Atrial fibrillation is significantly associated with morbidity and mortality and erodes the quality and quantity of life. It is standard of care to treat patients with AF and an increased risk of stroke with oral anticoagulation therapy, but the more daunting question many clinicians face is whether to pursue a “rate-only” or “rhythm” control strategy. Historical studies over the years have sought to answer this question but have found no significant difference in major clinical outcomes between the two strategies. There are opportunities based on new data to improve the natural history of the disease. The EAST AFnet trial for the first time revealed a significant morbidity and mortality advantage to rhythm control therapy when performed early in the disease process of AF and in the setting of comprehensive medical management that was maintained. The CABANA trial clearly demonstrated that catheter ablation was a more effective long-term treatment of AF in general and significantly lowers risk of AF progression compared to medical therapy. Like multiple prior trials of rhythm management strategies, when rhythm control was effective in these trials, independent of therapy assignment, there was a significantly lower risk of adverse outcomes and death. These contemporary data provide optimism that the pervasive mortality risk in patients with AF observed over the past 50 years may be improved by the timing, use, and efficacy of use of therapeutic interventions.

Previous research has examined the impact of family and school separately on adolescents' psychological well-being. This study focuses on the integrated role of family and school to observe their effects on children's psychological well-being. Using a random sample of 1180 Chinese children from Grades 4 to 9, this study explores the psychological well-being of rural Chinese children within this joint family-school framework. The PROCESS macro is used to conduct the moderation analysis. Results of this study show that attachment security is significantly and directly related and indirectly associated with adolescents' psychological well-being through the intermediary mechanism of self-efficacy. Moreover, peer isolation moderates the relationship between psychological well-being with attachment security and its association with self-efficacy. This study contributes to confirming self-efficacy and peer isolation's mediating and moderating role and highlights the family-school as two synergistic links that influence adolescents' psychological well-being.

The loss of coastal wetlands represents a grave threat to waterbirds, prompting the use of artificial wetlands, such as aquaculture ponds, as a means of conservation. Aquaculture ponds are common in coastal areas and provide production value and ecological function as waterbird habitats. However, certain piscivorous birds may cause economic losses to the aquaculture industry. Different types of ponds provide habitat for various bird assemblages, and waterbirds exhibit nocturnal feeding behavior and utilize habitats distinct from those used during the day. Most waterbird surveys were conducted during the daytime, limiting our understanding of their nocturnal habitat utilization. This study conducted diurnal and nocturnal surveys on shorebirds, waterfowl, and Black-crowned Night Heron (Nycticorax nycticorax) ten times in three aquaculture ponds situated in the Cigu District of Tainan, namely fish/shrimp, hard clam, and abandoned ponds between October 2021 and November 2022. The results showed no significant difference in shorebird density between day and night. However, shorebird density in fish/shrimp ponds was significantly higher than in abandoned ponds. Conversely, waterfowl density exhibits a significant increase in abandoned ponds compared to the other two pond types, irrespective of diurnal or nocturnal conditions. Furthermore, waterfowl density in abandoned ponds was significantly higher during daylight compared to the nocturnal period. In the daytime, the density of night herons was significantly higher in abandoned ponds than in the other two ponds. Nevertheless, during nighttime, fish/shrimp ponds exhibit the highest density of night herons, significantly surpassing that found in hard clam ponds. Notably, water coverage also influences the density of both shorebirds and waterfowl. The foraging frequency of waterfowl and night herons was greater during nocturnal hours, while shorebirds did not exhibit significant variations between day and night. Consequently, this study underscores the significance of considering both diurnal and nocturnal habitats in formulating strategies for waterbird conservation.

Amelia Yin,1,2 Wenyan Fu,1,2 Anthony Elengickal,2 Joonhee Kim2, Yang Liu,1,2, Anne Bigot,3 Kamal Mamchaoui,3 Jarrod A. Call,4 and Hang Yin1,2,#1 Center for Molecular Medicine, The University of Georgia, Athens, GA 30602, USA2 Department of Biochemistry and Molecular Biology, The University of Georgia, Athens, GA 30602, USA3 Sorbonne Université, Inserm, Institut de Myologie, Centre de Recherche en Myologie, F-75013 Paris, France4 Department of Physiology and Pharmacology, The University of Georgia, Athens, GA 30602, USA# Correspondence: hyin@uga.edu

