Visible light photo-disinfection patch
10166402 ยท 2019-01-01
Assignee
Inventors
Cpc classification
G02B6/001
PHYSICS
A61L2202/16
HUMAN NECESSITIES
A61F13/05
HUMAN NECESSITIES
A61L2202/15
HUMAN NECESSITIES
Y10T29/49826
GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
International classification
A61B5/06
HUMAN NECESSITIES
A61L2/00
HUMAN NECESSITIES
Abstract
A method and device are presented for providing patient safe light to a wound. The device includes a radiation source producing flora lethal radiation wavelengths, a radiation conduit detachably optically coupled to the radiation source, and a patch remotely located from the radiation source configured to at least partially conform to a surface contour of the wound. The patch includes a flexible panel formed of a radiation transmitting material able to withstand sterilization, including at least one surface with a disturbed surface area configured to emit radiation upon the wound.
Claims
1. A light conveying device configured to convey light received from a radiation source to a wound, comprising: a radiation conduit optically coupled to the radiation source comprising a radiation ingress portion and a radiation egress portion; and a flexible panel of radiation transmitting material optically coupled to the radiation conduit, and configured to at least partially conform to a surface contour of the wound, the flexible panel formed of a single flexible film of the radiation transmitting material defining a first surface, a second surface opposite the first surface, wherein the first surface has a disrupted surface area that causes radiation received from the radiation conduit to be emitted from the first surface toward the wound, wherein all of the light that is emitted from the light conveying device toward the wound passes through the first surface of the flexible panel at the disrupted surface area, wherein the radiation conduit comprises a plurality of fibrous appendages contiguously extending from the flexible panel, wherein the radiation conduit, including the fibrous appendages of the radiation conduit, is integral with the flexible panel such that the radiation conduit and the flexible panel are formed as a single continuous element, and wherein the radiation conduit and the flexible panel are formed from the same material and by a process consisting of: providing a thin sheet or film of the material that includes a panel portion and a skiving portion; and skiving the skiving portion into the plurality of fibrous appendages, wherein the panel portion forms the flexible panel of the light conveying device.
2. The device of claim 1, wherein the flexible panel comprises an edge lit film.
3. The device of claim 1, wherein each of the plurality of fibrous appendages comprises a tip configured for radiation ingress into the fibrous appendage.
4. The device of claim 1, wherein the light conveying device further comprises a transparent gas permeable biocompatible laminate mechanically attached to the panel.
5. The device of claim 1, wherein the flexible panel and the radiation conduit are formed from a single flexible film of the radiation conducting material.
6. The device of claim 5, wherein each of the plurality of fibrous appendages has a substantially square cross section.
7. The device of claim 5, wherein a first group of the plurality of fibrous appendages are grouped in a first bundle.
8. The device of claim 7, wherein a second group of the plurality of fibrous appendages are grouped in a second bundle.
9. The device of claim 1, wherein the patch further comprises a negative pressure wound therapy device.
10. The device of claim 1, wherein the radiation conduit is flexible and able to flex independently relative to the flexible panel.
11. The device of claim 1, wherein the radiation transmitting material is able to withstand sterilization by steam or Ethylene Oxide sterilization.
12. The device of claim 1, wherein the device does not include a separate connector between the radiation conduit and the flexible panel, since the radiation conduit is integral with and is formed as a single continuous element with the flexible panel.
13. The device of claim 1, wherein the single flexible film of radiation transmitting material further defines side edges, wherein each of the side edges extends between the first surface and the second surface at an outer periphery of the first surface and the second surface, and wherein the first surface extends continuously, without interruption, to all of the side edges of the flexible panel.
