Portable device for automated ventilation
10912903 ยท 2021-02-09
Assignee
Inventors
- Elchanan Fried (Jerusalem, IL)
- Moni Solomonov (New York, NY, US)
- Ariel Shrem (Petach Tikva, IL)
- Shany Rimon (Arsuf Kedem, IL)
- Tom Weiss-Sadan (Jerusalem, IL)
Cpc classification
A61M2205/3344
HUMAN NECESSITIES
A61M16/0084
HUMAN NECESSITIES
A61M16/024
HUMAN NECESSITIES
A61M16/00
HUMAN NECESSITIES
International classification
Abstract
The present invention relates to the field of devices accommodating bag ventilators applied in medical settings, and, more particularly to devices for automation of the use of bag ventilators.
Claims
1. A portable device for automated ventilation comprising: (i) a base body having a proximal base surface; (ii) a drive mechanism attached to the base body, the drive mechanism comprising an actuator and a transmission system configured to be driven thereby, the transmission system comprising a first pulley shaft and a second pulley shaft; and (iii) a squeezing assembly comprising a strap, the strap comprising a first strap portion having a first strap distal end, and a second strap portion having a second strap distal end, wherein the proximal base surface and the squeezing assembly are configured to accommodate a bag ventilator there between, wherein the first strap distal end and the second strap distal end are attached to the transmission system; wherein the squeezing assembly is configured to be movable between a released state and a pulled state, and to reciprocate between these states for a plurality of cycles; wherein the first pulley shaft and the second pulley shaft are configured to be rotatable in opposite directions, and wherein the first strap portion is movable by the first pulley shaft and the second strap portion is movable by the second pulley shaft.
2. The portable device for automated ventilation of claim 1, wherein the transmission system comprises a gear train, and wherein the first pulley shaft and the second pulley shaft are rotateably attached to the gear train.
3. The portable device for automated ventilation of claim 2, wherein the gear train comprises: (i) a first gear connected to the actuator and rotatable thereby; (ii) a second gear interconnected with the first gear; (iii) a third gear interconnected with the first gear; and (iv) a fourth gear interconnected with the third gear, wherein the first pulley shaft is rigidly connected to the second gear, and wherein the second pulley shaft is connected to the fourth gear.
4. The portable device for automated ventilation of claim 1, wherein the first strap distal end is rigidly attached to the first pulley shaft, and wherein the second strap distal end is rigidly attached to the second pulley shaft.
5. The portable device for automated ventilation of claim 1, wherein the transmission system comprises: (i) a first transmission pulley, rotateably attached to the actuator and configured to be driven thereby; (ii) a second transmission pulley; (iii) a first conveyor belt; and (iv) a second conveyor belt, wherein the second transmission pulley is rotateably connected to the first transmission pulley via the first conveyor belt; wherein the first pulley shaft is rigidly attached to the second transmission pulley, and is configured to rotate in the same direction therewith; wherein the second pulley shaft is rotateably connected to the first pulley shaft via the second conveyor belt; wherein the first strap distal end is rigidly attached to a distal surface of the second conveyor belt; and wherein the second strap distal end is rigidly attached to a proximal surface of the second conveyor belt.
6. The portable device for automated ventilation of claim 1, wherein the proximal base surface comprises a base protrusion.
7. The portable device for automated ventilation of claim 1, wherein the squeezing assembly further comprises a rigid member connected to the strap.
8. The portable device for automated ventilation of claim 7, wherein the first strap portion and the second strap portion are two distinct separate straps, and wherein the rigid member is connected to the first strap portion and the second strap portion.
9. The portable device for automated ventilation of claim 8, wherein the rigid member comprises a first rigid member portion and a second rigid member portion detachably attached to each other, wherein the first strap portion is rigidly connected the first rigid member portion, and wherein the second strap portion is rigidly connected the second rigid member portion.
10. The portable device for automated ventilation of claim 7, wherein the rigid member comprises a rigid member protrusion.
11. The portable device for automated ventilation of claim 1, wherein the base body further comprises at least one of: a power supply socket, and/or a power source compartment configured to house at least one power source.
12. The portable device for automated ventilation of claim 1, wherein the base body further comprises a data port.
13. The portable device for automated ventilation of claim 1, wherein the base body further comprises a control circuitry for controlling the drive mechanism.
