Thomas G. Roberts, Georgia Institute of Technology

The next president of the United States could be the first in that office to accept a phone call from the Moon and hear a woman’s voice on the line. To do so, they’ll first need to make a series of strategic space policy decisions. They’ll also need a little luck.

Enormous government investment supports outer space activities, so the U.S. president has an outsize role in shaping space policy during their time in office.

Past presidents have leveraged this power to accelerate U.S. leadership in space and boost their presidential brand along the way. Presidential advocacy has helped the U.S. land astronauts on the surface of the Moon, establish lasting international partnerships with civil space agencies abroad and led to many other important space milestones.

But most presidential candidates refrain from discussing space policy on the campaign trail in meaningful detail, leaving voters in the dark on their visions for the final frontier.

For many candidates, getting into the weeds of their space policy plans may be more trouble than it’s worth. For one, not every president even gets the opportunity for meaningful and memorable space policy decision-making, since space missions can operate on decades-long timelines. And in past elections, those who do show support for space initiatives often face criticism from their opponents for their high price tags.

But the 2024 election is different. Both candidates have executive records in space policy, a rare treat for space enthusiasts casting their votes this November.

As a researcher who studies international affairs in outer space, I am interested in how those records interface with the strategic and sustainable use of that domain. A closer look shows that former President Donald Trump and Vice President Kamala Harris have used their positions to consistently prioritize U.S. leadership in space, but they have done so with noticeably different styles and results.

Trump’s space policy record

As president, Trump established a record of meaningful and lasting space policy decisions, but did so while attracting more attention to his administration’s space activities than his predecessors. He regularly took personal credit for ideas and accomplishments that predated his time in office.

The former president oversaw the establishment of the U.S. Space Force and the reestablishment of the U.S. Space Command, as well as the National Space Council. These organizations support the development and operation of military space technologies, defend national security satellites in future conflicts and coordinate between federal agencies working in the space domain.

He also had the most productive record of space policy directives in recent history. These policy directives clarify the U.S. government‘s goals in space, including how it should both support and rely on the commercial space sector, track objects in Earth’s orbit and protect satellites from cyber threats.

He has called his advocacy for the creation of the Space Force one of his proudest achievements of his term. However, this advocacy contributed to polarized support for the new branch. This polarization broke the more common pattern of bipartisan public support for space programming.

Like many presidents, not all of Trump’s visions for space were realized. He successfully redirected NASA’s key human spaceflight destination from Mars back to the Moon. But his explicit goal of astronauts reaching the lunar surface by 2024 was not realistic, given his budget proposal for the agency.

Should he be elected again, the former president may wish to accelerate NASA’s Moon plans by furthering investment in the agency’s Artemis program, which houses its lunar initiatives.

He may frame the initiative as a new space race against China.

Harris’ space policy record

The Biden administration has continued to support Trump-era initiatives, resisting the temptation to undo or cancel past proposals. Its legacy in space is noticeably smaller.

As the chair of the National Space Council, Harris has set U.S. space policy priorities and represented the United States on the global stage.

Notably, the Trump administration kept this position that the president can alter at will assigned to the vice president, a precedent the Biden administration upheld.

In this role, Harris led the United States’ commitment to refrain from testing weapons in space that produce dangerous, long-lasting space debris. This decision marks an achievement for the U.S. in keeping space operations sustainable and setting an example for others in the international space community.

Like some Trump administration space policy priorities, not all of Harris’ proposals found footing in Washington.

The council’s plan to establish a framework for comprehensively regulating commercial space activities in the U.S., for example, stalled in Congress.

If enacted, these new regulations would have ensured that future space activities, such as private companies operating on the Moon or transporting tourists to orbit and back, pass critical safety checks.

Should she be elected, Harris may choose to continue her efforts to shape responsible norms of behavior in space and organize oversight over the space industry.

Alternatively, she could cede the portfolio to her own vice president, Minnesota Gov. Tim Walz, who has virtually no track record on space policy issues.

Stability in major space policy decisions

Despite the two candidates’ vastly different platforms, voters can expect stability in U.S. space policy as a result of this year’s election.

Given their past leadership, it is unlikely that either candidate will seek to dramatically alter the long-term missions the largest government space organizations have underway during the upcoming presidential term. And neither is likely to undercut their predecessors’ accomplishments.

Thomas G. Roberts, Postdoctoral Fellow in International Affiars, Georgia Institute of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Amy Huebschmann, University of Colorado Anschutz Medical Campus and Judith Regensteiner, University of Colorado Anschutz Medical Campus

A simple difference in the genetic code – two X chromosomes versus one X chromosome and one Y chromosome – can lead to major differences in heart disease. It turns out that these genetic differences influence more than just sex organs and sex assigned at birth – they fundamentally alter the way cardiovascular disease develops and presents.

