Abstract:
An endotracheal intubation assistance device for use in assisting a practitioner in performing an endotracheal intubation on a patient. The endotracheal intubation assistance device comprises a thumb member which is engaged with a practitioner&#39;s thumb thereby creating a protective barrier between the practitioner&#39;s thumb and the patient&#39;s teeth. The endotracheal intubation assistance device further comprises a blade member which extends beyond a distal side of the thumb member and serves to expose the patient&#39;s glottis in an efficient and effective manner, thereby enhancing the accuracy of a digitally performed endotracheal intubation.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 61/512,498 filed on Jul. 28, 2011. 
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The invention relates to an endotracheal intubation assistance device used to assist in endotracheal intubation. More particularly, the invention relates to an endotracheal intubation assistance device that, when properly applied to a practitioner&#39;s hand, assists the practitioner in performing an endotracheal intubation. 
     2. Background of the Invention 
     Endotracheal intubation is the process of passing an endotracheal tube through the glottis and into the trachea, just above the corina, to open the airway for purposes of administering oxygen, medication, anesthesia, and the like. Practitioners generally use a laryngoscope to assist them in performing an endotracheal intubation, wherein the laryngoscope is inserted through the mouth and used to aid the practitioner in locating the trachea. A disadvantage of using a laryngoscope is that a patient oftentimes bites down on the laryngoscope thereby causing the patient to crack and/or chip a tooth. Additionally, oftentimes a laryngoscope is not available and/or its use is not desirable. In these cases, a practitioner may opt for performing the endotracheal intubation via digital or tactile means. 
     When performing a digital, tactile endotracheal intubation on a patient the practitioner does so in a “blind” fashion. That is, while the patient is in a generally supine position, a healthcare practitioner, while face to face with the patient, places four fingers of the practitioner&#39;s first hand down into the patient&#39;s throat, and with the practitioner&#39;s index and middle fingers of the first hand, the practitioner reaches and feels for the patient&#39;s epiglottis. Once the epiglottis is located, the practitioner holds his first hand in place forming a passage to the epiglottis. Then, with the practitioner&#39;s second hand, which is holding the tracheal tube, passes the tracheal tube through the passage formed by the fingers of the first hand, and attempts to position the tracheal tube into the patient&#39;s trachea. 
     Unfortunately, because the practitioner&#39;s first hand is blocking visualization of the patient&#39;s trachea, the intubation is performed essentially blindly, and, oftentimes, the tracheal tube passes into the esophagus rather than the trachea. Such a failed attempt at inserting the tracheal tube into the patient&#39;s trachea wastes valuable time and patient oxygenation. Another problem inherent in digital endotracheal intubation is that the patient oftentimes bites down on the practitioner&#39;s hand while the practitioner is performing the intubation. 
     Therefore, what is needed is a device capable of efficiently and safely assisting in the performance of a digital endotracheal intubation by providing a device which will allow a practitioner to perform a digital endotracheal intubation with the added advantage of being able to visualize the patient&#39;s airway and vocal cords, as well as, to see the passage of the endotracheal tube into the trachea, while simultaneously protecting the practitioner&#39;s hand during the endotracheal intubation. 
