Introduction: Peri-ictal breathing dysfunction was proposed as a potential mechanism for SUDEP. We examined the incidence and risk factors for both ictal (ICA) and post-convulsive central apnea (PCCA) and their relationship with potential seizure severity biomarkers (i. e., post-ictal generalized EEG suppression (PGES) and recurrence.Methods: Prospective, multi-center seizure monitoring study of autonomic, and breathing biomarkers of SUDEP in adults with intractable epilepsy and monitored seizures. Video EEG, thoraco-abdominal excursions, capillary oxygen saturation, and electrocardiography were analyzed. A subgroup analysis determined the incidences of recurrent ICA and PCCA in patients with ≥2 recorded seizures. We excluded status epilepticus and obscured/unavailable video. Central apnea (absence of thoracic-abdominal breathing movements) was defined as ≥1 missed breath, and ≥5 s. ICA referred to apnea preceding or occurring along with non-convulsive seizures (NCS) or apnea before generalized convulsive seizures (GCS).Results: We analyzed 558 seizures in 218 patients (130 female); 321 seizures were NCS and 237 were GCS. ICA occurred in 180/487 (36.9%) seizures in 83/192 (43.2%) patients, all with focal epilepsy. Sleep state was related to presence of ICA [RR 1.33, CI 95% (1.08–1.64), p = 0.008] whereas extratemporal epilepsy was related to lower incidence of ICA [RR 0.58, CI 95% (0.37–0.90), p = 0.015]. ICA recurred in 45/60 (75%) patients. PCCA occurred in 41/228 (18%) of GCS in 30/134 (22.4%) patients, regardless of epilepsy type. Female sex [RR 11.30, CI 95% (4.50–28.34), p < 0.001] and ICA duration [RR 1.14 CI 95% (1.05–1.25), p = 0.001] were related to PCCA presence, whereas absence of PGES was related to absence of PCCA [0.27, CI 95% (0.16–0.47), p < 0.001]. PCCA duration was longer in males [HR 1.84, CI 95% (1.06–3.19), p = 0.003]. In 9/17 (52.9%) patients, PCCA was recurrent.Conclusion: ICA incidence is almost twice the incidence of PCCA and is only seen in focal epilepsies, as opposed to PCCA, suggesting different pathophysiologies. ICA is likely to be a recurrent semiological phenomenon of cortical seizure discharge, whereas PCCA may be a reflection of brainstem dysfunction after GCS. Prolonged ICA or PCCA may, respectively, contribute to SUDEP, as evidenced by two cases we report. Further prospective cohort studies are needed to validate these hypotheses.

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease and major pulmonary complication after premature birth. We have previously shown that increased intermittent hypoxemia (IH) events have been correlated to adverse outcomes and mortality in extremely premature infants. We hypothesize that early IH patterns are associated with the development of BPD. Methods: IH frequency, duration, and nadirs were assessed using oxygen saturation (SpO 2 ) waveforms in a retrospective cohort of 137 extremely premature newborns (<28 weeks gestation). Daily levels of inspired oxygen and mean airway pressure exposures were also recorded. Results: Diagnosis of BPD at 36 weeks postmenstrual age was associated with increased daily IH, longer IH duration, and a higher IH nadir. Significant differences were detected through day 7 to day 26 of life. Infants who developed BPD had lower mean SpO 2 despite their expose to increased inspired oxygen and increased mean airway pressure. Conclusions: BPD was associated with more frequent, longer, and less severe IH events in addition to increased oxygen and pressure exposure within the first 26 days of life. Early IH patterns may contribute to the development of BPD or aid in identification of neonates at high-risk.

This paper tackles the key challenges for dynamics, control, and automation of power systems that are imposed by the integration of renewable power plants. First, the current practice of automation and control in large-scale power systems are reviewed. Then, dynamics and control of electrical transmission systems are discussed and the issues associated with the integration of large-scale wind and solar power plants are exploited. The discussion carries on with a focus on control of electrical distribution systems and the key issues associated with the integration of distributed generation power plants. An emerging concern in power and energy industry is the dynamic interaction between transmission and distribution systems as a result of technological and topological changes in power systems that can put their control at risk. These topics are also covered in this paper. In terms of automation, the key challenges and opportunities for accommodation of higher penetration and share of renewable energy, as part of the vision for grid modernization, are explored in this paper. Throughout the discussion, some results from the recent studies are shown. This article is categorized under: Energy Infrastructure > Systems and Infrastructure K E Y W O R D S automation, control, dynamics, power systems, renewable energy, stability 1 | INTRODUCTION Power systems are compounded of hundreds of thousands of controllable and noncontrollable components that function in a variety of ways (Machowski, Bialek, & Bumby, 1997). Hence, this complex process requires a superb automation to sustain the power delivery. In current power systems, energy management system (EMS) and distribution management system (DMS) represent the highest level of automation at transmission and distribution systems, respectively. These automation systems include the supervisory control and data acquisition systems and a set of real-time and off-line power system applications. The automation and control of traditional power systems with centralized dispatchable power plants and also the stability related issues have been extensively studied and discussed in the literature, including the studies by

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