Abstract:
A medical carbon monoxide generator provides for a solid carbon material that may be heated at substantially normal atmospheric pressure to provide a source of medical quality carbon monoxide. The heating source may be an electrical filament or laser controllable by a microcontroller to provide accurate delivery rates and amounts. In one embodiment, a replaceable cartridge holding the carbon material may be used.

Description:
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR  DEVELOPMENT 
     CROSS REFERENCE TO RELATED APPLICATION 
     BACKGROUND OF THE INVENTION 
       [0001]    The present invention relates to medical gas generators and in particular to a device for producing medical purity carbon monoxide for therapeutic purposes. 
         [0002]    Carbon monoxide is a colorless and odorless gas that is frequently a byproduct of combustion and which can be toxic to humans in high concentrations. In lower concentrations, however, recent research has suggested that carbon monoxide can have efficiency in bio protective and anti-inflammatory applications. In such situations, low concentrations of carbon monoxide may provide therapies for cardiovascular disease and cancer treatment, aid in organ preservation and in preventing acute and chronic rejection of transplanted organs, and may help in the treatment of acute lung and kidney injury or in cases of sepsis and shock. 
         [0003]    Medical grade carbon monoxide is available in pressurized cylinders from medical gas providers. Carbon monoxide is an odorless and colorless toxic and flammable gas. Pressurized cylinders are naturally heavy and difficult to manage. All pressurized cylinders possess inherent and unavoidable safety issues including the risk of asphyxiation and of explosive rupture of the tank. The toxic and flammable properties of carbon monoxide engenders additional risk as even a relatively slow, and difficult to detect, leak could have catastrophic consequences in an uncontrolled environment. These risks lead to a general desire to minimize the presence of pressurized cylinders, particularly of toxic and flammable gases, in many situations including public transport, all flying vehicles (airplanes and helicopters), and in-home care. This presents a significant problem in the use of carbon monoxide for many of the possible indications including organ preservation, at least to the extent that such organs are often transported in a helicopters and other aircraft on a rush basis. 
       SUMMARY OF THE INVENTION 
       [0004]    The present invention provides a carbon monoxide generator for medical use that operates substantially at standard atmospheric pressure. The generator produces carbon monoxide from a solid carbon source that is heated on demand to specific temperatures to generate a desired carbon monoxide stream. A control system provides both versatile delivery and monitoring of the stream for safety. Eliminating the need for a pressurized bottle of carbon monoxide allows the generator to be portable and generally allowable in many situations in which pressurized cylinders are problematic 
         [0005]    Specifically then, in one embodiment, the invention provides a medical carbon monoxide generator having a reaction chamber holding a purified carbon element and providing an ingress port and egress port. A pump communicates with the ingress port to provide a source of air passing into the reaction chamber and out of the egress port and within the reaction chamber an electrically controllable heater element heats the purified carbon element in the presence of the air to generate carbon monoxide gas from the reaction of the heated purified carbon with the air of the reaction chamber. A sensor system monitors carbon monoxide passing out the egress port and provides a signal to an electronic controller to control the electrically controllable heater in response thereto. The carbon monoxide is delivered to a respiratory delivery appliance through the egress port to provide carbon monoxide to a patient for respiration thereof. 
         [0006]    It is thus a feature of at least one embodiment of the invention to provide a convenient source of medical carbon monoxide eliminating the need for pressurized gas bottles. 
         [0007]    The purified carbon element may be at least USP grade pure carbon and may be of a limited volume to prevent generation of enough carbon monoxide to present either a toxicological or flammability risk in even a relatively small enclosure. 
         [0008]    It is thus a feature of at least one embodiment of the invention to provide medically pure carbon monoxide by employing a pure solid carbon precursor eliminating the need for substantial filtration or purification of the resulting gas flow. 
         [0009]    The sensor system may include a flow sensor measuring flow from the egress port and at least one carbon monoxide concentration sensor. 
         [0010]    It is thus a feature of at least one embodiment of the invention to provide close loop control for precise and accurate delivery of a potentially toxic gas. 
         [0011]    The electronic controller may control the electrically controllable heater element to provide a predetermined time varying change in carbon monoxide delivered to the respiratory delivery appliance. 
