Patent Publication Number: US-9421357-B2

Title: Systems, apparatuses, and methods for providing non-transcranial electrotherapy

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     This application is a U.S. national stage application filed under 35 U.S.C. §371 of International Patent Application PCT/US2009/047952, accorded an international filing date of Jun. 19, 2009, which claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 61/074,530, filed Jun. 20, 2008; both of which are incorporated herein by reference in their entirety. 
    
    
     BACKGROUND 
     1. Technical Field 
     This disclosure generally relates to the field of electrotherapy and, more particularly, to system, devices, and methods for providing non-transcranial electrotherapy to a biological subject. 
     2. Description of the Related Art 
     The term temporomandibular joint (TMJ) disorder, sometimes referred to as temporomandibular disorder, TMJ syndrome, or myofacial pain dysfunction syndrome, encompasses a whole spectrum of conditions and diseases associated with pain and/or dysfunction in the jaw joint and the muscles that control jaw movement. These conditions and diseases include injured or damaged tissues affecting the function of the TMJ, discomfort or pain in the muscles that control jaw function, displacement of a TMJ disc, a dislocated jaw, an injury to the condyle, derangements of the articulating elements in the TMJ, degenerative or inflammatory joint disorders, progressive degenerative and very painful breakdown of TMJ cartilage, tenderness and pain of the TMJ, and pivoting of the jaw. It has been estimated that about 8 to 15 percent of women and about 3 to 10 percent of men experience pain associated with TMJ disorder. There are no known cures for TMJ disorder. 
     Conventional conservative treatments for TMJ disorder include eating soft foods, applying ice packs, avoiding extreme jaw movements, learning techniques for relaxing and reducing stress, as well as short-term use of over-the-counter pain medicines, nonsteroidal anti-inflammatory drugs, muscle relaxants, or anti-depressants. Conventional conservative treatments often provide only temporary pain relief. 
     Conventional irreversible TMJ disorder treatments include surgery, orthodontics to change the bite, crown and bridge work to balance the bite, grinding down teeth to bring the bite into balance, and repositioning splints (e.g., orthotics), which permanently alter the bite. Surgical treatments, such as the replacement of jaw joints with artificial implants, are often irreversible and in some cases may cause severe pain and permanent jaw damage. For example, some artificial implants may fail to function properly or may break apart in the jaw over time. 
     Bone and other tissues such as cartilage respond to electrical signals in a physiologically useful manner. For example, electric and electromagnetic fields regulate extra-cellular matrix synthesis and stimulate repair of fractures and nonunions. Other less well-known outcomes attributed to bioelectrical stimulation are positive bone density changes (Tabrah, 1990), and prevention of osteoporosis (Chang, 2003). A recent report offered adjunctive evidence that stimulation with pulsed electromagnetic field (PEMF) significantly accelerates bone formed during distraction osteogenesis (Fredericks, 2003). 
     A disadvantage of most electrotherapeutic devices now available, however, is that they often rely on direct implantation of electrodes (or entire electronic packages), or they rely on inductive coupling through the skin using coils which generate time-varying magnetic fields, thereby inducing weak eddy currents within body tissues which inefficiently provide the signal to tissues. Consequently, in addition to bulky coils these systems require relatively large signal generators and battery packs. The need for surgery and biocompatible materials in the one case, and excessive circuit complexity and input power in the other, has kept the price of most such apparatus relatively high, and has also restricted the application of such devices to highly trained personnel. Further, it is noted that TENS (Class II) medical devices are contra-indicated for use on the head. 
     Accordingly, there remains a need for a versatile, cost-effective system that can be used to provide bioelectric stimulation in a wide range of applications, including healing acceleration and pain relief. There is also a need in the art for a bioelectric stimulation system that is power efficient, capable of being powered by safe, low-voltage batteries, and can reduce the likelihood of a shock hazard. 
     The present disclosure is directed to overcoming one or more of the shortcomings set forth above, and/or providing further related advantages. 
