Integration of Patient Reported Quality-of-life Data into Risk Assessment in Heart Failure.

BACKGROUND: Optimal management of outpatients with heart failure (HF) requires serially updating the estimates of their risk for adverse clinical outcomes to guide treatment. Patient-reported outcomes (PROs) are becoming increasingly used in clinical care. The purpose of this study was to determine whether the inclusion of PROs can improve the risk prediction for HF hospitalization and death in ambulatory patients with HF. METHODS AND RESULTS: We included consecutive patients with HF with reduced ejection fraction (HFrEF) and HF with preserved EF (HFpEF) seen in a HF clinic between 2015 and 2019 who completed PROs as part of routine care. Cox regression with a least absolute shrinkage and selection operator regularization and gradient boosting machine analyses were used to estimate risk for a combined outcome of HF hospitalization, heart transplant, left ventricular assist device implantation, or death. The performance of the prediction models was evaluated with the time-dependent concordance index (Cτ). Among 1165 patients with HFrEF (mean age 59.1 ± 16.1, 68% male), the median follow-up was 487 days. Among 456 patients with HFpEF (mean age 64.2 ± 16.0 years, 55% male) the median follow-up was 494 days. Gradient boosting regression that included PROs had the best prediction performance - Cτ 0.73 for patients with HFrEF and 0.74 in patients with HFpEF, and showed very good stratification of risk by time to event analysis by quintile of risk. The Kansas City Cardiomyopathy Questionnaire overall summary score, visual analogue scale and Patient Reported Outcomes Measurement Information System dimensions of satisfaction with social roles and physical function had high variable importance measure in the models. CONCLUSIONS: PROs improve risk prediction in both HFrEF and HFpEF, independent of traditional clinical factors. Routine assessment of PROs and leveraging the comprehensive data in the electronic health record in routine clinical care could help more accurately assess risk and support the intensification of treatment in patients with HF.

Supercritical CO2 and Subcritical H2O Analysis Instrument: Automated Lipid Analysis for In Situ Planetary Life Detection.

The search for extraterrestrial extant or extinct life in our Solar System will require highly capable instrumentation and methods for detecting low concentrations of biosignatures. This paper introduces the Supercritical CO2 and Subcritical H2O Analysis (SCHAN) instrument, a portable and automated system that integrates supercritical fluid extraction (SFE), supercritical fluid chromatography (SFC), and subcritical water extraction coupled with liquid chromatography. The instrument is compact and weighs 6.3 kg, making it suitable for spaceflight missions to planetary bodies. Traditional techniques, such as gas chromatography-mass spectrometry (MS), face challenges with involatile and thermally labile analytes, necessitating derivatization. The SCHAN instrument, however, eliminates the need for derivatization and cosolvents by utilizing neat supercritical CO2 with water as an additive. This SFE-SFC-MS method gives efficient lipid biosignature separations with median detection limits of 10 pg/g (ppt) for fatty acids and 50 pg/g (ppt) for sterols. Several free fatty acids and cholesterol were among the detected peaks in biologically lean samples from the Atacama Desert, demonstrating the instrument's potential for in situ life detection missions. The SCHAN instrument addresses the challenges of conventional systems, offering a compact, portable, and spaceflight-compatible tool for the analysis of organics for future astrobiology-focused missions.

Planetary Protection Assessment of Radioisotope Thermoelectric Generator (RTG)-Powered Landed Missions to Ocean Worlds: Application to Enceladus.

Landed missions to icy worlds with a subsurface liquid water ocean must meet planetary protection requirements and ensure a sufficiently small likelihood of any microorganism-bearing part of the landed element reaching the ocean. A higher bound on this likelihood is set by the potential for radioisotope thermoelectric generator (RTG) power sources, the hottest possible landed element, to melt through the ice shell and reach the ocean. In this study, we quantify this potential as a function of three key parameters: surface temperature, ice shell thickness (i.e., heat flux through the shell), and thickness of a porous (insulating) snow or regolith cover. Although the model we describe can be applied to any ocean world, we present results in the context of a landed mission concept to the south polar terrain of Saturn's moon Enceladus. In this particular context, we discuss planetary protection considerations for landing site selection. The likelihood of forward microbial contamination of Enceladus' ocean by an RTG-powered landed mission can be made sufficiently low to not undermine compliance with the planetary protection policy.

