METHOD FOR OBTAINING EXHALED RESPIRATORY SPECIMENS
20220061823 · 2022-03-03
Inventors
Cpc classification
A41D13/11
HUMAN NECESSITIES
International classification
A61B10/00
HUMAN NECESSITIES
A41D13/11
HUMAN NECESSITIES
Abstract
The invention provides articles, devices, and methods for sampling respiratory droplets, the article comprising a material capable of adsorbing or absorbing respiratory droplets such that the contents of said respiratory droplets can be recovered for analysis. The invention allows respiratory droplets to be collected directly from any source of moisture and commonly-used devices, for example face masks and air handling systems.
Claims
1. An article for sampling respiratory droplets, the article comprising: a material capable of adsorbing or absorbing respiratory droplets such that the contents of said respiratory droplets can be recovered for analysis.
2. The article of claim 1, wherein the respiratory droplets may be adsorbed or absorbed from one or more of the group consisting of moisture, exhaled air, circulating air, and ambient air.
3. The article of claim 1, wherein the material is a hygroscopic material.
4. The article of claim 3, wherein the hygroscopic material is capable of adsorbing respiratory droplets.
5. The method of claim 4, wherein the contents of the respiratory droplets may be recovered by elution.
6. The article of claim 1, wherein the contents of the respiratory droplets can be recovered for the analysis of microbes.
7. The article of claim 6, wherein the microbes are viral or bacterial.
8. The article of claim 3, wherein the material is selected from at least one of a desiccant or a superabsorbent polymer.
8. A device comprising the article of claim 1.
9. The device of claim 8, wherein the device is a face mask or a filter for circulating air or ambient air.
10. The device of claim 9, wherein the face mask is a surgical mask and the filter for circulating air or ambient air is a filter for an HVAC system, a filter for a vent, or a filter for a fan.
11. The device of claim 8, wherein the device is collection device for exhaled air.
12. The device of claim 11, wherein the device is an oral collector tube, a nasal collector tube, a hand-held lollipop device, a hand-held tea-bag device, a surface-resting device, a straw, or an insert for a straw.
13. A method for sampling respiratory droplets, the method comprising: contacting with respiratory droplets a material capable of adsorbing or absorbing respiratory droplets; recovering the contents of the respiratory droplets from the material; analyzing the recovered contents of the respiratory droplets.
14. The method of claim 13, wherein the respiratory droplets may be adsorbed or absorbed from one or more of the group consisting of moisture, exhaled air, circulating air, and ambient air.
15. The method of claim 13, wherein the material is a hygroscopic material.
16. The method of claim 15, wherein the hygroscopic material is capable of adsorbing respiratory droplets.
17. The method of claim 16, wherein the contents of the respiratory droplets may be recovered by elution.
18. The method of claim 13, wherein the material part of a device.
19. The method of claim 18, wherein the device is a face mask, a filter for circulating air, a filter for ambient air, or a collection device for exhaled air.
20. The device of claim 19, wherein the device is a surgical mask, a filter for an HVAC system, a filter for a vent, or a filter for a fan. an oral collector tube, a nasal collector tube, a hand-held lollipop device, a hand-held tea-bag device, a surface-resting device, a straw, or an insert for a straw.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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DETAILED DESCRIPTION
[0039] The invention provides articles, devices, and methods for sampling respiratory droplets, the article comprising a material capable of adsorbing or absorbing respiratory droplets such that the contents of said respiratory droplets can be recovered. Because the droplets can be adsorbed or absorbed such that the contents of the droplets can be recovered, the contents of the droplets can then be analyzed, for example for the presence of and/or to identify microbes such as viral particles.
[0040] Advantageously, the invention has the ability to accumulate respiratory droplets from any source, for example, moisture, such as from saliva or exhaled air, circulating air, and ambient air for any duration of time that the invention is employed, leading to increased sampling of infectious agents over time. This contrasts with the most common sampling methods which only provide samples for infectious agent analysis obtained at a single time point.
