Patent Application
20130024213
The present invention relates generally to a system for the administration of and support of administering diagnostic care to patients. Various symptoms experienced by individuals may be at least in-part diagnosed using an imaging device. For example, acute chest pain is presently a major health issue, constituting several million emergency department (ED) visits annually in the United States. The present standard of care for diagnosing such, e.g., chest pain, involves using serial blood tests and stress tests. Such tests, often administered in sequence, are time consuming, costly, and not always accurate.
Of the several million ED visits annually concerning acute chest pains, the majority of the cases are found to be false alarms. Each visit can cost a hospital a few thousand dollars at a minimum, and several hours of medical personnel time. Further, crowding in emergency rooms is a growing concern and patients with ailments needing attention may have to wait several hours before being treated. Unfortunately, the current standard of care for certain symptoms can sometimes miss the true or underlying cause for a set of presented symptoms. For example, the current standard of care for chest pain using stress testing often misses the presence of significant coronary disease. As a result, besides the detriment to the patients, hospitals may incur liability and a poor reputation for misdiagnosing patients—both false positive and negative.
Diagnostic test devices provide more accurate, efficient systems for diagnosing, but oftentimes hospitals and medical centers lack sufficient personnel trained in using such devices. For example, while a multi-detector computed tomography device is believed to be one of the most accurate non-invasive diagnostic imaging tests available for ruling out the presence of coronary artery disease, among other things, only a very small number of practicing physicians and technicians are currently qualified to operate and interpret computed tomography angiography (CTA) or other diagnostic imaging test devices.
Further, since many emergency departments and other locations lack a resident expert of the computed tomography (CT) device or other diagnostic imaging test devices, there exists a need for guidance through the use of such devices as well as expert assistance in the proper reading and analysis of the scan results. Accordingly, the present invention provides systems and methods for a streamlined qualified, timely and cost efficient use of available protocol(s) and/or diagnostic devices, for example, by hospitals and other service providers.
Embodiments of the present invention provide for a system and method in which diagnostic events are handled in an accurate, expedient and efficient manner. Preferred embodiments employ a computer implemented process in which critical patient attributes are entered into the patient's medical record to provide an assessment of the need for one or more diagnostic processes that can be used to accurately diagnose the condition of the patient. The system can be programmed to require entry of information regarding the patient's condition that will subsequently be used to select the proper diagnostic sequence. The system will consequently reduce or eliminate the use of diagnostic procedures that do not match the symptoms of the patient. In the case of a CT scan, for example, it will enhance the selection of proper scan parameters that will serve to minimize the radiation dose to which the patient is exposed and also reduce the need to repeat the scan which results in further unwanted radiation exposure and cost.
Thus, preferred embodiments of the invention utilize at least one diagnostic scanning system for imaging a patient. The scanning system has at least one processor to process image data and that transmits and receives information via a communication network. The network provides for data exchange between the scanning systems and a medical record system that includes a patient management sub-system. The patient management system involves the entry of patient data and the selection of scanning protocols to be described in great detail herein.
In embodiments, the symptoms and medical record of an entity, e.g., a mammalian subject, such as a patient, are identified. The patient may be in a first location, e.g., an emergency department (ED) of a hospital or clinic. In reviewing the initially identified symptoms and medical record/history of the patient, a specific diagnostic test may be run. For example, in the situation of a patient complaining of chest pain, and based on that patient's earlier visit to the ED for a similar reason, medical personnel may determine, based on the protocol of the specific ED or medical center, that a diagnostic test such as a computed tomography (CT) scan of the patient's heart should be run. Because computed tomography machines can have numerous parameters that must be selected to run and review the resulting image data accurately, embodiments of the present invention provide for a monitoring system to initially determine a potential need for such a diagnostic test, and then guides one or more medical personnel through the administration of the diagnostic test and review of the subsequent results.