     BRIEF SUMMARY 
     In one aspect, the present disclosure is directed to an apparatus to provide a non-transcranial electrical stimulus to a biological subject. The term “non-transcranial electrical stimulation” generally refers to the non-evasive induction, delivery, and/or generation of an electrical current without substantially inducing, delivering, and/or generating, an electrical current across a region of the brain. Conversely, the term “transcranial electrical stimulation” or “cerebral electrical stimulation” generally refers to the non-evasive induction, delivery, and/or generation, of an electrical current across a region of the brain. Transcranial electrical stimulation has been used to, for example, directly stimulate the brain with low-level direct current, or to activate the motor cortex thorough the skull. 
     In some embodiments, the apparatus includes a support structure, at least one waveform generator, and at least a first electrode and a second electrode. The support structure can be sized and dimensioned to be worn on a head of the biological subject. 
     The at least one waveform generator can be carried by the support structure and configured to generate an electrical waveform. In some embodiments, the at least one waveform generator is configured to generate one or more waveforms selected from continuous waveforms, pulse waveforms, single-sine waveforms, multi-sine waveforms, frequency-swept sine waveforms, step waveforms, square waveforms, triangular waveforms, saw-tooth waveforms, arbitrary waveforms, generated waveforms, chirp waveforms, non-sinusoidal waveforms, ramp waveforms, regular or irregular waveforms, or combinations thereof, including single and multi-frequency formed waves. 
     The at least first and second electrodes are carried by the support structure and are electrically coupled to the waveform generator. The improvement includes the spacing of the first and second electrodes such that the first electrode is sufficiently spaced apart from the second electrode so as to generate a first non-transcranial therapeutic electric stimulus operable to flow through a region within the biological subject in response to a generated electrical waveform from the at least one waveform generator. 
     In some embodiments, at least one of the first electrode or second electrode may include a first electrically conductive contacting surface. The first electrically conductive contacting surface is adapted to contact a surface of the biological subject and to provide the first non-transcranial therapeutic electric stimulus to the biological subject. 
     In another aspect, the present disclosure is directed to a method for providing a non-transcranial electrical stimulus to a biological subject. The method employs a wearable electrotherapy system adapted to be worn on a head of the biological subject, the wearable electrotherapy system is configured to retain at least a first plurality of electrodes proximate to at least one temporomandibular joint of the biological subject, when the wearable electrotherapy system is worn. The improvement includes spacing the first plurality of electrodes sufficiently spaced apart so as to generate an electric field within the biological subject in response to a first electric current, without generating an appreciable electric field across a region of the brain of the biological subject. 
     In some embodiments, the method may further include applying a sufficient amount of an electrical current to the first plurality of electrodes so as to generate a non-transcranial electric field in a region that encompasses at least one temporomandibular joint of the biological subject. 
     In yet another aspect, the present disclosure is directed to a method for treating a condition associated with a temporomandibular joint disorder. The improvement includes delivering a first non-transcranial electric current from a first electrode assembly located proximate to a first temporomandibular joint of a biological subject. The method may further include delivering a second non-transcranial electric current from a second electrode assembly located proximate to a second temporomandibular joint of the biological subject. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
       In the drawings, identical reference numbers identify similar elements or acts. The sizes and relative positions of elements in the drawings are not necessarily drawn to scale. For example, the shapes of various elements and angles are not drawn to scale, and some of these elements are arbitrarily enlarged and positioned to improve drawing legibility. Further, the particular shapes of the elements, as drawn, are not intended to convey any information regarding the actual shape of the particular elements, and have been solely selected for ease of recognition in the drawings. 
         FIG. 1  is a side view of a mandible, temporal bone, and temporomandibular joint of biological subject according to one illustrated embodiment. 
         FIG. 2  is an exploded cross-sectional view of a portion of the temporomandibular joint of  FIG. 1  according to one illustrated embodiment. 
         FIG. 3  is a front view of user wearing an apparatus, in the form of a wearable electrotherapy system adapted to be worn on a head of a user, for providing a non-transcranial electrical stimulus to the user, according to one illustrated embodiment. 