[0041] Additionally, the articles and methods of the present invention may directly sample droplets from exhaled breath (exhalant) from the respiratory tract, which are the direct biological material responsible for the transmission of respiratory infectious agents between individuals. In contrast, sampling methods that collect different biological material, while possibly containing the infectious agent, only serve as indirect surrogates of the capacity of an individual to infect those in their immediate surroundings and/or the create a broader environmental hazard from aerosolized droplet persistence in the general vicinity. Thus, a key feature and advantage of the present invention is that it provides articles and methods to measure how infectious an individual will be to those in their immediate surroundings.
[0042] The length of time over which the invention is applied and/or the length of time that source of droplets to be analyzed is in contact with the article or device of the invention is a variable aspect of the invention, and can be varied to modulate the amount of infectious agent collected so as to accommodate different biologic characteristics of an infectious agent and thereby modulate the sensitivity and specificity of the downstream analytic method used to identify the infectious agent. For example, the sensitivity of a given analytic method can be increased by increasing the amount of time the article is in contact with the source of droplets to be analyzed, leading to increased accumulation of the infectious agent and an opportunity to both detect the presence of the agent and/or to determine the rate and quantity of the infectious agent in the source of the droplets over time. In aspects of the invention, the length of time over which the source of droplets is in contact with the articles or devices of the present invention (for example as incorporated into a naso/oral facial covering, a breath collection tube, or present without being incorporated into a device or specific container) may be varied.
[0043] The adsorbent or adsorbent material used in the article or devices of the invention can be any known material capable of collecting respiratory droplets. Advantageously, the material may be a material that collects moisture directly from air and respiratory droplets in the air can collected and the contents of the respiratory droplets can then be recovered, for example by elution, for analysis. For example, the material may comprise silica gel, a cellulose-based absorbent such as corn husk, polymeric foam, sodium polyacrylate, sodium alginate, hyaluronic acid, or other water-absorbing hydrogels.
[0044] Silica gel is an amorphous and porous form of silicon dioxide (silica), consisting of an irregular tridimensional framework of alternating silicon and oxygen atoms with nanometer-scale voids and pores. The voids may contain water or some other liquids, or may be filled by gas or vacuum.
[0045] A polymeric foam is a foam, in liquid or solidified form, formed from polymers. Examples include: Ethylene-vinyl acetate (EVA) foam, the copolymers of ethylene and vinyl acetate; also referred to as polyethylene-vinyl acetate (PEVA) Low-density polyethylene (LDPE) foam, first grade of polyethylene (PE)
[0046] Sodium polyacrylate is a sodium salt of polyacrylic acid with the chemical formula [—CH2-CH(CO2Na)-]n.
[0047] Sodium alginate is derived from brown algae or seaweed and forms heat stable gels in the presence of calcium.
[0048] The invention may further comprise infectious agent specific molecules, for example antibodies and aptamers that bind to constituents of the infectious particle, including nucleic acids, cell membranes, and intracellular structural proteins and/or intracellular contents, whether from intact or degenerating infectious agent or released from intact or degenerating infectious agent. The invention may comprise hybrid capture probes to bind the target pathogen's DNA or RNA. Proteins, antibodies, and any other known molecule may be used in the article to bind targets. The target may be a viral capsid protein.
[0049] Advantageously, the invention may further comprise an indicator of moisture absorption, for example a colorimetric indicator. The colorimetric indicator may comprise any known colorimetric assay, for example the colorimetric indicator may be methyl violet and may be in silica gels, thereby leading the gels to turn from orange, when dry, to green when hydrated. The colorimetric indicator may be provided together with the material capable of adsorbing or absorbing respiratory droplets. The colorimetric indicator may be provided separately from the material capable of adsorbing or absorbing respiratory droplets.
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[0052] The article may also be free standing. For example, the article may lay flat on a surface and collect respiratory droplets from ambient or circulating air that comes in contact with the surface. An individual may also hold the article up to their face and exhale into the article. In aspects of the invention, the article may comprise a handle that allows the user to hold the article in place to make contact with exhaled respiratory droplets. The handle may allow the user to hold the article at variable distances and lengths of time from the nose or mouth. The article may comprise a “tea-bag” shape, with the material incorporated into the pouch shape of the tea bag. For example, the “tea-bag” article may comprise food-grade mesh bags, for example nylon tea bags. The “tea-bag” article may comprise a string for the user to hold the article and exhale onto the pouch shape of the tea bag. The “tea-bag” article may be affixed to clothing of the user, for example affixed by a pin and worn like a badge by the user. The “tea-bag” article may comprise colorimetric beads that change color to indicate when the “tea-bag” is saturated with moisture.