14. The portable device for automated ventilation of claim 1, wherein the base body further comprises at least one controller, configured for controlling functionality of the portable device for automated ventilation.
15. The portable device for automated ventilation of claim 1, wherein the base body further comprises an indication zone, configured to provide at least one visual or auditory indicator corresponding to a state of at least one characteristic of the portable device for automated ventilation.
16. The portable device for automated ventilation of claim 1, further comprising at least one physiological sensing mechanism configured to measure signals related to at least one physiological characteristic of a patient, wherein the physiological sensing mechanism comprises at least one of: a pressure sensor and/or a CO.sub.2 level sensor.
17. The portable device for automated ventilation of claim 1, further comprising at least one operational sensing mechanism configured to measure signals related to at least one operational characteristic of portable device for automated ventilation.
18. The portable device for automated ventilation of claim 1, wherein the base body further comprises a distal base surface, and wherein the distal base surface comprises an attachment strap.
Description
BRIEF DESCRIPTION OF THE FIGURES
(1) Some embodiments of the invention are described herein with reference to the accompanying figures. The description, together with the figures, makes apparent to a person having ordinary skill in the art how some embodiments may be practiced. The figures are for the purpose of illustrative description and no attempt is made to show structural details of an embodiment in more detail than is necessary for a fundamental understanding of the invention. For the sake of clarity, some objects depicted in the figures are not to scale.
(2) In the Figures:
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DETAILED DESCRIPTION OF SOME EMBODIMENTS
(25) In the following description, various aspects of the disclosure will be described. For the purpose of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the different aspects of the disclosure. However, it will also be apparent to one skilled in the art that the disclosure may be practiced without specific details being presented herein. Furthermore, well-known features may be omitted or simplified in order not to obscure the disclosure. In the figures, like reference numerals refer to like parts throughout.
(26) Reference is now made to
(27) The term strap, as used herein, refers to any elongated flexible structure known in the art, capable of being wrapped and unwrapped around rods or pulleys, such as a strap, a cord, a cable, a chain and the like.
(28) The term portable, as used herein in relation to device 100, refers to a device 100 being sufficiently light and small that it can be carried by a single adult.
(29) The terms portable device for automated emergency ventilation, portable device for automated ventilation and device, as used herein, are interchangeable.
(30) The term bag ventilator, as used herein, also known as Bag Valve Mask (BVM), manual resuscitator of self-inflating bag, refers to ambulatory or movable bags which are manually squeezable to provide or assist in respiration of a patient, such as, but not limited to, Ambu-bags.
(31) According to some embodiments, portable device for automated ventilation 100 is configured to operate as a portable device for automated ventilation 100, during emergency situations.
(32) Proximal base surface 104 and squeezing assembly 130 are configured to accommodate a bag ventilator 10 when placed there between. Bag ventilator 10 is termed to be accommodated within device 100, between proximal base surface 104 and squeezing assembly 130, when at least a portion of bag ventilator 10 rests upon and is in contact with proximal base surface 104, and when at least a portion of squeezing assembly 130 is pressed against bag ventilator 10 at squeezing assembly contact region 116, opposite thereto.
(33) Portable device for automated ventilation 100, as disclosed in any of the embodiments throughout the current disclosure, does not include bag ventilator 10, but is configured to accommodate bag ventilator 10 therein.
(34) Advantageously, portable device for automated ventilation 100, as disclosed in any of the embodiments throughout the current disclosure, is devoid of any housing surrounding bag ventilator 10. Thus, device 100 which is not configured to house bag ventilator 10 between at least three rigid sidewalls, but rather accommodate it between one base surface and a squeezing assembly, provides a compact, portable and user-friendly structure. Moreover, the disclosed configuration enables an operator of the device to quickly and easily switch between automated and manual bag ventilation.
(35) Within the context of this application, the term proximal generally refers to the side or end of any device or a component of a device, which is closer to the contact region of squeezing assembly contact region 116.
(36) Within the context of this application, the term distal generally refers to the side or end of any device or a component of a device, which is opposite the proximal side, and is farther from squeezing assembly contact region 116.