In embodiments of the present invention, such guiding can be conducted via a dashboard. The dashboard can be a displayed image or sequence of images that are displayed on an electronic display. This can be the display on a computer workstation, a portable or mobile computing device, such as a handheld computer, or telephone display. In embodiments, such guiding can be conducted at the same location as the patient and/or medical personnel, or at a remote location separate from the patient and/or medical personnel. For example, a separate medical center having experts in the use of the specific diagnostic machine and analysis of the subsequent results can be called manually, or alerted automatically, in an embodiment of the present invention. The data or diagnostic test results are reviewed at the remote location, and the analysis is then transmitted to the patient's and/or hospital location. The remotely located expert can monitor the scan by receiving the measurement parameters and images in real time during acquisition, and can alter the procedure remotely
In embodiments of the present invention, the dashboard is used as a device to monitor the various steps of the medical procedure. For example, the dashboard is a graphical user interface which displays each of the steps of the procedure, such as, prepare patient for CT scan, apply CT scan, analyze the CT scan, transmit the CT scan to a remote analysis center, consult with remote analysis center, determine diagnosis of patient based on the consult and analysis. In embodiments, the dashboard shows each of the steps of the procedure, and shows either directly and/or through request information regarding each of the steps. For example, if the first two steps have taken place, those steps on the user interface may be shown differently from the other remaining steps. For example, the completed steps have a notation which indicates that the steps are completed, or are grayed out in color. The step currently in action can be shown in a bright color and/or notation indicating that that particular step is the current step. The subsequent steps to be completed, likewise, can have a text and/or color notation indicating that those steps are still to be completed.
Thus, preferred embodiments of the present invention serve to merge the patient management system and the diagnostic systems used in hospitals and clinics in order to more efficiently use those resources in a safe manner for the benefit of patients. Currently, these systems are not well integrated, requiring extensive manual entry of data that is subject to human error or in poor decision making. For example, cardiac stress tests remain widely used for the assessment of patients arriving at emergency rooms with acute chest pain. These tests have remained only partially effective in the accurate assessment of these conditions. CT angiography has improved the diagnostic capabilities in comparison to the stress test, however, these systems are not integrated into the patient management systems of emergency departments.
In embodiments, the user interface allows for pop-up windows or different display screens which provide more information regarding one or more of the identified steps. For example, in a situation where a selected step is the use of a CT device, an authorized user or entity may obtain additional information guiding one through the imaging sequence of the CT device, or other related information. Likewise, the user interface may be linked to transmissions from the diagnostic test machine itself (e.g., CT device) which indicate when the diagnostic test machine is available for use and/or needing maintenance. In embodiments, the user interface allows for pop-up windows or screens which indicate a specific alert, such as an exceeding of a predetermined suggested time to complete a specific step. In embodiments, the pop-up windows or screens can request input by an attending medical personnel for authorization to label a procedure step as completed or other notation. In embodiments, the pop-up windows or screens can request input by an attending medical personnel for actual authorization to view the dashboard and/or additional information therein. In embodiments, such authorization can be in the form of a personal identification number, passcode, smartcard having a passcode, and/or biometric passcode, and/or by any other available means. The system can use a web enabled system in which a website address can be accessed using a public access network such as the internet Using an encrypted access protocol, the user can access the medical record of a particular patient, the active dashboard displaying the current status of the patient undergoing a diagnostic evaluation, as well as the previously acquired results and image data.
In embodiments of the present invention, a resulting review determination is transmitted to the patient's or medical center's location. Such determination may include instructions regarding treatment, a reading and/or analysis of the diagnostic test, e.g., CT scan, and/or other information. The transmission of such review can be effected by any method available, such as facsimile, email, local area network connection, instant messaging (IM), multimedia messaging service (MMS), short messaging service (SMS), teleconference, video conference, and upload/download to a system automatically, etc.
In embodiments of the present invention, the dashboard device and/or display device show the procedure steps, and indicates which method step is currently in progress. In embodiments, the procedure steps are monitored via the dashboard device in real-time for at least one of efficiency, quality, and accuracy.
In embodiments of the present invention, a storage device, e.g., a repository, database, and/or server, is provided to maintain and/or communicate data of the diagnostic test and data of the method steps. In embodiments, the storage device is located at the ED or another department in the hospital, and/or at a remote location such as a medical center or electronic storage facility. In embodiments, the dashboard includes software and/or coded instructions which when implemented by a processor provide for a transmission message or record to be sent to, e.g., the repository, to identify that a specific step of the procedure was completed, not completed, took a certain amount of time to complete, was delayed due to a specific reason (e.g., appropriate personnel was not available to sign off on the step completion), or other information. In embodiments, software and/or coded instructions which when implemented by a processor provide for a generation of at least one report using data from, e.g., the repository. In embodiments, the report concerns efficiency of a process of the method steps; frequency of diagnostic testing; timing of care for the entity; transmission of data; resulting review determinations based on a specific diagnostic test result; and/or transmission of determinations.
