Lunar outpost sustaining human space exploration by utilizing in-situ resources with a focus on propellant production

Space exploration has recently witnessed a surge of renewed interest, in particular, the concept of a human mission to the Moon is increasingly being discussed by national agencies and private enterprises alike. A lunar base is commonly regarded as a good first step for humanity’s expansion beyond Earth. This paper proposes a pre-phase A study about infrastructure on the Moon surface with the capability of sustaining future human space exploration. The outpost will be relying on In-Situ Resources Utilization (ISRU) and on the support of the orbiting Deep Space Gateway (DSG), in line with the current ISECG exploration roadmap. In this context, precursor robotic missions, such as the concept proposed in the ESA-led Heracles study, and related activities on the Moon surface are considered as sources of insight and technology validation. The incremental steps necessary for setting up the Lunar outpost are discussed and analysed, both for surface and on-orbit missions. A feasibility and sustainability study is carried out for a propellant production plant, the primary purpose of which is to provide the capability of refuelling space vehicles. The design of the overall mission revolves around four main building blocks, which are analysed in detail: crew habitats, a large pressurized crew rover, ISRU facilities and a lunar spaceport. The overall mission scenario has been derived from a set of trade-off analyses that have been performed to choose the mission architecture and operations that satisfy the stakeholder expectations: the most important features of these analyses and their results are described within the paper. Regarding the timeframe, the analysed mission is expected to take place after robotic precursor expeditions, which are scheduled to launch in the 2020s. The first manned mission shall follow before 2030 with the purpose of setting up the propellant production facility, which shall be operational by 2035. The study is carried out by the 10th edition of the Specializing Master programme in SpacE Exploration and Development Systems (SEEDS) of 2017/18 at Politecnico di Torino (Italy). This work was performed in cooperation with students from ISAE-Supaero (France) and University of Leicester (UK). The project is supported by Thales Alenia Space Italy, the European Space Agency, and the Italian Space Agency

Liver Retransplantation in Patients with HIV-1 Infection: An International Multicenter Cohort Study

Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents

Management and 1-year outcomes of patients with newly diagnosed atrial fibrillation and chronic kidney disease: Results from the prospective garfield-af registry

Background-—Using data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD–Atrial Fibrillation), we evaluated the impact of chronic kidney disease (CKD) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation (AF). Methods and Results-—GARFIELD-AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate-to-severe CKD, based on the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate-to-severe CKD, 16.9% (n=5595) mild CKD, and 72.1% (n=23 816) no CKD. The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA2DS2-VASc score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate-to-severe CKD were independent risk factors for all-cause mortality. Moderate-to-severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new-onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate-to-severe CKD on mortality was significantly greater in patients from Asia than the rest of the world (P=0.001). Conclusions-—In GARFIELD-AF, moderate-to-severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate-to-severe CKD on mortality was even greater in patients from Asia than the rest of the world