Science Objectives for Flagship-Class Mission Concepts for the Search for Evidence of Life at Enceladus.

Cassini revealed that Saturn's Moon Enceladus hosts a subsurface ocean that meets the accepted criteria for habitability with bio-essential elements and compounds, liquid water, and energy sources available in the environment. Whether these conditions are sufficiently abundant and collocated to support life remains unknown and cannot be determined from Cassini data. However, thanks to the plume of oceanic material emanating from Enceladus' south pole, a new mission to Enceladus could search for evidence of life without having to descend through kilometers of ice. In this article, we outline the science motivations for such a successor to Cassini, choosing the primary science goal to be determining whether Enceladus is inhabited and assuming a resource level equivalent to NASA's Flagship-class missions. We selected a set of potential biosignature measurements that are complementary and orthogonal to build a robust case for any life detection result. This result would be further informed by quantifications of the habitability of the environment through geochemical and geophysical investigations into the ocean and ice shell crust. This study demonstrates that Enceladus' plume offers an unparalleled opportunity for in situ exploration of an Ocean World and that the planetary science and astrobiology community is well equipped to take full advantage of it in the coming decades.

Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model.

BACKGROUND AND OBJECTIVE: Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program. METHODS: Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS. RESULTS: A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality. CONCLUSIONS: A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.

Astrobiology of life on Earth.

Astrobiology is mistakenly regarded by some as a field confined to studies of life beyond Earth. Here, we consider life on Earth through an astrobiological lens. Whereas classical studies of microbiology historically focused on various anthropocentric sub-fields (such as fermented foods or commensals and pathogens of crop plants, livestock and humans), addressing key biological questions via astrobiological approaches can further our understanding of all life on Earth. We highlight potential implications of this approach through the articles in this Environmental Microbiology special issue 'Ecophysiology of Extremophiles'. They report on the microbiology of places/processes including low-temperature environments and chemically diverse saline- and hypersaline habitats; aspects of sulphur metabolism in hypersaline lakes, dysoxic marine waters, and thermal acidic springs; biology of extremophile viruses; the survival of terrestrial extremophiles on the surface of Mars; biological soils crusts and rock-associated microbes of deserts; subsurface and deep biosphere, including a salticle formed within Triassic halite; and interactions of microbes with igneous and sedimentary rocks. These studies, some of which we highlight here, contribute to our understanding of the spatiotemporal reach of Earth'sfunctional biosphere, and the tenacity of terrestrial life. Their findings will help set the stage for future work focused on the constraints for life, and how organisms adapt and evolve to circumvent these constraints.

Life on Mars: Independent Genesis or Common Ancestor?

The possibility of biological transfer between planetary bodies is seldom factored into life detection strategies, although the actuality of such an event would have profound implications for how we interpret potential biosignatures found on other worlds. This article addresses the possibility of life on Mars in the context of a biological transfer and an independent genesis of life. The phylogenetic tree of life on Earth is used as a blueprint to interpret evidence of life and as a guideline to determine the likelihood that potential biosignatures could be expressed by martian organisms. Several transfer scenarios are considered, depending on the timing of transfer with respect to the evolution of life on Earth. The implications of each transfer scenario and an independent genesis of life on the biochemical nature of the resulting martian organisms are discussed. The analysis highlights how conceding the possibility of a biological transfer has practical implications for how we search for evidence of life, both in terms of the quality of potential biosignatures and the likelihood that certain biosignatures might be expressed. It is concluded that a degree of uncertainty on the origin of martian organisms might be unavoidable, particularly in the absence of a biochemical context.

Incorporation of Unmanned Aerial Vehicle (UAV) Point Cloud Products into Remote Sensing Evapotranspiration Models.