[0053] The article may come in a package together with instructions that instruct the user as to the distance at which to hold the article in place. The article may come in a package together with instructions that instruct the user as to the length of time for which to hold the article in place. The “tea-bag” article may be shipped for analysis dry, or may be packaged together with an extraction buffer or stabilizing buffer, for example in a sealed vial. The “tea-bag article” may be being placed on the inner surface of a facial covering, for example a surgical mask.
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[0060] The collector tube 605 can be used for oral sampling methods and/or nasal sampling methods. The tube may be placed either in the mouth and/or nostrils and exhaled air is delivered into the collector tube that allows the exhalant to contact material that absorbs or adsorbs respiratory droplets and the contents of the respiratory droplets as the exhalant passes through the collector tube and out the collector tube exit port. The material may or may not be removed from the device prior to analyzing the sample. The collector tube may be mechanically fixed to the patient's oral or nasal cavity, for example with a cannula or by medical tape, or may be held in place by the user or a third party.
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[0062] The mouthpiece 703 may be configured to be removable from the collector tube 701. The mouthpiece 703 may attach to the collector tube by any known means. For example, the mouthpiece may attach and detach from the collector tube through a screw type assembly or an air-tight fitted assembly. The mouthpiece 703 may be shaped to improve oral collection, for example, the mouthpiece may be flanged.
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[0070] Hand-held aspects of the invention may be held in front of the mouth by the user similar to a lollipop or “blow pop”, which may be advantageous for testing of children. The article may further be configured to comprise a bead 1621. Once exposed to or saturated with moisture, the bead 1621 may change color to indicate saturation.
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[0073] The article may come in a package together with instructions that instruct the user as to the distance at which to hold the article in place. The article may come in a package together with instructions that instruct the user as to the length of time for which to hold the article in place. The “tea-bag” article may be shipped for analysis dry, or may be packaged together with an extraction buffer or stabilizing buffer, for example in a sealed vial. The tea-bag size may be about 2×2.4 inches or about 2×2 inches, which advantageously lends itself to being capable of being placed on the inner surface of a facial covering, for example a surgical mask.
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[0075] Aspects of the invention may comprise a mesh at the point of contact between the device and exhaled air. The mesh may comprise beads. Beads are preferably greater than 0.75 mm in diameter in order to not significantly impede breath. The mesh advantageously serves to protect the user from inhaling the material or the material from otherwise escaping the device while still allowing air to pass through the device, The mesh can be welded, for example ultrasonically welded, or otherwise adhered to the device. The mesh may be shaped to snap-fit onto one or more ends of the device. The mesh and beads comprising the mesh may be commercially available. The mesh and other aspects of the device may be sterilized, for example using UV sterilized or chemically sterilized. Aspects that require contact with the mouth or nose of the subject advantageously may be sterilized using a process that avoids imparting a taste on the device.
[0076] The article may also be shaped to filter circulating air. For example, the article may be shaped to filter air in an air purification system or an air conditioning system, such as a humidifier, dehumidifier, air exchanger, air cleaner, or HVAC system. The article may be shaped to filter air passing through a vent.
[0077] Heating, ventilation, and/or air conditioning (HVAC) systems control the temperature within a building or other structure. HVAC systems may include boiler systems, radiant heating systems, electric heating systems, a system of ductwork and air vents, and one or more HVAC controllers. The one or more HVAC components may include a furnace, a heat pump, an electric heat pump, a geothermal heat pump, an electric heating unit, an air conditioning unit, a humidifier, a dehumidifier, an air exchanger, an air cleaner, and/or the like. HVAC systems typically include an air filter to help remove dust and other pollutants from within the building and to protect the HVAC equipment from dust buildup which may negatively impact system performance. The article of the present invention may be provided as a filter for an HVAC system, or may be provided as part of an existing filter for an HVAC system. HVAC systems are described in U.S. Pat. No. 10,119,718, herein incorporated by reference in its entirety.
