Opto-E-Dura: A Soft, Stretchable ECoG Array for Multimodal, Multiscale Neuroscience

Origami-inspired soft fluidic actuation for minimally invasive large-area electrocorticography

Electrocorticography is an established neural interfacing technique wherein an array of electrodes enables large-area recording from the cortical surface. Electrocorticography is commonly used for seizure mapping however the implantation of large-area electrocorticography arrays is a highly invasive procedure, requiring a craniotomy larger than the implant area to place the device. In this work, flexible thin-film electrode arrays are combined with concepts from soft robotics, to realize a large-area electrocorticography device that can change shape via integrated fluidic actuators. We show that the 32-electrode device can be packaged using origami-inspired folding into a compressed state and implanted through a small burr-hole craniotomy, then expanded on the surface of the brain for large-area cortical coverage. The implantation, expansion, and recording functionality of the device is confirmed in-vitro and in porcine in-vivo models. The integration of shape actuation into neural implants provides a clinically viable pathway to realize large-area neural interfaces via minimally invasive surgical techniques.

Exploring the Elastomer Influence on the Electromechanical Performance of Stretchable Conductors

Stretchable electronics has received major attention in recent years due to the prospects of integrating electronics onto and into the human body. While many studies investigate how different conductive fillers perform in stretchable composites, the effect of different elastomers on composite performance, and the related fundamental understanding of what is causing the performance differences, is poorly understood. Here, we perform a systematic investigation of the elastomer influence on the electromechanical performance of gold nanowire-based stretchable conductors based on five chemically different elastomers of similar Young's modulus. The choice of elastomer has a huge impact on the electromechanical performance of the conductors under cyclic strain, as some composites perform well, while others fail rapidly at 100% strain cycling. The lack of macroscopic crack formation in the failing composites indicates that the key aspect for good electromechanical performance is not homogeneous films on the macroscale but rather beneficial interactions on the nanoscale. Based on the comprehensive characterization, we propose a failure mechanism related to the mechanical properties of the elastomers. By improving our understanding of elastomer influence on the mechanisms of electrical failure, we can move toward rational material design, which could greatly benefit the field of stretchable electronics.

A large-scale optogenetic neurophysiology platform for improving accessibility in NHP behavioral experiments

Optogenetics has been a powerful scientific tool for two decades, yet its integration with non-human primate (NHP) electrophysiology has been limited due to several technical challenges. These include a lack of electrode arrays capable of supporting large-scale and long-term optical access, inaccessible viral vector delivery methods for transfection of large regions of cortex, a paucity of hardware designed for large-scale patterned cortical illumination, and inflexible designs for multi-modal experimentation. To address these gaps, we introduce a highly accessible platform integrating optogenetics and electrophysiology for behavioral and neural modulation with neurophysiological recording in NHPs. We employed this platform in two rhesus macaques and showcased its capability of optogenetically disrupting reaches, while simultaneously monitoring ongoing electrocorticography activity underlying the stimulation-induced behavioral changes. The platform exhibits long-term stability and functionality, thereby facilitating large-scale electrophysiology, optical imaging, and optogenetics over months, which is crucial for translationally relevant multi-modal studies of neurological and neuropsychiatric disorders.

Multimodal Technologies for Closed-Loop Neural Modulation and Sensing

Existing methods for studying neural circuits and treating neurological disorders are typically based on physical and chemical cues to manipulate and record neural activities. These approaches often involve predefined, rigid, and unchangeable signal patterns, which cannot be adjusted in real time according to the patient's condition or neural activities. With the continuous development of neural interfaces, conducting in vivo research on adaptive and modifiable treatments for neurological diseases and neural circuits is now possible. In this review, current and potential integration of various modalities to achieve precise, closed-loop modulation, and sensing in neural systems are summarized. Advanced materials, devices, or systems that generate or detect electrical, magnetic, optical, acoustic, or chemical signals are highlighted and utilized to interact with neural cells, tissues, and networks for closed-loop interrogation. Further, the significance of developing closed-loop techniques for diagnostics and treatment of neurological disorders such as epilepsy, depression, rehabilitation of spinal cord injury patients, and exploration of brain neural circuit functionality is elaborated.

