Feasibility of using a depth camera or pressure mat for visual feedback balance training with functional electrical stimulation.

Individuals with incomplete spinal-cord injury/disease are at an increased risk of falling due to their impaired ability to maintain balance. Our research group has developed a closed-loop visual-feedback balance training (VFBT) system coupled with functional electrical stimulation (FES) for rehabilitation of standing balance (FES + VFBT system); however, clinical usage of this system is limited by the use of force plates, which are expensive and not easily accessible. This study aimed to investigate the feasibility of a more affordable and accessible sensor such as a depth camera or pressure mat in place of the force plate. Ten able-bodied participants (7 males, 3 females) performed three sets of four different standing balance exercises using the FES + VFBT system with the force plate. A depth camera and pressure mat collected centre of mass and centre of pressure data passively, respectively. The depth camera showed higher Pearson's correlation (r > 98) and lower root mean squared error (RMSE < 10 mm) than the pressure mat (r > 0.82; RMSE < 4.5 mm) when compared with the force plate overall. Stimulation based on the depth camera showed lower RMSE than that based on the pressure mat relative to the FES + VFBT system. The depth camera shows potential as a replacement sensor to the force plate for providing feedback to the FES + VFBT system.

Identifying priorities for balance interventions through a participatory co-design approach with end-users.

BACKGROUND: Most individuals living with spinal cord injuries/diseases (SCI/D) or stroke experience at least one fall each year; hence, the development of interventions and technologies that target balance control is needed. The purpose of this study was to identify and explore the priorities for balance-focused interventions and technologies from the perspectives of end-users to assist with the design of an intervention that combines functional electrical stimulation (FES) with visual feedback training for standing balance. METHODS: Two individuals with SCI/D, one individual with stroke, two physical therapists (PT) and one hospital administrator were recruited. Participants attended three focus group meetings that followed a participatory co-design approach. A semi-structured interview guide, developed from the FAME (Feasibility, Appropriateness, Meaningfulness, Effectiveness, Economic Evidence) framework, was used to lead the discussion, querying participants' experiences with balance deficits and interventions, and FES. Meetings were audio-recorded and transcribed verbatim. An iterative and reflexive inductive thematic analysis was applied to the transcripts by three researchers. RESULTS: Four themes were identified: (1) Balance is meaningful for daily life and rehabilitation. Participants acknowledged various factors influencing balance control and how balance deficits interfered with participation in activities. End-users stressed the importance of continuing to work on one's balance after discharge from hospital-based rehabilitation. (2) Desired characteristics of balance interventions. Participants explained that balance interventions should be tailored to an individual's unique needs and goals, relevant to their lives, balance their safety and risk, and be engaging. (3) Prior experiences with FES to inform future therapeutic use. Participants with stroke or SCI/D described initial apprehension with FES, but experienced numerous benefits that motivated them to continue with FES. Challenges with FES were mentioned, including wires, cost, and time of set up. (4) Potential role of FES in balance interventions. Participants felt that FES would complement balance interventions; however, they had not experienced this combination of therapies previously. CONCLUSIONS: End-users described how their experiences with balance deficits, rehabilitation, and FES informed their priorities for balance interventions. The findings inform the design and implementation of future balance interventions for individuals with SCI/D or stroke, including an intervention involving FES and visual feedback training.

Perspectives of individuals with chronic spinal cord injury following novel balance training involving functional electrical stimulation with visual feedback: a qualitative exploratory study.

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described. METHODS: Five individuals with a motor iSCI took part in this study. Each individual was at least 12 months post-injury, capable of unassisted standing for 60 s and had a Berg Balance Scale Score < 46. Participants completed twelve sessions of a novel balance intervention combining closed-loop functional electrical stimulation with visual feedback balance training (FES + VFBT). Participants received visual feedback regarding their centre of pressure position as they completed balance-training exercises while FES was applied to the ankle plantarflexors and dorsiflexors bilaterally. Semi-structured interviews were conducted after completion of the balance training intervention and eight-weeks post-training to understand participant's experiences. Categories and themes were derived from the transcripts using conventional content analysis. RESULTS: Three themes were identified from the collected transcripts: (1) Perceived benefits across International Classification of Functioning, Disability and Health levels; (2) Change in perceived fall risk and confidence; (3) Motivation to keep going. CONCLUSIONS: Participation in the FES + VFBT program resulted in perceived benefits that led to meaningful improvements in activities of daily living. Following completion of the training, individuals felt they still had the capacity to improve. Individuals felt they had increased their balance confidence, while a few participants also reported a decrease in their risk of falling. The inclusion of qualitative inquiry allows for the evaluation of the meaningfulness of an intervention and its perceived impact on the lives of the participants. TRIAL REGISTRATION: NCT04262414 (retrospectively registered February 10, 2020).

The histone H3-lysine 4-methyltransferase Mll4 regulates the development of growth hormone-releasing hormone-producing neurons in the mouse hypothalamus.

In humans, inactivating mutations in MLL4, which encodes a histone H3-lysine 4-methyltransferase, lead to Kabuki syndrome (KS). While dwarfism is a cardinal feature of KS, the underlying etiology remains unclear. Here we report that Mll4 regulates the development of growth hormone-releasing hormone (GHRH)-producing neurons in the mouse hypothalamus. Our two Mll4 mutant mouse models exhibit dwarfism phenotype and impairment of the developmental programs for GHRH-neurons. Our ChIP-seq analysis reveals that, in the developing mouse hypothalamus, Mll4 interacts with the transcription factor Nrf1 to trigger the expression of GHRH-neuronal genes. Interestingly, the deficiency of Mll4 results in a marked reduction of histone marks of active transcription, while treatment with the histone deacetylase inhibitor AR-42 rescues the histone mark signature and restores GHRH-neuronal production in Mll4 mutant mice. Our results suggest that the developmental dysregulation of Mll4-directed epigenetic control of transcription plays a role in the development of GHRH-neurons and dwarfism phenotype in mice.