         FIG. 4  is a side view of user wearing an apparatus, in the form of a headset including electrodes configured to surround an ear, for providing a non-transcranial electrical stimulus to the user according to another illustrated embodiment. 
         FIG. 5  is a schematic view of a waveform used in stimulating bone fracture healing according to one illustrated embodiment. 
         FIG. 6  is a schematic view of an effective electrical signal waveform in pulse mode based on an inductive coil waveform, which is adapted for skin application for promoting mineralization of bone, according to one illustrated embodiment. 
         FIG. 7  provides an illustration showing an effective electrical stimulus waveform in continuous mode for promoting mineralization of bone, according to one illustrated embodiment. 
         FIG. 8  is a schematic view of an effective electrical stimulus waveform in pulse mode for promoting proliferation of bone cells, according to one illustrated embodiment. 
         FIG. 9  is a schematic view of an effective electrical stimulus waveform in continuous mode for promoting proliferation of bone cells, according to one illustrated embodiment. 
         FIG. 10  is a schematic diagram of a system for providing a non-transcranial electrical stimulus to a biological subject, according to one illustrated embodiment. 
         FIG. 11  is a side view of a user wearing an apparatus, in the form of a headset including electrodes configured to surround an ear, for providing a non-transcranial electrical stimulus to the user, according to another illustrated embodiment. 
         FIG. 12  is side view of an electric field distribution in a region encompassing a temporomandibular joint of the biological subject, according to one illustrated embodiment. 
         FIG. 13  is a side view of a user wearing an apparatus, in the form of a headset including electrodes configured to surround an ear, for providing a non-transcranial electrical stimulus to the user, according to another illustrated embodiment. 
         FIG. 14  is side view of an electric field distribution in a region encompassing a temporomandibular joint of a biological subject, according to another illustrated embodiment. 
         FIG. 15  is a side view depiction of acupuncture points associated with the left side of the head of a biological subject, according to one illustrated embodiment. 
         FIG. 16  is a flow diagram of a method for treating a condition associated with a temporomandibular joint disorder, according to one illustrated embodiment. 
         FIG. 17  is a flow diagram of a method for providing a non-transcranial electrical stimulus to a biological subject, according to one illustrated embodiment. 
     
    
    
     DETAILED DESCRIPTION 
     In the following description, certain specific details are included to provide a thorough understanding of various disclosed embodiments. One skilled in the relevant art, however, will recognize that embodiments may be practiced without one or more of these specific details, or with other methods, components, materials, etc. In other instances, well-known structures associated with electrically powered devices including but not limited to voltage and/or current regulators have not been shown or described in detail to avoid unnecessarily obscuring descriptions of the embodiments. 
     Unless the context requires otherwise, throughout the specification and claims which follow, the word “comprise” and variations thereof, such as, “comprises” and “comprising” are to be construed in an open, inclusive sense, that is as “including, but not limited to.” 
     Reference throughout this specification to “one embodiment,” or “an embodiment,” or “in another embodiment,” or “in some embodiments,” means that a particular referent feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, the appearance of the phrases “in one embodiment,” or “in an embodiment,” or “in another embodiment,” or “in some embodiments,” in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. 
     It should be noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the content clearly dictates otherwise. Thus, for example, reference to an apparatus to provide a non-transcranial electrical stimulus to a biological subject including a “support structure” includes a single support structure, or two or more support structures. It should also be noted that the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise. 
     As shown in  FIGS. 1 and 2 , the temporomandibular joint  10  is the ball-and-socket joint located on each side of the head where the lower jawbone (mandible)  12  joins the temporal bone  14  of the skull. The normal human skull has two temporomandibular joints, one on the right and one on the left. 
     The lower jawbone  12  has rounded ends (condyles)  18  that glide in and out of the joint socket  20  during talking, chewing, or yawning. As show in  FIG. 2 , the surfaces of the condyle  18  and the socket of the temporal bone  14  are covered with cartilage  22  and separated by a small articular disk  24  (also known as the meniscus), which absorbs shock and keeps the movement smooth. The articular disk  24  divides the joint cavity into two small spaces and provides the gliding surface for the condyle  18 , resulting in smooth joint movement. Muscles enable opening and closing of the mouth, and stabilize the temporomandibular joint  10 . 
