Generator Replacement Research Articles

Electrification in Urban Transport: A Case Study with Real-time Data

Electrification in urban transportation is becoming more popular, beside it is also becoming a necessity due to climate changes and sustainability issues. Trolleybuses are presenting an alternative for this purpose. Although their technology is a mature technology that has been used for decades, there are still some technical problems that need to be overcome. In this study, a technical method is presented for the conversion of trolleybus auxiliary power units. The electrification conversion demanded by the metropolitan public transportation company operating 22 trolleybuses in the province of Malatya is the replacement of diesel generators, used as auxiliary power units, with battery units capable of meeting the local operational requirements. For this purpose, a method is proposed and followed. At first step of the implementation, real-time data has gathered from a trolleybus and this one round tour data is used to run on a scaled experiment. The setup has prepared as hardware and software to simulate the consumption on a scaled battery pack. Experimental results were interpreted with capacity and voltage restrictions resulting the determination of battery chemistry and casing to be used. Then optimal battery placement was defined as a container loading problem and application was made with the first fit decreasing algorithm considering mass and volume restrictions. It was found that only two packing types out of six combinations is enough to form a battery pack within the mass and volumetric limitations. It is evaluated that the method adopted in this study can be used in conversion applications to be made in the future.

Formación de académicos para el recambio generacional en la universidad pedagógica nacional

El objetivo de esta investigación es conocer los conocimientos y competencias establecidos en el Programa de Formación Académica de la Universidad Pedagógica Nacional (UPN), con el fin de estar preparados para un posible reemplazo generacional. Con este fin, se plantearon preguntas relacionadas con el perfil de los formadores académicos y se preguntó sobre la necesidad real de formación de los académicos, así como el perfil de las entidades encargadas de llevar a cabo este proceso de formación profesional. Tanto el instrumento de investigación –entrevista semiestructurada– como la selección de temas de estudio se establecieron juntos sobre la base de una metodología hermenéutica-filosófica. Los resultados revelaron que la formación de los futuros académicos de UPN debe desarrollarse en comunidades epistémicas apoyadas y orientadas por un paradigma científico, las que se presentan como sugerencias formativas en este estudio.

Gender, socio-political cleavages and the co-constitution of gender identities: a multidimensional analysis of self-assessed masculine and feminine characteristics

This study offers a multidimensional analysis of individuals’ self-assessments of their masculine and feminine characteristics to better understand variation from more to less binary gender identities. Through gender’s co-constitution along with various social localities, we expect that a number of socio-political factors differentiate individuals’ gender identities through self-assessments of their masculine and feminine characteristics. Using data from a 2013 Swedish survey, our results show that men and women tend towards traditionally polarised gender identities and that social location is a particularly influential correlate of men’s claims of feminine characteristics and women’s of masculine characteristics. Individuals from younger generations and individuals who are more educated are consistently more likely to ascribe to less binary feminine and masculine characteristics. This suggests that generational replacement and higher education may increase the tendency of populations to ascribe to less binary gender identities.

Trends in the use, complications, and costs of permanent pacemakers in Australia: A nationwide study from 2008 to 2017.

To characterize contemporary pacemaker procedure trends. Nationwide analysis of pacemaker procedures and costs between 2008 and 2017 in Australia. The main outcome measures were total, age- and gender-specific implant, replacement, and complication rates, and costs. Pacemaker implants increased from 12,153 to 17,862. Implantation rates rose from 55.3 to 72.6 per 100,000, a 2.8% annual increase (incidence rate ratio [IRR] 1.028; 95% CI, 1.02-1.04; p<.001). Pacemaker implants in the 80+ age group were 17.37-times higher than the<50 group (95% CI 16.24-18.59; p<.001), and in males were 1.48-times higher than in females (95% CI 1.42-1.55; p<.001). However, there were similar increases according to age (p=.10) and gender (p=.68) over the study period. Left ventricular lead rates were stable (IRR 0.995; 95% CI 0.98-1.01; p=.53). Generator replacements decreased from 20.5 to 18.3 per 100,000 (IRR 0.975; 95% CI 0.97-0.98; p<.001). Although procedures for generator-related complications were stable (IRR 0.995; 95% CI 0.98-1.01; p=.54), those for lead-related complications decreased (IRR 0.985; 95% CI 0.98-0.99; p<.001). Rates for all pacemaker procedures were consistently greater in males (p<.001). Although annual costs of all pacemaker procedures increased from $178 million to $329 million, inflation-adjusted costs were more stable, rising from $294 million to $329 million. Increasing demand for pacemaker implants is driven by the ageing population and rising rates across all ages, while replacement and complication procedure rates appeared more stable. Males have consistently greater pacemaker procedure rates than females. Our findings have significant clinical and public health implications for healthcare resource planning.

