Copilot key will eventually be required in new PC keyboards, though not yet. - <a href="https://arstechnica.com/?p=1993416">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Mandiant, the security firm Google bought for $5.4 billion, gets its X account hacked</strong> - Scammer impersonates legitimate cryptocurrency wallet, then pivots to trolling Mandiant. - <a href="https://arstechnica.com/?p=1993618">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>Forget the proverbial wisdom: Opposites don’t really attract, study finds</strong> - Educational attainment, substance use were most common shared traits among couples. - <a href="https://arstechnica.com/?p=1992842">link</a></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>ChatGPT bombs test on diagnosing kids’ medical cases with 83% error rate</strong> - It was bad at recognizing relationships and needs selective training, researchers say. - <a href="https://arstechnica.com/?p=1993601">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>An FBI agent tells a Montana rancher, ‘I need to inspect your ranch for illegal grown drugs.’ The old rancher says, ‘Okay, but don’t go in that field over there.’</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The agent turns and quickly s in the face of the rancher: ‘Mister, I have the authority of the Federal Government with me.’ Reaching into his rear pant pocket and removing his badge. The officer proudly displays it to the farmer. ‘See this badge? This badge means I am allowed to go wherever I wish, on any land. No questions asked or answered given. Have I made myself clear? Do you understand?’<br/> The old rancher nods politely and goes about his chores. Later, the old rancher hears loud screams and spies the agent running for his life and close behind is the rancher’s bull. With every step the bull is gaining ground on the agent. The agent is clearly terrified.<br/> The old rancher immediately throws down his tools, runs to the fence and yells at the top of his lungs….. ‘Your badge! Show him your badge!’
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Waitsfornoone"> /u/Waitsfornoone </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/18xzgnq/an_fbi_agent_tells_a_montana_rancher_i_need_to/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/18xzgnq/an_fbi_agent_tells_a_montana_rancher_i_need_to/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>I love “technically true” jokes, like:</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
If everybody in the world held hands around the equator, most of them would drown.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Or
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Did you know that after all these years, the swimming pool on Titanic is still filled with water?
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Or
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
There are more airplanes in the ocean than submarines in the sky.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
What else you got? (It doesn’t have to be water-related…)
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/TheBeautySara"> /u/TheBeautySara </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/18xolhz/i_love_technically_true_jokes_like/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/18xolhz/i_love_technically_true_jokes_like/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>A little boy was saying his prayers before bed one night …</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
… and his dad happened to walk by and overheard him.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He said “God bless mommy, god bless daddy, god bless grammy, and goodbye grampy”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The next day his grandpa died. The boy’s dad thought that was pretty strange, but just a coincidence.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The next night the dad was walking by the boy’s room again while he was saying his prayers again, and he heard “God bless mommy, god bless daddy, goodbye grammy”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
The next day his grandma passed away. Now the father was really freaked out. That night he again overheard the little boy praying before bed. “God bless mommy, goodbye daddy”.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Well, the next morning he got up really early, and went to work. Stayed there all day, and came home at midnight. He started to apologize to his wife when he got home about being late.
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
He said, “I’m really sorry, I had a really bad day at work and really long.”
</p>
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
His wife said “You think you had a bad day, the postman dropped dead on the front porch this afternoon!”
</p>
</div>
<!-- SC_ON -->
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/Boofrick"> /u/Boofrick </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/18y1jm0/a_little_boy_was_saying_his_prayers_before_bed/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/18y1jm0/a_little_boy_was_saying_his_prayers_before_bed/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>What do you call someone who is gender neutral and lactose intolerant?</strong> - <!-- SC_OFF --></p>
<div class="md">
<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom">
Non buy-dairy
</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/BigDanRTW"> /u/BigDanRTW </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/18y4hwc/what_do_you_call_someone_who_is_gender_neutral/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/18y4hwc/what_do_you_call_someone_who_is_gender_neutral/">[comments]</a></span></p></li>
<li><p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"><strong>My ex gf was buy sexual</strong> - <!-- SC_OFF --></p>
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When you buy her stuff, she becomes sexual
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<p data-aos="fade-left" data-aos-anchor-placement="bottom-bottom"> submitted by <a href="https://www.reddit.com/user/iluvreddit"> /u/iluvreddit </a> <br/> <span><a href="https://www.reddit.com/r/Jokes/comments/18yabrk/my_ex_gf_was_buy_sexual/">[link]</a></span> <span><a href="https://www.reddit.com/r/Jokes/comments/18yabrk/my_ex_gf_was_buy_sexual/">[comments]</a></span></p></li>
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