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At least 235 records · Page 13
All sourcesNASA NTRSDOE OSTI
DOE OSTI2020

From Prevention to Disease Perturbations: A Multi-Omic Assessment of Exercise and Myocardial Infarctions

While a molecular assessment of the perturbations and injury arising from diseases is essential in their diagnosis and treatment, understanding changes due to preventative strategies is also imperative. Currently, complex diseases such as cardiovascular disease (CVD), the leading cause of death worldwide, suffer from a limited understanding of how the molecular mechanisms taking place following preventive measures (e.g., exercise) differ from changes occurring due to the injuries caused from the disease (e.g., myocardial infarction (MI)). Therefore, this manuscript assesses lipidomic changes before and one hour after exercise treadmill testing (ETT) and before and one hour after a planned myocardial infarction (PMI) in two separate patient cohorts. Strikingly, unique lipidomic perturbations were observed for these events, as could be expected from their vastly different stresses on the body. The lipidomic results were then combined with previously published metabolomic characterizations of the same patients. This integration provides complementary insights into the exercise and PMI events, thereby giving a more holistic understanding of the molecular changes associated with each.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2022

The Evolution of Medical Countermeasures for Ebola Virus Disease: Lessons Learned and Next Steps

The Ebola virus disease outbreak that occurred in Western Africa from 2013–2016, and subsequent smaller but increasingly frequent outbreaks of Ebola virus disease in recent years, spurred an unprecedented effort to develop and deploy effective vaccines, therapeutics, and diagnostics. This effort led to the U.S. regulatory approval of a diagnostic test, two vaccines, and two therapeutics for Ebola virus disease indications. Moreover, the establishment of fieldable diagnostic tests improved the speed with which patients can be diagnosed and public health resources mobilized. The United States government has played and continues to play a key role in funding and coordinating these medical countermeasure efforts. Here, we describe the coordinated U.S. government response to develop medical countermeasures for Ebola virus disease and we identify lessons learned that may improve future efforts to develop and deploy effective countermeasures against other filoviruses, such as Sudan virus and Marburg virus.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2019

MicroRNAs as diagnostic and therapeutic tools for Alzheimer’s disease: advances and limitations

Alzheimer’s disease (AD) is the most common age-related, progressive neurodegenerative disease. It is characterized by memory loss and cognitive decline and responsible for most cases of dementia in the elderly. Late-onset or sporadic AD accounts for > 95% of cases, with age at onset > 65 years. Currently there are no drugs or other therapeutic agents available to prevent or delay the progression of AD. The cellular and molecular changes occurring in the brains of individuals with AD include accumulation of β-amyloid peptide and hyperphosphorylated tau protein, decrease of acetylcholine neurotransmitter, inflammation, and oxidative stress. Aggregation of β-amyloid peptide in extracellular plaques and the hyperphosphorylated tau protein in intracellular neurofibrillary tangles are characteristic of AD. A major challenge is identifying molecular biomarkers of the early-stage AD in patients as most studies have been performed with blood or brain tissue samples (postmortem) at late-stage AD. Subjects with mild cognitive impairment almost always have the neuropathologic features of AD with about 50% of mild cognitive impairment patients progressing to AD. They could provide important information about AD pathomechanism and potentially also highlight minimally or noninvasive, easy-to-access biomarkers. MicroRNAs are dysregulated in AD, and may facilitate the early detection of the disease and potentially the continual monitoring of disease progression and allow therapeutic interventions to be evaluated. Four recent reviews have been published of microRNAs in AD, each of which identified areas of weakness or limitations in the reported studies. Importantly, studies in the last three years have shown considerable progress in overcoming some of these limitations and identifying specific microRNAs as biomarkers for AD and mild cognitive impairment. Further large-scale human studies are warranted with less disparity in the study populations, and using an appropriate method to validate the findings.

Cell Biology↗
NASA NTRS1991

Technologies for the marketplace from the Centers for Disease Control

The Centers for Disease Control, a Public Health Service agency, is responsible for the prevention and control of disease and injury. Programs range from surveillance and prevention of chronic and infectious diseases to occupational health and injury control. These programs have produced technologies in a variety of fields, including vaccine development, new methods of disease diagnosis, and new tools to ensure a safer work environment.

