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      Closed-Loop Fuzzy Energy Regulation in Patients With Hypercortisolism via Inhibitory and Excitatory Intermittent Actuation

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          Abstract

          Hypercortisolism or Cushing's disease, which corresponds to the excessive levels of cortisol hormone, is associated with tiredness and fatigue during the day and disturbed sleep at night. Our goal is to employ a wearable brain machine interface architecture to regulate one's energy levels in hypercortisolism. In the present simulation study, we generate multi-day cortisol profile data for ten subjects both in healthy and disease conditions. To relate an internal hidden cognitive energy state to one's cortisol secretion patterns, we employ a state-space model. Particularly, we consider circadian upper and lower bound envelopes on cortisol levels, and timings of hypothalamic pulsatile activity underlying cortisol secretions as continuous and binary observations, respectively. To estimate the hidden cognitive energy-related state, we use Bayesian filtering. In our proposed architecture, we infer one's cognitive energy-related state using wearable devices rather than monitoring the brain activity directly and close the loop utilizing fuzzy control. To model actuation in the real-time closed-loop architecture, we simulate two types of medications that result in increasing and decreasing the energy levels in the body. Finally, we close the loop using a knowledge-based control approach. The results on ten simulated profiles verify how the proposed architecture is able to track the energy state and regulate it using hypothetical medications. In a simulation study based on experimental data, we illustrate the feasibility of designing a wearable brain machine interface architecture for energy regulation in hypercortisolism. This simulation study is a first step toward the ultimate goal of managing hypercortisolism in real-world situations.

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          Most cited references62

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          Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline.

          The objective is to formulate clinical practice guidelines for treating Cushing's syndrome.
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            Molecularly selective nanoporous membrane-based wearable organic electrochemical device for noninvasive cortisol sensing

            A new wearable nanoporous organic electrochemical device used as a medical diagnostics tool for noninvasive hormone sensing.
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              Assessment of the cortisol awakening response: Expert consensus guidelines.

              The cortisol awakening response (CAR), the marked increase in cortisol secretion over the first 30-45 min after morning awakening, has been related to a wide range of psychosocial, physical and mental health parameters, making it a key variable for psychoneuroendocrinological research. The CAR is typically assessed from self-collection of saliva samples within the domestic setting. While this confers ecological validity, it lacks direct researcher oversight which can be problematic as the validity of CAR measurement critically relies on participants closely following a timed sampling schedule, beginning with the moment of awakening. Researchers assessing the CAR thus need to take important steps to maximize and monitor saliva sampling accuracy as well as consider a range of other relevant methodological factors. To promote best practice of future research in this field, the International Society of Psychoneuroendocrinology initiated an expert panel charged with (i) summarizing relevant evidence and collective experience on methodological factors affecting CAR assessment and (ii) formulating clear consensus guidelines for future research. The present report summarizes the results of this undertaking. Consensus guidelines are presented on central aspects of CAR assessment, including objective control of sampling accuracy/adherence, participant instructions, covariate accounting, sampling protocols, quantification strategies as well as reporting and interpreting of CAR data. Meeting these methodological standards in future research will create more powerful research designs, thus yielding more reliable and reproducible results and helping to further advance understanding in this evolving field of research.
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                Author and article information

                Contributors
                Journal
                Front Neurosci
                Front Neurosci
                Front. Neurosci.
                Frontiers in Neuroscience
                Frontiers Media S.A.
                1662-4548
                1662-453X
                09 August 2021
                2021
                : 15
                : 695975
                Affiliations
                [1] 1Computational Medicine Lab, Department of Electrical and Computer Engineering, University of Houston , Houston, TX, United States
                [2] 2Department of Mechanical Engineering, University of Maryland , College Park, MD, United States
                Author notes

                Edited by: Lionel Carneiro, The Ohio State University, United States

                Reviewed by: Vincent Wester, Erasmus Medical Center, Netherlands; Margaret F. Keil, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), United States

                *Correspondence: Rose T. Faghih rtfaghih@ 123456uh.edu

                This article was submitted to Neuroenergetics, Nutrition and Brain Health, a section of the journal Frontiers in Neuroscience

                Article
                10.3389/fnins.2021.695975
                8381152
                34434085
                3fe19ff8-9622-466a-a563-ed66aeb2b8fe
                Copyright © 2021 Fekri Azgomi, Hahn and Faghih.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 April 2021
                : 28 June 2021
                Page count
                Figures: 9, Tables: 1, Equations: 19, References: 63, Pages: 16, Words: 10403
                Categories
                Neuroscience
                Original Research

                Neurosciences
                closed-loop,energy state,cortisol,hypercortisolism,bayesian estimation,wearable,fuzzy control

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