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Mars is known to host large quantities of water in solid or gaseous form, and surface rocks show clear evidence that there was liquid water on the planet in the distant past. Whether any liquid water remains on Mars today has long been debated. Orosei et al. used radar measurements from the Mars Express spacecraft to search for liquid water in Mars' southern ice cap (see the Perspective by Diez). They detected a 20-km-wide lake of liquid water underneath solid ice in the Planum Australe region. The water is probably kept from freezing by dissolved salts and the pressure of the ice above. The presence of liquid water on Mars has implications for astrobiology and future human exploration. Science , this issue p. 490 ; see also p. 448 Radar data from Mars Express show that there is a lake of liquid water underneath the solid ice of Mars’ southern ice cap. The presence of liquid water at the base of the martian polar caps has long been suspected but not observed. We surveyed the Planum Australe region using the MARSIS (Mars Advanced Radar for Subsurface and Ionosphere Sounding) instrument, a low-frequency radar on the Mars Express spacecraft. Radar profiles collected between May 2012 and December 2015 contain evidence of liquid water trapped below the ice of the South Polar Layered Deposits. Anomalously bright subsurface reflections are evident within a well-defined, 20-kilometer-wide zone centered at 193°E, 81°S, which is surrounded by much less reflective areas. Quantitative analysis of the radar signals shows that this bright feature has high relative dielectric permittivity (>15), matching that of water-bearing materials. We interpret this feature as a stable body of liquid water on Mars.

In this work, we present the most updated catalog of Io hot spots based on Juno/JIRAM data. We find 242 hot spots, including 23 previously undetected. Over the half of the new hot spots identified, are located at high northern and southern latitudes (>70°). We observe a latitudinal variability and a larger concentration of hot spots in the polar regions, in particular in the North. The comparison between JIRAM and the most recent Io hot spot catalogs listing power output (Veeder et al., 2015, https://doi.org/10.1016/j.icarus.2014.07.028; de Kleer, de Pater, et al., 2019, https://doi.org/10.3847/1538-3881/ab2380), shows JIRAM detected 63% and 88% of the total number of hot spots, respectively. Furthermore, JIRAM observed 16 of the 34 faint hot spots previously identified. JIRAM data revealed thermal emission from 5 dark pateræ inferred to be active from color ratio images, thus confirming that these are hot spots. Plain Language Summary We mapped the hot spot distribution on Io's surface by analyzing the images acquired by the JIRAM instrument onboard the Juno spacecraft. We identified 242 hot spots, including 23 not present in other catalogs. A large number of the new hot spots identified are in the polar regions, specifically in the northern hemisphere. The comparison between our work and the most recent and updated catalog reveals that JIRAM detected 82% of the most powerful hot spots previously identified and half of the intermediate‐power hot spots, thus showing that these are still active. JIRAM detected 16 out of the 34 faint hot spots previously reported. The resolution of JIRAM may not have been sufficient to detect these faint hot spots, or activity might have faded or stopped. Key Points We produced a new Io hot spot map based on Juno/JIRAM data We identified 242 hot spots, including 23 previously undetected The latitudinal hot spot distribution is uneven with a larger concentration at the poles

Like Earth, Jupiter has aurorae generated by energetic particles hitting its atmosphere. Those incoming particles can come from Jupiter's moons Io and Ganymede. Mura et al. used infrared observations from the Juno spacecraft to image the moon-generated aurorae. The pattern induced by Io showed an alternating series of spots, reminiscent of vortices, and sometimes split into two arcs. Aurorae related to Ganymede could also show a double structure. Although the cause of these unexpected features remains unknown, they may provide a way to examine how the moons produce energetic particles or how the particles propagate to Jupiter. Science , this issue p. 774 Auroral features induced on Jupiter by the moons Io and Ganymede have complex spatial structures. Jupiter’s aurorae are produced in its upper atmosphere when incoming high-energy electrons precipitate along the planet’s magnetic field lines. A northern and a southern main auroral oval are visible, surrounded by small emission features associated with the Galilean moons. We present infrared observations, obtained with the Juno spacecraft, showing that in the case of Io, this emission exhibits a swirling pattern that is similar in appearance to a von Kármán vortex street. Well downstream of the main auroral spots, the extended tail is split in two. Both of Ganymede’s footprints also appear as a pair of emission features, which may provide a remote measure of Ganymede’s magnetosphere. These features suggest that the magnetohydrodynamic interaction between Jupiter and its moon is more complex than previously anticipated.

