Mixed urinary incontinence presents a clinical conundrum. Patients with mixed urinary incontinence report symptoms of both stress incontinence (loss of urine with exertion) and urge incontinence (loss of urine with urgency). Mixed urinary incontinence is a combination of the two that affects 37% of women older than age 65 years.¹ The personal and societal costs of incontinence are significant. In women with symptoms of severe urinary incontinence, the cost of supplies, laundry, and dry cleaning range from $900 to $4000 annually.² By 80 years of age, 20% of women will undergo surgery for stress or mixed urinary incontinence.³ Physical and behavioral therapy improves both incontinence types, and medications are standard treatment for urgency urinary incontinence. When conservative therapies fail, conventional guidance has been to treat the urgency prior to the stress component of mixed incontinence, because anti-incontinence surgical procedures can worsen urgency incontinence, and many urgency treatments are medical rather than surgical.^4-7 Another strategy has been to treat whichever symptom is dominant.⁸

A previously published randomized trial of patients with mixed urinary incontinence compared midurethral sling plus behavioral and physical therapy vs sling alone. Findings from the Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence (ESTEEM) trial revealed that both groups, with or without behavioral and physical therapy, reported improved urgency symptoms, findings that substantiated prior cohort studies.^9-11 While the original hypothesis of ESTEEM was that treating both components of mixed urinary incontinence with behavioral and physical therapy plus sling would result in better patient outcomes, ESTEEM revealed that urgency symptoms can improve with the midurethral sling alone, challenging previously held beliefs about the impact of anti-incontinence surgeries worsening the urgency component of mixed incontinence.

In this issue of JAMA, investigators report the results of an important trial that is the next natural step in exploring how best to treat mixed urinary incontinence.¹² The Treatment for Mixed Urinary Incontinence: Midurethral Sling vs Botox A (MUSA) is a randomized clinical trial of 137 patients with mixed urinary incontinence and moderate bother from both stress and urge symptoms randomized to either the midurethral sling or 100 U of onabotulinumtoxinA.¹² Participants had an average number of 7 leakage episodes a day, representing patients severely affected by incontinence. Importantly, patients previously had unsuccessful conservative interventions, including medications. The investigators hypothesized that treating the urgency component of mixed urinary incontinence with onabotulinumtoxinA would result in better outcomes than focusing on the stress component with a midurethral sling.

Mucosal-associated invariant T (MAIT) cells are innate-like T cells defined by their semi-invariant T cell receptor (TCR) and restriction by the MHC class I-related molecule (MR1). These cells are pr…

A team of physicists from the University at Albany has proposed scientifically rigorous methods for documenting and analyzing Unidentified Anomalous Phenomena (UAP) building upon the work of numerous past and present researchers in the field.

The team tested their methods in the field for the first time and reported their findings in Progress in Aerospace Sciences.

UAP is the term used by government agencies like NASA to refer to “observations of events in the sky that cannot be identified as aircraft or known natural phenomena.”

Scientists at the Institute for Basic Science (IBS) have uncovered a non-invasive method to boost the brain’s natural waste drainage system—a discovery that could open new avenues for tackling age-related neurological disorders.

In a study published in Nature, researchers from the IBS Center for Vascular Research, led by Director Koh Gou Young, along with senior researchers Jin Hokyung, Yoon Jin-Hui, and principal researcher Hong Seon Pyo, demonstrate that precisely stimulating the lymphatics under skin on the neck and face can significantly enhance the flow of cerebrospinal fluid (CSF)—the liquid that cushions the brain and helps remove toxic waste —through lymphatic vessels.

This offers a new approach to clearing brain waste using safe, non-invasive mechanical stimulation, rather than relying on drugs or surgical interventions.

New research has overturned a long-held belief in neuroscience by showing that the brain uses separate synaptic transmission sites for spontaneous and evoked signaling.

Eclampsia is a serious pregnancy complication and is associated with cerebral edema and infarctions. However, the underlying pathophysiology of eclampsia remains poorly explored.

A team at the University of California, Los Angeles has developed a low-cost diagnostic pen that converts handwriting into electrical signals for early detection of Parkinson’s disease, achieving 96.22% accuracy in a pilot study.

Parkinson’s disease impairs the motor system, leading to tremors, stiffness, and slowed movements that impair fine motor functions such as handwriting. Clinical diagnosis today largely relies on subjective observations, which are prone to inconsistency and often inaccessible in low-resource settings. Biomarker-based diagnostics, while objective, remain constrained by cost and technical complexity.

In the study, “Neural network-assisted personalized handwriting analysis for Parkinson’s disease diagnostics,” published in Nature Chemical Engineering, researchers engineered a diagnostic pen to capture real-time motor signals during handwriting and convert them into quantifiable electrical outputs for disease classification.

A new simulation by researchers shows how a neutron star violently cracks seconds before vanishing into a black hole.

In Experiment 1, chimpanzees and children are significantly more motivated to watch videos of social interactions compared with videos of a conspecific acting alone. Children are also significantly more likely to open the social box compared with the nonsocial box, and trend towards opening the door of the social box wider. What is driving this effect? One option is that chimpanzees and children possess a specific drive to gain information about social interactions. Another option is information quantity: a social interaction between two agents naturally contains more information than does a single agent acting alone, as the interaction provides information not only about the two actors but also about the nature of their relationship. Therefore, children and chimpanzees might show stronger curiosity for social interactions compared with individual agents to gain more information.

The Big Bang is often described as the explosive birth of the universe—a singular moment when space, time and matter sprang into existence. But what if this was not the beginning at all? What if our universe emerged from something else—something more familiar and radical at the same time?

In a new paper, published in Physical Review D, my colleagues and I propose a striking alternative. Our calculations suggest the Big Bang was not the start of everything, but rather the outcome of a gravitational crunch or collapse that formed a very massive black hole—followed by a bounce inside it.

This idea, which we call the black hole universe, offers a radically different view of cosmic origins, yet it is grounded entirely in known physics and observations.