     BRIEF SUMMARY OF THE INVENTION 
     The above-discussed problems are greatly reduced or alleviated by an endotracheal intubation assistance device specially configured to assist a practitioner in viewing a patient&#39;s glottis when, e.g., the practitioner is about to perform an endotracheal intubation on the patient, and, more especially, a digital endotracheal intubation. In an exemplary embodiment, the endotracheal intubation assistance device comprises a sleeve having a distal end oppositely situated from a proximal end, wherein the proximal end forms an opening for receiving a thumb of the practitioner, and further wherein, when the sleeve is positioned on the practitioner&#39;s thumb, the sleeve extends along at least a portion of the practitioner&#39;s thumb which comprises a distal phlange, a proximal phlange, and a metacarpal bone I. The endotracheal intubation assistance device further comprises a blade member which extends from the distal end of the sleeve. The blade member is specially configured to move the patient&#39;s tongue in a manner that will allow the practitioner to readily detect the patient&#39;s glottis. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The benefits and advantages of the present invention will become more readily apparent to those of ordinary skill in the relevant art after reviewing the following detailed description and accompanying drawings, wherein: 
         FIG. 1  is a schematic depicting the skeletal bones of a human forearm, wrist, and hand; 
         FIG. 2  is a schematic depicting a top side view of an exemplary endotracheal intubation assistance device as applied to a practitioner; 
         FIG. 3  is a schematic depicting an exemplary application of the endotracheal intubation assistance device depicted in  FIG. 2 ; 
         FIG. 4  is a schematic depicting a top perspective view of another exemplary endotracheal intubation assistance device; 
         FIG. 5  is a schematic depicting a side view of the endotracheal intubation assistance device depicted in  FIG. 4 ; 
         FIG. 6  is a schematic depicting an exemplary application of the endotracheal intubation assistance device depicted in  FIGS. 4 and 5  disposed within an exemplary glove; and 
         FIG. 7  is a schematic depicting an exemplary apparatus comprising the endotracheal intubation assistance device depicted in  FIGS. 4 and 5  in combination with an exemplary light providing sub-assembly. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Disclosed herein is an endotracheal intubation assistance device configured to remove a patient&#39;s tongue from a line of sight, and to further enhance the visibility of the patient&#39;s glottis, thereby assisting a practitioner in detecting the location of the patient&#39;s trachea for purposes of performing an endotracheal intubation, and, more especially, a digital endotracheal intubation. It is to be understood herein and throughout that the term “patient” shall refer to any animal upon which endotracheal intubations are performed, either presently or in the future, and shall include, for example and without limitation, humans, dogs, cats, horses, and the like. 
     The endotracheal intubation assistance device comprises a sleeve which is configured to fit onto at least a portion of a practitioner&#39;s thumb. In addition to holding the endotracheal intubation assistance device onto the practitioner&#39;s thumb, the sleeve also serves as a safety barrier which protects the practitioner&#39;s hand in the event that the patient bites down on the practitioner&#39;s hand, while also protecting the patient from cracking and/or chipping a tooth should the patient bite down upon the sleeve. Accordingly, to aid in flexibility of the endotracheal intubation assistance device, but also to avoid harm to the practitioner and to the patient, in an exemplary embodiment the thumb region comprises one or more of a thick rubber; a soft plastic, such as, for example, neoprene; and the like. 
     The endotracheal intubation assistance device further comprises a blade member which extends from a distal end of the thumb region. The blade member, which essentially serves as an extension of the practitioner&#39;s thumb, is configured to assist in the movement of the patient&#39;s tongue away from the practitioner&#39;s line of sight, and to assist in the insertion of the blade member anterior and/or posterior to the patient&#39;s epiglottis so that the patient&#39;s glottis may be viewed more readily by the practitioner. 
     The blade member may comprise a substantially curved shape or a substantially linear shape, depending upon the patient&#39;s specific needs and/or based upon the size of the patient. A substantially curved shaped blade member would be appropriate where exposure of the glottis is accomplished by positioning the blade member anterior to the epiglottis, and a substantially linear shaped blade member would be appropriate where exposure of the glottis is accomplished by positioning the blade member posterior to the epiglottis. Additionally, the blade may be formed in a variety of sizes, wherein the specific sized-blade used during the intubation is preferably determined based upon the specific needs of the patient. 
     Although the blade member may comprise a wide variety of materials, in an exemplary embodiment, the blade member comprises a heavy plastic; a metal, such as, for example, an iron aluminum alloy; and the like. Furthermore, in an exemplary embodiment the thumb region and the blade member may be integrally formed such that the two members may be bonded together by, for example, impregnating, for example, a metal alloy with the thick rubber and/or soft plastic. 
     Prior to performing an essentially standard digital intubation technique, the endotracheal intubation assistance device first may be applied such that the thumb region of the device covers the practitioner&#39;s thumb and the thumb blade extends over the distal end of the practitioner&#39;s thumb, i.e., in a direction oppositely situated from the practitioner&#39;s wrist. While the patient is in a generally supine position, the practitioner may then tilt the patient&#39;s chin upwards while opening the patient&#39;s mouth, and maneuver the blade member such that the blade member moves the patient&#39;s tongue upwards towards the patient&#39;s upper palate, thereby moving the tongue out of the practitioner&#39;s line of sight so that the blade member further exposes the patient&#39;s glottis. To accomplish such an end, in an exemplary embodiment, the blade member may comprise a length (as measured from a proximal end to a distal end thereof) of about 1.5 inches to about 3 inches, wherein about 2 inches is especially preferred, and a width (as measured from a lateral end to an oppositely situated lateral end thereof) of up to about 0.5 inch to about 2.5 inches, wherein a width of up to about 2 inches is especially preferred. 