In embodiments of the present invention, an apparatus and/or system is provided which includes a monitor, the monitor displaying in real-time the execution of a procedure. In embodiments, the procedure is a medical procedure in which an entity is identified as needing a specific diagnostic test at a location, the diagnostic test is conducted, the data from the diagnostic test is transmitted to another location, the data is analyzed at one or both of the locations, a resulting review determination/analysis is transmitted from the second location to the first location, and the diagnostic test result and analysis are stored in a repository.
In embodiments of the present invention, a monitor is provided to work as a dashboard in which all of the procedural aspects of a system are monitored. In embodiments, the monitor includes a touchscreen so that a user can input a request to obtain more information and/or update the dashboard.
In embodiments of the present invention, a software system and/or coded instructions implemented by a processor provide a graphical interface via a monitor which displays at least one procedure specific to a set of recorded symptoms of an entity. In embodiments, the software system is updated to include information regarding the at least one procedure specific to the set of recorded symptoms of the entity, the information including at least one of appropriate use guidelines, exclusionary criteria, predetermined timing data for respective steps of the at least one procedure, and access permission. For certain diagnostic procedures, the coded instructions can include automated steps in which particular procedures and parameters are selected based on the patient information provided. In embodiments, the updating can be executed asynchronously or synchronously. In embodiments, the updating can be executed through a mobile device, such as a handheld wireless mobile computing device having a display and control panel which is connected to the network with which the graphical user interface communicates.
In embodiments of the present invention, a computer-readable storage medium storing a set of instructions adapted to be executed by a processor to perform a method in which data concerning a patient is inputted and stored, an electronic record (e.g., an electronic medical record (EMR)) associated with the patient is downloaded from a source and stored, the stored data concerning the patient is compared to a pre-inputted list of symptoms and medical history in order to determine if a specific diagnostic test is needed, once the recommended diagnostic test is done then the results can be automatically transmitted or manually authorized to be transmitted via the set of instructions, a communication connection is initialized and/or activated between two or more locations, and/or the resulting analysis of the diagnostic test results are transmitted back to the place administering the diagnostic test.
In embodiments of the present invention, a system for implementation of a medical procedure includes at least one activity monitoring dashboard, the activity monitoring dashboard displaying real-time execution of a medical procedure, the procedure including: identifying a patient for diagnostic test, the patient being located in a first location, conducting a diagnostic test, transmitting resulting data of the diagnostic test to at least one second location, reviewing the diagnostic test at the at least one second location, transmitting a resulting review determination from the at least one second location to the first location, and storing the diagnostic test result in a repository. In embodiments, the activity monitoring dashboard has an interactive screen so that additional information can be displayed for steps of the procedure. In embodiments, the repository is located in the same location as the diagnostic device, and/or at one or more other locations (e.g., medical center, electronic storage facility, hospital, office of the general practitioner of the patient). Embodiments include a report generating system for generating at least one report from data located in the repository concerning at least one of: efficiency of the procedure of the method steps; frequency of diagnostic testing; timing of care for the entity; transmission of data; resulting review determinations based on a specific diagnostic test result; cost of each of the method steps; cost effectiveness of the procedure; and transmission of determinations.
In embodiments, a software system implemented by a processor provides a graphical interface via the activity monitoring dashboard displaying the at least one procedure specific to a set of recorded symptoms of the entity. In embodiments, the software system is updatable to include information regarding the at least one procedure specific to the set of recorded symptoms of the entity, the information including at least one of appropriate use guidelines, exclusionary criteria, predetermined timing data for respective steps of the at least one procedure, an alert if a procedure step exceeds a respective predetermined time data limit, and/or access permission. In embodiments, a portable mobile device is used to communicate with the first location (e.g., hospital ED) and/or communication with or view the activity monitoring dashboard. In embodiments, the communication with or viewing of the activity monitoring dashboard is effected in real-time.
In embodiments of the present invention, the dashboard monitoring activity allows for access to and monitoring of an electronic medical record associated with the entity, a physician ordering system specific to a health care institution, use criteria data identifying an appropriate diagnostic test or intervention for specific symptoms and medical history, alert for any exclusionary criteria for the appropriate diagnostic test or intervention, and alert for each critical checkpoint of the procedure.
Embodiments of the present invention provide for a system and method in which the diagnostic device is a computed tomography machine or multi-detector computed tomography (MDCT) machine.