     As previously noted, the term temporomandibular joint disorder encompasses a whole spectrum of conditions and diseases associated with pain and/or dysfunction in the jaw joint and the muscles that control jaw movement. In some embodiments, the problem of reliving pain or stimulating healing of a condition associated with temporomandibular joint disorder is solved by applying an electric stimulus (e.g., low energy waveforms (such as those provided by MedRelief®), transcutaneous electrical nerve stimulation (TENS), interferential current therapy (IFC) stimulus, and the like, or combinations thereof) to a region including a temporomandibular joint  10 . In some embodiments, the problem of relieving pain or stimulating healing of a condition associated with temporomandibular joint disorder is solved by the delivery of a bioelectrical stimulus optimized to correspond to natural body signals resulting in accelerated and more permanent healing. In some embodiments, one or more of the disclosed electrical stimuli described herein uniquely conforms to natural signals and consequently tissues subjected to electrostimulation undergo less physiological stress when compared to electrostimulation from previous devices. 
       FIG. 3  shows an exemplary apparatus  50  for providing a non-transcranial electrical stimulus to a biological subject. The apparatus  50  includes a support structure  52 , at least one waveform generator  54 , and at least a first electrode  56  and a second electrode  58 . In some embodiments, the apparatus  50  may further include at least a third electrode  60  and a fourth electrode  62 . 
     The support structure  52  can be sized and dimensioned to be worn on a head of a user. Any suitable structure may be used as the support structure  52 . Examples of the support structure  52  include headsets, headbands, fastening clips (sized and dimensioned to be worn on or over an ear), ear-buds, ear-cups, and the like. In some embodiments, the support structure  52  is constructed and arranged to transfer a portion of a force applied by the support structure  52  to a temporal region  66  of the user so as to maintain the first and second electrodes  56 ,  58  relatively stationary with respect to a region proximate an ear and/or a temporomandibular joint  10  of a user. The support structure  52  can include a fastening clip configured to surround an ear of the biological subject and maintain the first and second electrodes  56 ,  58  proximate an ear and/or a temporomandibular joint  10  of a user. In some embodiments, the support structure  52  is constructed and arranged to quickly and conveniently affix one or more of the electrodes around an ear and/or proximate the temporomandibular joint  10  of a user. The support structure  52  may include one or more fitting assemblies  68  for adjusting the position of the one or more electrodes carried by the support structure  52 . In some embodiments, the fitting assemblies  68  permit symmetrically or asymmetrically adjustment of the length of the support structure  52 . 
     In some embodiments, the apparatus  50  may include one or more over-the-ear structures  70 , such as, for examples headphones, earphones, noise cancelling headphones, earcups, sound-attenuating earcups, sound-blocking cups, cup-shaped shells, and the like coupled to the support structure  52 . The over-the-ear structures  70  may further include, for example, a component that covers a portion or the entire ear, or a component that simply surrounds an ear of the user. In some embodiments, one or more of the electrodes may be incorporate or connected to the over-the-ear structures  70 . In some embodiments, part or most of the skin contacting surfaces of the over-the-ear structures  70  may be electrically conductive and serve as electrodes. In some embodiments, some or all of the electrodes, stimulation circuitry, and power is contained within the over-the-ear structures  70 . 
     In some embodiments, the apparatus  50  may include one or more earphone units  72 , with each earphone unit  72  having a transducer  76  operable to output an audio signal. In some embodiments, the apparatus  50  may include an ambient noise cancelling apparatus  74  coupled to a noise cancelling-circuit  77 . In some embodiments, the ambient noise cancelling apparatus  74  is operable to provide a noise cancelling signal to the transducer  76  to provide active acoustic noise cancellation when the apparatus  50  is worn by the biological subject. 
