Tractography-based DBS lead repositioning improves outcome in refractory OCD and depression.

Deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) has been used to treat refractory obsessive-compulsive disorder (OCD) and depression, but outcomes are variable, with some patients not responding to this form of invasive neuromodulation. A lack of benefit in some patients may be due to suboptimal positioning of DBS leads. Recently, studies have suggested that specific white matter tracts within the ALIC are associated with improved outcomes. Here, we present the case of a patient who initially had a modest improvement in OCD and depressive symptoms after receiving DBS within the ALIC. Subsequently, he underwent unilateral DBS lead repositioning informed by tractography targeting the ventrolateral and medial prefrontal cortex's connection with the mediodorsal thalamus. In this patient, we also conducted post-implant and post-repositioning diffusion imaging and found that we could successfully perform tractography even with DBS leads in place. Following lead repositioning into tracts predictive of benefit, the patient reached responder criteria for his OCD, and his depression was remitted. This case illustrates that tractography can potentially be used in the evaluation and planning of lead repositioning to achieve therapeutic outcomes.

Pretreatment of municipal solid waste prior to landfilling.

An outdoor pilot-scale study was undertaken to pretreat municipal solid waste by windrow composting. The raw waste was introduced to active composting without any source separation or pulverization. Pretreatment indicators were developed and used as a tool to measure the optimum level of sorting and waste stabilization. The moisture content of the waste dropped from 68% to 61% and the pile attained a thermophilic temperature in one week. It was observed that the C/N ratio, pH profile and temperature gradients were comparable to that of traditional windrow composting. Within one week of active bulk composting, the easily degradable organic matter was consumed and there was a significant reduction in the bulk volume of the mixed waste. The pre-composted wastes were then sorted into four fractions. Compared to the initial untreated waste, the pretreated waste showed greater sorting efficiency and reduced volatile solids. A 1-m(3) cage was used to study pile settlement and volume reduction. The results indicate that pretreatment by bulk composting could reduce by approximately 40% the total mass of waste hauled to landfill sites in developing countries.