Embodiments of the present invention provide for a system and method in which the object being imaged is at least one of a body organ, a heart, a lung, a liver, a gall bladder, an eye, an artery, and a brain.
In embodiments, the transmission occurs via at least one of a wired network and a wireless network. The wireless network can be used by physicians, nurses and technicians to access the dashboard on a handheld portable display and computing device.
Embodiments of the present invention provide for a system and method which includes evaluating the transmitted image data file by the location, determining full diagnostics from the transmitted medical imaging data, and transmitting the full diagnostics to at least one of a storage location and a use location.
Embodiments of the present invention provide for a system and method in which the storage location is at least one of a server, a plurality of servers, a storage device, a magnetic strip storage device, a chip storage device. In embodiments of the present invention, the first location is at least one of a hospital, a location from where the image data file was acquired, a university, a clinic, and another evaluation location to check accuracy of the full diagnostics.
In embodiments of the present invention, the evaluation of the transmitted image data is effected by at least one of an urgent care clinic, a large cardiology practice group, a primary care practice group, a hospital, a university, and a location remote from where the image data was acquired.
In embodiments of the present invention, the image data file is compressed further for faster transfer of data via at least one of the Internet and a video conference system, and/or via download to a storage device.
In embodiments of the present invention, various imaging and/or diagnostic test devices, e.g., computed tomography (CT), cardiac magnetic resonance imaging (CMR), electron beam computed tomography (EBCT), electrocardiogram (ECG), myocardial perfusion imaging (MPI), transesophageal echocardiography (TEE) or ultrasound imaging procedure, catheterization procedures, and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI), can be used. Such devices, when properly used and analyzed may assist in the diagnosis of various illnesses, including, for example, in the cardiology realm, acute coronary syndrome (ACS), coronary artery disease (CAD), coronary heart disease (CHD), heart failure (HF), myocardial infarction (MI), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
In embodiments of the present invention, sending or transmission of data or information can be via a wired connection or wireless connection to another machine(s), another location(s), or to a data storage location(s) such as a chip card.
Alternatively or in addition to that, such sending or transmission can be via a video conferencing capability in which the images can be viewed as they are being transmitted. The images may then be further processed. For example, such processing can be to convert the files to a viewable state by the remote location. For example, such processing can be used to render a 2-dimensional or 3-dimensional image from the data. Other medical imaging devices (MIP) and/or multiplanar reconstruction devices (MPR) may be used. Once any desired data visualization and/or manipulation takes place, the processed data is sent to, e.g., an expert center. At an expert center, for example, an expert, other qualified individual and/or processing application reviews the processed data to determine a diagnosis. In such a system, the expert center representative or processor may contact the originating source, e.g., a hospital emergency department, for the data with the diagnosis. For example, the processor may send a text message, email, electronic voicemail, and/or page to the intended destination to advise of a recommended diagnosis. Preferred embodiments can also include systems and processes for the training of physician and/or medical technicians.
The present invention provide for a systematic approach to the care, diagnosis, and subsequent treatment of a patient. Preferred embodiments employ a computer implemented diagnostic system that is networked to enable a more efficient and safe patient management process for hospitals and clinics.
In
In
Upon initial diagnosis and receiving of appropriate guidelines for the use of the diagnostic machine or tool, the test or measurement is run on the patient, e.g., an image processing scan/3-dimensional rendering/MIP/MPR, 104 of the patient's heart. Using the machine, the specific area of interest can be visualized and manipulated in order to get a clear insight into possible causes for the symptoms. Such test results, e.g., scans of the patient's body organ, are then transmitted or displayed via, e.g., videoconferencing, internet document sharing device, etc., to an entity for accurate reading and analysis 105 of the test results. For example, the test results could be transmitted/viewed via email, facsimile, storage medium, internet-connected server database, temporary cache location, etc. by a remote entity such as an expert reading center. For example, the expert(s) can be connected via video conferencing, web conferencing, teleconferencing and/or other communication network method, as well as through the dashboard, with the attending physician and/or medical personnel(s).
The “expert” entity can include the appropriate expert for reading such tests, such as a cardiologist, radiologist, computer-aided diagnostics and analysis is based on the past history of the patient, aggregate past history of multiple patients, and/or theoretical data. Such expert analysis and eventual diagnosis is then transmitted back to the patient and/or the medical center 106 which conducted the diagnostic tests. For example, a remote center known for its experts on the specific diagnostic machine and area of medicine is used to proffer the diagnosis to an emergency room physician. Such systems involving a remote center provides for additional expert care for a facility which may lack in experienced personnel, or in availability of personnel.