Shaping high-performance wearable robots for human motor and sensory reconstruction and enhancement

Most wearable robots such as exoskeletons and prostheses can operate with dexterity, while wearers do not perceive them as part of their bodies. In this perspective, we contend that integrating environmental, physiological, and physical information through multi-modal fusion, incorporating human-in-the-loop control, utilizing neuromuscular interface, employing flexible electronics, and acquiring and processing human-robot information with biomechatronic chips, should all be leveraged towards building the next generation of wearable robots. These technologies could improve the embodiment of wearable robots. With optimizations in mechanical structure and clinical training, the next generation of wearable robots should better facilitate human motor and sensory reconstruction and enhancement.

Multiscale co-simulation design pattern for neuroscience applications

Integration of information across heterogeneous sources creates added scientific value. Interoperability of data, tools and models is, however, difficult to accomplish across spatial and temporal scales. Here we introduce the toolbox Parallel Co-Simulation, which enables the interoperation of simulators operating at different scales. We provide a software science co-design pattern and illustrate its functioning along a neuroscience example, in which individual regions of interest are simulated on the cellular level allowing us to study detailed mechanisms, while the remaining network is efficiently simulated on the population level. A workflow is illustrated for the use case of The Virtual Brain and NEST, in which the CA1 region of the cellular-level hippocampus of the mouse is embedded into a full brain network involving micro and macro electrode recordings. This new tool allows integrating knowledge across scales in the same simulation framework and validating them against multiscale experiments, thereby largely widening the explanatory power of computational models.

Validation of transparent and flexible neural implants for simultaneous electrophysiology, functional imaging, and optogenetics

The combination of electrophysiology and neuroimaging methods allows the simultaneous measurement of electrical activity signals with calcium dynamics from single neurons to neuronal networks across distinct brain regions in vivo. While traditional electrophysiological techniques are limited by photo-induced artefacts and optical occlusion for neuroimaging, different types of transparent neural implants have been proposed to resolve these issues. However, reproducing proposed solutions is often challenging and it remains unclear which approach offers the best properties for long-term chronic multimodal recordings. We therefore created a streamlined fabrication process to produce, and directly compare, two types of transparent surface micro-electrocorticography (μECoG) implants: nano-mesh gold structures (m-μECoGs) versus a combination of solid gold interconnects and PEDOT:PSS-based electrodes (pp-μECoGs). Both implants allowed simultaneous multimodal recordings but pp-μECoGs offered the best overall electrical, electrochemical, and optical properties with negligible photo-induced artefacts to light wavelengths of interest. Showing functional chronic stability for up to four months, pp-μECoGs also allowed the simultaneous functional mapping of electrical and calcium neural signals upon visual and tactile stimuli during widefield imaging. Moreover, recordings during two-photon imaging showed no visible signal attenuation and enabled the correlation of network dynamics across brain regions to individual neurons located directly below the transparent electrical contacts.

Brainmask: an ultrasoft and moist micro-electrocorticography electrode for accurate positioning and long-lasting recordings

Bacterial cellulose (BC), a natural biomaterial synthesized by bacteria, has a unique structure of a cellulose nanofiber-weaved three-dimensional reticulated network. BC films can be ultrasoft with sufficient mechanical strength, strong water absorption and moisture retention and have been widely used in facial masks. These films have the potential to be applied to implantable neural interfaces due to their conformality and moisture, which are two critical issues for traditional polymer or silicone electrodes. In this work, we propose a micro-electrocorticography (micro-ECoG) electrode named "Brainmask", which comprises a BC film as the substrate and separated multichannel parylene-C microelectrodes bonded on the top surface. Brainmask can not only guarantee the precise position of microelectrode sites attached to any nonplanar epidural surface but also improve the long-lasting signal quality during acute implantation with an exposed cranial window for at least one hour, as well as the in vivo recording validated for one week. This novel ultrasoft and moist device stands as a next-generation neural interface regardless of complex surface or time of duration.

Polymer nanofiber network reinforced gold electrode array for neural activity recording

Flexible and stretchable neural electrodes are promising tools for high-fidelity interfacing with soft and curvilinear brain surface. Here, we describe a flexible and stretchable neural electrode array that consists of polyacrylonitrile (PAN) nanofiber network reinforced gold (Au) film electrodes. Under stretching, the interweaving PAN nanofibers effectively terminate the formation of propagating cracks in the Au films and thus enable the formation of a dynamically stable electrode-tissue interface. Moreover, the PAN nanofibers increase the surface roughness and active surface areas of the Au electrodes, leading to reduced electrochemical impedance and improved signal-to-noise ratio. As a result, PAN nanofiber network reinforced Au electrode arrays can allow for reliable in vivo multichannel recording of epileptiform activities in rats.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-022-00257-5.