Waterborne transmission of the bacterium L. pneumophila has emerged as a major cause of severe nosocomial infections of major public health impact. The major route of transmission involves the uptake of aerosolized bacteria, often from the contaminated hot water systems of large buildings. Public health regulations aimed at controlling the mesophilic pathogen are generally concerned with acute pasteurization and maintaining high temperatures at the heating systems and throughout the plumbing of hot water systems, but L. pneumophila is often able to survive these treatments due to both bacterium-intrinsic and environmental factors. Previous work has established an experimental evolution system to model the observations of increased heat resistance in repeatedly but unsuccessfully pasteurized L. pneumophila populations. Here, we show rapid fixation of novel alleles in lineages selected for resistance to heat shock and shifts in mutational profile related to increases in the temperature of selection. Gene-level and nucleotide-level parallelisms between independently-evolving lineages show the centrality of the DnaJ/DnaK chaperone system in the heat resistance of L. pneumophila. Inference of epistatic interactions through reverse genetics shows an unexpected interaction between DnaJ/DnaK and the polyhydroxybutyrate-accumulation energy storage mechanism used by the species to survive long-term starvation in low-nutrient environments.

Background: Colic is the commonest emergency in first opinion equine practice. Early referral is important for horses requiring surgery. Fast localised abdominal ultrasonography of horses (FLASH) is frequently used as a diagnostic tool in the investigation of colic at referral hospitals, but its use in first opinion practice has not been evaluated. Objective: To assess the value of FLASH scanning in the primary assessment of horses with colic in the field, using a portable wireless ultrasound system. Study design: Prospective study (2018-2021). Methods: Any horse examined for colic as an emergency in a first opinion ambulatory practice was eligible for inclusion in the study. A FLASH examination was performed using a wireless handheld ultrasound scanner, with the images displayed on a smartphone or tablet. The findings on FLASH scans and outcome of the case (recovered, referred for surgery or euthanised without referral) were recorded. Results: 135 equids with acute colic were evaluated. Of the 135 horses, 49 (36%) had an abnormal finding on FLASH scanning, including distended loops of small intestine (n=34), thickened small intestinal walls (n=23) and/or distension of the stomach (n=7). Reduced small intestinal motility was recorded in 52 animals (38%). Follow-up information was available in all animals: 50 (37%) were euthanised due to clinical deterioration and the owners’ decision not to undertake surgery; 85/135 (63%) survived, including 5/85 (6%) that underwent surgery and 80/85 (94%) that resolved with medical management. Main limitations: Small number of cases. Lack of results of post-mortem examination of horses that were euthanised. Potential selection bias. Conclusion: The FLASH technique can be valuable in the primary assessment of horses with colic in first opinion ambulatory practice. Further evaluation with more cases is required.

Predators can affect ecosystems through non-consumptive effects on their prey, which can lead to cascading effects on the vegetation. In mammalian communities, such cascading effects on whole ecosystems have mainly been demonstrated in protected areas, but the extent to which such effects may occur in more human-dominated landscapes remains disputable. With the recolonisation of wolves (Canis lupus) in Europe, understanding the potential for such cascading processes becomes crucial for understanding the ecological consequences of wolf recovery and making appropriate management recommendations. Here, we investigate the evidence for non-consumptive effects of wolves on their wild ungulate prey and cascading effects on the vegetation in European landscapes. We reviewed empirical studies reporting wild ungulate responses to wolves involving spatio-temporal behaviour at large and fine spatial scales, activity patterns, vigilance, grouping, physiological effects, and effects on the vegetation. We reveal that non-consumptive effects of wolves in Europe have been studied in few regions and with focus on regions with low human impact and are highly context-dependent and might often be overruled by human-related factors. Further, we highlight the need for a description of human influence in NCE studies. We discuss challenges in NCE research and the potential for advances in future research on NCE of wolves in a human dominated landscape. Further, we emphasise the need for wildlife management to restore ecosystem complexity and processes, to allow non-consumptive predator effects to occur.