14. The device of claim 1, wherein the material of the flexible panel is not harmed by sterilization.
15. A light conveying device configured to convey light received from a radiation source to a wound, comprising: a radiation conduit comprising fibrous appendages, a radiation ingress portion, and a radiation egress portion; and a flexible panel of radiation transmitting material optically coupled to the radiation conduit, and configured to at least partially conform to a surface contour of the wound, the flexible panel formed of a single flexible film with a first planar surface, a second planar surface, and side edges, wherein each of the side edges extends between the first planar surface and the second planar surface at an outer periphery of the first planar surface and the second planar surface, wherein the first surface extends continuously, without interruption, to all of the side edges of the flexible panel, wherein the radiation conduit, including the fibrous appendages, is integral with the flexible panel, including the one piece integral light emission area formed of a single flexible film, such that the radiation conduit and the flexible panel are formed as a single continuous element, wherein the radiation conduit and the flexible panel are formed from the same material and by a process consisting of: providing a thin sheet or film of the material that includes a panel portion and a skiving portion; and skiving the skiving portion into the plurality of fibrous appendages, wherein the panel portion forms the flexible panel ,of the light conveying device, wherein the radiation conduit and the flexible panel are formed of a material not harmed by sterilization, and wherein all of the light that is emitted by the light conveying device toward the wound passes through a disrupted surface area on the first planar surface.
16. The device of claim 15, wherein each fibrous appendage has a substantially rectangular cross section.
17. The device of claim 15, wherein a first group of the fibrous appendages is grouped in a first bundle.
18. The device of claim 17, wherein a second group of the fibrous appendages is grouped in a second bundle.
19. The device of claim 15, further comprising the radiation source configured to produce radiation having average emittance from the flexible film less than 750 milliwatts per square centimeter, wherein the flora lethal radiation wavelengths comprise a bandwidth substantially within the range of 400 nm-410 nm.
20. A system providing patient safe light to a wound, comprising: a radiation source, producing flora lethal radiation wavelengths; a radiation conduit optically coupled to the radiation source comprising a radiation ingress portion and a radiation egress portion conveying the floral lethal radiation from the radiation source; and a patch remotely located from the radiation source and optically coupled to the radiation conduit, configured to at least partially conform to a surface contour of the wound comprising: a flexible panel comprising a one piece integral light emission area formed of a single flexible film of radiation transmitting material not harmed by sterilization, the panel comprising a first planar surface, a second planar surface, and side edges that extend from the first planar surface to the second planar surface at an outer periphery of the first planar surface and the second planar surface, wherein the first planar surface comprises a disrupted surface area configured to emit radiation received from the radiation conduit egress portion toward the wound, wherein the first planar surface extends continuously, without interruption, to all of the side edges of the flexible panel, wherein all of the light that is emitted by the patch toward the wound passes through the disrupted surface area on the first planar surface, and wherein the radiation conduit, including fibrous appendages of the radiation conduit, is integral with the flexible panel, including the one piece integral light emission area formed of a single flexible film, such that the radiation conduit and the flexible panel are formed as a single continuous element, and wherein the radiation conduit and the flexible panel are formed from the same material and by a process consisting of; providing a thin sheet or film of the material that includes a panel portion and a skiving portion; and skiving the skiving portion into the plurality of fibrous appendages, wherein the panel portion forms the flexible panel of the light conveying device.
21. The system of claim 20, wherein the flora lethal radiation wavelengths comprise a bandwidth substantially within the range of 400 nm-410 nm.
22. The system of claim 20, wherein the flora lethal radiation wavelengths comprise a bandwidth substantially within the range of 380 nm-500 nm.
23. The system of claim 20, wherein a level of the radiation is configured to provide a penetration depth of at least 2 cm through human skin.
24. The system of claim 20, wherein the flexible panel emits a substantially uniform level of illuminance across its length and width.
25. The system of claim 20, wherein the radiation source is configured to produce radiation having average emittance from the flexible film less than 750 milliwatts per square centimeter.
26. The system of claim 20, wherein the radiation has an average emittance from the flexible film between about 50 microwatts per square centimeter and 750 milliwatts per square centimeter.
27. The system of claim 20, wherein the radiation transmitting material is able to withstand sterilization by steam or Ethylene Oxide sterilization.
