High-energy particle observations from the Moon.

The Moon is a unique natural laboratory for the study of the deep space plasma and energetic particles environment. During more than 3/4 of its orbit around the Earth it is exposed to the solar wind. Being an unmagnetized body and lacking a substantial atmosphere, solar wind and solar energetic particles bombard the Moon's surface, interacting with the lunar regolith and the tenuous lunar exosphere. Energetic particles arriving at the Moon's surface can be absorbed, or scattered, or can remove another particle from the lunar regolith by sputtering or desorption. A similar phenomenon occurs also with the galactic cosmic rays, which have fluxes and energy spectra representative of interplanetary space. During the remaining part of its orbit the Moon crosses the tail of the terrestrial magnetosphere. It then provides the opportunity to study in-situ the terrestrial magnetotail plasma environment as well as atmospheric escape from the Earth's ionosphere, in the form of heavy ions accelerated and streaming downtail. The lunar environment is thus a unique natural laboratory for analysing the interaction of the solar wind, the cosmic rays and the Earth's magnetosphere with the surface, the immediate subsurface, and the surface-bounded exosphere of an unmagnetized planetary body. This article is part of a discussion meeting issue 'Astronomy from the Moon: the next decades (part 2)'.

Demographic disparities in children with retropharyngeal and parapharyngeal abscesses.

PURPOSE: To explore the impact that demographic and socioeconomic factors such as age, gender, race, and insurance status have on the diagnosis of retropharyngeal (RPA) and parapharyngeal abscesses (PPA) in the pediatric population. METHODS: The 2016 HCUP KID was searched for all RPA/PPA discharges using the joint ICD-10 code J39.0. Descriptive statistics, univariate, and multivariate analyses were performed to assess the relationship between demographic factors and their impact on RPA/PPA diagnosis. Results were reported with their corresponding odds ratio with a 95 % confidence interval and p-value. RESULTS: 56.4 per 100,000 weighted discharges were discharged with a diagnosis of a RPA/PPA, the average age was 5.7 years old, with a male predominance. Pediatric discharges diagnosed with a RPA/PPA were less likely to identify as Hispanic or Asian/Island Pacific. They were also less likely to be insured by Medicaid and reside in zip codes with a lower median income. CONCLUSION: The analysis of this national pediatric database demonstrated significant demographic differences in children diagnosed with RPA/PPAs. Following the multivariate analysis, children from a higher socioeconomic background and those with private insurance were more likely to be diagnosed with a RPA/PPAs. However, disparities in children's overall hospital course and complications is a potential area for future research.

Integrating Cosmic Microwave Background Readings with Celestial Navigation to Enhance Deep Space Navigation.

This research unveils a cutting-edge navigation system for deep space missions that utilizes cosmic microwave background (CMB) sensor readings to enhance spacecraft positioning and velocity estimation accuracy significantly. By exploiting the Doppler-shifted CMB spectrum and integrating it with optical measurements for celestial navigation, this approach employs advanced data processing through the Unscented Kalman Filter (UKF), enabling precise navigation amid the complexities of space travel. The simulation results confirm the system's exceptional precision and resilience in deep space missions, marking a significant advancement in astronautics and paving the way for future space exploration endeavors.

Research and Verification of a Novel Interferometry Method by Joint Processing of Downlink Pseudo-Noise Ranging and DOR Signals for Deep Space Exploration.

The remarkably long distances covered by deep space probes result in extremely weak downlink signals, which poses great challenges for ground measurement systems. In the current climate, improving the comprehensive utilization of downlink signal power to increase the detection distance or enhance the measurement accuracy is of great significance in deep space exploration. Facing this problem, we analyze the delta Differential One-way Range (ΔDOR) error budget of the X-band of the China Deep Space Network (CDSN). Then, we propose a novel interferometry method that detunes one group of DOR beacons and reuses the clock components of regenerative pseudo-code ranging signals for interferometry delay estimation. The primary advantage of this method is its ability to enhance the power utilization efficiency of downlink signals, thereby facilitating more efficient tracking and measurement without necessitating additional design requirements for deep space transponders. Finally, we analyze and verify the correctness and effectiveness of our proposed method using measured data from CDSN. Our results indicate that the proposed method can save approximately 13% of the downlink signal power and increase the detection distance by about 6.25% using typical modulation parameters. Furthermore, if the relative power of other signal components remains unchanged, the power of the DOR tone can be directly increased by more than 100%, improving the deep space exploration ability more significantly.

Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery - a retrospective study.

OBJECTIVES: The aim of this study was to evaluate the current resistance situation concerning routinely used antibiotics for treatment in odontogenic abscesses. MATERIALS AND METHODS: This retrospective study assessed patients with deep space head and neck infections who were treated by surgical intervention under general anesthesia at our department. The target parameter was the ascertainment of the resistance rates in order to identify the bacterial spectrum, sites in the body, length of inpatient stay, and the age and sex of the patients. RESULTS: A total of 539 patients, 268 (49.7%) males and 271 (50.3%) females were included in the study. The mean age was 36.5 ± 22.1 years. There was no significant difference between the two sexes with regard to the mean duration of hospitalization (p = 0.574). The predominant bacteria in the aerobic spectrum were streptococci of the viridans group and staphylococci, in the anaerobic spectrum Prevotella and Propionibacteria spp. Rates of resistance to clindamycin were between 34 and 47% in both the facultative and obligate anaerobic spectrum. Increased resistance was likewise found in the facultative anaerobic spectrum, with 94% resistance to ampicillin and 45% to erythromycin. CONCLUSION: Due to the increasing levels of resistance to clindamycin, their use in empiric antibiotic treatment for deep space head and neck infections should be viewed critically. CLINICAL RELEVANCE: Resistance rates continue to increase compared to previous studies. The use of these antibiotic groups in patients with a penicillin allergy needs to be called into question and alternative medications sought.

Celestial Bodies Far-Range Detection with Deep-Space CubeSats.

Detecting celestial bodies while in deep-space travel is a critical task for the correct execution of space missions. Major bodies such as planets are bright and therefore easy to observe, while small bodies can be faint and therefore difficult to observe. A critical task for both rendezvous and fly-by missions is to detect asteroid targets, either for relative navigation or for opportunistic observations. Traditional, large spacecraft missions can detect small bodies from far away, owing to the large aperture of the onboard optical cameras. This is not the case for deep-space miniaturized satellites, whose small-aperture cameras pose new challenges in detecting and tracking the line-of-sight directions to small bodies. This paper investigates the celestial bodies far-range detection limits for deep-space CubeSats, suggesting active measures for small bodies detection. The M-ARGO CubeSat mission is considered as the study case for this activity. The analyses show that the detection of small asteroids (with absolute magnitude fainter than 24) is expected to be in the range of 30,000-50,000 km, exploiting typical miniaturized cameras for deep-space CubeSats. Given the limited detection range, this paper recommends to include a zero-phase-angle way point at close range in the mission design phase of asteroid rendezvous missions exploiting deep-space CubeSats to allow detection.

Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections-a retrospective study.

OBJECTIVES: Descending necrotizing mediastinitis (DNM) is the most serious complication of deep neck infections (DNI). The objective of this retrospective study was to evaluate prognostic factors for DNM development in deep space neck infections. METHODS: The study enrolled patients admitted to the Emergency Center of Vojvodina with the diagnosis of multispace DNI with or without DNM either as the primary diagnosis or with discharged diagnosis after surgical treatment during 7-year period. The data were obtained from patient medical records. RESULTS: After final analysis total of 141 charts were randomized for statystical analysis, 124 charts in DNI and 17 in DNI + DNM groups. The most common cause of infection in both groups was odontogenic. On multivariate regression analysis of collected data infection of retropharyngeal, pretracheal and carotid space, C-reactive protein and procalcitonine values were statistically significant predictors for DNM development. CONCLUSIONS: Treatment and diagnosis of DNM requires multidisciplinary approach, with prompt clinical and radiological examinations, empirical broad spectrum antibiotic therapy and radical surgical debridement. Multispace neck infection and especially infection of retropharyngeal, carotid and pretracheal spaces are the most sensitive predictors for DNM development in deep space neck infections. CLINICAL RELEVANCE: If the infection from deep neck spaces reach retropharyngeal, carotid or pretracheal space, the DNM is probable to occur. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT04865003. Date of registration 27.4.2021.

Outcomes of Exploratory Laparotomy and Abdominal Infections Among Combat Casualties.