         [0012]    It is thus a feature of at least one embodiment of the invention to permit complex treatment schedules without the need for high pressure metering valves or the like or a venting of excess carbon monoxide. 
         [0013]    The electrically controllable heater element may be an ohmic resistor in thermal communication with the purified carbon element. 
         [0014]    It is thus a feature of at least one embodiment of the invention to provide a simple and low-cost method of generating carbon monoxide in controlled quantities. 
         [0015]    Alternatively, the electrically controllable heater element may be an optical radiation source focused on the purified carbon element, for example, a laser. 
         [0016]    It is thus a feature of at least one embodiment of the invention to provide for extremely high-speed temperature control possible with localized optical heating for precise carbon monoxide metering. 
         [0017]    The sensor system may include redundant carbon monoxide sensors and the electronic controller may use readings from the carbon monoxide sensors to deduce carbon monoxide concentration in the egress port. 
         [0018]    It is thus a feature of at least one embodiment of the invention to provide for a high degree of safety commensurate with possible toxicity and flammability of carbon monoxide. 
         [0019]    The electronic controller may record a time record of carbon monoxide delivery through the egress port. 
         [0020]    It is thus a feature of at least one embodiment of the invention to provide for precise record-keeping of the treatment for verification of the treatment plan and monitoring proper operation of the generator. 
         [0021]    The electronic controller may determine a total amount of carbon monoxide generated in the reaction chamber during operation of the medical carbon monoxide generator. 
         [0022]    It is thus a feature of at least one embodiment of the invention to permit treatment monitoring and control according to total carbon monoxide delivery. 
         [0023]    The reaction chamber may be in a cartridge releasably connectable to at least one of the fan and sensor system. 
         [0024]    It is thus a feature of at least one embodiment of the invention to provide a convenient method of replacing the carbon source for reliable and consistent behavior. 
         [0025]    It is thus a feature of at least one embodiment that the carbon source be of limited volume such that a “worst case scenario” cannot generate enough carbon monoxide to create a hazard in most environments. 
         [0026]    The cartridge may include a data communication element communicating with a remainder of the medical carbon monoxide generator system to identify the cartridge for controlling operation of the medical carbon monoxide generator. 
         [0027]    It is thus a feature of at least one embodiment of the invention to permit treatment protocols to be implemented by selection of the proper cartridge without the need for complex programming of the generator by the user. 
         [0028]    The electronic controller may control the electric heater according to the identification of the cartridge to provide at least one of a predetermined schedule of carbon monoxide delivery from the cartridge and a predetermined total production of carbon monoxide from the cartridge. 
         [0029]    It is thus a feature of at least one embodiment of the invention to ensure proper operation of the cartridge by monitoring its use and possible exhaustion. 
         [0030]    The data communication element may include a memory for storing usage data with respect to the reaction chamber. 
         [0031]    It is thus a feature of at least one embodiment of the invention to ensure spent cartridges are not reused regardless of the device with which they are associated. 
         [0032]    The medical carbon monoxide generator may further include a filter filtering the air received by the fan. 
         [0033]    It is thus a feature of at least one embodiment of the invention to provide a system that may work with atmospheric pressure air from the room or the like. 
         [0034]    One embodiment the invention may provide an organ transplant container system having an insulated container for receiving a transplant organ held in a storage liquid and a carbon monoxide generator attached to the insulated container and communicating with the storage liquid to provide a source of carbon monoxide to the storage liquid by heating a carbon source in atmospheric air. 
         [0035]    It is thus a feature of at least one embodiment of the invention to provide a system for preserving transplant organs during transportation compatible with high-speed air transport by helicopter or the like. 
         [0036]    The organ transplant container may include a scrubber element communicating with the storage liquid to vent gas from the storage liquid into the scrubber element and to scrub carbon monoxide from the vented gas. 
         [0037]    It is thus a feature of at least one embodiment of the invention to provide a system that may be used in a closed environment such as a cockpit without concern about excess carbon monoxide levels accumulating. 