Since wolf-year 2014-2015, wolves have been recolonizing the Netherlands, even though the small size of the country and the high densities of humans and livestock. In this article, the main policies on wolves and methods of monitoring wolves in the Netherlands are explained. Field monitoring is mostly done by a coordinated network of volunteers and use of genetics in both monitoring and livestock depredation events. The strategy of collecting and validation of the data is in line with the German standards, including a close collaboration between the genetic laboratories in the CEwolf consortium. In nine years of wolf monitoring, 15.347 reports of possible sightings of wolves and their tracks have been documented and validated. Of these, 3666 reports (24%) classified as direct proof of wolf (C1) and 651 reports (4%) classified as indirect proof of wolf (C2). Most abundant proof of wolves are sightings verified by imagery (N=2652), scats (N=942) and livestock depredation events (N=648). Up to April 2023, 90 wolf individuals were genetically identified in the Netherlands. These originated from Germany (36%), Belgium (13%) and the French Italian-Alps (3%) or were born in the Netherlands (27%). The first wolf territory was established in July 2018 and the population has increased since, with four wolf packs, five wolf pairs and one solitary territorial wolf in the Netherlands at the end of wolf year 2022/2023. Most of the 648 livestock depredation events involved sheep (94%). In only nine events, it was confirmed that the wolf deterrent fencing was correctly placed. The perception on wolves to the Netherlands seem to be ambiguous, even though the authorities aim for coexistence between humans, livestock and wolves. An increase in international cooperation regarding expertise with human-wildlife conflict and coexistence is recommended.

A reexamination of clinical principles of long-term opioid therapy (LTOT) for chronic pain is long overdue amid the ongoing opioid crisis. Most patients on LTOT report ineffectiveness (poor pain control, function, and health), but still find deprescribing challenging. Although prescribed as analgesics, opioids more likely provide pain relief primarily through reward system actions (enhanced relief and motivation) and placebo effect and less through anti-nociceptive effects. The unavoidable physiologic LTOT dependence can automatically lead to a paradoxical worsening of pain, disability, and medical instability (maladaptive opioid dependence) without addiction due to allostatic opponent neuroadaptations involving reward/anti-reward and nociceptive/anti-nociceptive systems. This opioid induced chronic pain syndrome (OICP) can persist/progress whether LTOT dose is maintained at the same level, increased, decreased, or discontinued. Current conceptualization of LTOT as a straightforward long-term analgesic therapy appears incongruous in view of the complex mechanisms of opioid action, LTOT dependence and OICP. LTOT can be more appropriately conceptualized as therapeutic induction and maintenance of an adaptive LTOT dependence for functional improvement irrespective of analgesic benefits. Adaptive LTOT dependence should be ideally used for a limited time to achieve maximum functional recovery and deprescribed while maintaining functional gains. Patients on LTOT should be regularly reevaluated to identify if maladaptive LTOT dependence with OICP has diminished any functional gains or lead to ineffectiveness. Ineffective LTOT (with maladaptive LTOT dependence) should be modified to make it safer and more effective. An adequately functional life without opioids is the ideal healthy long-term goal for both LTOT initiation and LTOT modification.

Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, be-cause ongoing opioid use brings changes in pain responses and most pain assess-ment tools have not been validated for this population. In this narrative review, we dis-cuss the fundamentals of pain assessment for populations with OUD. First, we de-scribe biological, psychological, and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena and healthcare dispari-ties in this population may contribute to the pain experience. Second, we review meth-ods to assess pain including: (1) traditional self-reported methods, such visual analog scales, and structured questionnaires; (2) behavioral observations and physiological indicators; (3) and laboratory-based approaches, such as functional brain imaging, electroencephalography, and quantitative sensory testing. These methods are consid-ered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. Substan-tial gaps persist in our knowledge, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial back-grounds, we will be better equipped to reduce these gaps.

The incidence of drug administration errors in hospitals in India is not known. We aimed to extract and investigate India-specific incidents of intrathecal tranexamic acid (TXA) administration during spinal anaesthesia. Our secondary aim was to identify any publications related to national drug error and reporting systems for hospitals in India. We analysed eleven published reports of tranexamic acid administration intrathecally in place of heavy bupivacaine. The primary cause was the availability of look-like TXA and local anaesthetic (heavy 0.5% bupivacaine) ampoules in operating rooms. We found three manufacturers designed, manufactured and supplied identical TXA and heavy bupivacaine ampules. In addition, different manufacturers had similar products available in operating rooms. We searched PubMed and Google Scholar for any publication on India’s national medication error reporting system for hospitals. There was no publication on the national medication safety system involving hospitals. It demonstrates there needs to be a federal structure to report and monitor medication administration and other types of errors in hospitals in India. We highlight potential difficulties and barriers in creating a national system to notify, monitor and prevent medication errors in hospitals in India.