Ranked Choice Voting as a Generational Issue in Modern American Politics

Ranked Choice Voting (RCV) is a class of reforms increasingly used in the United States to replace plurality and runoff elections. We ask whether support for RCV taps a larger generational divide in politics. We consult five surveys, two of these from recent adoption campaigns, and all with different ways of asking about RCV support. Generation is a significant predictor in four of these samples, accounting for standard demographic factors and partisanship. This relationship also holds within black and Republican subgroups, two groups often thought to be less likely to support RCV. Finally, we find that dissatisfaction with “the way that democracy works in America” is a plausible link between generation and reform support. For better or worse, RCV has potential to divide two important voting blocs in America. Our results suggest that, rather than turn away from electoral politics, a disaffected young generation may turn to reform.Related ArticlesCormack, Lindsey. 2019. “Leveraging Peer‐to‐Peer Connections to Increase Voter Participation in Local Elections.” Politics &amp; Policy 47 (2): 248‐266. https://doi.org/10.1111/polp.12297Fisher, Patrick. 2020. “Generational Replacement and the Impending Transformation of the American Electorate.” Politics &amp; Policy 48 (1): 38‐68. https://doi.org/10.1111/polp.12340Shaykhutdinov, Renat. 2019. “Socialization, Rationality, and Age: Generational Gaps and the Attitudes toward the Chechen War in Russia.” Politics &amp; Policy 47 (5): 931‐955. https://doi.org/10.1111/polp.12323

Exploring the Utilization of Energy Storage Systems for Frequency Response Adequacy of a Low Inertia Power Grid

The utilization of Energy Storage Systems (ESS) for improving the frequency response of a low inertia power system is investigated in this article. Substantial wind power penetration is causing the replacement of conventional synchronous generators in several power systems. Variable speed wind machines traditionally do not contribute to frequency regulation without additional control strategy. As a result, a wind dominated power grid may have inadequate inertia and governor responsive reserve. In such situation, a large contingency may yield undesirable Rate of Change of Frequency (ROCOF) and frequency deviation. To overcome this problem, deployment of ESS, namely, Superconducting Magnetic Energy Storage (SMES) and Battery Energy Storage System (BESS) can be a worthwhile solution. Since these devices are costly, their appropriate sizing and operational approach are crucial. Therefore, in this paper, analytical expressions are derived to find the minimum ratings of SMES and BESS. To this end, system frequency deviation, ROCOF, inertial response and governor response are taken into account. Also, a coordinated operational strategy is proposed to retain frequency response adequacy and minimize under-frequency load shedding where SMES is triggered when system ROCOF supersedes a certain limit and BESS is activated due to system frequency surpassing a preset threshold. The performance of the proposed strategy is explored in a low inertia network under substantial wind penetration considering several different wind penetration levels. Also, the results are validated against two existing approaches. Simulation results reveal that the proposed methodology considerably enhances the frequency response in various operating conditions.

NATALITY IN THE GREEK COMMUNITY OF ODESSA IN THE LATE NINETEENTH CENTURY: PROSPECTS FOR HISTORICAL AND ANTHROPOLOGICAL RECONSTRUCTIONS

NATALITY IN THE GREEK COMMUNITY OF ODESSA IN THE LATE NINETEENTH CENTURY: PROSPECTS FOR HISTORICAL AND ANTHROPOLOGICAL RECONSTRUCTIONS

Research progress in fecundity study of Coleoidea (Cephalopoda)