         [0038]    These particular features and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0039]      FIG. 1  is a perspective view of a first embodiment of the carbon monoxide generator of the present invention as may be used with a respiratory appliance for delivery of carbon monoxide to a patient&#39;s respiratory tract; 
           [0040]      FIG. 2  is a block diagram of the generator of  FIG. 1  showing a cartridge based filament system in which an electrical filament is heated in the proximity of purified carbon to generate carbon monoxide in the control loop as controlled by sensors; 
           [0041]      FIG. 3  is a figure similar to that of  FIG. 2  showing an alternative cartridge design employing a laser for heating of the carbon material to produce carbon monoxide; 
           [0042]      FIG. 4  is a chart showing an example predetermined delivery schedule that may be implemented with the present invention together with monitoring data that may be logged and tracked for safety purposes; 
           [0043]      FIG. 5  is a cross-sectional view of an organ transplant container employing the medical carbon monoxide generator of the present invention providing both a source of carbon monoxide to an organ pouch and the scrubbing of excess carbon monoxide recovered from that pouch; and 
           [0044]      FIG. 6  is a block diagram of the generator of  FIG. 5  showing the various components thereof. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0045]    Referring now to  FIG. 1 , a medical carbon monoxide generator system  10 , may include a generator unit  12  communicating with a delivery appliance  14  such as a nasal cannula  16  or a face mask  18  of a type that may deliver gases to a patient&#39;s respiratory tract such as are generally understood in the art. 
         [0046]    The generator unit  12  may be a portable device having a housing  20  transported by use of the handle  21  or the like extending upward from the housing  20 . One sidewall  22  of the housing  20  may provide for a releasable tubing connector  24  for attachment to flexible tubing  26  of the delivery appliance  14  (the latter of which may be disposable) and in particular for communicating with flexible tubing  26  leading to either the nasal cannula  16  or the face mask  18 . 
         [0047]    A front wall  28  of the housing  20  may provide for a socket  30  that may receive a replaceable cartridge  32  as will be described in further detail below as held by mechanical snap elements or the like. An upper surface  33  of the housing  20  may provide for a user interface  35 , for example, including an LCD display and membrane or other type pushbuttons for user control of the medical carbon monoxide generator system  10 . Power for the generator system  10  may be provided, for example, by a line cord  36  or by internal battery systems, or both. 
         [0048]    Referring now also to  FIG. 2  the generator unit  12  may incorporate an electric fan  40  or similar blower or pump receiving air from an air filter  42 , for example a HEPA filter suitable for removing dust, mold and allergens from room air. The air filter  42  may further include activated carbon filtration or the like for odor and volatile reductions. Generally, the generator unit  12  may thus operate at standard atmospheric pressures with standard room air without the need for bottled or compressed gas. An outlet of the fan  40  may pass to a port  43  in the side of the socket  30  that may engage with the corresponding port  44  in one side of the cartridge  32  when the cartridge  32  is in place within the socket  30 . An air stream from the fan  40  through port  43  and port  44  may pass through the cartridge  32  to an exit port  46  in the cartridge  32  that connects to port  48  of the generator unit  12  when the cartridge  32  is in the socket  30 . One or both of the ports  44  and  46  operate in conjunction with the fan  40  to limit the oxygen in the cartridge  32  favoring the production of CO over CO 2 . 
         [0049]    A resistive filament  50  may be positioned in the air stream within the cartridge  32 , and may be coated with or proximate to a purified carbon material  52 , for example, having a USP medical grade meeting or exceeding requirements of the US Pharmacopeia. In one embodiment, this purified carbon material  52  may be elemental carbon or elemental carbon compounded with a binder material with low volatility and reactivity. The resistive filament  50  provides ohmic resistance to produce a desired and predetermined heating as a function of current introduced through the resistive filament  50  as may be controlled, for example, by a controlled current source of a type known in the art. Desirably, the resistive filament  50  is operated to provide temperatures of 600 C or more that favor CO production in a limited oxygen environment enforced by the operation of the fan  40 . 
         [0050]    Generally, the amount of purified carbon material  52  may be limited to approximately an amount needed for a particular medical procedure and the cartridges  32  may be identified to a particular medical procedure in this regard as will be discussed below. The resistive filament  50  may extend longitudinally along the axis of airflow within insulating walls  54  sized to allow airflow outside of the carbon material  52  within the walls  54 . Ends of the resistive filament  50  may communicate by releasable electrical connectors  56  to a controller  58  within the housing  20  of the generator unit  12 . A thermal sensor  57  may also be attached to the carbon material  52  to provide a reading of temperature of the carbon material  52  during heating and may communicate through similar connectors  56  with the controller  58 . 