[0078] The invention also provides methods of analyzing the presence of microbes, such as viral particles using the articles and devices of the invention. The method may analyze respiratory droplets by passing air through the article comprising an absorbent or adsorbent material, wherein the material collects respiratory droplets in the air, recovering the contents of the droplets from the material, and analyzing the contents of the droplets.
[0079] Advantageously, articles, devices, and methods of the present invention allow for the contents of respiratory droplets to be recovered from the article after collection to be further analyzed. The method of recovery in the case of an adsorbent material may elution, for example by the addition of an aqueous buffer, for example but not limited to saline or phosphate-buffered saline, onto the adsorbent material. For some absorbent materials, addition of an aqueous buffer may suffice to extract the droplets. For most absorbent materials, additional treatment will be required to recover the contents of the respiratory droplets. These treatments will vary depending on the characteristics of the absorbent material used, and could include for example centrifugation, temperature modulation, or the addition of solvents or other chemicals or molecules that serve to liberate the absorbed droplets from the absorbent material. Upon recovery, the droplets will be coalesced into an aqueous phase for subsequent analysis.
[0080] Analyses of the contents of the respiratory droplets may comprise any known method of analysis, for example any method for detecting the presence of identity of a virus. The analysis may be used to detect any target analyte. The target analyte refers to the substance in the sample that will be captured and isolated. The target analyte may be inorganic (e.g., a metal, a cyanide or cyanate, a salt, etc.) or organic chemicals, macromolecules (chitin, peptidoglycan, carbohydrates, proteins, nucleic acids, lipids, etc.,), bacteria, fungi, a cell (such as a cancer cell, a white blood cell a virally infected cell, or a fetal cell circulating in maternal circulation), a virus, a nucleic acid (e.g., DNA or RNA), a receptor, a ligand, a hormone, a drug, a chemical substance, or any molecule known in the art. In preferred aspects of the invention, the analyte is not a volatile organic compound.
[0081] For example, the analysis may comprise DNA or RNA amplification, such as PCR, nucleic acid sequencing, such as next generation sequencing (NGS) and/or droplet-based sequencing, anti-body based analysis, an immunoassay, or any combination of analytic techniques and methods.
[0082] Nucleic acid template molecules (e.g., DNA or RNA) can be isolated from a biological sample in the respiratory droplet containing a variety of other components, such as proteins, lipids, and non-template nucleic acids. Nucleic acid template molecules can be obtained from any cellular material, obtained from animal, plant, bacterium, fungus, or any other cellular organism. Biological samples for use in the present invention also include viral particles or preparations. Nucleic acid template molecules can also be isolated from cultured cells, such as a primary cell culture or cell line. The cells or tissues from which template nucleic acids are obtained can be infected with a virus or other intracellular pathogen. A sample can also be total RNA extracted from a biological specimen, a cDNA library, viral, or genomic DNA. A sample may also be isolated DNA from a non-cellular origin, e.g. amplified/isolated DNA from the freezer.
[0083] Generally, nucleic acid can be extracted, isolated, amplified, or analyzed by a variety of techniques such as those described by Green and Sambrook, Molecular Cloning: A Laboratory Manual (Fourth Edition), Cold Spring Harbor Laboratory Press, Woodbury, N.Y. 2,028 pages (2012); or as described in U.S. Pat. Nos. 7,957,913; 7,776,616; 5,234,809; U.S. Pub. 2010/0285578; and U.S. Pub. 2002/0190663.
[0084] Nucleic acid from a sample may optionally be fragmented or sheared to a desired length, using a variety of mechanical, chemical, and/or enzymatic methods. DNA may be randomly sheared via sonication using, for example, an ultrasonicator sold by Covaris (Woburn, Mass.), brief exposure to a DNase, or using a mixture of one or more restriction enzymes, or a transposase or nicking enzyme. RNA may be fragmented by brief exposure to an RNase, heat plus magnesium, or by shearing. The RNA may be converted to cDNA. If fragmentation is employed, the RNA may be converted to cDNA before or after fragmentation. Generally, individual nucleic acid template molecules can be from about 2 kb bases to about 40 kb, Nucleic acid molecules may be single-stranded, double-stranded, or double stranded with single-stranded regions (for example, stem- and loop-structures).