Cephalopods are characterized by fast growth, short generation replacement and high abundance. These species live in all oceans of the world with the exception of the Black Sea, not only playing an important role in the trophic webs of the marine ecosystem but also being one of the most important fishery resources in the world. It is important to well study the fecundity of cephalopods, which can improve our understandings of their life history, and more importantly can promote to realize their population dynamics and recruitment processes. Herein, the fecundity of Coleoidea (Cephalopoda) was summarized in details, including the definitions and their determination methodologies, the values of fecundity among species, and the changeable characteristics of fecundity in relation to species body size, egg diameter and living habitats. The potential fecundity was one of the most popular approaches to determine the reproductive value, and represented the theoretical value that one species could produce during its lifecycle. Other approaches such as actual realized fecundity, effective fecundity, and relative fecundity were also used to estimate the fecundity of cephalopod species. It showed that there was species-specific fecundity for Coleoida species. The maximum potential fecundity was reported for <italic>Dosidicus gigas</italic>, and the minimum was reported for <italic>Pareledone turqueti</italic>. The fecundity of Coleoidea was generally found a linear relation to adult body size, indicating a larger body size with a higher fecundity value. At the guild level, there was a significantly negative relationship between the fecundity and egg size for both Octopoda and Teuthoidea. In contrast, there was a slightly positive relationship between the fecundity and egg size for Sepioidea. Generally, species living at lower latitudes exhibited a relatively higher fecundity, and those living at higher latitudes had a relatively lower fecundity. Meanwhile, such fecundity characteristics were also detected at the species level. Water temperature and primary production appeared to be the most important environmental factors that influenced the latitudinal trend of fecundity among the species. It is worthy to note that Coleoida species is semelparous reproduction and the fecundity is associated with the pattern and amount of energy allocation to reproduction. The reproductive investment strategy would determine the actual fecundity of a species and subsequently the biomass of recruitment, and hence studies on the potential reproductive investment will be an important area for better understanding of the fecundity characteristics of cephalopods. Increasingly, the importance of cephalopods has been recognized not only in their ecological roles as trophic indicators but also in their high abundance supporting global fisheries. Therefore, it is necessary to deeply understand the fecundity characteristics of cephalopods, which will largely increase our knowledge about their ecological roles and also assist the sustainable exploitation and the policy-making of resource assessment and management.

Abstract 14091: Outcomes of Patients With Recalled Defibrillator Leads: Results From the NCDR-ICD Registry

Introduction: Whether to reuse, abandon, or extract functioning, recalled ICD leads at the time of generator replacement is an area of uncertainty as lead failure is more common following generator replacement, and long term failure rates of recalled ICD leads are unknown. We sought to evaluate outcomes following various lead management strategies at the time of generator replacement. Hypothesis: Functional St. Jude Riata and Medtronic Sprint Fidelis leads at the time of elective generator replacement are more frequently reused than replaced, and extracting them poses significant procedural risk. Methods: We queried the NCDR ICD Registry for Medicare patients undergoing elective generator replacement with a normal Fidelis or Riata lead from 2010-2016 and categorized patients based on the fate of the recalled lead: reused, abandoned, or extracted. We report pre-discharge complications by group. Results: There were 9937 generator replacement patients between 2010-2016 with a functioning Riata or Fidelis lead in which lead management was reported. The lead was reused in 9806 (98%) patients, extracted in 55 (0.6%), and abandoned in 76 (0.8%). Compared with the reused group, extracted patients were &gt;10 years younger, had less heart failure and fewer comorbidities. In-hospital death occurred in 4 (7.3%) patients in the extracted group and 7 (0.07%) in the reused group (P&lt;0.0001). The combination of death or any pre-discharge event occurred in 11% of extracted patients compared with 0.3% and 0% in the reused and abandoned groups, respectively.(Table) Conclusions: At the time of generator replacement, a small percentage of functional Riata and Fidelis leads were extracted. Even in this highly selected extraction population, extraction posed significant risk of in-hospital mortality and severe complications. Future work will help clarify whether these peri-procedural risks may be justified by improved medium and long term outcomes.

Complications related to elective generator replacement of the subcutaneous implantable defibrillator.