Reid-Sanden, Frances L.↗
NASA NTRS1996

Use of Remote Sensing Surveillance to Monitor Environmental Parameters Associated with Mosquito Abundance and Vector-borne Diseases

Lymphatic filariasis persists as a major cause of clinical morbidity and a significant impediment to socioeconomic development in various parts of the world including Egypt. In Egypt, filariasis has been endemic since time immemorial. Early epidemiologic studies identified Culex pipiens L. as the main vector of the disease and also showed that the geographic distribution of the disease is highly focal and concentrated in lower Egypt. Between 1950 and 1965, a large scale filariasis control program was carried out by the Egyptian Ministry of Health (EMOH) in the endemic areas. Control efforts led to a steady decrease of the disease in areas of the country previously identified as endemic. However, spot surveys conducted in various parts of the Nile Delta during the 1970's and 1980's revealed that the downward trend of the disease had stopped and that the prevalence and intensity of microfilaraemia had increased.

Source record↗
NASA NTRS1993

Abnormal Eye Movements in Creutzfeldt-Jakob Disease

We report 3 patients with autopsy-proven Creutzfeldt-Jakob disease who, early in their course, developed abnormal eye movements that included periodic alternating nystagmus and slow vertical saccades. These findings suggested involvement of the cerebellar nodulus and uvula, and the brainstem reticular formation, respectively. Cerebellar ataxia was also an early manifestation and, in one patient, a frontal lobe brain biopsy was normal at a time when ocular motor and cerebellar signs were conspicuous. As the disease progressed, all saccades and quick phases of nystagmus were lost, but periodic alternating gaze deviation persisted. At autopsy, 2 of the 3 patients had pronounced involvement of the cerebellum, especially of the midline structures. Creutzfeldt-Jakob disease should be considered in patients with subacute progressive neurological disease when cognitive changes are overshadowed by ocular motor findings or ataxia.

Grant, Michael P.↗
NASA NTRS1997

Spectral quality affects disease development of three pathogens on hydroponically grown plants

Plants were grown under light-emitting diode (LED) arrays with various spectra to determine the effects of light quality on the development of diseases caused by tomato mosaic virus (ToMV) on pepper (Capsicum annuum L.), powdery mildew [Sphaerotheca fuliginea (Schlectend:Fr.) Pollaci] on cucumber (Cucumis sativus L.), and bacterial wilt (Pseudomonas solanacearum Smith) on tomato (Lycopersicon esculentum Mill.). One LED (660) array supplied 99% red light at 660 nm (25 nm bandwidth at half-peak height) and 1% far-red light between 700 to 800 nm. A second LED (660/735) array supplied 83% red light at 660 nm and 17% far-red light at 735 nm (25 nm bandwidth at half-peak height). A third LED (660/BF) array supplied 98% red light at 660 nm, 1% blue light (BF) between 350 to 550 nm, and 1% far-red light between 700 to 800 nm. Control plants were grown under broad-spectrum metal halide (MH) lamps. Plants were grown at a mean photon flux (300 to 800 nm) of 330 micromoles m-2 s-1 under a 12-h day/night photoperiod. Spectral quality affected each pathosystem differently. In the ToMV/pepper pathosystem, disease symptoms developed slower and were less severe in plants grown under light sources that contained blue and UV-A wavelengths (MH and 660/BF treatments) compared to plants grown under light sources that lacked blue and UV-A wavelengths (660 and 660/735 LED arrays). In contrast, the number of colonies per leaf was highest and the mean colony diameters of S. fuliginea on cucumber plants were largest on leaves grown under the MH lamp (highest amount of blue and UV-A light) and least on leaves grown under the 660 LED array (no blue or UV-A light). The addition of far-red irradiation to the primary light source in the 660/735 LED array increased the colony counts per leaf in the S. fuliginea/cucumber pathosystem compared to the red-only (660) LED array. In the P. solanacearum/tomato pathosystem, disease symptoms were less severe in plants grown under the 660 LED array, but the effects of spectral quality on disease development when other wavelengths were included in the light source (MH-, 660/BF-, and 660/735-grown plants) were equivocal. These results demonstrate that spectral quality may be useful as a component of an integrated pest management program for future space-based controlled ecological life support systems.