Offspring phenotype in most organisms is significantly mediated by genetically-based traits inherited from both parents. For instance, in many well-studied organisms, such as mammals, traits like body size and morphology are heritable and are passed on from one generation to the next. In invertebrates, such as arthropods, the situation is more complex, because traits like growth rate and body size are often more strongly correlated with biotic and abiotic parameters like food quality and availability and temperature. Thus, growth and body size are less based on heritability from parents (‘nature’) and more influenced by short-term environmental factors (‘nurture’). Here, we evaluate maternal and host size-related effects on the development of an asexually reproducing (= female only) parasitoid, Gelis agilis on pre-pupae in cocoons of its host, the primary parasitoid, Cotesia glomerata. Female G. agilis from two adult size classes, ‘small’ (mean 0.7 mg) or ‘large’ (mean 1.2 mg) were allowed to parasitize cocoons of differing size along a continuum from ~1.2 mg to ~4.0 mg and the body size and development time of their offspring was measured. In both body size classes of G. agilis mothers, offspring adult body size correlated strongly with host cocoon size, whereas there was no maternal effect on offspring size. Our results reveal that host quality completely overrides any effects of maternal size on the development of G. agilis. Given that parasitoids are under strong selection for optimal exploitation, allocation and utilization of limited resources contained in individual hosts, we argue that host quality is far more of a constraint on parasitoid development and fitness than traits inherited from one or both parents when producing sexually.

A document by Ruxin ZHANG. Click on the document to view its contents.

CommentaryKadir Uludag PhD.aShanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, China*Corresponding Authors:Kadir Uludag; Shanghai Mental Health Center, Shanghai Jiao Tong University China Tel: +86-18401653162, Email: kadiruludag@mails.ucas.ac.cn&kadiruludag@protonmail.com& kadiruludag233@gmail.comFunding: There is no funding associated with this study.Competing interests: No potential competing interest was reported by the authors.Ethical approval: Not required.Patient Consent: Not required.Acknowledgment: Not required.Author Statement: K.U. wrote the manuscript and is the only author.

Stipa breviflora (Stipa breviflora Griseb.) and Cleistogenes songorica (Cleistogenes songorica (Roshev.) Ohwi) are two dominant species in the critically important desert steppe of northern China. Under the interference of grazing, the two species will have the phenomenon of plant cluster fragmentation to varying degrees. Therefore, when the two plant populations appear in the same plant community, what changes will happen in the inter-specific relationship during grazing has important guiding significance for its regulation of plant community and function. To study this, we observed populations of wild S. breviflora and C. songorica in field under a suite of grazing intensities and at a variety of scales. The density changes of dominant species S. breviflora and C. songorica in desert steppe in Inner Mongolia were studied under four grazing intensities (no grazing, CK, 0 sheep·ha-1·half year-1, light grazing, LG, 0.93 sheep·ha-1·half year-1, moderate grazing, MG, 1.82 sheep·ha-1·half year-1, heavy grazing, HG, 2.71 sheep·ha-1·half year-1) and six scales (5 cm×5 cm, 10 cm×10 cm, 20 cm×20 cm, 25 cm×25 cm, 50 cm×50 cm and 100 cm×100 cm). Results showed that grazing changes the relationship between dominant species. With the increase of grazing intensity, the densities of S. breviflora and C. songorica increased, and the increase was more obvious with the increase of scale. Under heavy grazing conditions, the dominant populations of clustered grasses in Inner Mongolia desert steppe resisted the interference of high-intensity grazing by reducing inter-specific competition ability (increasing inter-specific affinity).

Rigorous statistical methodology represents a vital framework for upholding research integrity and maximizing benefits in medical science. However, the misuse of statistical tools contradicts ethical tenets and compromises validity. Problematic trends like p-hacking, hyping delicate results, and overemphasizing statistical significance relative to clinical meaning introduce prejudice and impede reproducibility. Case studies, including hormone replacement therapy trials, exhibit how unsound statistics propagate doubtful conclusions and potential injury. Resolving the "reproducibility crisis" necessitates proper statistical techniques such as sufficient power, preregistration, transparent data, and Bayesian approaches. Statistics and ethics are profoundly intertwined in accountable medical inquiry. By prioritizing statistical meticulousness, investigators can satisfy their ethical duty to generate reproducible discoveries that aid patients and society. Proper statistical application is indispensable for advancing medically and socially impactful research.