Conformable neural interface based on off-stoichiometry thiol-ene-epoxy thermosets

Off-stoichiometry thiol-ene-epoxy (OSTE+) thermosets show low permeability to gases and little absorption of dissolved molecules, allow direct low-temperature dry bonding without surface treatments, have a low Young's modulus, and can be manufactured via UV polymerisation. For these reasons, OSTE+ thermosets have recently gained attention for the rapid prototyping of microfluidic chips. Moreover, their compatibility with standard clean-room processes and outstanding mechanical properties make OSTE+ an excellent candidate as a novel material for neural implants. Here we exploit OSTE+ to manufacture a conformable multilayer micro-electrocorticography array with 16 platinum electrodes coated with platinum black. The mechanical properties allow conformability to curved surfaces such as the brain. The low permeability and strong adhesion between layers improve the stability of the device. Acute experiments in mice show the multimodal capacity of the array to record and stimulate the neural tissue by smoothly conforming to the mouse cortex. Devices are not cytotoxic, and immunohistochemistry stainings reveal only modest foreign body reaction after two and six weeks of chronic implantation. This work introduces OSTE+ as a promising material for implantable neural interfaces.

Fully desktop fabricated flexible graphene electrocorticography (ECoG) arrays

Objective:Flexible Electrocorticography (ECoG) electrode arrays that conform to the cortical surface and record surface field potentials from multiple brain regions provide unique insights into how computations occurring in distributed brain regions mediate behavior. Specialized microfabrication methods are required to produce flexible ECoG devices with high-density electrode arrays. However, these fabrication methods are challenging for scientists without access to cleanroom fabrication equipment.Results:Here we present a fully desktop fabricated flexible graphene ECoG array. First, we synthesized a stable, conductive ink via liquid exfoliation of Graphene in Cyrene. Next, we established a stencil-printing process for patterning the graphene ink via laser-cut stencils on flexible polyimide substrates. Benchtop tests indicate that the graphene electrodes have good conductivity of ∼1.1 × 103S cm-1, flexibility to maintain their electrical connection under static bending, and electrochemical stability in a 15 d accelerated corrosion test. Chronically implanted graphene ECoG devices remain fully functional for up to 180 d, with averagein vivoimpedances of 24.72 ± 95.23 kΩ at 1 kHz. The ECoG device can measure spontaneous surface field potentials from mice under awake and anesthetized states and sensory stimulus-evoked responses.Significance:The stencil-printing fabrication process can be used to create Graphene ECoG devices with customized electrode layouts within 24 h using commonly available laboratory equipment.

Transparent neural interfaces: challenges and solutions of microengineered multimodal implants designed to measure intact neuronal populations using high-resolution electrophysiology and microscopy simultaneously

The aim of this review is to present a comprehensive overview of the feasibility of using transparent neural interfaces in multimodal in vivo experiments on the central nervous system. Multimodal electrophysiological and neuroimaging approaches hold great potential for revealing the anatomical and functional connectivity of neuronal ensembles in the intact brain. Multimodal approaches are less time-consuming and require fewer experimental animals as researchers obtain denser, complex data during the combined experiments. Creating devices that provide high-resolution, artifact-free neural recordings while facilitating the interrogation or stimulation of underlying anatomical features is currently one of the greatest challenges in the field of neuroengineering. There are numerous articles highlighting the trade-offs between the design and development of transparent neural interfaces; however, a comprehensive overview of the efforts in material science and technology has not been reported. Our present work fills this gap in knowledge by introducing the latest micro- and nanoengineered solutions for fabricating substrate and conductive components. Here, the limitations and improvements in electrical, optical, and mechanical properties, the stability and longevity of the integrated features, and biocompatibility during in vivo use are discussed.