BACKGROUND: Abdominal injuries historically account for 13% of battlefield surgical procedures. We examined the occurrence of exploratory laparotomies and subsequent abdominal surgical site infections (SSIs) among combat casualties. METHODS: Military personnel injured during deployment (2009-2014) were included if they required a laparotomy for combat-related trauma and were evacuated to Landstuhl Regional Medical Center, Germany, before being transferred to participating US military hospitals. RESULTS: Of 4304 combat casualties, 341 (7.9%) underwent laparotomy. Including re-explorations, 1053 laparotomies (median, 2; interquartile range, 1-3; range, 1-28) were performed with 58% occurring within the combat zone. Forty-nine (14.4%) patients had abdominal SSIs (four with multiple SSIs): 27 (7.9%) with deep space SSIs, 14 (4.1%) with a deep incisional SSI, and 12 (3.5%) a superficial incisional SSI. Patients with abdominal SSIs had larger volume of blood transfusions (median, 24 versus 14 units), more laparotomies (median, 4 versus 2), and more hollow viscus injuries (74% versus 45%) than patients without abdominal SSIs. Abdominal closure occurred after 10 d for 12% of the patients with SSI versus 2% of patients without SSI. Mesh adjuncts were used to achieve fascial closure in 20.4% and 2.1% of patients with and without SSI, respectively. Survival was 98% and 96% in patients with and without SSIs, respectively. CONCLUSIONS: Less than 10% of combat casualties in the modern era required abdominal exploration and most were severely injured with hollow viscus injuries and required massive transfusions. Despite the extensive contamination from battlefield injuries, the SSI proportion is consistent with civilian rates and survival was high.

Is Human Enhancement in Space a Moral Duty? Missions to Mars, Advanced AI and Genome Editing in Space.

Any space program involving long-term human missions will have to cope with serious risks to human health and life. Because currently available countermeasures are insufficient in the long term, there is a need for new, more radical solutions. One possibility is a program of human enhancement for future deep space mission astronauts. This paper discusses the challenges for long-term human missions of a space environment, opening the possibility of serious consideration of human enhancement and a fully automated space exploration, based on highly advanced AI. The author argues that for such projects, there are strong reasons to consider human enhancement, including gene editing of germ line and somatic cells, as a moral duty.

Coronary artery bypass graft surgery complications: A review for emergency clinicians.

INTRODUCTION: Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION: While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care. CONCLUSIONS: Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload.

Pyomyositis Diagnosed by Point-of-Care Ultrasound in the Emergency Department.

BACKGROUND: Currently, the role of ultrasound in diagnosing superficial abscesses is well validated, however, its role for deep space infections and intramuscular pathology is limited. Distinguishing between simple cellulitis and abscess is critical for emergency physicians (EP), as the treatment is very different. Management of cellulitis relies on antibiotic therapy, whereas abscess treatment requires incision and drainage. It is important that EPs can accurately distinguish between the two entities. CASE REPORT: We report a case of a 41-year-old man with a history of high blood pressure and poorly controlled diabetes who presented with right lateral thigh redness, warmth, and tenderness. A point-of-care ultrasound (POCUS) of the patient's right lateral thigh with a high-frequency linear (8 MHz) ultrasound probe showed a 2.93 × 3.38 × 6.0-cm complex fluid collection deep to the fascial plane, approximately 3.0 cm from the skin surface, that contained mixed echogenicities with posterior acoustic enhancement consistent with an intramuscular abscess of the vastus lateralis. The patient was diagnosed with pyomyositis of his vastus lateralis. He was started on vancomycin and admitted to the surgical service for antibiotic treatment and surgical drainage. WHY SHOULD EMERGENCY PHYSICIANS BE AWARE OF THIS?: This case demonstrates that the use of POCUS by EPs can facilitate the rapid recognition and treatment of a disease that is challenging to diagnose on physical examination and can be potentially life-threatening if missed. EPs can consider performing a POCUS when evaluating skin infections to ensure rapid diagnosis and appropriate medical care for a potentially severe condition.

A Lot to Choke on: Case of Adult Epiglottitis with Concurrent Peritonsillar Abscess in a Patient with a Sore Throat.