(37) Within the context of this application, the term proximal direction refers to a direction pointing towards squeezing assembly contact region 116, and the term distal direction refers to an opposite direction pointing away from squeezing assembly contact region 116. For example, arrows 22 and 24 in
(38) Within the context of this application, the term lateral plane generally refers to any plane perpendicular to the proximal direction or the distal direction.
(39) Within the context of this application, the term lateral direction refers to any possible direction along a lateral plane.
(40) According to some embodiments, base body 102 further comprises a distal base surface 106, and at least two sidewalls and two panels connecting proximal base surface 104 with distal base surface 106, such as first base sidewall 108, second base sidewall 110, first base panel 112 and second base panel 114.
(41) According to some embodiments, proximal base surface 104 is formed as a flat surface (see
(42) According to some embodiments, proximal base surface 104 is lined with friction increasing material, such as, but not limited to, rubber.
(43) According to some embodiments, base body 102 is shaped as a rectangular compartment (embodiment not shown). According to some embodiments, at least one of first base sidewall 108 or second base sidewall 110 is formed with at least one discontinuity (see
(44) Drive mechanism 160 comprises an actuator 162 and a transmission system 164, configured to be driven thereby. Transmission system 164 comprises a first pulley shaft 174 and a second pulley shaft 176. According to some embodiments, transmission system further comprises a gear train, wherein first pulley shaft 174 and second pulley shaft 176 are rotateably attached to the gear train.
(45) According to some embodiments, first pulley shaft 174 and second pulley shaft 176 are configured to be rotatable in opposite directions.
(46) The term actuator, as used herein, refers to any powered actuator known in the art for providing rotational motion, such as an electric motor, a solenoid, and the like.
(47) According to some embodiments, the gear train of transmission system 164 comprises at least a first gear 166 connected to actuator 162 and rotatable thereby. According to some embodiments, the gear train of transmission system 164 comprises a plurality of gears. In the example depicted in
(48) According to some embodiments, each one of first pulley shaft 174 and second pulley shaft 176 is rigidly connected to a different gear. In the example depicted in
(49) First strap portion 134 and second strap portion 136 are moveable, either directly or via intermediary components, to first pulley shaft 174 and second pulley shaft 176, respectively. According to some embodiments, first strap distal end 138 is rigidly attached to first pulley shaft 174 (see
(50) Squeezing assembly 130 is configured to be movable between a released state and a pulled state. In a released state, squeezing assembly contact region 116 is distanced from proximal base surface 104 such that bag ventilator 10, when accommodated there between, is normally expanded. In a pulled state, the distance between squeezing assembly contact region 116 and proximal base surface 104 is shorter than such distance in the released state, such that bag ventilator 10, when accommodated there between, is squeezed.
(51) In use, when bag ventilator 10 is accommodated within device 100 and squeezing assembly 130 is in a released state, actuator 162 is actuated so as to drive transmission system 164. First pulley shaft 174 and second pulley shaft 176 are configured to rotate in opposite directions to one another, thereby pulling first strap portion 134 and second strap portion 136 in the distal direction, towards a pulled state of squeezing assembly 130. During transition from a released state to a pulled state, first strap portion 134 and second strap portion 136 are wrapped around first pulley shaft 174 and second pulley shaft 176, respectively. When squeezing assembly 130 is in a pulled state, actuator 162 stops driving gear train transmission system 164, such that the gears of the gear train, along with first pulley shaft 174 and second pulley shaft 176, are free to rotate in any direction. Squeezed bag ventilator 10 is self-inflating to its normally expanded form, pushing against squeezing assembly contact region 116, thereby extending first strap portion 134 and second strap portion 136 in the proximal direction, towards a released state of squeezing assembly 130, while first strap portion 134 and second strap portion 136 are unwrapped from first pulley shaft 174 and second pulley shaft 176, respectively.
(52) The term squeezed, as used herein in relation to bag ventilator 10, refers to a bag ventilator 10 with decreased volume. The term normally expanded, as used herein in relation to bag ventilator 10, refers to an un-collapsed or un-squeezed state of bag ventilator 10.
(53) The term self-inflating, as used herein in relation to bag ventilator 10, refers to a bag ventilator 10 increasing in volume to a normally expanded state.
(54) According to some embodiments, squeezing assembly 130 is configured to reciprocate between the released state and the pulled state for a plurality of cycles.
(55) The term cycle, as used herein, refers to squeezing and releasing bag ventilator 10.