In this paper will be presented the equations of Unified Physics. The beautiful equations of the unification of the fundamental interactions. We calculate the unity formulas that connect the coupling constants of the fundamental forces. These equations are applicable for all energy scales. Also we present the unification of atomic physics and cosmology and the formulas for the cosmological constant. It will discover a new simple Large Number Hypothesis which calculates the Mass,the Age and the Radius of the universe. The diameter of the observable universe will be calculated to be equal to the ratio of electric force to gravitational force between electron and proton on the reduced Compton wavelength of the electron. We will prove the shape of the Universe is Poincaré dodecahedral space. We propose a possible solution for the density parameter of baryonic matter,dark matter and dark energy.

The Sentinel-2 mission satellites provide multispectral images with 13 spectral bands at three different spatial resolutions (10, 20 and 60m Ground Sample Distance - GSD). In contrast, the Sentinel-3 mission products have 21 spectral bands at a minimum spatial resolution of 300m. Therefore, the article’s objective is to combine the data of two satellite missions to improve the spatial resolution of the latter. We use a convolutional neural network (CNN), which has already been proven to improve the resolution of Sentinel-2 bands from 20 and 60m GSD to 10m, and a generative adversarial network (GAN), both of which are trained with data from different latitudes and terrains at lower resolution, i.e., from 9km to 300m, to predict the step from 300m to 10m. The results of both neural networks are compared with those of the traditional pansharpening and bicubic interpolation super-resolution algorithms. Thus, it shows that the newly proposed methods improve the previous ones both through quantitative analysis and visual comparison. In particular, the outstanding performance of the GAN used is remarkable, which manages to improve the global numerical results of traditional algorithms by around 30%.

We propose a visual programming framework that helps a designer easily convert an existing analog layout into the layout generator. Using a graphical user interface (GUI), designers can easily load an existing layout, convert it into the layout generator, and visually verify the generated layout result. A GUI-supported visual programming method enables intuitive and straightforward programming to significantly reduce the required programming skills and coding workload. Through program blocks, designers can easily describe and compile a layout generator. Layout-code synchronization updates the program blocks automatically when layout elements are created, edited, or deleted via GUI. Expression assistance semi-automatically completes parameterized expressions of layout geometry through simple GUI manipulation. These methods greatly reduce the time and workload for development of the analog layout generator. Using the framework, a complex 20 Gb/s high-speed receiver was converted to the generator in 20 hours, which is just 45% of the time required for manual coding of the layout generator. Other high-speed analog blocks including DCDL, and DCC circuits were also converted to generators. The generators created hundreds of different layout designs, all of them passed design rule verification. The generated layouts achieved almost the same performance in post-layout simulation as the reference layouts.

In this article, a compact, wideband, and high-gain frequency beam-scanning planar microstrip series-fed antenna array based on  PCB technology is presented at 60 GHz ISM band with enhanced performance.  First, a wideband 8-element linear antenna array is designed that provides -10 dB impedance bandwidth of 41.52% (54–82.3 GHz) covering the entire 60 GHz millimeter-wave (mmWave) ISM band from 57–71 GHz. The linear array produces fan-beam patterns, and has a peak realized gain of 13.48 dBi at 64 GHz, with less than 1 dB gain variation within the entire 57–71 GHz. Then, the proposed linear array is employed as a sub-array in a hybrid parallel-series topology to design a compact and high-gain 64-element (8 × 8) planar array. The planar array covers entire 57–71 GHz band with the peak measured gain of 20.12 dBi at 64 GHz and less than 1 dB gain variation within 57–71 GHz, thereby providing 1 dB gain bandwidth of 14 GHz. The planar array provides narrow directional beams with an average half-power beamwidth of 9.7° and 11.78° in the elevation and azimuth planes respectively, for point-to-point multi-gigabit mmWave connectivity. The phase variation of the series-fed topology is employed to produce frequency beam-scanning range 40° in 57–71 GHz band, which is experimentally elucidated. The array prototypes are fabricated and measured. The measured and simulated results show reasonably good agreement, thus validating the performance of the proposed antenna array for 60 GHz mmWave ISM band applications.  The proposed wideband antenna array is a suitable candidate for numerous emerging mmWave industrial wireless applications in context of Industry 4.0 and Industry 5.0, as well as 60 GHz FMCW radars. The array is compatible to work with various 60 GHz physical layer protocols such as IEEE 802.11ay, IEEE 802.11ad, IEEE 802.15.3c, WirelessHD, and ECMA-387 as well as other customized industrial protocols such as WirelessHP.