     In some embodiments, electrically isolated left and right channels are provided. Alternatively, a wireless audio feature might be provided with, for example, an FM tuner built in and powered by the same battery as the stimulator. An inexpensive FM modulator could then act as bridge between the headphones and a non-broadcast source. 
     In some other embodiments, the first and the second electrodes  56 ,  58  are sufficiently spaced apart so as to generate a localized electric field in tissue associated with a temporomandibular joint  10  of the biological subject such that at least 10% of the localized electric field passes through the temporomandibular joint  10 . In some embodiments, the first and the second electrodes  56 ,  58  are spaced apart by the presence of a suitable electrically insulation material. 
     In some other embodiments, the first electrode  56  is spatially positioned in the range from about twice the length of a temporomandibular joint  10  to about four times the length of temporomandibular joint  10  away from the second electrode  58 . In some embodiments, the apparatus  50  may further comprise a third electrode  60  and a fourth electrode  62  carried by the support structure and electrically coupled to the waveform generator, the third electrode  60  being sufficiently spaced apart from the fourth electrode  62  so as to generate a second non-transcranial therapeutic electric stimulus operable to flow through a region within the biological subject in response to a generated electrical waveform from the at least one waveform generator  54 . 
     In some embodiments, the apparatus  50  includes a first coupling member between the support structure and the first and the second electrodes  56 ,  58 , and a second coupling member between the support structure  52  and the third and the fourth electrodes  60 ,  62 , the first and second coupling members configured to releasably hold the first and the second electrodes  56 ,  58 , and the third and the fourth electrodes  60 ,  62 , respectively. In some embodiments, the apparatus  50  is operable to allow operation of the first, the second, the third, and the fourth electrodes  56 ,  58 ,  60 ,  62  individually or jointly. In some embodiments, the apparatus  50  is operable to allow concurrent or sequential operation of the first and the second electrodes  56 ,  58 , and the third and a fourth electrodes  60 ,  62 . 
     The at least one waveform generator  54  is carried by the support structure  52  and configured to generate an electrical waveform. In some embodiments, the waveform generator  54  may comprise at least one of a processor, a wave-shaping circuit, a digital signal processor based waveform generator, and the like. The waveform generator  54  may be coupled (for example, electrically, wirelessly, and/or inductively coupled or connected) to a one or more of the electrodes and operable to generated an electrical waveform when activated. 
     In some embodiments, the least one waveform generator  54  is configured to generate one or more waveforms selected from single-sine waveforms, multi-sine waveforms, frequency-swept sine waveforms, step waveforms, pulse waveforms, square waveforms, triangular waveforms, saw-tooth waveforms, arbitrary waveforms, generated waveforms, chirp waveforms, non-sinusoidal waveforms, ramp waveforms, or combinations thereof, including single and multi-frequency formed waves. In some embodiments, the least one waveform generator  54  is operable to generate low energy waveforms such as those provided by MedRelief®), transcutaneous electrical nerve stimulation (TENS), interferential current therapy (IFC) stimulus, and the like, or combinations thereof. 
     In some embodiments, the generated waveform comprises intermittent bursts of quasi-rectangular waves (waves of generally rectangular shape but typically somewhat distorted), based on a plurality of relatively long primary timing intervals T 1 , T 2  and so forth, forming in succession a primary repeating cycle; a plurality of shorter secondary timing intervals t 1 , t 2  and so forth, into which at least one of said primary intervals is divided, and forming in succession a secondary repeating cycle which continues throughout the length of that primary interval, while at least one other of said primary intervals is not so divided; and a plurality of constant voltage or current levels L 1 , L 2  and so forth, one of which is selected during each primary timing interval or, if that interval is divided, during each secondary timing interval within it. The series of constant current or voltage levels which are selected during successive timing intervals comprises the waveform. The average magnitude of these levels selected during a given primary interval determines the signal amplitude within that interval, and the signal amplitudes within all primary intervals, taken in succession, comprise the envelope of the waveform. 
     In some embodiments, the waveforms generated by the waveform generator  54  can be used to provide electrical stimuli and waveforms that enable specific actions on biological tissues. Osteochondral tissues are shown herein to respond differently to markedly different frequencies and waveforms. 