AimsTo guarantee uninterrupted function of the subcutaneous implantable cardioverter-defibrillator (S-ICD), the pulse generator needs to be surgically replaced before the battery is depleted. The risks related to this replacement substantially impact long-term outcome for S-ICD recipients, as the majority will undergo one or several of these procedures in their lifetime. We aim to describe the procedural characteristics of the replacement procedure and to provide an insight in the complications associated with these replacements.Methods and resultsIn this retrospective analysis, data from replacement procedures and follow-up visits were collected from all patients who underwent elective S-ICD generator replacement in our tertiary centre from June 2014 until November 2019. Original device position was assessed using the PRAETORIAN score. Complications were defined as those requiring surgical intervention, systemic antibiotic treatment, or device extraction. Seventy-two patients were included, with a median follow-up of 1.9 years (IQR 0.6–3.3 years) after replacement. Battery depletion occurred after 5.9 ± 0.7 years. The pulse generator was repositioned in patients with a PRAETORIAN score ≥90 to minimize the defibrillation threshold. Although there was an increase in impedance compared to the implant procedure, first shock conversion rate during defibrillation testing was 91.4% with a success rate of 100% after multiple attempts. Two patients developed a complication after, respectively, 9 and 21 months, resulting in a complication rate of 1.4% per year.ConclusionWith a median follow-up of 1.9 years, this study shows a low complication rate after S-ICD replacement, with a first shock conversion rate of 91.4%.

Low-temperature electrocautery reduces lead-related complications: insights from the WRAP-IT study

Abstract Background Patients with an existing cardiovascular implantable electronic device (CIED) often require a generator replacement or system upgrade/revision, during which some degree of dissection is usually necessary to free the existing lead(s). Commonly used techniques include blunt dissection, standard surgical electrocautery, or newer forms of electrocautery such as the low-temperature electrosurgical device (PlasmaBlade Soft Tissue Dissection Device) designed to minimize inadvertent thermal injury to leads. Objective Determine whether the dissection technique impacts the likelihood of developing a lead-related complication. Methods The WRAP-IT trial enrolled patients undergoing CIED replacement, upgrade, revision or de novo CRT-D implant. This analysis excluded patients undergoing a de novo procedure. All adverse events were adjudicated by an independent physician committee. Data were analyzed using Cox proportional hazard regression modeling, controlling for capsulectomies and lead dissections. Results 5639 patients (mean [±SD] age: 70.6±12.7 years; 28.8% female) underwent a replacement/upgrade/revision. Electrocautery was used in 5203 (92.3%) patients and among these, low-temperature electrocautery was used in 1866 (35.9%) patients. Compared to standard electrocautery, low-temperature electrocautery was used more often when leads were dissected or mobilized (P&amp;lt;0.001) or when a partial or complete capsulectomy was performed (P&amp;lt;0.001). Use of low-temperature electrocautery was associated with a 31% reduction in lead-related complications (HR: 0.69, 95% CI: 0.49–0.98, P=0.037) (Figure). Conclusion The low-temperature electrosurgical device (PlasmaBlade) uses precise pulses of radiofrequency energy to dissect tissue with only minimal thermal damage. In this large cohort of replacement, revision, and upgrade procedures, use of low-temperature electrocautery led to significantly fewer lead-related complications. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Flexible operation of low-inertia power systems connected via high voltage direct current interconnectors

The replacement of conventional synchronous generators with converter-interfaced generation units calls for increased amounts of flexibility. This paper proposes a novel formulation of the security-constrained unit commitment (SCUC) model applied to a multi-area power system connected via High Voltage Direct Current (HVDC) links. From a system perspective, this paper provides a critical analysis of the synergies and differences between the exploitation of thermostatic loads and HVDC links when providing different layers of flexibility to the system. The former units operate within a local dimension, while the latter enable cross-border exchange of flexibility. Eight different ancillary services are modelled to tackle generation/load outages and uncertainty/variability in renewable energy output. The model is applied to the Great Britain network, which is connected to the Irish network and to the one in Continental Europe. Results suggest a critical review of the operation of future low-carbon HVDC-interconnected systems. Feasibility studies on the benefit for interconnection should no longer neglect considerations on local post-fault frequency dynamics in each area of the system. Then, fundamental changes to the mechanisms that price ancillary services become necessary in order to align these mechanisms with the technical needs of the system.

Welfare state development and Finnish criminal justice reform from the 1910s to the 1960s

In contemporary research, Nordic countries are considered to have comparatively lenient penal policies, such as the restricted use of imprisonment. However, criminal justice in Finland during the early decades of its independence was exceptionally harsh. Due to its history, Finland is considered a difficult case for institutionalist theories that have related the Nordic welfare state model with lenient penal policy. This analysis argues that Finland’s development away from this severity was, in fact, caused by the shift of its social policy toward that of a (Nordic) welfare state in the 1940s, which is associated with the adoption of the model of democratic corporatism after decades of intense political conflict. The 1940s were a turning point when regulation of prison population sizes started to become an objective in legislation concerning the penal system. Meanwhile, independent of legislation, judges’ attitudes and sentencing practices began to relax. A generational replacement began among the criminal justice elite that manifested as generational disagreement in the 1950s, and by the 1970s, a reformist consensus was achieved.