Throughout the procedure, the dashboard keeps all authorized personnel informed on the status of the procedure and treatment of the patient. Authorization access is implemented using an available method (e.g., access code). Further, the dashboard provides for alerts to medical personnel if certain time limits, e.g., effectiveness of a dye administered to a patient is about to decrease, are about to be or are exceeded. In an embodiment, the dashboard is configured to send an electronic page/SMS/MMS/transmission to a medical personnel who is needed and/or due to perform a step in the procedure.
In
For example, if the initial diagnosis is a cardiac disease, then the ED's protocol(s) for cardiac disease is observed and followed. For example, the ED's protocol may indicate that certain criteria and selection processes need to be satisfied 203 before proceeding to use of an imaging device. For example, the ED may have a specific patient selection criteria based on in-use medications, pre-existing diseases and/or allergies, etc. For example, in the case of acute chest pain, the ED may look to the patient's family history of coronary artery disease, existence of diabetes, smoking habits, aspirin use, sedentary lifestyle, congestive heart failure history, cardiac arrest history, asthma, pacemaker/defibrillator, chronic kidney disease, etc.
For example, the ED may follow appropriate use criteria published by a recognized group authority or diagnostic machine manufacturer. For example, in the case of acute chest pain, appropriate use criteria may include: low/intermediate/high pre-test probability of CAD, no ECG changes and serial enzymes negative, etc. For example, the ED may require review of exclusion criteria which may “automatically” prevent a patient from being an appropriate candidate for a specific diagnostic test. For example, in the case of acute chest pain, exclusion criteria may include: history of documented coronary artery disease (e.g., stent, bypass surgery, etc.), heart rate staying at a rate greater than a specified amount even after administration of appropriate medication, known history of contrast reaction, renal insufficiency, inability of patient to cooperate with scan acquisition (e.g., hold breath instructions), clinical instability, etc.
Once a patient has succeeded in being selected for a diagnostic test, then the specific protocol rules for the diagnostic test are identified and followed 202. For example, the software system then identifies on the dashboard the various steps needed to prepare the patient for an, e.g., CTA scan. For example, the software system then identifies the specific or specific types of personnel needed for each of the various steps 205. For example, a notification process is implemented to alert each of the personnel needed at their appropriate times, including, e.g., early alerts and overtime alerts. For example, the various steps may include an ED nursing order in which IV/oral beta blocker/SL NTG is needed for administering. Such administering can be done manually by a nurse or other qualified personnel, or can be done by an automatic dispenser associated with the patient. For example, the various steps may include information for the CT technician, including how to effectively prepare the room, use the ECG monitor, and handle the scanning protocol selection; For example, the various steps may include information for the radiologist/ACPD regarding instructions for patient preparation and scanning. For example, the various steps may include information for the cardiac CTA NP observing the patient preparation and scanning.
After a patient is prepared, the software system tracks the procedure to the actual activation of the diagnostic tool, e.g., CTA scan. In an embodiment, during the scan, in order to assist in the expertise of using the diagnostic tool, a remote monitoring of the scanning process occurs. For example, such monitoring can occur using the various methods described herein, and/or also using a webcam, videoconferencing system, and/or telephone/VoIP connection. Subsequent to the acquisition of the image scans, the ED or remote monitoring location processes the images, and the data is obtained by one or both of the ED and remote monitoring location 207. For example, in the acute chest pain example, a radiologist/ACPD may be required to provide CTA diagnosis, and/or a cardiac CTA NP observation unit ensures that basic CTA post processing occurs. For example, in the acute chest pain example, a technician conducts the calcium scoring and ventricular function calculation. Alternatively, the technician or other medical personnel may input or execute an imaging process software to observe and determine such calcium scoring and ventricular function calculations. Thus, the image data processing occurs 206, whether onsite and/or at a remote location, and the patient may be provided with the observed results, a physician's order of medication, recommended surgery or other treatment, lifestyle changes, and/or a clean bill of health, and next steps. In embodiments, the dashboard is configured to follow the procedure through to post image data processing, including, e.g., sending email/page alerts in advance (to be delivered by an appropriate electronic method) to medical personnel for follow-up care contact with the patient.