     While the present invention is susceptible of embodiment in various forms, there is shown in the drawings, and will hereinafter be described, presently preferred embodiments with the understanding that the present disclosure is to be considered an exemplification of the invention and is not intended to limit the invention to the specific embodiments herein illustrated. 
     Referring to  FIGS. 1-3 , an exemplary endotracheal intubation assistance device  10  comprises a sleeve  12  having a cuff region  14  coextensive with a thumb region  16  and with a thumb/index finger web region  18 . Sleeve  12  preferably comprises a material which provides a protective barrier to the practitioner in the event that the patient bites down on the practitioner&#39;s hand during the endotracheal intubation, and which further prevents chipping and/or cracking of the patient&#39;s teeth which may otherwise result from such a bite. Cuff region  14  may be configured to overlie at least a portion of a dorsal side  20  and a ventral side  22  of a practitioner&#39;s forearm  23 , wrist  24 , and hand  32 , and preferably extends, when properly worn, from a distal region  25  of a radius bone  26  to a distal end  28  of a metacarpal bone I  30 . 
     Thumb/index finger web region  18  continuously extends from cuff region  14  and, when properly worn by a practitioner, may, at least partially, overlie dorsal side  20  and ventral side  22  in the region of the practitioner&#39;s metacarpal bone II  38  of an index finger  62 . 
     Thumb region  16  is configured to at least partially envelop a practitioner&#39;s thumb  44  in the area of a proximal phlange  40  and of a distal phlange  42  of the practitioner&#39;s thumb  44 . Extending from a distal end  46  of thumb region  16  is a blade member  48 . Although blade member  48  is depicted as having a generally arched-shaped body  49 , body  49  may also be substantially linear. 
     Endotracheal intubation assistance device  10  further comprises a ring member  58  which is physically attached to thumb/index finger web region  18 . Ring member  58  is configured to cover, at least partially, a proximal end  60  of index finger  62  of the practitioner&#39;s hand  32  in an area approximating the general location of a proximal phlange  63  of index finger  62 . 
     Endotracheal intubation assistance device  10  also comprises a secondary attachment member  64  which is physically attached to a proximal lateral side  66  and to an oppositely situated distal lateral side (not shown) of cuff region  14 , wherein an exemplary secondary attachment member comprises a strap. When properly worn by a practitioner, secondary attachment member  64  wraps around dorsal side  20  of the practitioner&#39;s wrist  24  and rests thereon to further secure device  10  to the practitioner. 
     An exemplary application of endotracheal intubation assistance device  10  is depicted in  FIG. 3 . Referring to  FIG. 3 , a practitioner dons device  10  by inserting the practitioner&#39;s thumb through sleeve  12  such that: cuff region  14  overlies at least a portion of metacarpal bone I  30  of the practitioner&#39;s thumb  44 , thumb region  16  overlies at least a portion of distal phlange  42  and proximal phlange  40  of the practitioner&#39;s thumb  44 , and blade member  48  extends away from distal phlange  42  of the practitioner&#39;s thumb  44 . Additionally, index finger  62  may be inserted through ring member  58  and/or secondary attachment member  64  may be positioned over dorsal side  20  of the practitioner&#39;s hand  32  to further secure endotracheal intubation assistance device  10  in place. When performing the intubation, the practitioner may insert the practitioner&#39;s thumb  44  into a mouth  51  of the patient. Blade member  48  may be used to move the patient&#39;s tongue (not shown) up and away from the practitioner&#39;s line of site, and to make apparent the position of the patient&#39;s glottis. 
     Another exemplary endotracheal intubation assistance device is depicted in  FIGS. 4 and 5 . Here, an endotracheal intubation assistance device  100  comprises a sleeve  102  and a blade member  160 . Sleeve  102  is configured to receive a practitioner&#39;s thumb and to secure the thumb therein, while blade member  160  is configured to move a patient&#39;s tongue and to expose the patient&#39;s glottis. 