28. A light conveying device configured to convey light received from a radiation source to a wound, comprising: a radiation conduit optically coupled to the radiation source comprising a radiation ingress portion and a radiation egress portion; and a patch remotely located from the radiation source and optically coupled to the radiation conduit, configured to at least partially conform to a surface contour of the wound, comprising: a flexible panel comprising a one piece integral light emission area formed of a single flexible film of radiation transmitting material, the panel comprising a first planar surface and a second planar surface, wherein at least one of the first planar surface and the second planar surface comprises a disrupted surface area configured to emit radiation received from the radiation conduit egress portion upon the wound, wherein the radiation conduit comprises a plurality of fibrous appendages contiguously extending from the flexible film, wherein all of the light that is emitted by the patch toward the wound passes through the disrupted surface area on the first planar surface or the second planar surface, and wherein the radiation conduit, including the fibrous appendages of the radiation conduit, is integral with the flexible panel, including the one piece integral light emission area formed of a single flexible film, such that the radiation conduit and the flexible panel are formed as a single continuous element, and wherein the radiation conduit and the flexible panel are formed from the same material and by a process consisting of: providing a thin sheet or film of the material that includes a panel portion and a skiving portion; and skiving the skiving portion into the plurality of fibrous appendages, wherein the pane portion forms the flexible panel of the light conveying device.
29. The device of claim 28, wherein the radiation transmitting material is able to functionally withstand sterilization.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
(1) The accompanying drawings are included to provide a further understanding of the invention, and are incorporated in and constitute a part of this specification. The drawings illustrate embodiments of the invention and, together with the description, serve to explain the principals of the invention.
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DETAILED DESCRIPTION
(19) Reference will now be made in detail to embodiments of the present invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers are used in the drawings and the description to refer to the same or like parts.
(20) The following definitions are useful for interpreting terms applied to features of the embodiments disclosed herein, and are meant only to define elements within the disclosure. No limitations on terms used within the claims are intended, or should be derived, thereby. Terms used within the appended claims should only be limited by their customary meaning within the applicable arts.
(21) As used within this disclosure, radiation refers to electromagnetic radiation having wavelengths both within and outside of the visible spectrum.
(22) As used within this disclosure, a Negative Pressure Wound Therapy (NPWT) device refers to a specialized bandage, for example, with a vacuum pump, causing blood to come to the surface of a wound.
(23) As used within this disclosure, skiving means slitting, or cutting, a portion of a flat panel of material into approximately parallel strips of material; while leaving the strips attached and contiguous with the flat panel. The slitting or cutting maybe performed by multiple conventional means such as with knives, rotary cutting wheels, laser, water jet etc.
(24) As used within this disclosure, open-cell foam refers to a fluid bearing material, for example, but not limited to sponge, foam, and gauze.
(25) As used within this disclosure, vacuum permeable refers to a material permeable such that a fluid may pass through the material when drawn by a vacuum or negative pressure. Such a material many have a single perforation or multiple perforations.
(26) Exemplary embodiments are described of a device providing flora lethal, patient safe light to a wound site via a flexible, sterile, gas permeable, disposable patch detachably optically coupled to a non-disposable, non-sterile remote light source in order to deny wound site colonization of light sensitive flora and possible subsequent infection. The device provides this light without light wavelengths known to induce detrimental effects on skin tissue, or unproductive thermal energy that would harm or discomfort the patient. The device is of sufficient simplicity of construction to allow for conventional sterile manufacture and disposable use, including a laminate of a transparent gas permeable biocompatible diffuser mechanically attached to a light transmitting panel.
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(28) The light source 230 produces flora lethal, patient safe light/radiation with one or more light producing elements, for example, LEDs. The light source 230 may include an internal power source, for example, one or more chemical batteries, or receive power from an external power source, for example via a power line 235. The light source may produce thermal emissions 237, and therefore it may be desirable to position the light source remotely from a patient 250. The light source 230 produces light that is introduced to an ingress end of the light/radiation conduit 220. The light conduit 220 is formed of a light conveying material, for example, polycarbonate, that conveys light produced by the light source 230, but does not substantially convey thermal emissions 237 from the light source 230. The light conduit 220 may be detachably connected to the light source 230, for example with an optical coupling 231, such that the light source may be easily replaced, for example, by a light source producing different light wavelengths or intensities. The detachability of the light conduit 220 also facilitates sterilization of the light conduit 220 and/or the patch 210 independent of the light source 230. The patch 210 and/or the conduit 220 may be sterilized using any of several methods, for example, but not limited to, gamma radiation, steam, Ethylene Oxide, peroxide, and ultraviolet radiation, among others.