(56) The term plurality, as used herein, refers to more than one.
(57) According to some embodiments, squeezing assembly 130 is configured to reciprocate between the released state and the pulled state for a predetermined number of cycles. According to some embodiments, squeezing assembly 130 is configured to reciprocate between the released state and the pulled state until stopped by an operator of device 100. According to some embodiments, squeezing assembly 130 is configured to reciprocate between the released state and the pulled state until an external trigger is received, such as a physiological reading of a patient, exceeding a predetermined threshold.
(58) In the example depicted in
(59) When squeezing, assembly 130 is in a pulled state, first gear 166 is no longer rotated by actuator 162, and all gears of transmission system 164 are free to rotate in any direction. As no additional force is exerted by squeezing assembly 130 on bag ventilator 10, bag ventilator 10 is free to expand, due to its nature, back to the normally expanded state thereof. During self-inflation of bag ventilator 10, squeezing assembly contact region 116 is forced to move away from proximal base surface 104, in the distal direction, while first strap portion 134 and second strap portion 136 are unwrapped from first pulley shaft 174 and second strap distal end 174, respectively.
(60) According to some embodiments, squeezing assembly 130 comprises a single strap 132, wherein first strap portion 134 and second strap portion 136 constitute two portions of the same strap 132. According to some embodiments, strap 132 is lined with friction increasing material, such as, but not limited to, rubber.
(61) According to some embodiments, strap 132 is configured to wrap around at least a portion of a circumference of bag ventilator 10 when accommodated within device 100 (embodiment not shown).
(62) According to some embodiments, first strap portion 134 and second strap portion 136 form two distinct separate straps, permanently attached or detachably attached to each other, either directly or indirectly.
(63) According to some embodiments, squeezing assembly 130 further comprises a rigid member 142 connected to strap 132 (see
(64) According to some embodiments, rigid member 142 comprises a first slit 144 and a second slit 146, through which strap 132 is laced. It will be clear to a skilled person in the art that any other methods known in the art for attaching either one of strap 132, first strap portion 134 or second strap portion 136, with rigid member 142, are applicable, such as gluing, riveting and the like.
(65) Rigid member 142 is configured to press against bag ventilator 10 when accommodated within device 100, squeezing it when squeezing assembly 130 moves from a released state to a pulled state, and pushable by bag ventilator 10 when squeezing assembly 130 moves from a pulled state to a released state.
(66) Advantageously, having rigid member 142 comprised within squeezing assembly 130 enables more homogenous force dispersing across bag ventilator 10 when squeezed, and more homogenous force dispersing acting on squeezing assembly 130 when bag ventilator 10 self-inflates, relative to a squeezing assembly 130 having a strap 132 configured to directly abut at least a portion of bag ventilator 10. Moreover, rigid member 142 is configured to apply gradual squeezing force on bag ventilator 10, since the region of direct contact between rigid member 142 and bag ventilator 10 gradually expands as bag ventilator 10 is further squeezed thereby.
(67) According to some embodiments, rigid member 142 is lined with friction increasing material, such as, but not limited to, rubber.
(68) According to some embodiments, proximal base surface 104 further comprises base protrusion 118 (see
(69) Advantageously, any of base protrusion 118 or rigid member protrusion 148 reduce the magnitude of force required to squeeze bag ventilator 10 when squeezing assembly 130 is in the released state. A further advantage of having rigid member 142 comprised within squeezing assembly 130, is that it provides the option to include rigid member protrusion 148 therein.
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(71) While
(72) According to some embodiments, device 100 further comprises control circuitry 303 (see
(73) According to some embodiments, the at least one controller 126 comprises a power on/off switch. According to some embodiments, the at least one controller 126 comprises a start/stop switch. According to some embodiments, the at least one controller 126 comprises a selector between different modes of operation, controlling at least one of: squeezing force or pressure applied by squeezing assembly 130 on bag ventilator 10, squeezing speed for moving squeezing assembly 130 from a released state to a pulled state, and cycle frequency. According to some embodiments, the selector is configured to switch between predefined modes adapted for ventilating different patient-types, such as: children, small adults, and large adults (defined as adults weighing less or more than a predefined weight threshold).