NASA Center KSC↗
NASA NTRS2011

Climate Change, Extreme Weather Events, and Fungal Disease Emergence and Spread

Empirical evidence from multiple sources show the Earth has been warming since the late 19th century. More recently, evidence for this warming trend is strongly supported by satellite data since the late 1970s from the cryosphere, atmosphere, oceans, and land that confirms increasing temperature trends and their consequences (e.g., reduced Arctic sea ice, rising sea level, ice sheet mass loss, etc.). At the same time, satellite observations of the Sun show remarkably stable solar cycles since the late 1970s, when direct observations of the Sun's total solar irradiance began. Numerical simulation models, driven in part by assimilated satellite data, suggest that future-warming trends will lead to not only a warmer planet, but also a wetter and drier climate depending upon location in a fashion consistent with large-scale atmospheric processes. Continued global warming poses new opportunities for the emergence and spread of fungal disease, as climate systems change at regional and global scales, and as animal and plant species move into new niches. Our contribution to this proceedings is organized thus: First, we review empirical evidence for a warming Earth. Second, we show the Sun is not responsible for the observed warming. Third, we review numerical simulation modeling results that project these trends into the future, describing the projected abiotic environment of our planet in the next 40 to 50 years. Fourth, we illustrate how Rift Valley fever outbreaks have been linked to climate, enabling a better understanding of the dynamics of these diseases, and how this has led to the development of an operational predictive outbreak model for this disease in Africa. Fifth, We project how this experience may be applicable to predicting outbreaks of fungal pathogens in a warming world. Lastly, we describe an example of changing species ranges due to climate change, resulting from recent warming in the Andes and associated glacier melt that has enabled amphibians to colonize higher elevation lakes, only to be followed shortly by the emergence of fungal disease in the new habitats.

Tucker, Compton J.↗
NASA NTRS2011

Space Radiation Cancer, Circulatory Disease and CNS Risks for Near Earth Asteroid and Mars Missions: Uncertainty Estimates for Never-Smokers

The uncertainties in estimating the health risks from galactic cosmic rays (GCR) and solar particle events (SPE) are a major limitation to the length of space missions and the evaluation of potential risk mitigation approaches. NASA limits astronaut exposures to a 3% risk of exposure induced cancer death (REID), and protects against uncertainties in risks projections using an assessment of 95% confidence intervals after propagating the error from all model factors (environment and organ exposure, risk coefficients, dose-rate modifiers, and quality factors). Because there are potentially significant late mortality risks from diseases of the circulatory system and central nervous system (CNS) which are less well defined than cancer risks, the cancer REID limit is not necessarily conservative. In this report, we discuss estimates of lifetime risks from space radiation and new estimates of model uncertainties are described. The key updates to the NASA risk projection model are: 1) Revised values for low LET risk coefficients for tissue specific cancer incidence, with incidence rates transported to an average U.S. population to estimate the probability of Risk of Exposure Induced Cancer (REIC) and REID. 2) An analysis of smoking attributable cancer risks for never-smokers that shows significantly reduced lung cancer risk as well as overall cancer risks from radiation compared to risk estimated for the average U.S. population. 3) Derivation of track structure based quality functions depends on particle fluence, charge number, Z and kinetic energy, E. 4) The assignment of a smaller maximum in quality function for leukemia than for solid cancers. 5) The use of the ICRP tissue weights is shown to over-estimate cancer risks from SPEs by a factor of 2 or more. Summing cancer risks for each tissue is recommended as a more accurate approach to estimate SPE cancer risks. 6) Additional considerations on circulatory and CNS disease risks. Our analysis shows that an individual s history of smoking exposure has a larger impact on GCR risk estimates than amounts of radiation shielding or age at exposure (amongst adults). Risks for never-smokers compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for never-smokers, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity and esophagus, and leukemia. The relative contribution of CNS risks to the overall space radiation detriment is potentially increased for never-smokers such as most astronauts. Problems in estimating risks for former smokers and the influence of second-hand smoke are discussed. Compared to the LET approximation, the new track structure derived radiation quality functions lead to a reduced risk for relativistic energy particles and increased risks for intermediate energy particles. Revised estimates for the number of safe days in space at solar minimum for heavy shielding conditions are described for never-smokers and the average U.S. population. Results show that missions to near Earth asteroids (NEA) or Mars violate NASA's radiation safety standards with the current levels of uncertainties. Greater improvements in risk estimates for never-smokers are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Cucinotta, Francis A.↗
NASA NTRS2011