(29) The optical coupling 231 provides mechanical attachment and detachment between segments of one or more optical conduits, as known to persons having ordinary skill in the art. The optical coupling 231 may be implemented at any location along the optical conduit between light source 230 and patch 210. There may also be multiple optical couplings 231, for example, a first optical coupling (not shown) near to the light source 230 and a second optical coupling 231 near to the patch 210 to allow different lengths of conduit 220 and easy dis-connection and sterilization of the conduit 220.
(30) An egress end of the light conduit 220 is attached to the patch 210. The patch 210 contains a flexible panel, for example, but not limited to a polycarbonate edge lit film. At least one planar surface of the flexible panel is disturbed (see
(31) An exemplary embodiment of a flexible panel of a photo-disinfection patch 210 is formed of a one-piece integral light emission area contiguously attached to a light conduit 220 made up of a plurality of optic fibers, where the optic fibers are skived from the sheet of material forming the light emission area. The fibers may be bundled together and paired with one or more light sources providing flora lethal, patent safe radiation/light. The light conduit 220 conveys the light from the one or more light sources 230 to the emission area in the patch 210, where the light is dispersed through surface disruptions formed on the flexible panel of the patch 210.
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(35) While the above description describes the individual fibrous appendage strands 360 being skived from a single sheet of light transmitting material 305, there is no objection to forming the fibrous appendages 360 and the panel portion 310 concurrently, for example in a mold.
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(38) Similarly, fibrous appendages 360 may be more flexible and provide additional handling benefits over, for example, wide flat legs attached to the panel 310. While the fibrous appendages 360 may provide more degrees of freedom regarding the direction of flexibility, it should be noted that a sharp bend of one or more of the fibrous appendages 360 may defeat the TIR of the lightguide material, allowing at least some light to escape the fibrous appendages. The TIR of the fibrous elements 360 and the panel 310 depends on several factors, for example, the material the fibrous elements 360 and the panel 310 are made from, the geometry of how the fibrous elements 360 and the panel 310 are formed and arranged, the smoothness of the surface of the fibrous elements 360 and the panel 310, and the optical qualities of any coating or laminate applied to the fibrous elements 360 and the panel 310. The smoothness of the surface may be adjusted by polishing, for example, mechanical polishing, thermal treating, and/or chemical treatments.
(39) The maximum bend of a lightguide material is typically measured by the minimum bend radius of the material, in this case, the flexible panel 310 and/or the fibrous elements 360. The minimum bend radius of the lightguide material may be determined according to Eq. 1,
r.sub.min=m/((n*cos )1)Eq. 1
where r.sub.min is the minimum bend radius, m is the thickness of the material, is the ingress light collimation angle, and n is the material index of refraction.
(40) The individual strands of fibrous appendages 360 in a bundle 460 may be organized in a specific order, such that the relationship between an individual strand and an illuminated portion of the panel 310 is known. Alternatively, the bundle may be haphazardly ordered. The strands in the bundle 460 may be arranged for stability, for example, in a spiral or a weave. The fibrous appendages 360 may be bundled together into a single bundle 460, or into two or more bundles.
(41) The flexible panel 310 and/or the conduit 220 are formed of a light conducting material, for example, polycarbonate, that efficiently conducts light from the light source 230 (
(42) Other materials may also be chosen for the flexible panel 310 for other properties, for example, gas permeability, and/or steam, or Ethylene Oxide sterilization. Such a material may include, for example, a 4-methylpentene-1 based polyolefin. Such materials may be desirable due to their chemical resistance, which is better than that of polycarbonate and acrylic. Gas permeability may be desirable to allow oxygen flow to and/or from the wound. Autoclavability is desirable to maintain a sterile environment in the vicinity of the wound.
(43) Light sources, such as OLEDs, are difficult to sterilize as their inherent organic compounds degrade, as sterilization methods are designed to break down organic compounds. Sterilization procedures include exposure to gamma radiation, steam autoclave, and Ethylene Oxide (EtO) sterilization. A wider range of low cost materials that may withstand these sterilization techniques are available for the patch and light conduit than for light sources. For example, polymers, which are chosen to be generally resistant to levels of gamma radiation used for sterilization, may be used for the patch and light conduit.