     To these ends, sleeve  102  comprises a thumb region  104  and a cuff region  106 . Thumb region  104  comprises a bottom wall  108  attached to a proximal lateral wall  110  on an edge thereof and to a distal lateral wall  112  on an oppositely situated edge thereof. Bottom wall  108  is substantially planar. Each of proximal and distal lateral walls  110  and  112  respectively comprises a body  114  and  116  which terminates at a respective top edge  118  and  120 . Each of top edges  118  and  120  first slopes downwardly towards blade member  160 , then slopes at an even greater degree downwardly towards blade member  160  to form, along with bodies  114  and  116  and bottom wall  108 , an abutment region  122 . Each of top edges  118  and  120  then levels off to form, along with bodies  114  and  116  and bottom wall  108 , a forward leading member  126 . An opening  130  is formed between bottom wall  108 , proximal lateral wall  110 , and distal lateral wall  112 . 
     Cuff region  106  comprises a proximal side wall  132  oppositely situated from a distal side wall  134 , wherein each of proximal and distal side walls  132  and  134  respectively comprises a bottom edge  136  and  138  oppositely situated from a top edge  140  and  142 . Each of bottom edges  136  and  138  is contiguous with bottom wall  108  and extends upwardly therefrom to form a generally convex-shaped configuration. Each of top edges  140  and  142  is contiguous with respective top edges  118  and  120  and extends upwardly therefrom to form a generally concave-shaped configuration. 
     Cuff region  106  further comprises a collar  144 . Collar  144  comprises a top side  146  oppositely situated from a bottom side  148  and an anterior edge  150  oppositely situated from a posterior edge  152 . Anterior edge  150  is contiguously formed with bottom edges  136  and  138 , while posterior edge  152  is contiguously formed with top edges  140  and  142 . Top side  146  comprises a generally convex configuration, while bottom side  148  comprises a generally concave configuration. Collar  144 , proximal side wall  132  and distal side wall  134  surround an opening  154 , wherein opening  154  is contiguously formed with opening  130  of thumb region  104 . 
     Although sleeve  102  may be formed of a wide variety of materials, it is preferred that it is formed of a material that will protect the practitioner in the event that the patient bites down upon the practitioner, while soft enough that the patient&#39;s teeth will not crack and/or chip upon impact with the sleeve. Additionally, in an especially preferred embodiment, an exemplary material will confer pliability and elasticity to the sleeve such that the sleeve will adhere securely to the practitioner via a frictional fit. 
     Blade member  160  comprises a body  162  which is contiguous with forward leading member  126  and extends generally horizontally therefrom and which terminates at an end  164 . Blade member  160  further comprises a tip  166  which is contiguous with end  164  and which slopes downwardly therefrom. It is noted that blade tip  166  may be optional when, for example, it is desired to have a strictly generally linear shaped body. 
     In application, endotracheal intubation assistance device  100  may be worn by a practitioner by inserting the practitioner&#39;s thumb through openings  154  and  130  such that a tip of the practitioner&#39;s thumb  44  rests directly adjacent to abutment region  122 , such that thumb region  104  extends over at least a portion of distal phlange  42  and proximal phlange  40  of the practitioner&#39;s thumb  44 , and such that cuff region  106  extends over at least a portion of metacarpal bone I of the practitioner&#39;s thumb  44 . 
     Although endotracheal intubation assistance device  100  is not shown as having a web region a ring member, and a secondary attachment member as was shown in reference to endotracheal intubation assistance device  10 , endotracheal intubation assistance device  100  may be modified to include any one or more of these components such that the component(s) function in a manner substantially similar to that previously disclosed when worn in a similar manner as discussed above with reference to  FIGS. 2 and 3 . 
     Although not depicted in the figures, any of the endotracheal intubation assistance devices disclosed herein and/or variations thereto, may include a padding disposed on one or more of the sleeve and the blade member, wherein the padding is configured and formed to protect the practitioner in the event that the patient should bite down upon the practitioner&#39;s thumb while the practitioner is performing the endotracheal intubation. Additionally, the padding is preferably configured and formed to prevent injury to the patient&#39;s teeth which may result from the patient&#39;s biting down upon the endotracheal intubation assistance device. In an exemplary embodiment, the padding is in the form of a sheath that envelops the sleeve and/or the blade member. 