         [0051]    As will be discussed in greater detail below, an electrical current produced and controlled by the controller  58  may heat the filament  50  to cause heating of the carbon material  52  to a degree as to generate carbon monoxide  53  in reaction with oxygen in the air passing over the filament. In this regard, the cartridge  32  provides a replaceable reaction chamber for generating carbon monoxide. 
         [0052]    Carbon monoxide gas exiting port  46  through port  48  may pass into a sensor chamber  60  holding redundant carbon monoxide sensors  62  and a flow sensor  64 . The sensor chamber  60  connects at an outlet to connector  24  communicating with tubing  26  of appliance  14 . Each of the carbon monoxide sensors  62  and flow sensor  64  may provide an input signal to the controller  58  and the controller  58  may provide an output signal controlling the fan  40 . In this way, the controller  58  may effect a closed loop control algorithm to control the concentration and total volume of carbon monoxide delivered into the appliance  14  in accordance with control signals received from the control interface  35  and may confirm operation on the same control interface  35 . A delivery concentration (mg CO/hour) may be entered into the control interface  35  or a concentration per body weight per hour and body weight entered into the control interface  35 . In this latter case, the entered value may be compared against a safe maximum of 3 mg of CO per kg of patient body weight per hour to provide an override or alarm, if necessary. 
         [0053]    In one embodiment, a cleanup filter  25  may be placed in series with the tubing  26  to the appliance  14 , providing a filtration of particulate matter and possibly a chemical filter to remove undesired combustion byproducts such as nitrogen oxides or volatile materials. 
         [0054]    For purposes of control, the controller  58  may generally include a computer processor  66  executing a stored program  68  held in memory  70 . The stored program  68  may provide, for example, one or more schedules of carbon monoxide delivery (as will be discussed below) noting a series of concentrations and durations over time as implemented by an internal clock of the processor  66 . The concentrations of the schedules may be implemented by control of the fan  40  and/or current to the filament  50  according to feedback signals received from the thermal sensor  57 , the carbon monoxide sensors  62  and the flow sensor  64  using standard feedback techniques, for example, by implementing one or more PID type algorithms, for example, operating temperature control loops and flow control loops. The scheduling process will be described in greater detail below. 
         [0055]    Referring now to  FIG. 3 , in an alternative embodiment of the cartridge  32 , the cartridge  32  may provide for an insulating support  80  within the cartridge  32  supporting a purified carbon sheet  82  (of similar carbon material  52  described above) opposite an optical port  84  along an axis  86  generally perpendicular to the flow of air within the cartridge  32  between ports  44  and  46 . A solid-state laser  87  positioned within the housing  20  may direct a beam of light along axis  86  to provide intense surface heating of the carbon sheet  82  producing a stream of carbon monoxide  53  to be controlled and conducted to the appliance  14  in the manner described above with respect to the filament  50 . In one embodiment, a mechanism to scan the laser beam with respect to the carbon sheet  82  may be provided to ensure a fresh surface. Accurate control of the amount of carbon monoxide  53  generated may be provided by the duty cycle modulation of the laser  87  as part of a control feedback loop in conjunction with the sensors and fan described above, however, in this case with the controller  58  controlling operation of the laser  87  as opposed to current flow through a filament. The laser desirably operates to rapidly elevate the carbon sheet  82  to above 600 C in a small area that will be oxygen limited. 
         [0056]    In both of the embodiments described with respect to  FIG. 2  and  FIG. 3 , the cartridge  32  may provide for an identifying tag  90  such as an RFID tag or barcode or the like that may be read by a reader  92  held within the housing  20  adjacent to the tag  90  when the cartridge  32  is within the socket  30 . This identifying tag  90  may be “read-only” (as with the example of a barcode) or may provide for limited writable data storage. In both cases, the tag  90  may uniquely identify the cartridge  32 , for example with a serial number, and may identify the cartridge  32  to a particular medical procedure, for example, appropriate for the amount of carbon material within the cartridge. This latter information may be used to guide the protocol implemented by the controller  58  by a connection between the reader  92  and the controller  58 . In one example, this information may provide a particular schedule for the delivery of carbon monoxide including concentrations with respect to time (e.g., CO mg/kg of patient weight/hr or CO mg/hr) or total delivery (e.g. 100 mg for a single use cartridge intended for use for an hour or 1-2 grams for a multi use cartridge). It will be understood that the necessary information for this purpose may be stored directly on the tag  90  or the tag may provide an index to a separate storage of this information in the memory  70  of the controller  58 . Use of the cartridge  32  to effectively program the generator unit  12 , eliminates the need for complex programming of the generator unit  12 , for example, through the user interface  35 . In the case where the tag  90  may receive and store data, stored data may be used to designate a rated life of the cartridge that remains and prevent inadvertent reuse of spent cartridges  32 . In one system, the remaining life of the cartridge  32  may be stored on the tag  90 . Alternatively the remaining life may be stored in memory  70  linked to a unique serial number of a cartridge  32  provided by tag  90 , and the remaining life may be checked prior to use of a cartridge  32 . 