     In some embodiments, the waveforms generated by the waveform generator  54  comprises alternating rectangular or quasirectangular pulses having opposite polarities and unequal lengths, thereby forming rectangular, asymmetric pulse trains. Pulses of specific lengths have been theorized to activate specific cell biochemical mechanisms, especially the binding of calcium or other small, mobile, charged species to receptors on the cell membrane, or their (usually slower) unbinding. The portions of such a train having opposite polarities may balance to yield substantially a net zero charge, and the train may be either continuous or divided into pulse bursts separated by intervals of substantially zero signal. Stimuli administered in pulse-burst mode have similar actions to those administered as continuous trains, but their actions may differ in detail due to the ability (theoretically) of charged species to unbind from receptors during the zero-signal periods, and required administration schedules may also differ. 
     In some embodiments, a PEMF (pulsed electromagnetic field) is administered via electromagnetic coils. In some embodiments a PEF (pulsed electric field) is administered via electrochemical means (i.e., skin-attached capacitively coupled electrodes). Both PEMF and PEF may employ a repetition of pulse train, and/or individual pulses. In some embodiments, the burst width (duration of the signal) may vary; however, the underlying signal itself remains the same for both PEMF and PEF. In certain alternative embodiments, the pulse train may contain an added signal for no net charge. 
       FIG. 5  shows a schematic view of a base waveform  220  effective for stimulating bone and cartilage tissue, where a line  222  represents the waveform in continuous mode, and a line  224  represents the same waveform on a longer time scale in pulse-burst mode, levels  226  and  228  represent two different characteristic values of voltage or current, and intervals  230 ,  232 ,  234 , and  236  represent the timing between specific transitions. Levels  226  and  228  are usually selected so that, when averaged over a full cycle of the waveform, there is no net direct-current (DC) component although levels  226  and  228  may be selected to result in a net positive or net negative DC component if desired. In real-world applications, waveform such as  220  is typically modified in that all voltages or currents decay exponentially toward some intermediate level between levels  226  and  228 , with a decay time constant preferably longer than interval  234 . The result is represented by a line  238 . The waveforms described herein generally have two signal components: a longer component shown as interval  230  and a shorter component shown as interval  232  relative to each other. 
     Variation in the short and long signal component lengths confers specific effects of a stimulated tissue. In some embodiments, the pulse lengths of interest may be defined as follows, in order of increasing length. Length α: between 5 and 75 μsec in duration, in some embodiments between 10 and 50 μsec in duration, in some embodiments between 20 and 35 μsec in duration, and in some embodiments between about 28 μsec in duration. Length β: between 20 and 100 μsec in duration, preferably between 40 and 80 μsec in duration, in some embodiments between 50 and 70 μsec in duration, and in some embodiments about 60 μsec in duration. Length γ: between 100 and 1000 μsec in duration, in some embodiments between 150 and 800 μsec in duration, in some embodiments between 180 and 500 μsec in duration, and in some embodiments about 200 μsec in duration. Length δ: in excess of 1 millisecond in duration, in some embodiments between 5 and 100 msec in duration, in some embodiments between 10 and 20 msec in duration, and in some embodiments about 13 msec in duration. 
     In some embodiments, the electrical signal has a shorter component of length α and a longer component of length β: thus having, with the most preferable pulse lengths of each type (28 μsec and 60 μsec respectively), a frequency of about 11.4 KHz. Signals comprised of pulses alternately of length α and length β are referred to herein as “type A” signals and their waveforms as “type A” waveforms. An example a “type-A signal administered as a continuous pulse train is shown in  FIG. 6 . These signals may be useful for promoting the proliferation of a tissue sample or culture for a variety of biological or therapeutic applications. 
     In pulse-burst mode, “type A” waveforms would be turned on in bursts  240  of about 0.5 to 500 msec, in some embodiments about 50 msec, with bursts  240  repeated at 0.1-10 Hz or preferably about 1 Hz. An example of this type of waveform is shown in  FIG. 7 . 