An example of a CTA system 240 is illustrated in
In CTA systems, a cardiac sensor 257 can be used to provide electro-cardiographic signals from circuit 254 to the central processor 262. The processor can be programmed to control the x-ray source controller 256, gantry 252, table 255 in combination with sensor 254 to provide one or more 3D scans of the human heart timed the cardiac cycle. The system 240 can include the CT scanner assembly 225 and a camera 275 used to provide a live video feed and recording of the room in which the procedure takes place, and the control system workstation 241. Image data are collected at collection unit 250, forwarded to image processor 267 and stored at image storage device 268. The processor 262 is connected to a user workstation with a user control panel 264 and display 266. The system can be connected to a hospital network via network connection 270. The hospital server 272 is interfaced to emergency department workstations 276, to internal expert workstation 274 and through internet portal 278 by wired connection to remote expert workstation 282 or by wireless transmission to mobile computing device 280 having control panel 284 and display 286. Thus, devices 280, 282 are able to observe data entry onto the dashboard as described herein and observe the diagnostic sequence and imaging protocol of the system, and to remotely view images during acquisition and thereafter. Thus, a physician using device 280 can remotely participate, approve or alter steps in the procedure.
In embodiments of the present invention, the various graphical user interfaces provided to a user are made relatively simple to read, such that minimal effort need be made in order to transmit/enter data/learn information in an efficient manner.
As shown in
In connection with the step of running the diagnostic procedure 609 on the patient, this step can be remotely monitored 208 as shown in
In embodiments, the information displayed and/or available for display on the monitor 701 is transmitted to the repository 702. In embodiments, one or more of the alerts, timestamps, authorizations, delays, and other features are transmitted to the repository 702. In embodiments, data is transmitted to the repository 702 in at least one of: wirelessly, wired connection, portable storage means, manually, and automatically. For example, when new data is entered into the system which is displayed on the monitor 701, the new data is automatically transmitted wirelessly to a remote repository 702 and/or to another storage means hard-wired 702 to the monitor 701. In embodiments, the repository 702 is used to store and safe-keep the data for statistical use.
In embodiments, the repository 702 is used in the generation of report(s). For example, such report(s) include an efficiency report on the personnel at a hospital, an efficiency report on the use of the monitor system and/or remote assistance. For example, such report(s) include a cost report on the use of certain resources (e.g., imaging machines, network, medical personnel, instruments, video conferencing system, etc.). For example, such report(s) include a report on the effectiveness of the use of certain devices in specific situations. For example, such report(s) include a report on the effectiveness of the use of CTA in the accurate and efficient diagnosis of heart disease. For example, such report(s) include a report on the effectiveness of the use of a dashboard and the medical center/hospital ED's established protocol(s). Thus a data analysis and reporting step 704 can be used for quality assurance and quality control functions.
In embodiments, the repository 702 can be represented as one or more of the following: database, server, cache, flash drive, portable storage means, DVD, CD-ROM, multiple electronic storage devices and/or methods, and other storage means. In embodiments, the repository 702 can be configured to have an application (e.g., a software application), or an association with an application, which pulls information from the monitor 701 and/or receives pushed information from the monitor 701. In embodiments, the repository 702 is a plurality of repositories.
The system shown in
In embodiments, the transmissions of a patient's or other's information to and from the dashboard and/or remote medical personnel are handled in a confidential communication manner as needed by the information involved. For example, the transmissions of data are encrypted by any number of available methods, e.g., public key encryption, certificate, etc. Or, for example, a dedicated and secure transmission channel may be open for the transmission of unencrypted and/or encrypted data.
It should be understood that there exist implementations of other variations and modifications of the invention and its various aspects, as may be readily apparent to those of ordinary skill in the art, and that the invention is not limited by specific embodiments described herein. Features and embodiments described above are combinable with and without each other. It is therefore contemplated that the present invention covers any and all modifications, variations, combinations or equivalents that fall within the scope of the basic underlying principals disclosed and claimed herein.
This International application claims the benefit under 35 U.S.C. 119(e) of U.S. Provisional Application No. 61/317,690, filed Mar. 25, 2010, the entire contents of the above referenced application being incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/US11/29803 | 3/24/2011 | WO | 00 | 9/28/2012 |
| Number | Date | Country | |
|---|---|---|---|
| 61317690 | Mar 2010 | US |