Climate Teleconnections and Recent Patterns of Human and Animal Disease Outbreaks

Recent clusters of outbreaks of mosquito-borne diseases (Rift Valley fever and chikungunya) in Africa and parts of the Indian Ocean islands illustrate how interannual climate variability influences the changing risk patterns of disease outbreaks. Extremes in rainfall (drought and flood) during the period 2004 - 2009 have privileged different disease vectors. Chikungunya outbreaks occurred during the severe drought from late 2004 to 2006 over coastal East Africa and the western Indian Ocean islands and in the later years India and Southeast Asia. The chikungunya pandemic was caused by a Central/East African genotype that appears to have been precipitated and then enhanced by global-scale and regional climate conditions in these regions. Outbreaks of Rift Valley fever occurred following excessive rainfall period from late 2006 to late 2007 in East Africa and Sudan, and then in 2008 - 2009 in Southern Africa. The shift in the outbreak patterns of Rift Valley fever from East Africa to Southern Africa followed a transition of the El Nino/Southern Oscillation (ENSO) phenomena from the warm El Nino phase (2006-2007) to the cold La Nina phase (2007-2009) and associated patterns of variability in the greater Indian Ocean basin that result in the displacement of the centres of above normal rainfall from Eastern to Southern Africa. Understanding the background patterns of climate variability both at global and regional scale and their impacts on ecological drivers of vector borne-diseases is critical in long-range planning of appropriate response and mitigation measures.

Anyamba, Assaf↗
NASA NTRS2015

An Overview of NASA's Risk of Cardiovascular Disease from Radiation Exposure

The association between high doses of radiation exposure and cardiovascular damage is well established. Patients that have undergone radiotherapy for primary cancers of the head and neck and mediastinal regions have shown increased risk of heart and vascular damage and long-term development of radiation-induced heart disease [1]. In addition, recent meta-analyses of epidemiological data from atomic bomb survivors and nuclear industry workers has also shown that acute and chronic radiation exposures is strongly correlated with an increased risk of circulatory disease at doses above 0.5 Sv [2]. However, these analyses are confounded for lower doses by lifestyle factors, such as drinking, smoking, and obesity. The types of radiation found in the space environment are significantly more damaging than those found on Earth and include galactic cosmic radiation (GCR), solar particle events (SPEs), and trapped protons and electrons. In addition to the low-LET data, only a few studies have examined the effects of heavy ion radiation on atherosclerosis, and at lower, space-relevant doses, the association between exposure and cardiovascular pathology is more varied and unclear. Understanding the qualitative differences in biological responses produced by GCR compared to Earth-based radiation is a major focus of space radiation research and is imperative for accurate risk assessment for long duration space missions. Other knowledge gaps for the risk of radiation-induced cardiovascular disease include the existence of a dose threshold, low dose rate effects, and potential synergies with other spaceflight stressors. The Space Radiation Program Element within NASA's Human Research Program (HRP) is managing the research and risk mitigation strategies for these knowledge gaps. In this presentation, we will review the evidence and present an overview of the HRP Risk of Cardiovascular Disease and Other Degenerative Tissue Effects from Radiation Exposure.

