•DARPA's programs foster multi-disciplinary collaborations.•DARPA's BCI programs span four major challenges: detect, emulate, restore, & improve.•Aims: restore function after injury; improve ...performance of healthy individuals.
The Defense Advanced Research Projects Agency (DARPA) has funded innovative scientific research and technology developments in the field of brain–computer interfaces (BCI) since the 1970s. This review highlights some of DARPA's major advances in the field of BCI, particularly those made in recent years. Two broad categories of DARPA programs are presented with respect to the ultimate goals of supporting the nation's warfighters: (1) BCI efforts aimed at restoring neural and/or behavioral function, and (2) BCI efforts aimed at improving human training and performance. The programs discussed are synergistic and complementary to one another, and, moreover, promote interdisciplinary collaborations among researchers, engineers, and clinicians. Finally, this review includes a summary of some of the remaining challenges for the field of BCI, as well as the goals of new DARPA efforts in this domain.
This paper presents the software framework established to facilitate cloud-hosted robot simulation. The framework addresses the challenges associated with conducting a task-oriented and real-time ...robot competition, the Defense Advanced Research Projects Agency (DARPA) Virtual Robotics Challenge (VRC), designed to mimic reality. The core of the framework is the Gazebo simulator, a platform to simulate robots, objects, and environments, as well as the enhancements made for the VRC to maintain a high fidelity simulation using a high degree of freedom and multisensor robot. The other major component used is the CloudSim tool, designed to enhance the automation of robotics simulation using existing cloud technologies. The results from the VRC and a discussion are also detailed in this work. Note to Practitioners - Advances in robot simulation, cloud hosted infrastructure, and web technology have made it possible to accurately and efficiently simulate complex robots and environments on remote servers while providing realistic data streams for human-in-the-loop robot control. This paper presents the software and hardware frameworks established to facilitate cloud-hosted robot simulation, and addresses the challenges associated with conducting a task-oriented robot competition designed to mimic reality. The competition that spurred this innovation was the VRC, a precursor to the DARPA Robotics Challenge, in which teams from around the world utilized custom human-robot interfaces and control code to solve disaster response-related tasks in simulation. Winners of the VRC received both funding and access to Atlas, a humanoid robot developed by Boston Dynamics. The Gazebo simulator, an open source and high fidelity robot simulator, was improved upon to met the needs of the VRC competition. Additionally, CloudSim was created to act as an interface between users and the cloud-hosted simulations. As a result of this work, we have achieved automated deployment of cloud resources for robotic simulations, near real-time simulation performance, and simulation accuracy that closely mimics real hardware. These tools have been released under open source licenses and are freely available, and can be used to help reduce robot and algorithm design and development time, and increase robot software robustness.
Background and AimsWalled-off pancreatic necrosis is a well-known serious adverse event of severe acute pancreatitis. EUS-guided transluminal access followed by direct endoscopic necrosectomy is ...increasingly used to remove necrosis, with good efficacy and a superior safety profile when compared with surgery. However, a percentage of patients is too critically ill to undergo this procedure or lack an appropriate transluminal window for access. Here we describe the use of percutaneous flexible endoscopic necrosectomy (PEN) with use of standard-sized upper endoscopes and accessories in a retrospective single-institution experience with a video demonstration of 1 patient in the series.MethodsThe authors present a 23-patient retrospective case series of PEN with standard-sized endoscopes. The series includes 12 patients from a previously published analysis in 2016 and 11 additional patients from 2013 to 2018. A representative case illustrates the described technique in a patient with severe acute pancreatitis complicated by multisystem organ failure who required immediate drainage of a pancreatic fluid collection and placement of a percutaneous drain into the collection for decompression. The drain was serially upsized to 28F, and its tract was used for PEN.ResultsA total of 23 patients have undergone PEN at our institution. On average, the size of the pancreatic fluid collection was 11.6 cm in cross-sectional diameter. Of those 23 patients, 11 presented with symptoms of severe disease. The median time from onset of symptoms to PEN was 84 days. The median number of procedures per patient was 2.1. The median time to complete resolution of symptoms and fluid collections was 67 days. In total, resolution was reached in 22 of 23 patients. Two patients died of unrelated causes.ConclusionPEN is a minimally invasive and effective treatment approach to walled-off pancreatic necrosis in patients who are not amenable to transluminal drainage and in whom percutaneous drains have been successfully placed. This case series demonstrates the efficacy and safety of this approach. A randomized prospective trial would be warranted to validate these results.
Acute, high-grade esophageal perforation and postoperative leak after esophagogastrostomy are associated with high morbidity and mortality due to the development of mediastinitis and thoracic ...contamination. Endoscopic vacuum therapy has proven to be a feasible, safe therapy for management of esophageal wall defects, but with limited success. We describe a retrospective single-center analysis of two patients who underwent endoscopic vacuum therapy for significant esophageal disruptions with a median cross-sectional diameter of 10.7 cm. The technique involved the use of a standard upper video endoscope, nasogastric tube, and vacuum-assisted closure dressing kit, with endoscopic placement of a polyurethane sponge and nasogastric tube assembly into the mediastinal or thoracic cavity. Serial washout and debridement were performed prior to each sponge insertion. Data were collected on indication, size of the cavities, time to intervention, number of procedures, time to resolution, outcomes, and adverse events. Two patients underwent therapy with a mean age of 69.5. The median size of the collections via longest cross-sectional diameter was 10.7 cm. The average number of endoscopic vacuum therapy performed was six and average duration of therapy was 49 days. Complete resolution was achieved in both patients. One patient died 6 weeks later due to severe sepsis from aspiration pneumonia. Endoscopic washout and debridement followed by endoscopic vacuum therapy can be effective for large, even multiple, thoracic and mediastinal contaminations following esophageal perforation and gastroesopagheal anastomotic dehiscence and leaks in appropriately selected patients.
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