         [0057]    In some embodiments, the controller  58  may communicate with the data recorder device  96 , for example a thermal printer, that may log measurements made by the carbon monoxide sensors  62  and flow sensor  64  to confirm a particular medical treatment. The data recorder device  96  may alternatively be a memory storage device such as a flash memory or other memory type and may communicate with the controller  58  either by direct electrical connection through a connector or wirelessly or the like as is understood in the art. 
         [0058]    In an alternative embodiment, the cartridges  32  may be designed to operate open loop using a known strength of the laser  87  or electrical current provided to the filament  50  and known restricted airflow control by the fan  42  to favor the production of CO over CO 2 . To the extent that this open loop preference can only be ensured for limited period of time (for example with a pristine carbon source receiving the laser beam  86  or operation with a relatively fresh coating of carbon material  52  on the filament  50 ) the cartridge  32  may be programmed to require replacement by the operator after this period of time has been exhausted before the carbon source is exhausted. 
         [0059]    Referring now to  FIG. 4 , the generator unit  12  may operate to implement a stored protocol  98  providing a schedule of carbon monoxide delivery (for example concentration and/or flow rate delivered to the appliance  14 ) as a function to time. For example, as depicted, an initial high concentration amount may be delivered followed by a lower steady state concentration amount ultimately terminating at a predetermined time. The depicted schedule assumes a constant flow rate; however, this is not required. Delivery may begin when the generator unit  12  is activated by a user through the user interface  35  and may proceed as monitored by the sensors  62  and  74 . In one embodiment, readings from the sensors  62  are compared and averaged so long as the difference between the carbon monoxide sensors  62  is less than a predetermined threshold amount. A difference beyond this threshold amount, such as may indicate a failure of a carbon monoxide sensor  62 , may stop operation of the generator of unit  12  in production of carbon monoxide and provide an alarm to the user through user interface  35 . In such cases, fan  40  may remain on to provide a purging of excess carbon monoxide from the appliance  14 . Audible or visual alarms may then be provided on the user interface  35  and alarm signals may be transmitted, for example, wirelessly to remote monitoring devices. 
         [0060]    The readings of the carbon monoxide sensors  62  and flow sensor  64  may be tracked and stored to provide actual delivery schedule  99  which will generally conform closely to the stored protocol  98  or the close loop control affected by the controller  58 . Deviation between these two curves of actual delivery schedule  99  and a stored protocol  98  may be used to provide for an alarm condition indicating possible equipment malfunction, again through user interface  35 , and again may stop generation of carbon monoxide. The information of delivery schedule  99  may be provided to the data recorder device  96  as discussed above or recording. 
         [0061]    Total carbon monoxide delivery  100  may also be tracked by calculating the integral of the actual delivery schedule  99  weighted by a flow rate from flow sensor  64 . This total carbon monoxide delivery  100  may be used to determine the lifetime of the cartridge  32 . Alternatively, a simply lapsed time of use of the cartridge  32  may be employed. Either the actual delivery schedule  99  or total carbon monoxide delivery  100  may be compared against an alarm limit  102  to provide an indication of possible problems with the delivery procedure that may trigger a shutdown of the generator unit  12  and suitable alarms. 