Visible and infrared images obtained from above each pole of Jupiter by the Juno spacecraft reveal polygonal patterns of large cyclones; it is unknown how these cyclones evolved, or how they persist without merging. Polygonal cyclones around Jupiter's poles Jupiter's colourful low-latitude weather bands turn into cyclones at high latitudes, but the polar region is not visible from Earth and was poorly characterized by previous spacecraft. Alberto Adriani and colleagues report visible and infrared observations of Jupiter's polar regions made by the Juno spacecraft, which is in a highly elliptical polar orbit. They find that the cyclones create persistent polygonal patterns. There are eight circumpolar cyclones rotating around a single cyclone in the north, while the South Polar Cyclone is circled by five such features. The authors do not know how these cyclones evolved to their current state or how they persist without merging. The familiar axisymmetric zones and belts that characterize Jupiter’s weather system at lower latitudes give way to pervasive cyclonic activity at higher latitudes 1 . Two-dimensional turbulence in combination with the Coriolis β-effect (that is, the large meridionally varying Coriolis force on the giant planets of the Solar System) produces alternating zonal flows 2 . The zonal flows weaken with rising latitude so that a transition between equatorial jets and polar turbulence on Jupiter can occur 3 , 4 . Simulations with shallow-water models of giant planets support this transition by producing both alternating flows near the equator and circumpolar cyclones near the poles 5 , 6 , 7 , 8 , 9 . Jovian polar regions are not visible from Earth owing to Jupiter’s low axial tilt, and were poorly characterized by previous missions because the trajectories of these missions did not venture far from Jupiter’s equatorial plane. Here we report that visible and infrared images obtained from above each pole by the Juno spacecraft during its first five orbits reveal persistent polygonal patterns of large cyclones. In the north, eight circumpolar cyclones are observed about a single polar cyclone; in the south, one polar cyclone is encircled by five circumpolar cyclones. Cyclonic circulation is established via time-lapse imagery obtained over intervals ranging from 20 minutes to 4 hours. Although migration of cyclones towards the pole might be expected as a consequence of the Coriolis β-effect, by which cyclonic vortices naturally drift towards the rotational pole, the configuration of the cyclones is without precedent on other planets (including Saturn’s polar hexagonal features). The manner in which the cyclones persist without merging and the process by which they evolve to their current configuration are unknown.

Background Until very recently the only therapeutic alternative for the management of patients affected by gout/hyperuricemia that did not respond to a first-line treatment based on allopurinol alone or who cannot tolerate allopurinol was febuxostat, a xanthine oxidase non-purine-selective inhibitor. Lately, however, a new therapeutic alternative has become available for the management of this pathology: lesinurad, a urate transporter inhibitor. Objective To objective of this study was to evaluate the cost effectiveness of lesinurad/allopurinol in comparison with febuxostat as a second-line therapeutic strategy for the management of patients affected by gout and hyperuricemia that did not respond to a first-line therapy based on allopurinol alone. Methods A Markov model was built based on the natural history of the pathology; patients entered the model according to their level of serum uric acid concentration and flowed across it according to their response to the therapy. The analysis was carried out considering the perspective of the Italian National Health Service on a lifetime horizon and 6-month cycles. Costs and quality-adjusted life-years (QALYs) were discounted at a 3.5% yearly rate. The results of the model were expressed in terms of incremental cost-effectiveness ratio (ICER). Both a one-way and a multi-way Monte–Carlo analysis were carried out in order to check the robustness of the results achieved. Results The ICER derived from the comparison was equal to €77.53/QALY on the lifetime horizon, as there was a higher level of costs associated with the combination as compared with febuxostat (€10,658.27 vs. €10,645.87, for a differential of €12.40) and a higher level of QALYs achieved (7.77 vs. 7.61, for a differential of 0.16). Conclusions The lesinurad/allopurinol combination is recommended for the treatment of patients affected by gout/hyperuricemia in the Italian Health System as it appears to be cost effective and thus sustainable for the Italian healthcare sector.

The Radiation Monitoring Investigation of the Juno Mission will actively retrieve and analyze the noise signatures from penetrating radiation in the images of Juno’s star cameras and science instruments at Jupiter. The investigation’s objective is to profile Jupiter’s > 10 -MeV electron environment in regions of the Jovian magnetosphere which today are still largely unexplored. This paper discusses the primary instruments on Juno which contribute to the investigation’s data suite, the measurements of camera noise from penetrating particles, spectral sensitivities and measurement ranges of the instruments, calibrations performed prior to Juno’s first science orbit, and how the measurements may be used to infer the external relativistic electron environment.