Integration of hydrogels in microfabrication processes for bioelectronic medicine: Progress and outlook

Recent research aiming at the development of electroceuticals for the treatment of medical conditions such as degenerative diseases, cardiac arrhythmia and chronic pain, has given rise to microfabricated implanted bioelectronic devices capable of interacting with host biological tissues in synergistic modalities. Owing to their multimodal affinity to biological tissues, hydrogels have emerged as promising interface materials for bioelectronic devices. Here, we review the state-of-the-art and forefront in the techniques used by research groups for the integration of hydrogels into the microfabrication processes of bioelectronic devices, and present the manufacturability challenges to unlock their further clinical deployment.

Large-scale multimodal surface neural interfaces for primates

Deciphering the function of neural circuits can help with the understanding of brain function and treating neurological disorders. Progress toward this goal relies on the development of chronically stable neural interfaces capable of recording and modulating neural circuits with high spatial and temporal precision across large areas of the brain. Advanced innovations in designing high-density neural interfaces for small animal models have enabled breakthrough discoveries in neuroscience research. Developing similar neurotechnology for larger animal models such as nonhuman primates (NHPs) is critical to gain significant insights for translation to humans, yet still it remains elusive due to the challenges in design, fabrication, and system-level integration of such devices. This review focuses on implantable surface neural interfaces with electrical and optical functionalities with emphasis on the required technological features to realize scalable multimodal and chronically stable implants to address the unique challenges associated with nonhuman primate studies.

A flexible implantable microelectrode array for recording electrocorticography signals from rodents

Electrocorticography signals, the intracranial recording of electrical signatures of the brain, are recorded by non-penetrating planar electrode arrays placed on the cortical surface. Flexible electrode arrays minimize the tissue damage upon implantation. This work shows the design and development of a 32-channel flexible microelectrode array to record electrocorticography signals from the rat's brain. The array was fabricated on a biocompatible flexible polyimide substrate. A titanium/gold layer was patterned as electrodes, and a thin polyimide layer was used for insulation. The fabricated microelectrode array was mounted on the exposed somatosensory cortex of the right hemisphere of a rat after craniotomy and incision of the dura. The signals were recorded using OpenBCI Cyton Daisy Biosensing Boards. The array faithfully recorded the baseline electrocorticography signals, the induced epileptic activities after applying a convulsant, and the recovered baseline signals after applying an antiepileptic drug. The signals recorded by such fabricated microelectrode array from anesthetized rats demonstrate its potential to monitor electrical signatures corresponding to epilepsy. Finally, the time-frequency analyses highlight the difference in spatiotemporal features of baseline and evoked epileptic discharges.

Fabrication and in vivo 2-photon microscopy validation of transparent PEDOT:PSS microelectrode arrays

Transparent microelectrode arrays enable simultaneous electrical recording and optical imaging of neuronal networks in the brain. Electrodes made of the conducting polymer poly(3,4-ethylenedioxythiophene) doped with polystyrene sulfonate (PEDOT:PSS) are transparent; however, device fabrication necessitates specific processes to avoid deterioration of the organic material. Here, we present an innovative fabrication scheme for a neural probe that consists of transparent PEDOT:PSS electrodes and demonstrate its compatibility with 2-photon microscopy. The electrodes show suitable impedance to record local field potentials from the cortex of mice and sufficient transparency to visualize GCaMP6f-expressing neurons underneath the PEDOT:PSS features. The results validate the performance of the neural probe, which paves the way to study the complex dynamics of in vivo neuronal activity with both a high spatial and temporal resolution to better understand the brain.

Materials for Implantable Surface Electrode Arrays: Current Status and Future Directions

Surface electrode arrays are mainly fabricated from rigid or elastic materials, and precisely manipulated ductile metal films, which offer limited stretchability. However, the living tissues to which they are applied are nonlinear viscoelastic materials, which can undergo significant mechanical deformation in dynamic biological environments. Further, the same arrays and compositions are often repurposed for vastly different tissues rather than optimizing the materials and mechanical properties of the implant for the target application. By first characterizing the desired biological environment, and then designing a technology for a particular organ, surface electrode arrays may be more conformable, and offer better interfaces to tissues while causing less damage. Here, the various materials used in each component of a surface electrode array are first reviewed, and then electrically active implants in three specific biological systems, the nervous system, the muscular system, and skin, are described. Finally, the fabrication of next-generation surface arrays that overcome current limitations is discussed.