     In some embodiments, the electrical signal has a shorter component of length α but a longer component of length γ: thus having, in some embodiments, pulse lengths of each type (28 μsec and 200 μsec respectively), a frequency of about 4.4 KHz. Signals comprised of pulses alternately of length α and length γ are referred to herein as “type B” signals and their waveforms as “type B” waveforms. Such waveforms were previously described in U.S. patent application Ser. No. 10/875,801 (publication No. 2004/0267333). An example of a “type-B” signal administered as a continuous pulse train is shown in  FIG. 8 . These signals are useful in pain relief and in promoting bone healing, and also stimulate the development of cancellous-bone-like structures in osteoblast cultures in vitro, with applications to the field of surgical bone repair and grafting materials. 
     In pulse-burst mode, “type B” waveforms are turned on in bursts of about 1 to 50 msec, in some embodiments about 5 msec, with bursts repeated at 5-100 Hz or in some embodiments about 15 Hz. An example of this type of waveform is shown in  FIG. 9 . This waveform is similar in shape and amplitude to effective currents delivered by typical inductive (coil) electromagnetic devices that are commonly used in non-union bone stimulation products e.g. EBI MEDICA, INC® (Parsippany, N.J.) and ORTHOFIX, INC® (McKinney, Tex.). 
     In some embodiments, the electrical signal has a shorter component of length β but a longer component of length γ: thus having, with the most preferable pulse lengths of each type (60 μsec and 200 μsec respectively) a frequency of about 3.8 KHz. Signals comprised of pulses alternately of length β and length γ are referred to herein as “type C” signals and their waveforms as “type C” waveforms. These signals are useful in promoting bone regeneration, maturation, and calcification. 
     In pulse-burst mode, “type C” waveforms are turned on in bursts of about 1 to 50 msec, in some embodiments about 5 msec, with bursts repeated at 5-100 Hz or in some embodiments about 15 Hz, much the same as “type B.” This waveform is similar in shape and amplitude to effective currents delivered by other typical inductive (coil) electromagnetic devices commonly used in non-union bone stimulation products, e.g. the ORTHOFIX, INC® (McKinney, Tex.) PhysioStim Lite®, which is designed to promote healing of spinal fusions. 
     In some embodiments, the electrical signal has a shorter component of length γ and a longer component of length δ: thus having, in some embodiments, pulse lengths of each type (200 μsec and 13 msec respectively) a frequency of about 75 Hz. Signals comprised of pulses alternately of length γ and length δ are referred to herein as “type D” signals and their waveforms as “type D” waveforms. These signals are useful especially in promoting cartilage healing and bone calcification, and in treating or reversing osteoporosis and osteoarthritis. While broadly similar to that delivered through electrodes by the BIONICARE MEDICAL TECHNOLOGIES INC® BIO-1000™, as shown in FIG. 3 of U.S. Pat. No. 5,273,033, the “type D” signal differs substantially in wave shape (it is rectangular rather than exponential) and in the fact that it is preferably charge-balanced. 
     In pulse-burst mode, “type D” waveforms are turned on in bursts of at least 100 msec, in some embodiments about 1 second, with bursts repeated at intervals of one second or more. 
     The signal intensity may also vary; indeed, more powerful signals often give no more benefit than weaker ones, and sometimes less. For a typical signal (such as the signal of  FIG. 5 ), a peak effectiveness typically falls somewhere between one and ten microamperes per square centimeter (μA/cm 2 ), and a crossover point at about a hundred times this value. Beyond this point, the signal may slow healing or may itself cause further injury. 
     Of particular relevance to the present methods are electrical signals or waveforms that run in continuous mode instead of burst mode. (For example  FIG. 6 or 8 ). Continuously run signals have effects similar to those of pulse-burst signals, but may require different delivery regimes to achieve similar results. 