In recent years, the deployment of satellites and unmanned aerial vehicles (UAVs) has led to production of enormous amounts of data and to novel data processing and analysis techniques for monitoring crop conditions. One overlooked data source amid these efforts, however, is incorporation of 3D information derived from multi-spectral imagery and photogrammetry algorithms into crop monitoring algorithms. Few studies and algorithms have taken advantage of 3D UAV information in monitoring and assessment of plant conditions. In this study, different aspects of UAV point cloud information for enhancing remote sensing evapotranspiration (ET) models, particularly the Two-Source Energy Balance Model (TSEB), over a commercial vineyard located in California are presented. Toward this end, an innovative algorithm called Vegetation Structural-Spectral Information eXtraction Algorithm (VSSIXA) has been developed. This algorithm is able to accurately estimate height, volume, surface area, and projected surface area of the plant canopy solely based on point cloud information. In addition to biomass information, it can add multi-spectral UAV information to point clouds and provide spectral-structural canopy properties. The biomass information is used to assess its relationship with in situ Leaf Area Index (LAI), which is a crucial input for ET models. In addition, instead of using nominal field values of plant parameters, spatial information of fractional cover, canopy height, and canopy width are input to the TSEB model. Therefore, the two main objectives for incorporating point cloud information into remote sensing ET models for this study are to (1) evaluate the possible improvement in the estimation of LAI and biomass parameters from point cloud information in order to create robust LAI maps at the model resolution and (2) assess the sensitivity of the TSEB model to using average/nominal values versus spatially-distributed canopy fractional cover, height, and width information derived from point cloud data. The proposed algorithm is tested on imagery from the Utah State University AggieAir sUAS Program as part of the ARS-USDA GRAPEX Project (Grape Remote sensing Atmospheric Profile and Evapotranspiration eXperiment) collected since 2014 over multiple vineyards located in California. The results indicate a robust relationship between in situ LAI measurements and estimated biomass parameters from the point cloud data, and improvement in the agreement between TSEB model output of ET with tower measurements when employing LAI and spatially-distributed canopy structure parameters derived from the point cloud data.

The impact of shadows on partitioning of radiometric temperature to canopy and soil temperature based on the contextual two-source energy balance model (TSEB-2T).

Tests of the most recent version of the two-source energy balance model have demonstrated that canopy and soil temperatures can be retrieved from high-resolution thermal imagery captured by an unmanned aerial vehicle (UAV). This work has assumed a linear relationship between vegetation indices (VIs) and radiometric temperature in a square grid (i.e., 3.6 m × 3.6 m) that is coarser than the resolution of the imagery acquired by the UAV. In this method, with visible, near infrared (VNIR), and thermal bands available at the same high-resolution, a linear fit can be obtained over the pixels located in a grid, where the x-axis is a vegetation index (VI) and the y-axis is radiometric temperature. Next, with an accurate VI threshold that separates soil and vegetation pixels from one another, the corresponding soil and vegetation temperatures can be extracted from the linear equation. Although this method is simpler than other approaches, such as TSEB with Priestly-Taylor (TSEB-PT), it could be sensitive to VIs and the parameters that affect VIs, such as shadows. Recent studies have revealed that, on average, the values of VIs, such as normalized difference vegetation index (NDVI) and leaf area index (LAI), that are located in sunlit areas are greater than those in shaded areas. This means that involving or compensating for shadows will affect the linear relationship parameters (slope and bias) between radiometric temperature and VI, as well as thresholds that separate soil and vegetation pixels. This study evaluates the impact of shadows on the retrieval of canopy and soil temperature data from four UAV images before and after applying shadow compensation techniques. The retrieved temperatures, using the TSEB-2T approach, both before and after shadow correction, are compared to the average temperature values for both soil and canopy in each grid. The imagery was acquired by the Utah State University AggieAir UAV system over a commercial vineyard located in California as part of the USDA Agricultural Research Service Grape Remote sensing Atmospheric Profile and Evapotranspiration Experiment (GRAPEX) Program during 2014 to 2016. The results of this study show when it is necessary to employ shadow compensation methods to retrieve vegetation and soil temperature directly.

Validation of digital surface models (DSMs) retrieved from unmanned aerial vehicle (UAV) point clouds using geometrical information from shadows.