Influence of the transient conditions on release of corrosion products and oxidation of alloy 690 tubes during pressurized water reactor restart after steam generators replacement

The radioactivity of the Reactor Coolant System (RCS) of Pressurized Water Reactors (PWRs) mainly comes from the release of corrosion products of Steam Generator (SG) tubes made of Ni-base alloys. In order to reduce this activity and thus the radiation exposure of PWR operators during maintenance operations, it is necessary to minimize the release. That requires prior understanding of the various mechanisms involved. EDF R&D constructed a loop, BOREAL, to specifically measure rates of release of SG tubes in various conditions of primary environment. Tubes were usually tested at high temperature, under constant conditions of primary chemistry. So, it is necessary to carefully investigate the impact of transient conditions during a PWR restart after SG replacement. Tests were performed on the industrial material with curvature, roughness, defects and heterogeneities, regularly observed on this type of component. Characterisations of the inner surface were done on as-received and corroded specimens of SG tubes and were correlated with the obtained release kinetics.The native oxide layer is formed of a very thin layer (1-2 nm) of oxidised matrix, without specific enrichment. During the restart, the most critical step for the release phenomenon is revealed from 170°C to 297°C. The majority of the metal is indeed released into the fluid during this step. The characterisations after release tests have made it possible to propose oxidation and release mechanism during a PWR restart after SG replacement. Up to 170°C, a thin layer of amorphous chromium oxide is formed by selective dissolution of iron and nickel. When the temperature rises, this chromium oxide layer is not stable enough to be protective and the diffusion phenomena are activated. At 325°C, the oxide does not exhibit any particular enrichment and corresponds to an oxidised metal layer; an equilibrium is established and the rate of release reaches a pseudo-stationary regime.

High lead impedances requiring revision during vagal nerve stimulator generator replacement.

Vagal nerve stimulation (VNS) therapy is among the growing options in the treatment of intractable epilepsy. The phenomenon of surprise lead impedance issues found at the time of surgery resulting in unplanned lead revision is a challenge with this type of device. We reviewed our experience with VNS revisions. We retrospectively reviewed the records of all adult and pediatric patients between January 2009 and September 2018 who underwent surgery for VNS therapy, including revision surgery. Office and operative notes were reviewed to obtain the indications and operative details for VNS placement. A total of 570 operations were reviewed. The indication was intractable epilepsy in all cases. Primary implantation was performed in 232 patients, while the remaining 338 cases were revision cases of various natures. Surprise high lead impedance was found in 10 (3%) of these cases, resulting in a significantly increased complexity of surgery in those instances. Lead impedance issues can be caused by disconnection, electrode fracture, hardware failure, or tissue scarring but ultimately require a more extended surgery than may be initially planned. Anticipating the potential for a more extensive operation than a simple generator replacement may prevent perioperative frustrations on both sides.

False remote monitoring alerts from explanted cardiac implantable electronic device: How is this possible?

A 72-year-old woman with a dual-chamber implantable cardioverter-defibrillator (Biotronik Lumax 540 DR-T) at elective replacement indicator presented for generator replacement. A new MicroPort generator (Platinium DR) was attached to her existing leads. Eight days later, multiple red alert messages were received on the Biotronik remote monitoring system from the explanted generator. Investigations revealed alert transmission via a CardioMessenger Smart mobile device registered to another patient that came into proximity of the explanted generator. The Biotronik remote monitoring system is unique in that red alerts could be sent through any CardioMessenger Smart device regardless of whether they were paired.