         [0062]    Referring now to  FIGS. 5 and 6 , in an alternate embodiment, the generator unit  12  part of an organ carrier system  120  may provide, for example, an insulated watertight container  122  having a base wall  124  and upstanding sidewalls  126  constructed of expanded polymer foam within a plastic shell. An insulated lid  128  may attach at the top of the upstanding sidewalls  126  to provide an enclosed insulated volume that may receive a transplant organ  130 , for example, sealed in a plastic pouch  132  together with a preservation fluid  140  of a type known in the art and typically selected for the type of organ. The generator unit  12  may attach to one upstanding sidewall  126  and connector  24  of the generator unit  12  may attach to a carbon monoxide delivery line  134  threaded out of an opening in the sidewall  126  from the pouch  132 . At the pouch  132 , the delivery line  134  may be welded to a pass-through flange  136  of the pouch  132  to provide a conduit into the pouch  132  leading to a diffusion element  138  providing for a of bubbling carbon monoxide  53  through a transplant organ preservation fluid  140  during transport of the organ  130 . A monoxide return line  142  may attach to a similar pass-through flange  144  positioned near the top of the pouch  132  and attached within the pouch  132  to a liquid filter  146  resisting in flow of liquid to return excess gaseous carbon monoxide to the generator unit  12  at a connector  150  on cartridge  32 . 
         [0063]    Referring specifically to  FIG. 6 , cartridge  32 , in this embodiment, may incorporate the intake filter  42  described above. The intake filter  42  provides input air through a port interface  152  between the cartridge  32  and the housing  20  as drawn by the fan  40 . Fan  40 , in turn, may return this air to the cartridge  32  through a second port interface  154  to be received within a reaction chamber of the cartridge  32  being of the designs described above with respect to  FIGS. 2  or  FIGS. 3 . The reaction chamber outflow may pass through a third port interface  156  back into the housing  20  to be received by the sensor chamber  60  described as above, ultimately to be communicated to connector  24  and from there to the respiratory appliance  14  (not shown). 
         [0064]    In this embodiment, the cartridge  32  may also include a scrubber element  160  receiving excess carbon monoxide through connector  150  from return line  142  to reduce carbon monoxide discharged into the atmosphere. In this design, the consumable filter  42  and scrubber element  160  may thus be replaced with the cartridge  32  to ensure their freshness. 
         [0065]    In order to promote portability in the movement of organ carrier system  120  for transporting the organ  130 , a battery pack  162  may be included within the housing  20  which provides for short-term energy storage necessary for organ transportation. 
         [0066]    It will be generally appreciated that the fan  40  may be located either upstream or downstream from the reaction chamber provided by the cartridge  32 . Generally, the fan is not limited to propeller type designs but may be any kind of air pump including blowers, bellows, ionic pumps and the like. Other sources of heat beyond the laser and filament are also contemplated including non-coherent light sources such as flash tubes or LED arrays, or microwave and radiofrequency energy, and the like. 
         [0067]    Certain terminology is used herein for purposes of reference only, and thus is not intended to be limiting. For example, terms such as “upper”, “lower”, “above”, and “below” refer to directions in the drawings to which reference is made. Terms such as “front”, “back”, “rear”, “bottom” and “side”, describe the orientation of portions of the component within a consistent but arbitrary frame of reference which is made clear by reference to the text and the associated drawings describing the component under discussion. Such terminology may include the words specifically mentioned above, derivatives thereof, and words of similar import. Similarly, the terms “first”, “second” and other such numerical terms referring to structures do not imply a sequence or order unless clearly indicated by the context. 
         [0068]    When introducing elements or features of the present disclosure and the exemplary embodiments, the articles “a”, “an”, “the” and “said” are intended to mean that there are one or more of such elements or features. The terms “comprising”, “including” and “having” are intended to be inclusive and mean that there may be additional elements or features other than those specifically noted. It is further to be understood that the method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed. 
         [0069]    References to a processor, can be understood to include one or more microprocessors that can communicate in a stand-alone and/or a distributed environment(s), and can thus be configured to communicate via wired or wireless communications with other processors, where such one or more processor can be configured to operate on one or more processor-controlled devices that can be similar or different devices. Furthermore, references to memory, unless otherwise specified, can include one or more processor-readable and accessible memory elements and/or components that can be internal to the processor-controlled device, external to the processor-controlled device, and can be accessed via a wired or wireless network. 
         [0070]    It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein and the claims should be understood to include modified forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims. All of the publications described herein, including patents and non-patent publications are hereby incorporated herein by reference in their entireties.