Theoretically, the appearance of shadows in aerial imagery is not desirable for researchers because it leads to errors in object classification and bias in the calculation of indices. In contrast, shadows contain useful geometrical information about the objects blocking the light. Several studies have focused on estimation of building heights in urban areas using the length of shadows. This type of information can be used to predict the population of a region, water demand, etc., in urban areas. With the emergence of unmanned aerial vehicles (UAVs) and the availability of high- to super-high-resolution imagery, the important questions relating to shadows have received more attention. Three-dimensional imagery generated using UAV-based photogrammetric techniques can be very useful, particularly in agricultural applications such as in the development of an empirical equation between biomass or yield and the geometrical information of canopies or crops. However, evaluating the accuracy of the canopy or crop height requires labor-intensive efforts. In contrast, the geometrical relationship between the length of the shadows and the crop or canopy height can be inversely solved using the shadow length measured. In this study, object heights retrieved from UAV point clouds are validated using the geometrical shadow information retrieved from three sets of high-resolution imagery captured by Utah State University's AggieAir UAV system. These flights were conducted in 2014 and 2015 over a commercial vineyard located in California for the USDA Agricultural Research Service Grape Remote sensing Atmospheric Profile and Evapotranspiration Experiment (GRAPEX) Program. The results showed that, although this approach could be computationally expensive, it is faster than fieldwork and does not require an expensive and accurate instrument such as a real-time kinematic (RTK) GPS.

Authorship: from credit to accountability : Reflections from the Editors' Network.

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasised that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness of good scientific and editorial practices.

Effects of Gamma and Electron Radiation on the Structural Integrity of Organic Molecules and Macromolecular Biomarkers Measured by Microarray Immunoassays and Their Astrobiological Implications.

High-energy ionizing radiation in the form of solar energetic particles and galactic cosmic rays is pervasive on the surface of planetary bodies with thin atmospheres or in space facilities for humans, and it may seriously affect the chemistry and the structure of organic and biological material. We used fluorescent microarray immunoassays to assess how different doses of electron and gamma radiations affect the stability of target compounds such as biological polymers and small molecules (haptens) conjugated to large proteins. The radiation effect was monitored by measuring the loss in the immunoidentification of the target due to an impaired ability of the antibodies for binding their corresponding irradiated and damaged epitopes (the part of the target molecule to which antibodies bind). Exposure to electron radiation alone was more damaging at low doses (1 kGy) than exposure to gamma radiation alone, but this effect was reversed at the highest radiation dose (500 kGy). Differences in the dose-effect immunoidentification patterns suggested that the amount (dose) and not the type of radiation was the main factor for the cumulative damage on the majority of the assayed molecules. Molecules irradiated with both types of radiation showed a response similar to that of the individual treatments at increasing radiation doses, although the pattern obtained with electrons only was the most similar. The calculated radiolysis constant did not show a unique pattern; it rather suggested a different behavior perhaps associated with the unique structure of each molecule. Although not strictly comparable with extraterrestrial conditions because the irradiations were performed under air and at room temperature, our results may contribute to understanding the effects of ionizing radiation on complex molecules and the search for biomarkers through bioaffinity-based systems in planetary exploration.

Constraints on the Metabolic Activity of Microorganisms in Atacama Surface Soils Inferred from Refractory Biomarkers: Implications for Martian Habitability and Biomarker Detection.

Dryness is one of the main environmental challenges to microbial survival. Understanding the threshold of microbial tolerance to extreme dryness is relevant to better constrain the environmental limits of life on Earth and critically evaluate long-term habitability models of Mars. Biomolecular proxies for microbial adaptation and growth were measured in Mars-like hyperarid surface soils in the Atacama Desert that experience only a few millimeters of precipitation per decade, and in biologically active soils a few hundred kilometers away that experience two- to fivefold more precipitation. Diversity and abundance of lipids and other biomolecules decreased with increasing dryness. Cyclopropane fatty acids (CFAs), which are indicative of adaptive response to environmental stress and growth in bacteria, were only detected in the wetter surface soils. The ratio of trans to cis isomers of an unsaturated fatty acid, another bacterial stress indicator, decreased with increasingly dry conditions. Aspartic acid racemization ratios increased from 0.01 in the wetter soils to 0.1 in the driest soils, which is indicative of racemization rates comparable to de novo biosynthesis over long timescales (∼10,000 years). The content and integrity of stress proteins profiled by immunoassays were additional indicators that biomass in the driest soils is not recycled at significant levels. Together, our results point to minimal or no in situ microbial growth in the driest surface soils of the Atacama, and any metabolic activity is likely to be basal for cellular repair and maintenance only. Our data add to a growing body of evidence that the driest Atacama surface soils represent a threshold for long-term habitability (i.e., growth and reproduction). These results place constraints on the potential for extant life on the surface of Mars, which is 100-1000 times drier than the driest regions in the Atacama. Key Words: Atacama Desert-Dryness-Growth-Habitability-Biomarker-Mars. Astrobiology 18, 955-966.