BackgroundMultiple sclerosis imposes a heavy burden on the person who suffers from it and on the relatives, due to the caregiving load involved. The objective was to analyse whether the inclusion of social costs in economic evaluations of multiple sclerosis-related interventions changed results and/or conclusions.MethodsA systematic review was launched using Medline and the Cost-Effectiveness Analysis Registry of Tufts University (2000–2019). Included studies should: (1) be an original study published in a scientific journal, (2) be an economic evaluation of any multiple sclerosis-related intervention, (3) include productivity losses and/or informal care costs (social costs), (4) be written in English, (5) use quality-adjusted life years as outcome, and (6) separate the results according to the perspective applied.ResultsTwenty-nine articles were selected, resulting in 67 economic evaluation estimations. Social costs were included in 47% of the studies. Productivity losses were assessed in 90% of the estimations (the human capital approach was the most frequently used method), whereas informal care costs were included in nearly two-thirds of the estimations (applying the opportunity and the replacement-cost methods equally). The inclusion of social costs modified the figures for incremental costs in 15 estimations, leading to a change in the conclusions in 10 estimations, 6 of them changing from not recommended from the healthcare perspective to implemented from the societal perspective. The inclusion of social costs also altered the results from cost-effective to dominant in five additional estimations.ConclusionsThe inclusion of social costs affected the results/conclusions in multiple sclerosis-related interventions, helping to identify the most appropriate interventions for reducing its economic burden from a broader perspective.

We report the first observation of the vertical and temporal structure of the H3+ emission at the auroral footprint of Io, as observed by Juno/JIRAM. The brightness vertical profile shows a maximum at 600 km above 1 bar, with no apparent difference between the main Alfvén wing (MAW) spot emission and the tail of the footprint. This observation better aligns with a broadband energy distribution of the precipitating electrons, instead of a monoenergetic one. The temporal profile of H3+ column density has been observed after the passage of the MAW and shows a hyperbolic decrease. A model of H3+ decay is proposed, which takes into account the second-order kinetics of dissociative recombination of H3+ ions with electrons. The model is found to be in very good agreement with Juno observations. The conversion factor from radiance to column density has been derived, as well as the half-life for H3+, which is not constant but inversely proportional to the H3+ column density. This explains the wide range of H3+ lifetimes proposed before.

Background Many seniors need to increase their physical activity (PA) and participation in fall prevention exercise. Therefore, digital systems have been developed to support fall-preventive PA. Most of them lack video coaching and PA monitoring, two functionalities that may be relevant for increasing PA. Objective To develop a prototype of a system to support seniors’ fall-preventive PA, which includes also video coaching and PA monitoring, and to evaluate its feasibility and user experience. Methods A system prototype was conceived by integrating applications for step-monitoring, behavioural change support, personal calendar, video-coaching and a cloud service for data management and co-ordination. Its feasibility and user experience were evaluated in three consecutive test periods combined with technical development. In total, 11 seniors tested the system at home for four weeks with video coaching from health care professionals. Results Initially, the system's feasibility was non-satisfactory due to insufficient stability and usability. However, most problems could be addressed and amended. In the third (last) test period, both seniors and coaches experienced the system prototype to be fun, flexible and awareness-raising. Interestingly, the video coaching which made the system unique compared to similar systems was highly appreciated. Nonetheless, even the users in the last test period highlighted issues due to insufficient usability, stability and flexibility. Further improvements in these areas are needed. Conclusions Video coaching in fall-preventive PA can be valuable for both seniors and health care professionals. High reliability, usability and flexibility of systems supporting seniors are essential.

Background Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications. The treatments of chronic hepatitis B cannot totally cure the disease but can prevent its progression to hepatocellular carcinoma, decreasing the levels of both morbidity and mortality. To date, there are several therapies indicated by the international guidelines as first-line treatments for the management of hepatitis B; two of the most effective are those based on either tenofovir or entecavir. Objective The aim of this study is to evaluate the cost-effectiveness of tenofovir and entecavir in the treatment of naïve patients with chronic hepatitis B. The two treatments are compared with the “no treatment” and to one another. Methods The cost-effectiveness analysis was conducted using a Markov model; patients entered one of the following health states: chronic hepatitis, cirrhosis (compensated or decompensated), hepatocellular carcinoma, liver transplantation or death. The analysis was carried out from the perspective of the Italian National Health Service by considering a life-time horizon with cycles lasting 1 year and with costs and QALYs (quality-adjusted life years) discounted at a rate of 3.5%. The results of the model were analysed in terms of incremental cost-effectiveness ratio (ICER). Results ICERs for tenofovir and entecavir emerging from the comparison versus “no treatment” were equal to €10,274.73 and €16,300.44 per QALY gained, respectively, on the life-time horizon. Tenofovir was dominant in the direct comparison with entecavir, indicating more QALYs and a lower consumption of resources. The Monte Carlo simulation demonstrated that in 97% (tenofovir) and in 85% (entecavir) of the scenarios performed, the cost per QALY fell below the threshold of €30,000/QALY. The budget impact analysis showed savings for tenofovir amounting to 33% compared to entecavir in the first year on treatment and to 31% in following years. Conclusions Entecavir and tenofovir are recommended for the treatment of patients with chronic Hepatitis B in the Italian Health System. In particular, tenofovir appeared to be the more cost-effective drug for the management of chronic hepatitis B virus (HBV) infections. These results could help decision makers and clinicians to address their decision when choosing a first-line treatment for the management of people affected by chronic HBV.