     It is further contemplated herein that any of the endotracheal intubation assistance devices disclosed herein and/or contemplated herein, may be jointed and aligned with the practitioner&#39;s thumb joints to ease movement of the devices. In such an embodiment, the endotracheal intubation assistance device may comprise a sleeve and a blade member substantially similar to what has been previously described herein. Additionally, at a portion of the sleeve which corresponds to the junction between distal phlange  42  and proximal phlange  40  of a practitioner&#39;s thumb  44 , and at a portion of the sleeve which corresponds to the junction between proximal phlange  40  and metacarpal bone I  30  of the practitioner&#39;s thumb  44 , the sleeve may be hinged such that it is movable in an upward and downward direction, i.e., towards and away from dorsal side and ventral side  22  of the practitioner&#39;s hand  32 . 
     It is noted that for any of the endotracheal intubation assistance devices disclosed herein and/or variants thereof, the practitioner may further wear, in a conventional fashion, a glove, such as a conventionally known latex or neoprene-based medical glove, such that a thumb stall of the glove fits over the sleeve of the endotracheal intubation assistance device and the blade member extends from the thumb stall of the glove, to thereby protect the practitioner from the patient&#39;s bodily fluids and to assist in securing the device to the practitioner&#39;s thumb. Here, a hole may be formed at the tip of the thumb stall of the glove to thereby allow the blade member to readily extend from the glove. An exemplary embodiment of the integration of endotracheal intubation assistance device  100  with an exemplary glove is depicted in  FIG. 6  herein. 
     Referring to  FIG. 6 , endotracheal intubation assistance device  100  is integrated with a glove  200 , wherein glove  200  is depicted as being compatible with a practitioner&#39;s left hand, although it is to be understood that the device may be integrated with a right-handed glove as well depending upon the preferences of the practitioner. Glove  200  comprises a ventral side  202  oppositely situated from a dorsal side  204 , and further comprises a palm stall  206  from which extends a plurality of finger stalls  208  and a thumb stall  210 . A distal tip  212  of thumb stall  210  comprises a hole  214  formed there through. Glove  200  further comprises a hollow interior  216  through which the practitioner&#39;s hand is inserted to fit within glove  202  in a conventional manner. Endotracheal intubation assistance device  100  is fitted and installed within thumb stall  210  such that bottom wall  108  of thumb region  104  is directed towards ventral side  202  of thumb stall  210  and top edges  118  and  120  of proximal and distal lateral walls  110  and  112  are directed towards dorsal side  204  of thumb stall  210 . Additionally, blade member  160  extends from distal tip  212  of thumb stall  210 . 
     Once endotracheal intubation assistance device  100  is properly applied to the practitioner&#39;s thumb  44 , the practitioner may begin the endotracheal intubation procedure. Accordingly, once the patient is lying in a generally supine position, the practitioner may open the patient&#39;s mouth, and, with endotracheal intubation assistance device  100  in proper position on the practitioner&#39;s thumb, manipulate blade member  160  such that tip  166  moves the patient&#39;s tongue away from the practitioner&#39;s line of sight, and expose the patient&#39;s glottis. Once the pathway to the patient&#39;s trachea has been cleared and is readily apparent to the practitioner, the endotracheal intubation may then proceed as is conventionally known. 
     It is further disclosed herein that any of the endotracheal intubation assistance devices disclosed herein and/or variants thereof may be readily used with a lighting element which assists in the further ready visualization of the patient&#39;s glottis. 
     An exemplary lighting element includes, for example, a light-emitting stylet. An exemplary stylet includes, for example, a stylet disclosed in U.S. patent application Ser. No. 12/622,711 (“&#39;711”), the description of which is hereby incorporated by reference in its entirety. Such stylet is described in &#39;711 as for use with an endotracheal tube and includes a lighting element and a malleable rod which are completely enclosed within an elongated flexible sheath. The elongated flexible sheath has a proximal end and a distal end. In one embodiment, the lighting element is positioned at the distal end of the elongated flexible sheath and the malleable rod is positioned from a proximal end of the lighting element to the proximal end of the elongated flexible sheath. In another embodiment, the lighting element may be positioned between two malleable rods. 