The diversity and specificity of functional connectivity across spatial and temporal scales

Macroscopic neuroimaging modalities in humans have revealed the organization of brain-wide activity into distributed functional networks that re-organize according to behavioral demands. However, the inherent coarse-graining of macroscopic measurements conceals the diversity and specificity in responses and connectivity of many individual neurons contained in each local region. New invasive approaches in animals enable recording and manipulating neural activity at meso- and microscale resolution, with cell-type specificity and temporal precision down to milliseconds. Determining how brain-wide activity patterns emerge from interactions across spatial and temporal scales will allow us to identify the key circuit mechanisms contributing to global brain states and how the dynamic activity of these states enables adaptive behavior.

Seamless integration of bioelectronic interface in an animal model via in vivo polymerization of conjugated oligomers

Leveraging the biocatalytic machinery of living organisms for fabricating functional bioelectronic interfaces, in vivo, defines a new class of micro-biohybrids enabling the seamless integration of technology with living biological systems. Previously, we have demonstrated the in vivo polymerization of conjugated oligomers forming conductors within the structures of plants. Here, we expand this concept by reporting that Hydra, an invertebrate animal, polymerizes the conjugated oligomer ETE-S both within cells that expresses peroxidase activity and within the adhesive material that is secreted to promote underwater surface adhesion. The resulting conjugated polymer forms electronically conducting and electrochemically active μm-sized domains, which are inter-connected resulting in percolative conduction pathways extending beyond 100 μm, that are fully integrated within the Hydra tissue and the secreted mucus. Furthermore, the introduction and in vivo polymerization of ETE-S can be used as a biochemical marker to follow the dynamics of Hydra budding (reproduction) and regeneration. This work paves the way for well-defined self-organized electronics in animal tissue to modulate biological functions and in vivo biofabrication of hybrid functional materials and devices.

Learning from the brain's architecture: bioinspired strategies towards implantable neural interfaces

While early neural interfaces consisted of rigid, monolithic probes, recent implantable technologies include meshes, gels, and threads that imitate various properties of the neural tissue itself. Such mimicry brings new capabilities to the traditional electrophysiology toolbox, with benefits for both neuroscience studies and clinical treatments. Specifically, by matching the multi-dimensional mechanical properties of the brain, neural implants can preserve the endogenous environment while functioning over chronic timescales. Further, topological mimicry of neural structures enables seamless integration into the tissue and provides proximal access to neurons for high-quality recordings. Ultimately, we envision that neuromorphic devices incorporating functional, mechanical, and topological mimicry of the brain may facilitate stable operation of advanced brain machine interfaces with minimal disruption of the native tissue.

Next generation material interfaces for neural engineering

Neural implant technology is rapidly progressing, and gaining broad interest in research fields such as electrical engineering, materials science, neurobiology, and data science. As the potential applications of neural devices have increased, new technologies to make neural intervention longer-lasting and less invasive have brought attention to neural interface engineering. This review will focus on recent developments in materials for neural implants, highlighting new technologies in the fields of soft electrodes, mechanical and chemical engineering of interface coatings, and remotely powered devices. In this context, novel implantation strategies, manufacturing methods, and combinatorial device functions will also be discussed.

Multi-scale neural decoding and analysis

Objective.

Complex spatiotemporal neural activity encodes rich information related to behavior and cognition. Conventional research has focused on neural activity acquired using one of many different measurement modalities, each of which provides useful but incomplete assessment of the neural code. Multi-modal techniques can overcome tradeoffs in the spatial and temporal resolution of a single modality to reveal deeper and more comprehensive understanding of system-level neural mechanisms. Uncovering multi-scale dynamics is essential for a mechanistic understanding of brain function and for harnessing neuroscientific insights to develop more effective clinical treatment.

Approach.

We discuss conventional methodologies used for characterizing neural activity at different scales and review contemporary examples of how these approaches have been combined. Then we present our case for integrating activity across multiple scales to benefit from the combined strengths of each approach and elucidate a more holistic understanding of neural processes.

Main results.

We examine various combinations of neural activity at different scales and analytical techniques that can be used to integrate or illuminate information across scales, as well the technologies that enable such exciting studies. We conclude with challenges facing future multi-scale studies, and a discussion of the power and potential of these approaches.

Significance.