Abstract Background Unintended pregnancy (UIP) and substance use disorder (SUD) share underlying root causes with similar potential impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, use of alcohol and other drugs (AOD) increases the risk of UIP. Objectives To assess the available evidence on impact of UIP on health, social and economic outcomes, in women who use AOD. Search Strategy The review was conducted using the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA reporting guidelines. The search was conducted across multiple electronic databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023. Selection Criteria Studies reporting on interactions between AOD use and UIP, and subsequent pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high income countries. Data Collection and Analysis Selected articles were reviewed, and data collected by 2 independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively. Main Results A total of 2383 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes. Conclusion There is a paucity of data examining the intersection between AOD use and UIP and further research is needed. Funding The University of Sydney Albert S. McKern Scholarship; Australian National Health and Medical research Council fellowship (APP1197940) and Financial Markets Foundation for Children.

Background: Animal models play a crucial role in medicine and biology, but they can’t fully replace human models for studying human biology, disease mechanisms, and drug efficacy. Human organoids offer an opportunity to investigate human diseases and complement animal models. However, research on human organoids lacks comprehensive characterizations. Objective: Identify and describe publications exploring and applying organoids. Methods: Thorough analysis of articles from the past two decades retrieved from Web of Science core collection database. Examined publication year, authors, institutions, countries, references, and keywords. Reviewed top 100 highly cited articles using CiteSpace. Results: Found 6817 original articles on organoids, with a remarkable surge over the past decade (nearly 70-fold increase since 2009). Collaboration among the United States, China, Germany, Netherlands, England, and Japan was prominent. Key figures advancing this field include Clevers Hans, Van Der Laan, Jason R. Spence, and Sato Toshiro. Top articles covered basic research (39%), stem cell development, interactions; biobanking (9%) for organoid cultivation; precision medicine (15%) in cell therapy, drug development; disease modeling (37%) involving pathogen analysis, genetic variant screening. Challenges: high costs, technological barriers, lack of standardized protocols, precise immune system establishment, limited quality clinical trials. Overcoming these requires collaborative efforts, evaluation guidelines. Conclusions: Organoid research focuses on basic research, disease modeling, precision medicine, and biobanking. Prioritizing cost reduction, technology sharing, international standards, and high-quality clinical trials is crucial.

Abstract Wellens’ syndrome is predefined electrocardiographic (ECG) criteria associated with critical, proximal left anterior descending (LAD) coronary artery stenosis. Wellens’ syndrome represents a pre-infarction state. Patients are therefore at high risk of an extensive anterior myocardial infarction. It is critical for physicians to identify the subtle ECG signs for Wellens’ syndrome when managing patients with acute cardiac sounding chest pain.This case describes a 94-year-old female who presented to the Same Day Emergency Centre with bilateral jaw pain and mild chest discomfort. Her admission Troponin T was normal, but the 12-lead electrocardiogram on revealed a Wellens’ pattern B. The patient was treated conservatively for acute coronary care syndrome and was discharged in good condition.Keywords : Electrocardiography, Cardiology, Geriatric medicine, Wellens’ syndrome, Acute coronary syndrome

Microbial communities are gaining ground in biotechnology, as they offer many advantages over single-organism monocultures. To make microbial communities competitive as a biotechnological platform, it is essential that we develop strategies to engineering and optimizing their functionality. To this end, most efforts have focused on genetic manipulations. An alternative and also very promising strategy is to optimize the function of microbial communities by rationally engineering their environment and culture conditions. A major challenge is that the combinatorial space of environmental factors is enormous. Furthermore, environmental factors such as temperature, pH, nutrient composition, etc., generally combine their effects in complex, non-additive ways. In this piece, we overview the origins and consequences of these “interactions” between environmental factors, and discuss how they have been built into statistical models of microbial community function to identify optimal environmental conditions. We also overview alternative “top-down” approaches, such as genetic algorithms, to finding combinations of environmental factors that optimize the function of microbial consortia. By providing a brief summary of the state of this field, we hope to stimulate the development of novel methodologies to rationally manipulate and optimize microbial communities through their environment.