(44) Returning to
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(46) As shown by
(47) As shown by
(48) Any means of introducing light into the fibrous appendages 360 (
(49) While the light source 500 in
(50) As shown by
(51) As mentioned above, the fibrous appendages 360 may be bundled together into a single bundle 460, or into two or more bundles. Each bundle 460 may receive light from a separate light source. Indeed, there is no objection to a separate light source being used to provide light to a single strand. In an alternative embodiment, an addressed strand may be traced to a specific corresponding portion of the panel, such that directing light into the addressed strand will cause light to be emitted from the specific corresponding portion of the panel. Each light source may produce a fixed range of wavelengths, or may produce a changeable, controllable range of wavelengths. If multiple light sources are used, they may each be of the same type, or may be of different types.
(52) The light source(s) is optimized to produce radiation/light that is harmful to undesirable flora at the wound site, but otherwise not harmful to the patient. For example, radiation centered at approximately 405 nm, with a bandwidth of approximately 20 nm, has been shown to be effective in killing many organisms, including, but not limited to, staphylocccus aureus, clostridium perfringens, clostridium difficile, enterococcus faecalis, staphylocccus epidermidis (CONS), staphylocccus hyicus (CONS), streptococcus pyogenes, listeria monocytogenes, bacillus cereus, mycobacterium terrae, acinetobacter baumannii, pseudomonas aeruginosa, klebsiella pneumonia, proteus vulgaris, escherichia coli, salmonella enteritidis, shigella sonnei, serratia spp, aspergillus niger, candida albicans, and saccharomyces cerevisiae.
(53) Different levels of intensity of the light source may be used. In general, the maximum practical irradiance of the patch upon wound should be less than 750 mW/cm.sup.2, as this level may cause skin damage. Other considerations may include, for example, safety regulations requiring an irradiance limit of 200 mW/cm.sup.2. Irradiances in the range of 10 mW/cm.sup.2 to 30 mW/cm.sup.2 have been shown to be effective, although lower irradiances would also affect pathogenic organisms. However this embodiment is not limited to these ranges.
(54) Returning to
(55) As mentioned previously, light may be introduced to the panel 310 through the edge, and in particular, through the fibrous appendages 360. Light is caused to be emitted from the planar face of the panel 310 by disrupting the surface of the panel 310. The disruption may be caused by scratching, scuffing, or otherwise deforming the surface of the panel 310. The surface disruption of the panel 310 may be a physical disruption, a chemical disruption, or otherwise. For example, the planar surface of the panel 310 may be disturbed by abrading it, scratching it, sand blasting it, or printing upon the panel with a light disturbing material, for example, a clear or colored epoxy or reflective ink.
(56) The disruption on the planar surface of the panel 310 may be uniform, for example, if a uniform intensity of light is desired. The surface of the panel 310 may be disrupted in some portions, to allow the light to escape from the disrupted portions and not disturbed in other portions of the panel 310. Disrupted portions of the panel 310 may be unequally disrupted such that a first disrupted portion emits more light than a second disrupted portion.
(57) As shown by
(58) As shown by
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(60) A sheet of light transmitting material having a skiving region and an emitting region is formed, as shown by block 910. The sheet is formed of a suitable lightguide material, for example, polycarbonate. A plurality of fibers is formed from the skiving region. The emitting region and the skiving region may be formed as a continuous sheet, as shown by block 920, such that the individual fibers are formed by cutting or skiving the sheet material in the skiving region into fibers. Or the material in the skiving region may be formed as fibers, for example, by molding the lightguide material into individual fibers contiguous with the emitting region.
(61) An area of surface disruption is formed on a first surface of the emitting region, as shown by block 930. The first surface is typically a flat planar surface, and may be, for example, the planar surface nearest to a wound, or the planar surface farthest from the wound. The disruptions are used to defeat the TIR of the lightguide material, such that light transmitted through the lightguide material, for example, light transmitted into the end of the emitting region, is emitted from the area of surface disruption. The disruptions may be effected in many ways, for example, etching, painting, scratching and depressing the surface.
(62) A first group of the plurality of fibers is bundled into a group, as shown by block 940. The bundle may contain as few as one fiber, or as many as all of the fibers, and may be formed into a shaped bundle to facilitate handling the fibers, for example, in a rope configuration. A light source may be abutted against a detachable ingress end of at least one of the plurality of fibers, as shown by block 950. The light from the light source enters the end of the fiber, and may then be transmitted through the fiber to the emitting region, where the light may be emitted through the area of surface disruption and onto the wound.