     Alternatively, the endotracheal intubation assistance device may include a lighting element that is integrated with the sleeve and the thumb blade to further aid in the visualization of the glottis. Such a lighting element may include, for example and without limitation, a chemiluminescent member, a light emitting diode, an infrared light, a light bulb, and the like. An exemplary embodiment of an endotracheal intubation assistance device which incorporates a lighting element is depicted in  FIG. 7 . 
     Referring to  FIG. 7 , assembly  300  comprises endotracheal intubation assistance device  100  as discussed with reference to  FIGS. 4 and 5  herein, incorporated within a glove  302 , wherein glove  302  is depicted as being compatible with a practitioner&#39;s left hand, although it is to be understood that glove  302  may be compatible with a practitioner&#39;s right hand as well. Glove  302  comprises a ventral side  304  oppositely situated from a dorsal side  306 , and further comprises a palm stall  308  from which extends a plurality of finger stalls  310  and a thumb stall  312 . A distal tip  314  of thumb stall  312  comprises a hole  316  formed there through. Glove  302  further comprises a hollow interior  318  through which the practitioner&#39;s hand  32  may be inserted to fit within glove  302 . Although glove  302  may be formed of a variety of materials, and may include a conventionally known medical glove, it is preferred that the glove be formed to hold one or more of the components forming the light providing sub-assembly, wherein such sub-assembly is more specifically described below herein. Nevertheless, an exemplary material that may be used to form glove  302  may include silicone. 
     Endotracheal intubation assistance device  100  is fitted and installed within thumb stall  312  such that bottom wall  108  of thumb region  104  is directed towards ventral side  304  of thumb stall  312  and top edges  118  and  120  of proximal and distal lateral walls  110  and  112  are directed towards dorsal side  306  of thumb stall  312 . Additionally, blade member  160  extends from distal tip  314  of thumb stall  312 . 
     Assembly  300  further comprises a light providing sub-assembly  320  disposed on and/or within glove  302 . Light providing sub-assembly  320  comprises a light emitting diode  322  and a battery  326  disposed within a housing  327 , and a power switch  324 , wherein light emitting diode  322 , power switch  324 , and battery  326  are in electrical communication with one another via conventionally known means. Power switch  324  provides the means whereby the practitioner may activate light emitting diode  322 . 
     Although  FIG. 7  depicts a specific placement of light providing sub-assembly  320  in relation to glove  302 , it is importantly noted that light providing sub-assembly  320  may be placed anywhere on and/or within glove  302  and/or on and/or within endotracheal intubation assistance device  100 , and that the individual components of light providing sub-assembly  320  may be in an arrangement that differs from what is depicted in  FIG. 7 , wherein the most important consideration in the placement of light providing sub-assembly  320 , and of its individual components, lies in the ready accessibility of power switch  324  and in the placement of light emitting diode  322  such that a sufficient amount of light is emitted to further ease in the visibility of the glottis. In use, a practitioner need only actuate light emitting diode  322  via power switch  324 . 
     As evident from the present disclosure, the endotracheal intubation assistance device is lightweight, transportable, inexpensive to manufacture, and easy to use. The endotracheal intubation assistance device further considers and provides for the safety of the practitioner&#39;s hand and of the patient&#39;s teeth. The endotracheal intubation assistance device also eliminates the “blind” factor encountered when performing a digital intubation as the blade member is configured to remove the tongue from the practitioner&#39;s line of sight and to clearly expose the glottis. Additionally, when the endotracheal intubation assistance device is used with a lighting element, such as is disclosed herein, optimum illumination and visualization of the patient&#39;s glottis is achieved, thereby increasing the likelihood of the successful patency of the patient&#39;s airway. 
     Accordingly, the endotracheal intubation assistance device provides a viable, lightweight, and easy to use alternative to a laryngoscope, wherein the device has the additional benefit of protecting the practitioner and the patient from resulting from the potential biting down of the patient on the practitioner&#39;s hand. 
     From the foregoing it will be observed that numerous modifications and variations can be effectuated without departing from the true spirit and scope of the novel concepts of the present invention. It is to be understood that no limitation with respect to the specific embodiments illustrated is intended or should be inferred. The disclosure is intended to cover by the appended claims all such modifications as fall within the scope of the claims.