[0085] A biological sample may be lysed, homogenized, or fractionated in the presence of a detergent or surfactant as needed. Suitable detergents may include an ionic detergent (e.g., sodium dodecyl sulfate or N-lauroylsarcosine) or a nonionic detergent (such as the polysorbate 80 sold under the trademark TWEEN by Uniqema Americas (Paterson, N.J.) or C14H22O(C2H4)n, known as TRITON X-100).
[0086] A target may be analyzed by a multitude of existing technologies, such as nuclear magnetic resonance (NMR), miniature NMR Polymerase Chain Reaction (PCR), mass spectrometry, fluorescent labeling and visualization using microscopic observation, fluorescent in situ hybridization (FISH), growth-based antibiotic sensitivity tests, and variety of other methods that may be conducted with purified target without significant contamination from other sample components. Analysis using NMR is described in U.S. Pub. 2011/0262925, herein incorporated by reference in its entirety.
[0087] PCR may be used as described or any other amplification reaction may be performed. Amplification refers to production of additional copies of a nucleic acid sequence and is generally carried out using polymerase chain reaction (PCR) or other technologies known in the art. The amplification reaction may be any amplification reaction known in the art that amplifies nucleic acid molecules such as PCR (e.g., nested PCR, PCR-single strand conformation polymorphism, ligase chain reaction, strand displacement amplification and restriction fragments length polymorphism, transcription based amplification system, rolling circle amplification, and hyper-branched rolling circle amplification, quantitative PCR, quantitative fluorescent PCR (QF-PCR), multiplex fluorescent PCR (MF-PCR), real time PCR (RTPCR), restriction fragment length polymorphism PCR). See U.S. Pat. Nos. 5,242,794; 5,494,810; 4,988,617; 6,582,938; 4,683,195; and 4,683,202, hereby incorporated by reference. Primers for PCR, sequencing, and other methods can be prepared by cloning, direct chemical synthesis, and other methods known in the art. Primers can also be obtained from commercial sources such as Eurofins MWG Operon (Huntsville, Ala.) or Life Technologies (Carlsbad, Calif.).
[0088] Alternatively, an isothermal method of amplification, e.g. rolling circle amplification (RCA) or loop-mediated isothermal amplification (LAMP), may be performed.
[0089] Amplification adapters may be attached to the fragmented nucleic acid. Adapters may be commercially obtained, such as from Integrated DNA Technologies (Coralville, Iowa). The adapter sequences may be attached to the template nucleic acid molecule with an enzyme. The enzyme may be a ligase or a polymerase. The ligase may be any enzyme capable of ligating an oligonucleotide (RNA or DNA) to the template nucleic acid molecule. Suitable ligases include T4 DNA ligase and T4 RNA ligase, available commercially from New England Biolabs (Ipswich, Mass.). Methods for using ligases are well known in the art. The polymerase may be any enzyme capable of adding nucleotides to the 3′ and the 5′ terminus of template nucleic acid molecules.
[0090] Analysis may also involve attaching the bar code sequences to the template nucleic acids e.g., for barcode PCR. A bar code may be attached to each fragment. A plurality of bar codes, e.g., two bar codes, may be attached to each fragment. A bar code sequence generally includes certain features that make the sequence useful in sequencing reactions. For example the bar code sequences are designed to have minimal or no homo-polymer regions, i.e., 2 or more of the same base in a row such as AA or CCC, within the bar code sequence. The bar code sequences are also designed so that they are at least one edit distance away from the base addition order when performing base-by-base sequencing, ensuring that the first and last base do not match the expected bases of the sequence.
[0091] The bar code sequences are designed such that each sequence is correlated to a particular portion of nucleic acid, allowing sequence reads to be correlated back to the portion from which they came. Methods of designing sets of bar code sequences are shown for example in U.S. Pat. No. 6,235,475, the contents of which are incorporated by reference herein in their entirety. Since the bar code sequence is sequenced along with the template nucleic acid, the oligonucleotide length should be of minimal length so as to permit the longest read from the template nucleic acid attached. Generally, the bar code sequences are spaced from the template nucleic acid molecule by at least one base (minimizes homo-polymeric combinations). The bar code sequences are attached to the template nucleic acid molecule, e.g., with an enzyme. The enzyme may be a ligase or a polymerase, as discussed below. Attaching bar code sequences to nucleic acid templates is shown in U.S. Pub. 2008/0081330 and U.S. Pub. 2011/0301042, the contents of which are incorporated by reference herein in its entirety. Methods for designing sets of bar code sequences and other methods for attaching bar code sequences are shown in U.S. Pat. Nos. 7,544,473; 7,537,897; 7,393,665; 6,352,828; 6,172,218; 6,172,214; 6,150,516; 6,138,077; 5,863,722; 5,846,719; 5,695,934; and 5,604,097, each incorporated by reference.