While sex influences the mechanisms behind how cardiovascular disease develops, gender plays a role in how health care providers recognize and manage it. Sex refers to biological characteristics such as genetics, hormones, anatomy and physiology, while gender refers to social, psychological and cultural constructs. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to have additional or different heart attack symptoms that go beyond chest pain, such as nausea, jaw pain, dizziness and fatigue. It is often difficult to fully disentangle the influences of sex on cardiovascular disease outcomes versus the influences of gender.

While women who haven’t entered menopause have a lower risk of cardiovascular disease than men, their cardiovascular risk accelerates dramatically after menopause. In addition, if a woman has Type 2 diabetes, her risk of heart attack accelerates to be equivalent to that of men, even if the woman with diabetes has not yet gone through menopause. Further data is needed to better understand differences in cardiovascular disease risk among nonbinary and transgender patients.

Despite these differences, one key thing is the same: Heart attack, stroke and other forms of cardiovascular disease are the leading cause of death for all people, regardless of sex or gender.

We are researchers who study women’s health and the way cardiovascular disease develops and presents differently in women and men. Our work has identified a crucial need to update medical guidelines with more sex-specific approaches to diagnosis and treatment in order to improve health outcomes for all.

Gender differences in heart disease

The reasons behind sex and gender differences in cardiovascular disease are not completely known. Nor are the distinct biological effects of sex, such as hormonal and genetic factors, versus gender, such as social, cultural and psychological factors, clearly differentiated.

What researchers do know is that the accumulated evidence of what good heart care should look like for women compared with men has as many holes in it as Swiss cheese. Medical evidence for treating cardiovascular disease often comes from trials that excluded women, since women for the most part weren’t included in scientific research until the NIH Revitalization Act of 1993. For example, current guidelines to treat cardiovascular risk factors such as high blood pressure are based primarily on data from men. This is despite evidence that differences in the way that cardiovascular disease develops leads women to experience cardiovascular disease differently.

In addition to sex differences, implicit gender biases among providers and gendered social norms among patients lead clinicians to underestimate the risk of cardiac events in women compared with men. These biases play a role in why women are more likely than men to die from cardiac events. For example, for patients with symptoms that are borderline for cardiovascular disease, clinicians tend to be more aggressive in ordering artery imaging for men than for women. One study linked this tendency to order less aggressive tests for women partly to a gender bias that men are more open than women to taking risks.

In a study of about 3,000 patients with a recent heart attack, women were less likely than men to think that their heart attack symptoms were due to a heart condition. Additionally, most women do not know that cardiovascular disease is the No. 1 cause of death among women. Overall, women’s misperceptions of their own risk may hold them back from getting a doctor to check out possible symptoms of a heart attack or stroke.

These issues are further exacerbated for women of color. Lack of access to health care and additional challenges drive health disparities among underrepresented racial and ethnic minority populations.

Sex difference in heart disease

Cardiovascular disease physically looks different for women and men, specifically in the plaque buildup on artery walls that contributes to illness.

Women have fewer cholesterol crystals and fewer calcium deposits in their artery plaque than men do. Physiological differences in the smallest blood vessels feeding the heart also play a role in cardiovascular outcomes.

Women are more likely than men to have cardiovascular disease that presents as multiple narrowed arteries that are not fully “clogged,” resulting in chest pain because blood flow can’t ratchet up enough to meet higher oxygen demands with exercise, much like a low-flow showerhead. When chest pain presents in this way, doctors call this condition ischemia and no obstructive coronary arteries. In comparison, men are more likely to have a “clogged” artery in a concentrated area that can be opened up with a stent or with cardiac bypass surgery. Options for multiple narrowed arteries have lagged behind treatment options for typical “clogged” arteries, which puts women at a disadvantage.

In addition, in the early stages of a heart attack, the levels of blood markers that indicate damage to the heart are lower in women than in men. This can lead to more missed diagnoses of coronary artery disease in women compared with men.

The reasons for these differences are not fully clear. Some potential factors include differences in artery plaque composition that make men’s plaque more likely to rupture or burst and women’s plaque more likely to erode. Women also have lower heart mass and smaller arteries than men even after taking body size into consideration.

Reducing sex disparities

Too often, women with symptoms of cardiovascular disease are sent away from doctor’s offices because of gender biases that “women don’t get heart disease.”