(74) According to some embodiments, at least one interface panel 124 comprises indication zone 128 (see
(75) According to some embodiments, at least one interface panel 124 comprises indication zone 128 128, configured to provide at least one visual or auditory indicator, corresponding to the state of at least one characteristic of portable device for automated ventilation 100, such as power status.
(76) While at least one interface panel 124 is depicted in
(77) The term cycle frequency, as used herein, refers to the frequency of squeezing and releasing bag ventilator 10.
(78) According to some embodiments, base body 102 further comprises a power source compartment 188 (see
(79) According to some embodiments, power source compartment 188 is configured to house at least one rechargeable power source, such as a rechargeable battery. According to some embodiments, base body 102 further comprises a receiver unit (not shown) configured for receiving energy from an external base unit (not shown) via an inductive magnetic field, wherein the at least one rechargeable power source is capable of being inductively powered and/or charged by the receiver unit.
(80) As used herein, the term energy refers to electrical energy such as electricity or power. Energy is quantified in e.g. Watt-hour, Ampere-hour, or Joule.
(81) According to some embodiments, base body 102 further comprises a power supply socket 190 (see
(82) According to some embodiments, power supply socket 190 comprises a USB charging port configured for receiving a USB cable (not shown). The USB cable, when connected to the USB charging port, serves as a power charging cable in a similar manner described hereinabove.
(83) According to some embodiments, base body 102 further comprises a data port 192 (not shown in
(84) Reference is now made to
(85) According to some embodiments, as depicted in
(86) Squeezing assembly 230 comprises first strap portion 234 having first strap distal end 238, and second strap portion 236 having second strap distal end 240, wherein first strap portion 234 and second strap portion 236 are two distinct separate straps. First strap distal end 238 and second strap distal end 240 are attached to drive mechanism 260. According to some embodiments, as depicted in
(87)
(88) In the example depicted in
(89) According to some embodiments, rigid member 242 further comprises rigid member protrusion 248. According to some embodiments, each of first rigid member portion 250 and second rigid member portion 252 include a portion of a rigid member protrusion (see
(90) Advantageously, a rigid member 242 comprising two distinct portions that can be releasably attached to each other, provides simpler and easier operability by enabling quick placement of bag ventilator 10 on proximal base surface 204 when first rigid member portion 250 and second rigid member portion 252 are detached, then securing of bag ventilator 10 in position by attaching them to each other. Moreover, bag ventilator 10 can be removed in a quicker and simpler way from portable device for automated ventilation 100 by detaching first rigid member portion 250 and second rigid member portion 252. Advantageously, the disclosed configuration enables an operator of the device to quickly and easily switch between automated and manual bag ventilation.
(91) According to some embodiments, a method of switching between automatic and manual bag ventilation includes accommodating bag ventilator 10 between proximal base surface 104, 204 and squeezing assembly 130, 230, initiating automatic operation of device 100, 200, so as to reciprocally squeeze and release the bag ventilator by drive mechanism 160, 260 via squeezing assembly 130, 230, interrupting the automatic operation of device 100, 200, and manually squeezing and releasing the bag ventilator by an operator's hands.
(92) According to some embodiments, interrupting the automatic operation of device 100, 200 is manually performed by an operator, for example according to the state of the patient of reading from indicators on device 100, 200. According to some embodiments, interrupting the automatic operation of device 100, 200 is not voluntary, and occurs due to a malfunction of device 100, 200.
(93) According to some embodiments, interrupting the automatic operation of device 100, 200 is facilitated by turning off the automatic operation of device 100, 200 via the at least one controller 126, 226. According to some embodiments, switching to manual ventilation further involves detachment of rigid member 142, 242 so as to provide easy and comfortable placement of an operator's hands on bag ventilator 10.
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(95) According to some embodiments, as exemplified in
(96) In use, when bag ventilator 10 is accommodated within device 200 and squeezing assembly 230 is in a released state, actuator 262 is actuated so as to drive transmission system 264. Actuator 262 rotates first transmission pulley 294, which translates the rotational movement to second transmission pulley 296 via first conveyor belt 298. First pulley shaft 274, attached to second transmission pulley 296, rotates in the same direction therewith, while second transmission pulley 296 rotates in an opposite direction. The distal surface of second conveyor belt 278 moves in the direction of arrow 26 (see
(97) When squeezing assembly 230 is in a pulled state, actuator 262 stops driving transmission system 264, such that all pulleys, including first pulley shaft 174 and second pulley shaft 176, are free to rotate in any direction. Squeezed bag ventilator 10 is self-inflating to its normally expanded form, pushing against rigid member 142, thereby extending first strap portion 234 and second strap portion 236 in the proximal direction, towards a released state of squeezing assembly 230.
