Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy—part 1: clinical setting and neurophysiological procedure

Introduction: Selective dorsal rhizotomy (SDR) consists of microsurgical partial deafferentation of sensory nerve roots (L1-S2). It is primarily used today in decreasing spasticity in young cerebral palsy (CP) patients. Intraoperative monitoring (IOM) is an essential part of the surgical decision-making process, aimed at improving functional results. The role played by SDR-IOM is examined, while realizing that connections between complex EMG responses to nerve-root stimulation and a patient's individual motor ability remain to be clarified. Methods: We conducted this retrospective study, analyzing EMG responses in 146 patients evoked by dorsal-root and rootlet stimulation, applying an objective response-classification system, and investigating the prevalence and distribution of the assessed grades. Part1 describes the clinical setting and SDR procedure, reintroduced in Germany by the senior author in 2007. Results: Stimulation-evoked EMG response patterns revealed significant differences along the segmental levels. More specifically, a comparison of grade 3+4 prevalence showed that higher-graded rootlets were more noticeable at lower nerve root levels (L5, S1), resulting in a typical rostro-caudal anatomical distribution. Conclusions: In view of its prophylactic potential, SDR should be carried out at an early stage in all CP patients suffering from severe spasticity. It is particularly effective when used as an integral part of a coordinated, comprehensive spasticity program in which a team of experts pool their information. The IOM findings pertaining to the anatomical grouping of grades could be of potential importance in adjusting the SDR-IOM intervention to suit the specific individual constellation, pending further validation. Trial registration: ClinicalTrials.gov ID: NCT03079362

Internet of Things in Sustainable Energy Systems

Our planet has abundant renewable and conventional energy resources but technological capability and capacity gaps coupled with water-energy needs limit the benefits of these resources to citizens. Through IoT technology solutions and state-of-the-art IoT sensing and communications approaches, the sustainable energy-related research and innovation can bring a revolution in this area. Moreover, by the leveraging current infrastructure, including renewable energy technologies, microgrids, and power-to-gas (P2G) hydrogen systems, the Internet of Things in sustainable energy systems can address challenges in energy security to the community, with a minimal trade-off to environment and culture. In this chapter, the IoT in sustainable energy systems approaches, methodologies, scenarios, and tools is presented with a detailed discussion of different sensing and communications techniques. This IoT approach in energy systems is envisioned to enhance the bidirectional interchange of network services in grid by using Internet of Things in grid that will result in enhanced system resilience, reliable data flow, and connectivity optimization. Moreover, the sustainable energy IoT research challenges and innovation opportunities are also discussed to address the complex energy needs of our community and promote a strong energy sector economy

Novel synthetic co‐culture of Acetobacterium woodii and Clostridium drakei using CO2 and in situ generated H2 for the production of caproic acid via lactic acid

Abstract Acetobacterium woodii is known to produce mainly acetate from CO2 and H2, but the production of higher value chemicals is desired for the bioeconomy. Using chain‐elongating bacteria, synthetic co‐cultures have the potential to produce longer‐chained products such as caproic acid. In this study, we present first results for a successful autotrophic co‐cultivation of A. woodii mutants and a Clostridium drakei wild‐type strain in a stirred‐tank bioreactor for the production of caproic acid from CO2 and H2 via the intermediate lactic acid. For autotrophic lactate production, a recombinant A. woodii strain with a deleted Lct‐dehydrogenase complex, which is encoded by the lctBCD genes, and an inserted D‐lactate dehydrogenase (LdhD) originating from Leuconostoc mesenteroides, was used. Hydrogen for the process was supplied using an All‐in‐One electrode for in situ water electrolysis. Lactate concentrations as high as 0.5 g L–1 were achieved with the AiO‐electrode, whereas 8.1 g L–1 lactate were produced with direct H2 sparging in a stirred‐tank bioreactor. Hydrogen limitation was identified in the AiO process. However, with cathode surface area enlargement or numbering‐up of the electrode and on‐demand hydrogen generation, this process has great potential for a true carbon‐negative production of value chemicals from CO2

Heavy use of acute in-patient psychiatric services: the challenge to translate a utilization pattern into service provision

There is an inequality in resource utilization among acute psychiatric in-patients. About 20-30% of them absorb 60-80% of the total resources allocated to this form of treatment. This study intends to summarize findings related to heavy in-patient service use and to illustrate them by means of utilization data for acute psychiatric wards