Patel, Zarana S.↗
NASA NTRS2022

Peru Health and Air Quality II: Leveraging Earth Observations and Health Data to Map Outbreak Risk and Inform Public Health Interventions for Zoonotic Disease Prevention

Peru's Madre de Dios region is a hotspot for dengue fever and leishmaniasis due to its tropical Amazonian climate. Though treatable, these zoonotic diseases are debilitating for under-resourced communities whose already close proximity to mosquito and sandfly vectors continues to increase via rapid urbanization and deforestation. Peru’s Ministries of Health (MINSA) and Environment (MINAM) are working to better understand the environmental factors amplifying the risk of dengue fever and leishmaniasis transmission. The first term of this project classified the land use and land cover of Madre de Dios’ 11 districts for 2010, 2015, and 2020 and identified a correlation between both diseases and urbanization. Our team expanded this analysis by creating urban-forest edge maps and incorporating climatic and topographic variables with data from Landsat 7 Enhanced Thematic Mapper Plus (ETM+), Landsat 8 Operational Land Imager (OLI), the Global Precipitation Measurement (GPM) Integrated Multi-satellitE Retrievals for GPM (IMERG), and the Shuttle Radar Topography Mission (SRTM). We determined these variables’ impacts on disease incidence by assessing existing literature and running regression models. Dengue fever correlated with urban-forest edge, urban area, slope, temperature, and precipitation. Leishmaniasis primarily correlated with forest-edge area and elevation, but lacking additional statistical significance prevented further work, a decision supported by the literature. Thus, the risk matrix and risk map which we scripted in R to visualize the risk of disease posed to districts alongside health post locations addresses only dengue fever. The results and products will inform MINSA and MINAM in public health interventions, resource distribution, and policy initiatives.

Jennifer Rogers↗
NASA NTRS2021

Impact of Recent Climate Extremes on Mosquito-borne Disease Transmission in Kenya

Climate change and variability influence temperature and rainfall, which impact vector abundance and the dynamics of vector-borne disease transmission. Climate change is projected to increase the frequency and intensity of extreme climate events. Mosquito-borne diseases, such as dengue fever, are primarily transmitted by Aedes aegypti mosquitoes. Freshwater availability and temperature affect dengue vector populations via a variety of biological processes and thus influence the ability of mosquitoes to effectively transmit disease. However, the effect of droughts, floods, heat waves, and cold waves is not well understood. Using vector, climate, and dengue disease data collected between 2013 and 2019 in Kenya, this retrospective cohort study aims to elucidate the impact of extreme rainfall and temperature on mosquito abundance and the risk of arboviral infections. To define extreme periods of rainfall and land surface temperature (LST), we calculated monthly anomalies as deviations from long-term means (1983–2019 for rainfall, 2000–2019 for LST) across four study locations in Kenya. We classified extreme climate events as the upper and lower 10% of these calculated LST or rainfall deviations. Monthly Ae. aegypti abundance was recorded in Kenya using four trapping methods. Blood samples were also collected from children with febrile illness presenting to four field sites and tested for dengue virus using an IgG enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). We found that mosquito eggs and adults were significantly more abundant one month following an abnormally wet month. The relationship between mosquito abundance and dengue risk follows a non-linear association. Our findings suggest that early warnings and targeted interventions during periods of abnormal rainfall and temperature, especially flooding, can potentially contribute to reductions in risk of viral transmission

Aedes aegypti mosquitoes↗
NASA NTRSDate not supplied

Development of Machine Learning-Derived Microbiological and Immune Signatures: Applications in Adaptive Risk Assessment of Infectious Disease During Spaceflight

Infectious diseases represent an urgent risk for spaceflight with consequences ranging from loss in crew performance to crew incapacitation or loss of life should an outbreak occur. The resident environmental microbiome on the International Space Station has been monitored through routine surveillance over almost twenty years, beginning with culture-based microbial detection which has advanced to molecular methods in recent years. This has created a wealth of data that we have begun mining to define the microbial ecology of the ISS. Summarized here is our analysis of data from the historical microbial population defined by culture-based monitoring from the past two decades, organized by their likelihood to cause disease into clinical categories. As expected, many residents of the normal microflora in environments where people work and live were detected. However, some known pathogens were also detected. As the spaceflight environment can predispose humans to infection, crew health records were used to source additional data for the set to uncover clinical relevance. Data mining was performed on crew health records to capture adverse health events that may be related to infectious disease. Machine learning, specifically Random Forest analysis, was used to analyze the microbial and crew health datasets. The symptom categories were not explained by the ranked bacteria, due to lack of sufficient data for some categories and due to poor ranking of the pathogens for others. Poor ranking of the bacteria could be due to the clinical symptoms being linked to other disease-causing factors, such as allergy or viral infection. These findings suggest a lack of relationship between bacteria detected on surfaces in the ISS and historical health events experienced by astronauts.