Corrosion of bare carbon steel as a passive sensor to assess moisture availability for biological activity in Atacama Desert soils.

Here we consider that the corrosion of polished bared metal coupons can be used as a passive sensor to detect or identify the lower limit of water availability suitable for biological activity in Atacama Desert soils or solid substrates. For this purpose, carbon steel coupons were deposited at selected sites along a west-east transect and removed at predetermined times for morphological inspection. The advantage of this procedure is that the attributes of the oxide layer (corrosion extent, morphology and oxide phases) can be considered as a fingerprint of the atmospheric moisture history at a given time interval. Two types of coupons were used, long rectangular shaped ones that were half-buried in a vertical position, and square shaped ones that were deposited on the soil surface. The morphological attributes observed by SEM inspection were found to correlate to the so-called humectation time which is determined from local meteorological parameters. The main finding was that the decreasing trend of atmospheric moisture along the transect was closely related to corrosion behaviour and water soil penetration. For instance, at the coastal site oxide phases formed on the coupon surface rapidly evolve into well-crystallized species, while at the driest inland site Lomas Bayas only amorphous oxide was observed on the coupons.

Transitory microbial habitat in the hyperarid Atacama Desert.

Traces of life are nearly ubiquitous on Earth. However, a central unresolved question is whether these traces always indicate an active microbial community or whether, in extreme environments, such as hyperarid deserts, they instead reflect just dormant or dead cells. Although microbial biomass and diversity decrease with increasing aridity in the Atacama Desert, we provide multiple lines of evidence for the presence of an at times metabolically active, microbial community in one of the driest places on Earth. We base this observation on four major lines of evidence: (i) a physico-chemical characterization of the soil habitability after an exceptional rain event, (ii) identified biomolecules indicative of potentially active cells [e.g., presence of ATP, phospholipid fatty acids (PLFAs), metabolites, and enzymatic activity], (iii) measurements of in situ replication rates of genomes of uncultivated bacteria reconstructed from selected samples, and (iv) microbial community patterns specific to soil parameters and depths. We infer that the microbial populations have undergone selection and adaptation in response to their specific soil microenvironment and in particular to the degree of aridity. Collectively, our results highlight that even the hyperarid Atacama Desert can provide a habitable environment for microorganisms that allows them to become metabolically active following an episodic increase in moisture and that once it decreases, so does the activity of the microbiota. These results have implications for the prospect of life on other planets such as Mars, which has transitioned from an earlier wetter environment to today's extreme hyperaridity.

Visco-Hyperelastic Model with Damage for Simulating Cyclic Thermoplastic Elastomers Behavior Applied to an Industrial Component.

In this work a nonlinear phenomenological visco-hyperelastic model including damage consideration is developed to simulate the behavior of Santoprene 101-73 material. This type of elastomeric material is widely used in the automotive and aeronautic sectors, as it has multiple advantages. However, there are still challenges in properly analyzing the mechanical phenomena that these materials exhibit. To simulate this kind of material a lot of theories have been exposed, but none of them have been endorsed unanimously. In this paper, a new model is presented based on the literature, and on experimental data. The test samples were extracted from an air intake duct component of an automotive engine. Inelastic phenomena such as hyperelasticity, viscoelasticity and damage are considered singularly in this model, thus modifying and improving some relevant models found in the literature. Optimization algorithms were used to find out the model parameter values that lead to the best fit of the experimental curves from the tests. An adequate fitting was obtained for the experimental results of a cyclic uniaxial loading of Santoprene 101-73.