(98) According to some embodiments, base body 202 further comprises a bag-neck seat 280, configured to accommodate a neck region 16 of bag ventilator 10 therein.
(99) An open state of beg-neck seat 280 (see
(100) Advantageously, beg-neck seat 280 enables fast and easy centralization of bag ventilator 10 when accommodated within device 200, as well as an additional stabilization mechanism for bag ventilator 10 when used in device 200, without requiring additional housing surrounding bag ventilator 10 for the same purpose.
(101) According to some embodiments, base body 202 further comprises controller 226. In the example depicted in
(102) According to some embodiments, base body 202 further comprises indication zone 228. In the example depicted in
(103)
(104) According to some embodiments, base body 202 further comprises power source compartment 288. According to some embodiments, base body 202 further comprises power supply socket 290. According to some embodiments, base body 202 further comprises data port 292. According to some embodiments, distal base surface 206 further comprises an attachment strap 286, configured for attaching device 200 either to external structures, such as structures within vehicles or storage facilities, stretchers and patient beds, or to a patient, such as to a patient's chest or a patient's arm. According to some embodiments, attachment strap 286 comprises an elastic material, such as rubber.
(105) According to some embodiments, device 100, 200 further comprises at least one physiological sensing mechanism 300 (see
(106) According to some embodiments, the at least one physiological sensing mechanism comprises at least one pressure sensor. According to some embodiments, the at least one physiological sensing mechanism comprises at least one CO.sub.2 level sensor.
(107) According to some embodiments, the at least one physiological sensing mechanism comprises a first sensing mechanism portion connected to a second sensing mechanism portion, such that the first sensing mechanism portion is attached to base body 102, 202 and electronically connected to the control circuitry of device 100, 200, and the second sensing mechanism portion is configured for positioning either between bag ventilator 10 and a breathing tube connectable thereto (not shown), or between bag ventilator 10 and a and a breathing mask connectable thereto (not shown). The second sensing mechanism portion of the at least one sensing mechanism comprises at least one sensor, such as a pressure sensor, a flow sensor, a CO.sub.2 level sensor and the like, and is configured to electronically transmit the signals from the at least one sensor to the control circuitry of device 100, 200 via the first sensing mechanism portion.
(108) According to some embodiments, the at least one physiological sensing mechanism comprises a plurality of sensors. According to some embodiments, the second sensing mechanism portion comprises a plurality of sensors, such as a pressure sensors and a CO.sub.2 level sensor. According to some embodiments, device 100, 200 comprises a plurality of physiological sensing mechanisms.
(109) According to some embodiments, the second sensing mechanism portion is detachably attached to the first sensing mechanism portion. According to some embodiments, the second sensing mechanism portion is disposable, and is configured to be replaced for each patient or for each use of device 100, 200.
(110) According to some embodiments, device 100, 200 further comprises at least one operational sensing mechanism 302 (see
(111) According to some embodiments, the readings of the at least one physiological sensing mechanism and the at least one operational sensing mechanism are indicated via at least one visual or auditory indicator of indication zone 128, 228. According to some embodiments, the readings of the at least one physiological sensing mechanism and the at least one operational sensing mechanism are transferred to the control circuitry, and the control circuitry is configured to adjust the operation of device 100, 200 accordingly.
(112) It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable sub-combination or as suitable in any other described embodiment of the invention. No feature described in the context of an embodiment is to be considered an essential feature of that embodiment, unless explicitly specified as such.
(113) Although the invention is described in conjunction with specific embodiments thereof, it is evident that numerous alternatives, modifications and variations that are apparent to those skilled in the art may exist. It is to be understood that the invention is not necessarily limited in its application to the details of construction and the arrangement of the components and/or methods set forth herein. Other embodiments may be practiced, and an embodiment may be carried out in various ways. Accordingly, the invention embraces all such alternatives, modifications and variations that fall within the scope of the appended claims.