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(64) While each of the ribbons 1060 is depicted in
(65) The ribbons 1060 may be layered together in a bundle to form a light conduit 220. The light conduit 220 may be sheathed, for instance in a heat shrink tubing to contain the ribbons 1060 as a cable to run the layered ribbons 1060 to detachable optical coupling 1080. When the ribbons 1060 are long in relation to the size of the panel 310, bundling the ribbons 1060 may be advantageous for ease of routing the ribbons 1060 between the panel 310 and a detachable optical coupling 1080.
(66) The panel 310 may include a backing layer 1070, mechanically attached to the panel 310. The backing layer 1070 may be a transparent gas permeable biocompatible diffuser, for example, applied to the panel 310 with an adhesive. The backing layer 1070 may be formed of a gas permeable, autoclavable (sterilizable) transparent material, for example, to assist in dispersion of light from the panel. The backing layer 1070 may also serve to bind two or more ribbons 1060 together into what functions as a single panel 310.
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(68) The backing layer 1170 binds the optical fibers 1160 together into what functions as a single panel 310. The backing layer 1170 may be a transparent gas permeable biocompatible diffuser, for example, applied to the panel 310 with an adhesive. The backing layer 1170 may be formed of a gas permeable, autoclavable (sterilizable) transparent material, for example, to assist in dispersion of light from the panel 310. The optical fibers 1160 each have a substantially square cross section. Alternatively, the optical fibers 1160 may have other shaped cross sections, for example, circular or elliptical shaped cross sections.
(69) A flexible light bandage may incorporate one or more apertures to allow vacuum drawn fluid to pass through it, allowing use of a NPWT device, combining light therapy with a negative pressure wound therapy for use in wounds, for example, burns, with high risks of infection.
(70) In a fifth, a sixth, and a seventh exemplary embodiment, an NPWT device (or dressing) incorporates a flexible light transmitting panel. As shown by
(71) A flexible light transmitting panel 1310 is incorporated into the dressing 1300. The flexible light transmitting panel 1310 is configured to either directly or indirectly illuminate the wound 1360. A light conduit 1320 formed of one or more light transmitting fibers or films conducts light to the flexible light transmitting panel 1310 from a light source 230 (
(72) The open cell foam 1420 (
(73) As shown in
(74) As shown in
(75) Unlike the fifth embodiment, under the sixth embodiment the light emitting panel 1310 may not be configured such that fluid can generally pass through the light emitting panel 1310. The light emitting panel 1310 may include an opening 1393 to facilitate the vacuum port 1392 therethrough only at the location of the opening 1393. The light emitting panel 1310 may not be otherwise permeated to serve as the sealing layer for the vacuum.
(76) If the light emitting panel 1310 serves as the sealing layer for the vacuum, the light emitting panel 1310 includes one or more apertures 1393 for the vacuum port 1392 to physically pass through. In an alternative embodiment, the vacuum port 1392 may not physically pass through the aperture(s) 1393 in the light emitting panel 1310, but instead terminate at an attaching point on the light emitting panel 1310 to substantially surround the aperture 1393 in the light emitting panel 1310.
(77) Other embodiments are possible. Under a seventh exemplary embodiment of a light therapy device 1300, the light emitting panel 1310 may be incorporated into the open cell foam dressing layer 1420. The light emitting panel 1310 may include optical emitting elements incorporated into the open foam dressing layer 1420, for example as a weave of fiber optic elements, a plurality of individual fiber optic elements, or a perforated or otherwise fluid permeable flexible fiber optic panel. The light emitting panel 1310 portion of the open foam dressing layer 1420 may be disposed at or near the surface of the open foam dressing layer 1420, so that the light emitting panel 1310 portion is disposed near to or adjacent the wound 1360 surface. Alternatively, the open cell foam dressing material may be translucent to flora lethal radiation wavelengths, so that the light emitting panel 1310 portion need not be disposed in the immediate vicinity of the wound.
(78) In summary it will be apparent to those skilled in the art that various modifications and variations can be made to the structure of the present invention without departing from the scope or spirit of the invention. In view of the foregoing, it is intended that the present invention cover modifications and variations of this invention provided they fall within the scope of the following claims and their equivalents.