BACKGROUND: In the winter months, one often sees a large increase in the volume of patients presenting to emergency departments with acute pharyngitis. While most cases of acute pharyngitis are benign, a rare minority can be life threatening. CASE REPORT: We report a case of epiglottis with a concomitant peritonsillar abscess (PTA) in an adult who presented to the emergency department with a sore throat. Computed tomography (CT) scan showed epiglottitis with a developing left PTA. The patient was treated with broad-spectrum antibiotics, high-dose steroids, and underwent multiple laryngoscopies with eventual resolution of his epiglottic swelling. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case serves to highlight the importance of physical examination and CT imaging in identifying patients with pharyngitis who can benefit from additional interventions and monitoring. It is also an unusual example of the presence of two likely related upper respiratory pathologies presenting in the same patient.

Chang'E-5T Orbit Determination Using Onboard GPS Observations.

In recent years, Global Navigation Satellite System (GNSS) has played an important role in Space Service Volume, the region enclosing the altitudes above 3000 km up to 36,000 km. As an in-flight test for the feasibility as well as for the performance of GNSS-based satellite orbit determination (OD), the Chinese experimental lunar mission Chang'E-5T had been equipped with an onboard high-sensitivity GNSS receiver with GPS and GLONASS tracking capability. In this contribution, the 2-h onboard GPS data are evaluated in terms of tracking performance as well as observation quality. It is indicated that the onboard receiver can track 7-8 GPS satellites per epoch on average and the ratio of carrier to noise spectral density (C/N0) values are higher than 28 dB-Hz for 90% of all the observables. The C1 code errors are generally about 4.15 m but can be better than 2 m with C/N0 values over 36 dB-Hz. GPS-based Chang'E-5T OD is performed and the Helmert variance component estimation method is investigated to determine the weights of code and carrier phase observations. The results reveal that the orbit consistency is about 20 m. OD is furthermore analyzed with GPS data screened out according to different C/N0 thresholds. It is indicated that for the Chang'E-5T, the precision of OD is dominated by the number of observed satellite. Although increased C/N0 thresholds can improve the overall data quality, the available number of GPS observations is greatly reduced and the resulting orbit solution is poor.

Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman: a case-based review.

INTRODUCTION: Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms. CASE PRESENTATION: We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for total of four weeks resulted in a full recovery. CONCLUSION: RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.

Musculoskeletal perturbations of deep space radiation: Assessment using a Gateway MRI.

Human space exploration expansion from Low-Earth Orbit to deep space is accelerating the need to monitor and address the known health concerns related to deep space radiation. The human musculoskeletal system is vulnerable to these risks (alongside microgravity) and its health reflects the well-being of other body systems. Multiparametric magnetic resonance imaging (MRI) is an important approach for assessing temporal physiological changes in the musculoskeletal system. We propose that ultra-low-field MRI provides an optimal low Size Weight and Power (SwaP) solution for non-invasively monitoring muscle and bone changes on the planned Gateway lunar space station. Our proposed ultra-low-field Gateway MRI meets low SWaP design specifications mandated by limited room in the lunar space station. This review summarizes the current state of our knowledge on musculoskeletal consequences of spaceflight, especially with respect to radiation, and then elaborates how MRI can be used to monitor the deleterious effects of space travel and the efficacy of putative countermeasures. We argue that an ultra-low-field MRI in cis-lunar space on the Gateway can provide valuable research and medical insights into the effects of deep space radiation exposure on astronauts. Such an MRI would also allow the development of imaging protocols that would facilitate Earth-bound teams to monitor space personnel musculoskeletal changes during future interplanetary spaceflight. It will especially have a role in monitoring countermeasures, such as the use of melanin, in protecting space explorers.

Cultivation of Chroococcidiopsis thermalis Using Available In Situ Resources to Sustain Life on Mars.

The cultivation of cyanobacteria by exploiting available in situ resources represents a possible way to supply food and oxygen to astronauts during long-term crewed missions on Mars. Here, we evaluated the possibility of cultivating the extremophile cyanobacterium Chroococcidiopsis thermalis CCALA 050 under operating conditions that should occur within a dome hosting a recently patented process to produce nutrients and oxygen on Mars. The medium adopted to cultivate this cyanobacterium, named Martian medium, was obtained using a mixture of regolith leachate and astronauts' urine simulants that would be available in situ resources whose exploitation could reduce the mission payload. The results demonstrated that C. thermalis can grow in such a medium. For producing high biomass, the best medium consisted of specific percentages (40%vol) of Martian medium and a standard medium (60%vol). Biomass produced in such a medium exhibits excellent antioxidant properties and contains significant amounts of pigments. Lipidomic analysis demonstrated that biomass contains strategic lipid classes able to help the astronauts facing the oxidative stress and inflammatory phenomena taking place on Mars. These characteristics suggest that this strain could serve as a valuable nutritional resource for astronauts.