Vagus nerve stimulation with tachycardia detection provides additional seizure reduction compared to traditional vagus nerve stimulation

PurposeThis study investigates the clinical and cost effectiveness of switching from traditional vagus nerve stimulation (VNS) to responsive VNS (rVNS), which has an additional ictal tachycardia detection and stimulation (AutoStim) mode. MethodsRetrospective chart review was used to collect data from patients with medically refractory epilepsy who underwent generator replacements. Patients with confounding factors such as medication changes were excluded. Vagus nerve stimulation parameters, seizure frequency, and healthcare costs were collected for the 1-year period following generator replacement with the rVNS device. ResultsDocumented seizure frequency was available for twenty-five patients. After implant with rVNS, 28% of patients had an additional ≥50% seizure reduction. There was a significant decrease in the average monthly seizure count (p = 0.039). In patients who were not already free of disabling seizures (n = 17), 41.2% had ≥50% additional seizure reduction. There was no difference in healthcare costs during the 1-year follow-up after the rVNS implant compared with one year prior. ConclusionsIctal tachycardia detection and stimulation provided a significant clinical benefit in patients who were not free of disabling seizures with treatment from traditional VNS. There was no additional increase in healthcare costs during the first year after device replacement.

Grid Impedance Estimation Through Grid-Forming Power Converters

In more-electronics power systems, grid-forming power converters, which operate as ac voltage sources, regulate the grid frequency and voltages in replacement of synchronous generators. Notably, grid impedances greatly influence the small signal and voltage stability of grid-forming converters. As such, prior knowledge of grid impedances can be very helpful for controller design. However, grid impedance estimation schemes are normally designed for current-controlled grid-following converters. Moreover, they are either very complicated or only yield grid inductances in a generally intrusive way. To fill this research gap, an impedance estimation method well suited to grid-forming converters is proposed. The method consists of four operating modes, which work well in voltage and power control cases. In the voltage control case, the voltage amplitude perturbation or phase angle information is exploited. Subsequently, the grid inductance and resistance are derived from power measurement. Alternatively, the active or reactive power information serves to estimate the grid impedance in the power control case. The proposed method features an easy implementation without any harmonic distortion, safety concern, or dependence on control parameters. Moreover, the method operates nonintrusively in most scenarios. Furthermore, a novel Kalman filtering scheme is proposed to provide added incentives. Finally, simulation and experimental results validate the effectiveness and simplicity of the proposed method.

Sociodemographic analysis of an accelerated transition: the rise of solo living in Spain

ABSTRACT The rise in one-person households is one of the most significant sociodemographic phenomena Western societies have undergone since the mid-twentieth century. It is a phenomenon of particular interest in societies where family has traditionally held an important role in determining living arrangements. In Spain, only 4.1% of the population lived alone in 1991 while currently such percentage is more than 10% and approximately one in four homes are one-person households. This study analyses the process of generational replacement of these households taking into consideration four sociodemographic variables: age, sex, marital status and level of education. The influence of these variables, together with labour status, on solo-living is examined between 1991 and 2011 by applying demographic analysis and multivariate logistic regression models to census microdata samples from the Spanish National Institute of Statistics. Results show an inter-generational increase in solo living, affecting all age groups, as well as a diversification of the demographic profile of solo dwellers in Spain over the last three decades. This trend did not interrupt during the economic recession although being employed increased the probability of living alone invariably. Other factors contributing to a higher probability of living alone were being man and having higher education level (particularly among women). We find notable changes in the sociological profile of these households: an increase in the relative weight of young solo-dwellers and a drop in the weight of widowhood in favour of singlehood. These results are discussed in the context of the social changes that Spain has undergone

Generator replacement with cardiac-based VNS device in children with drug-resistant epilepsy: An observational study

PurposeThis study evaluated the seizure outcomes in children with drug-resistant epilepsy (DRE), having a pre-existing VNS device, after generator replacement with cardiac-based VNS device. MethodsThis retrospective study enrolled 30 children with DRE from 2 centers with an existing VNS device nearing end-of-service who underwent generator replacement with cardiac-based VNS device and had at least 1 year follow up. Seizure outcomes and adverse effects were studied. ResultsThe mean age at insertion of cardiac-based VNS device was 15.03 years. 26.7 % patients showed at least one class improvement at last follow up (mean 2.08 years) and half of the patients maintained their McHugh seizure-outcome class. Thirty-six percent of patients had > 50 % seizure reduction at last follow up. Ten patients reported improvement in ictal severity. Most of the patients tolerated the replacement well. ConclusionsNearly one-third of patients with DRE showed additional improvement after replacement with cardiac based VNS device. Half of the patients maintained their seizure control.