[0092] After any processing steps (e.g., obtaining, isolating, fragmenting, amplification, or barcoding), nucleic acid can be sequenced.
[0093] Sequencing may be by any method known in the art. DNA sequencing techniques include classic dideoxy sequencing reactions (Sanger method) using labeled terminators or primers and gel separation in slab or capillary, sequencing by synthesis using reversibly terminated labeled nucleotides, pyrosequencing, 454 sequencing, Illumina/Solexa sequencing, allele specific hybridization to a library of labeled oligonucleotide probes, sequencing by synthesis using allele specific hybridization to a library of labeled clones that is followed by ligation, real time monitoring of the incorporation of labeled nucleotides during a polymerization step, polony sequencing, and SOLiD sequencing. Sequencing of separated molecules has more recently been demonstrated by sequential or single extension reactions using polymerases or ligases as well as by single or sequential differential hybridizations with libraries of probes.
[0094] An advantage of the current invention is its ability to collect the respiratory material in a manner that enables subsequent assessment of active infectious particles in the material. Thus, when respiratory droplets are sampled using the articles and methods described herein, the recovered material may be analyzed functionally for the presence of active virus or bacterial particles. For example, active virus can be assessed by placing the recovered material onto cells in culture to determine if the virus in the recovered respiratory material is capable of self-propagation. Active bacteria can be assessed, for example, by placing the recovered material onto agar plates infused with the appropriate growth medium. Viable infectious agents may be assessed quantitatively or qualitatively using any number of methods known to those versed in the art. This contrasts with other methods for harvesting respiratory droplets, which often compromise the viability of any active infectious particles present in the droplets.
EXAMPLES
Example 1
[0095] Articles of the invention comprising silica gel beads were tested for their absorption and adsorption of moisture.
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[0098] Results for surgical masks with a nylon mesh teabag embodiment are shown to the left. Silica gel beads of a size range between 0.2-0.4 mm (200-400 um), with a methyl violet colorimetric indicator of hydration, were enclosed within a nylon mesh teabag embodiment, and the teabag affixed to the interior of a standard surgical face mask so that it was positioned between the mask and the mouth. Subjects were asked to breathe as they would normally for either 6 or 12 minutes as shown. Recovery of vapor from the breath was quantified as bead saturation, based on the colorimetric change.
[0099] Results for blow tube form embodiments are shown to the right. Silica gel beads with the same characteristics as above were placed inside a 4-inch-long tube with a diameter of 1 inch. The tube at one end has a removable cap, through which the subject blows, and a nylon mesh covering the other end of the tube through which the exhalant exits, allowing for air and vapors from the exhalant to flow freely through the tube while retaining the silica gel beads within the tube. The cap was removed, and subjects were asked to exhale into the tube for the indicated number of breaths. Subsequently the silica gel beads were analyzed for the recovery of vapor from the exhalant, quantified as bead saturation based on the colorimetric change. Positive control was 350 mg of silica gel beads incubated with 400 ul of 0.9% saline, while negative controls were untreated silica gel beads.
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INCORPORATION BY REFERENCE
[0102] References and citations to other documents, such as patents, patent applications, patent publications, journals, books, papers, web contents, have been made throughout this disclosure. All such documents are hereby incorporated herein by reference in their entirety for all purposes.
EQUIVALENTS
[0103] Various modifications of the invention and many further embodiments thereof, in addition to those shown and described herein, will become apparent to those skilled in the art from the full contents of this document, including references to the scientific and patent literature cited herein. The subject matter herein contains important information, exemplification and guidance that can be adapted to the practice of this invention in its various embodiments and equivalents thereof