Lack of Association of Tumor Necrosis Factor-α G-308A and Transforming Growth Factor-ß1 C-509T Polymorphisms in Patients with Deep Neck Space Infections.

Deep neck space infections are defined as infections that spread along the fascial planes and spaces of the head and neck. Even in the era of antibiotics, these infections can and have been potentially life-threatening conditions. The role of single nucleotide polymorphisms (SNPs) of tumor necrosis factor-α (TNF-α) and transforming growth factor-ß1 (TGF-ß1) genes in deep neck infections has not been studied. Thus, the aim of this study was to investigate the distribution of the TNF-α G-308A and TGF-ß1 C-509T polymorphisms in patients suffering from infections of deep neck spaces and to determine the correlation of these polymorphisms with the values of inflammation markers [C-reactive protein (CRP) and white blood cell (WBC) count]. A total of 41 patients with infections of deep neck spaces and 44 healthy controls were screened for TNF-α G-308A and TGF-ß1 C-509T polymorphisms using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The distribution of the TNF-α G-308A genotype in patients did not reveal statistically significant correlation compared to con-trols (p = 0.483, χ(2) = 0.491) as well as the distribution of the TGF-ß1 C-509T genotypes (p = 0.644, χ(2) = 0.725). The distribution of TNF-α -308 and TGF-ß1 -509 alleles was not significantly different in patients compared to controls. Moreover, CRP levels and WBC counts were not associated with TNF-α G-308A and TGF-ß1 C-509T promoter polymorphisms in patients with deep neck infections. In conclusion, our study suggests that the TNF-α G-308A and TGF-ß1 C-509T polymorphisms are not associated with infections of deep neck spaces.

BioSentinel: Long-Term Saccharomyces cerevisiae Preservation for a Deep Space Biosensor Mission.

The biological risks of the deep space environment must be elucidated to enable a new era of human exploration and scientific discovery beyond low earth orbit (LEO). There is a paucity of deep space biological missions that will inform us of the deleterious biological effects of prolonged exposure to the deep space environment. To safely undertake long-term missions to Mars and space habitation beyond LEO, we must first prove and optimize autonomous biosensors to query the deep space radiation environment. Such biosensors must contain organisms that can survive for extended periods with minimal life support technology and must function reliably with intermittent communication with Earth. NASA's BioSentinel mission, a nanosatellite containing the budding yeast Saccharomyces cerevisiae, is such a biosensor and one of the first biological missions beyond LEO in nearly half a century. It will help fill critical gaps in knowledge about the effects of uniquely composed, chronic, low-flux deep space radiation on biological systems and in particular will provide valuable insight into the DNA damage response to highly ionizing particles. Due to yeast's robustness and desiccation tolerance, it can survive for periods analogous to that of a human Mars mission. In this study, we discuss our optimization of conditions for long-term reagent storage and yeast survival under desiccation in preparation for the BioSentinel mission. We show that long-term yeast cell viability is maximized when cells are air-dried in trehalose solution and stored in a low-relative humidity and low-temperature environment and that dried yeast is sensitive to low doses of deep space-relevant ionizing radiation under these conditions. Our findings will inform the design and development of improved future long-term biological missions into deep space.

BioSentinel: A Biological CubeSat for Deep Space Exploration.

BioSentinel is the first biological CubeSat designed and developed for deep space. The main objectives of this NASA mission are to assess the effects of deep space radiation on biological systems and to engineer a CubeSat platform that can autonomously support and gather data from model organisms hundreds of thousands of kilometers from Earth. The articles in this special collection describe the extensive optimization of the biological payload system performed in preparation for this long-duration deep space mission. In this study, we briefly introduce BioSentinel and provide a glimpse into its technical and conceptual heritage by detailing the evolution of the science, subsystems, and capabilities of NASA's previous biological CubeSats. This introduction is not intended as an exhaustive review of CubeSat missions, but rather provides insight into the unique optimization parameters, science, and technology of those few that employ biological model systems.