This roadmap will lead the readers toward a broad range of multi-scale neural decoding techniques and their benefits over single-modality analyses. This Review article highlights the importance of multi-scale analyses for systematically interrogating complex spatiotemporal mechanisms underlying cognition and behavior.

A Suite of Neurophotonic Tools to Underpin the Contribution of Internal Brain States in fMRI

Recent developments in optical microscopy, applicable for large-scale and longitudinal imaging of cortical activity in behaving animals, open unprecedented opportunities to gain a deeper understanding of neurovascular and neurometabolic coupling during different brain states. Future studies will leverage these tools to deliver foundational knowledge about brain state-dependent regulation of cerebral blood flow and metabolism as well as regulation as a function of brain maturation and aging. This knowledge is of critical importance to interpret hemodynamic signals observed with functional magnetic resonance imaging (fMRI).

Multi-modal artificial dura for simultaneous large-scale optical access and large-scale electrophysiology in non-human primate cortex

Objective.Non-human primates (NHPs) are critical for development of translational neural technologies because of their neurological and neuroanatomical similarities to humans. Large-scale neural interfaces in NHPs with multiple modalities for stimulation and data collection poise us to unveil network-scale dynamics of both healthy and unhealthy neural systems. We aim to develop a large-scale multi-modal interface for NHPs for the purpose of studying large-scale neural phenomena including neural disease, damage, and recovery.Approach.We present a multi-modal artificial dura (MMAD) composed of flexible conductive traces printed into transparent medical grade polymer. Our MMAD provides simultaneous neurophysiological recordings and optical access to large areas of the cortex (∼3 cm2) and is designed to mitigate photo-induced electrical artifacts. The MMAD is the centerpiece of the interfaces we have designed to support electrocorticographic recording and stimulation, cortical imaging, and optogenetic experiments, all at the large-scales afforded by the brains of NHPs. We performed electrical and optical experiments bench-side andin vivowith macaques to validate the utility of our MMAD.Main results.Using our MMAD we present large-scale electrocorticography from sensorimotor cortex of three macaques. Furthermore, we validated surface electrical stimulation in one of our animals. Our bench-side testing showed up to 90% reduction of photo-induced artifacts with our MMAD. The transparency of our MMAD was confirmed both via bench-side testing (87% transmittance) and viain vivoimaging of blood flow from the underlying microvasculature using optical coherence tomography angiography.Significance.Our results indicate that our MMAD supports large-scale electrocorticography, large-scale cortical imaging, and, by extension, large-scale optical stimulation. The MMAD prepares the way for both acute and long-term chronic experiments with complimentary data collection and stimulation modalities. When paired with the complex behaviors and cognitive abilities of NHPs, these assets prepare us to study large-scale neural phenomena including neural disease, damage, and recovery.

Hybrid Electrical and Optical Neural Interfaces

Neural interfaces bridge the nervous system and the outside world by recording and stimulating neurons. Combining electrical and optical modalities in a single, hybrid neural interface system could lead to complementary and powerful new ways to explore the brain. It has gained robust and exciting momentum recently in neuroscience and neural engineering research. Here, we review developments in the past several years aiming to achieve such hybrid electrical and optical microsystem platforms. Specifically, we cover three major categories of technological advances: transparent neuroelectrodes, optical neural fibers with electrodes, and neural probes/grids integrating electrodes and microscale light-emitting diodes. We discuss examples of these probes tailored to combine electrophysiological recording with optical imaging or optical neural stimulation of the brain and possible directions of future innovation.

Soft Electronics Based on Stretchable and Conductive Nanocomposites for Biomedical Applications

Research on the field of implantable electronic devices that can be directly applied in the body with various functionalities is increasingly intensifying due to its great potential for various therapeutic applications. While conventional implantable electronics generally include rigid and hard conductive materials, their surrounding biological objects are soft and dynamic. The mechanical mismatch between implanted devices and biological environments induces damages in the body especially for long-term applications. Stretchable electronics with outstanding mechanical compliance with biological objects effectively improve such limitations of existing rigid implantable electronics. In this article, the recent progress of implantable soft electronics based on various conductive nanocomposites is systematically described. In particular, representative fabrication approaches of conductive and stretchable nanocomposites for implantable soft electronics and various in vivo applications of implantable soft electronics are focused on. To conclude, challenges and perspectives of current implantable soft electronics that should be considered for further advances are discussed.