Kristyn Hoffman↗
DOE OSTI2018

Apparatus, compositions, and methods for assessment of chronic obstructive pulmonary disease progression among rapid and slow decline conditions

Methods are disclosed for generating and isolating an informative content repository of respiratory related biomarkers to accurately determine whether an individual has normal or abnormal pulmonary function. Specifically, methods are directed to determination of whether individuals have chronic obstructive pulmonary disease, and if so, whether the affected individuals experience rapid long decline or slow lung decline as a result of COPD. Also disclosed is an informative content repository of chronic obstructive pulmonary disease biomarkers, which when linked with other informative content provides a powerful tool for diagnosis, study, therapeutic discovery and development, condition management, health maintenance, and linking chronic obstructive pulmonary disease through pattern of life style, environmental exposure, and genetic susceptibility and inheritance. Disclosed herein is a chronic obstructive pulmonary disease biomarker informative content repository comprising at least one COPD biomarker, apparatus and methods to diagnose, assess, address, and ameliorate related conditions.

Hoidal, John↗
DOE OSTI2020

Methods for treating diseases related to the wnt pathway

The present invention relates to methods for treating a disease, in which the disease arises from dysregulation of the Wnt signaling pathway. In some instances, the disease can be treated by administering a Wnt pathway inhibitory compound. In other instances, the method optionally includes conducting a genome-wide screening to determine one or more genes resulting in a reduced disease state and then identifying the gene(s) as being involved in the Wnt signaling pathway.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2021

Neuroanatomical and cognitive correlates of visual hallucinations in Parkinson’s disease and dementia with Lewy bodies: Voxel-based morphometry and neuropsychological meta-analysis

Visual hallucinations (VH) are common in Parkinson's disease and dementia with Lewy bodies, two forms of Lewy body disease (LBD), but the neural substrates and mechanisms involved are still unclear. We conducted meta-analyses of voxel-based morphometry (VBM) and neuropsychological studies investigating the neuroanatomical and cognitive correlates of VH in LBD. For VBM (12 studies), we used Seed-based d Mapping with Permutation of Subject Images (SDM-PSI), including statistical parametric maps for 50% of the studies. For neuropsychology (35 studies), we used MetaNSUE to consider non-statistically significant unreported effects. VH were associated with smaller grey matter volume in occipital, frontal, occipitotemporal, and parietal areas (peak Hedges' g -0.34 to -0.49). In patients with Parkinson's disease without dementia, VH were associated with lower verbal immediate memory performance (Hedges' g -0.52). Both results survived correction for multiple comparisons. Here, abnormalities in these brain regions might reflect dysfunctions in brain networks sustaining visuoperceptive, attention, and executive abilities, with the latter also being at the basis of poor immediate memory performance.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Ruminococcus gnavus , a member of the human gut microbiome associated with Crohn’s disease, produces an inflammatory polysaccharide

A substantial and increasing number of human diseases are associated with changes in the gut microbiota, and discovering the molecules and mechanisms underlying these associations represents a major research goal. Multiple studies associate Ruminococcus gnavus , a prevalent gut microbe, with Crohn’s disease, a major type of inflammatory bowel disease. We have found that R. gnavus synthesizes and secretes a complex glucorhamnan polysaccharide with a rhamnose backbone and glucose sidechains. Chemical and spectroscopic studies indicated that the glucorhamnan was largely a repeating unit of five sugars with a linear backbone formed from three rhamnose units and a short sidechain composed of two glucose units. The rhamnose backbone is made from 1,2- and 1,3-linked rhamnose units, and the sidechain has a terminal glucose linked to a 1,6-glucose. This glucorhamnan potently induces inflammatory cytokine (TNFα) secretion by dendritic cells, and TNFα secretion is dependent on toll-like receptor 4 (TLR4). We also identify a putative biosynthetic gene cluster for this molecule, which has the four biosynthetic genes needed to convert glucose to rhamnose and the five glycosyl transferases needed to build the repeating pentasaccharide unit of the inflammatory glucorhamnan.

60 APPLIED LIFE SCIENCES↗