One-pot selective production of levulinic acid and formic acid from spent coffee grounds in a catalyst-free biphasic system.

This study introduces the catalyst-free production of levulinic acid (LA) and formic acid (FA) from spent coffee grounds (SCGs) as a starting material in a biphasic system of 1,2-dichloroethane (DCE)-water at temperatures above 160 °C. In addition to the advantage of using the biphasic system attributed to the product equilibrium, DCE served as a source of hydrogen induced by subcritical water (SCW). The effect of temperature, the amount of DIW and DCE, and the pretreatment on SCG (raw or lipid extracted SCG (LE-SCG)) on the overall reaction and humin formation were studied. The maximum conversion of LA and FA was 47 and 29 w/w% of the total convertible monosaccharides in raw SCGs while 43 and 28 w/w% of the conversion were obtained at 180 °C when LE-SCG was used. The solvothermal effects of two media provides a non-catalytic route to utilize undried SCG for the production of LA and FA.

Wet in situ transesterification of spent coffee grounds with supercritical methanol for the production of biodiesel.

This work introduces biodiesel production from wet spent coffee grounds (SCGs) with supercritical methanol without any pre-drying process. Supercritical methanol and subcritical water effectively produced biodiesel via in situ transesterification by inducing more porous SCG and enhancing the efficiency of lipid extraction and conversion. It was also found that space loading was one of the critical factors for biodiesel production. An optimal biodiesel yield of 10.17 wt% of dry SCG mass (86.33 w/w% of esterifiable lipids in SCG) was obtained at reaction conditions of 270 °C, 90 bars, methanol to wet SCG ratio 5:1, space loading 58.4 ml/g and reaction time 20 min. Direct use of wet SCG waste as feedstock for supercritical biodiesel production eliminates the conventional dying process and the need of catalyst and also reduces environmental problems caused by landfill accumulation.

Solvo-thermal in situ transesterification of wet spent coffee grounds for the production of biodiesel.

This work addresses non-catalytic biodiesel production from spent coffee ground (SCG) by integrating solvo-thermal effect of 1,2-dichloroethane (DCE) with in situ transesterification over 160 °C. The SCG water content has a positive effect on the DCE hydrolysis up to 60 wt% due to the bimolecular substitution mechanism. The hydrolysis gives an acidic environment favorable for cellulose decomposition, SCG particle size reduction and lipid conversion. The optimal fatty acid ethyl ester yield was 11.8 wt% based on the mass of dried SCG with 3.36 ml ethanol and 3.16 ml DCE at 196.8 °C through the response surface methodology. Using the solvo-thermal effect, direct utilization of wet SCG as a biodiesel feedstock provides not only economic feasibility without using drying process and additional acid catalyst but also environmental advantage of recycling the municipal waste.

In-situ transesterification of wet spent coffee grounds for sustainable biodiesel production.

This work addresses in-situ transesterification of wet spent coffee grounds (SCGs) for the production of biodiesel. For in-situ transesterification process, the methanol, organic solvent and acid catalyst were mixed with wet SCG in one pot and the mixture was heated for simultaneous lipid extraction and transesterification. Maximum yield of fatty acid methyl esters (FAME) was 16.75wt.% based on the weight of dry SCG at 95°C. Comprehensive experiments were conducted with varying temperatures and various amounts of moisture, methanol, co-solvent and acid catalyst. Moderate polar and alcohol-miscible organic solvent is suitable for the high FAME yield. Unsaturated FAMEs are subject to oxidative cleavage by nitric acid and shorter chain (C6 and C10) FAMEs were mainly produced while sulfuric acid yielded long chain unsaturated FAMEs (C16 and C18). Utilization of wet SCGs as a biodiesel feedstock gives economic and environmental benefits by recycling the municipal waste.

Control of energy balance by hypothalamic gene circuitry involving two nuclear receptors, neuron-derived orphan receptor 1 and glucocorticoid receptor.

Nuclear receptors (NRs) regulate diverse physiological processes, including the central nervous system control of energy balance. However, the molecular mechanisms for the central actions of NRs in energy balance remain relatively poorly defined. Here we report a hypothalamic gene network involving two NRs, neuron-derived orphan receptor 1 (NOR1) and glucocorticoid receptor (GR), which directs the regulated expression of orexigenic neuropeptides agouti-related peptide (AgRP) and neuropeptide Y (NPY) in response to peripheral signals. Our results suggest that the anorexigenic signal leptin induces NOR1 expression likely via the transcription factor cyclic AMP response element-binding protein (CREB), while the orexigenic signal glucocorticoid mobilizes GR to inhibit NOR1 expression by antagonizing the action of CREB. Also, NOR1 suppresses glucocorticoid-dependent expression of AgRP and NPY. Consistently, relative to wild-type mice, NOR1-null mice showed significantly higher levels of AgRP and NPY and were less responsive to leptin in decreasing the expression of AgRP and NPY. These results identify mutual antagonism between NOR1 and GR to be a key rheostat for peripheral metabolic signals to centrally control energy balance.