Considering how symptoms of cardiovascular disease vary by sex and gender could help doctors better care for all patients.

One way that the rubber is meeting the road is with regard to better approaches to diagnosing heart attacks for women and men. Specifically, when diagnosing heart attacks, using sex-specific cutoffs for blood tests that measure heart damage – called high-sensitivity troponin tests – can improve their accuracy, decreasing missed diagnoses, or false negatives, in women while also decreasing overdiagnoses, or false positives, in men.

Our research laboratory’s leaders,collaborators and other internationally recognized research colleagues – some of whom partner with our Ludeman Family Center for Women’s Health Research on the University of Colorado Anschutz Medical Campus – will continue this important work to close this gap between the sexes in health care. Research in this field is critical to shine a light on ways clinicians can better address sex-specific symptoms and to bring forward more tailored treatments.

The Biden administration’s recent executive order to advance women’s health research is paving the way for research to go beyond just understanding what causes sex differences in cardiovascular disease. Developing and testing right-sized approaches to care for each patient can help achieve better health for all.

Amy Huebschmann, Professor of Medicine, University of Colorado Anschutz Medical Campus and Judith Regensteiner, Professor of Medicine, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Trirupa Chakraborty, University of Pittsburgh; Aniruddh Sarkar, Georgia Institute of Technology, and Jishnu Das, University of Pittsburgh

Blood samples of patients infected with a parasitic worm that causes schistosomiasis contain hidden information that marks different stages of the disease. In our recently published research, our team used machine learning to uncover that hidden information and improve early detection and diagnosis of infection.

The parasite that causes schistosomiasis completes its life cycle in two hosts – first in snails and then in mammals such as people, dogs and mice. Freshwater worm eggs enter human hosts through the skin and circulate throughout the body, damaging multiple organs, including the liver, intestine, bladder and urethra. When these larvae reach blood vessels connecting the intestines to the liver, they mature into adult worms. They then release eggs that are excreted when the infected person defecates, continuing the transmission cycle.

Since diagnosis currently relies on detecting eggs in feces, doctors usually miss the early stages of infection. By the time eggs are detected, patients have already reached an advanced stage of the disease. Because diagnosis rates are poor, public health officials typically mass-administer the drug praziquantel to populations in affected regions. However, praziquantel cannot clear juvenile worms in early stages of infection, nor can it prevent reinfection.

Our study provides a clear path forward to improving early detection and diagnosis by identifying the hidden information in blood that signals active, early stage infection.

Your body responds to a schistosomiasis infection by mounting an immune response involving several types of immune cells, as well as antibodies specifically targeting molecules secreted by or present on the worm and eggs. Our study introduces two ways to screen for certain characteristics of antibodies that signal early infection.

The first is an assay that captures a quantitative and qualitative profile of immune response, including various classes of antibodies and characteristics that dictate how they communicate with other immune cells. This allowed us to identify specific facets of the immune response that distinguish uninfected patients from patients with early and late-stage disease.

Second, we developed a new machine learning approach that analyzes antibodies to identify latent characteristics of the immune response linked to disease stage and severity. We trained the model on immune profile data from infected and uninfected patients and tested the model on data that wasn’t used for training and data from a different geographical location. We identified not only biomarkers for the disease but also the potential mechanism that underlies infection.

Why it matters

Schistosomiasis is a neglected tropical disease that affects over 200 million people worldwide, causing 280,000 deaths annually. Early diagnosis can improve treatment effectiveness and prevent severe disease.

In addition, unlike many machine learning methods that are black boxes, our approach is also interpretable. This means it can provide insights into why and how the disease develops beyond simply identifying markers of disease, guiding future strategies for early diagnosis and treatment.

What still isn’t known

The schistosomiasis infection signatures we identified remain stable across two geographical regions across two continents. Future research could explore how well these biomarkers apply to additional populations.

Further, our work identifies a potential mechanism behind disease progression. We found that a particular immune response against a specific protein on the surface of the worm signals an intermediate stage of infection. Understanding how the immune system responds to this understudied antigen could improve diagnosis and treatment.

What’s next

Besides improving our understanding of how the immune system responds to different stages of infection, our findings identify key antigens that could pave the way for designing cost-effective and efficient approaches to diagnosis and treatments. Our next steps will include actually deploying these strategies in the field for early detection and management of disease.

The Research Brief is a short take about interesting academic work.

Trirupa Chakraborty, Ph.D. Candidate in Integrative Systems Biology, University of Pittsburgh; Aniruddh Sarkar, Assistant Professor of Biomedical Engineering, Georgia Institute of Technology, and Jishnu DasUniversity of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.