     In some embodiments, the applied average current densities of the disclosed waveforms range from about 0.1 to about 1000 microamperes per square centimeter. In some embodiments, the applied average current densities range from about 0.3 to about 300 microamperes per square centimeter. In some embodiments, the applied average current densities range from about 1 and 100 microamperes per square centimeter, and in some embodiments about 10 microamperes per square centimeter, resulting in voltage gradients ranging between 0.01 and 1000, 0.03 and 300, 0.1 and 100, and 1 and 10 microamperes per centimeter, respectively, in typical body tissues. The individual nearly-square wave signal is asynchronous with a long positive segment and a short negative segment or vice versa. The positive and negative portions balance to yield a zero net charge or optionally may be charge imbalanced with an equalizing pulse at the end of the pulse to provide zero net charge balance over the waveform as a whole. These waveforms delivered by skin electrodes use continuous rectangular or approximately rectangular rather than sinusoidal or strongly exponentially decaying waveforms. Other waveforms useful in conjunction of the disclosed methods are disclosed in, for example, published U.S. patent application Ser. No. 10/875,801 (publication No. 2004/0267333). 
     In some embodiment, one or more of the disclosed electrical stimuli may be administered to cells, biological tissues, or individuals in need of treatment for intermittent treatment intervals or continuously throughout the day. A treatment interval is defined herein as a time interval that a waveform is administered in pulse or continuous mode. Treatment intervals may be about 10 minutes to about 4 hours in duration. In some embodiments, the treatment intervals may be from about 30 minutes to about 2.5 hours in duration. In some embodiments, the treatment intervals are about 1 hour in duration. Treatment intervals may occur between about 1 and 100 times per day. The duration and frequency of treatment intervals may be adjusted for each case to obtain an effective amount of electrical stimulation to promote cell proliferation, cell differentiation, bone growth, development, pain relief, repair, or the like. The parameters are adjusted to determine the most effective treatment parameters. 
     Signals do not necessarily require long hours of duration in the treatment interval although 24 hour administration may be used if desired. Typically, 30 minutes (repeated several times a day) is required for biological effectiveness. In vitro cell proliferation may be measured by standard means such as cell counts, increases in nucleic acid or protein synthesis. Upregulation or down regulation of matrix proteins (collagen types I, III, and IV) as well as growth factors and cytokines (such as TGF-B, VEGF, SLPI, FN, MMPs) may also be measured (mRNA and protein synthesis). In vivo effects may be determined by rate of healing of an injury or measuring bone mass density. Other diagnostic methods for proliferation, differentiation, or mineralization of bone tissue may be employed. 
     In one embodiment, proliferation-promoting and differentiation-promoting signals are used sequentially. This combination of waveforms is used to increase the cell number and then promote differentiation of the cells. As an example, the sequential use of proliferation and differentiation signals may be used to promote proliferation of osteoblasts and then differentiation of the osteoblasts into mineral producing osteocytes that promote mineralization of bone or vice versa. For example, a treatment paradigm may be used where a proliferation-promoting A-type signal is administered first to a cell population in vitro or ex vivo for hours, days or weeks and then the proliferation promoting signal is replaced with a mineralization-promoting B-type signal for hours, days or weeks until bone mineralization has been effected. The tissue produced may then be transplanted for patient benefit. Both signals may also be applied simultaneously to promote both proliferation, and differentiation and mineralization simultaneously. 
     The electric signals may be delivered by skin electrodes, or electrochemical connection. Skin electrodes are available commercially in sizes such as 1½×12, 2×3½, and 2×2 inches. These reusable electrodes are advantageous because they do not contain latex and have not shown significant skin irritation. The reusable electrodes can be used multiple times; also reducing costs to the patient. Such electrodes may include those by Koalaty Products Inc (Tampa, Fla.) or by Vermed, Inc. (Bellows Falls, Vt.). 
     There are multiple advantages of using skin electrodes instead of electromagnetic coils. Firstly, skin electrodes are more efficient. With electrodes, only the signal which will actually be sent into the body must be generated. With a coil, because of poor electromagnetic coupling with the tissues, the signal put in must be many, many times stronger than that desired in the tissues. This makes the required generating circuitry for electrodes potentially much simpler than for coils, while requiring much less power to operate. Secondly, skin electrodes are more user friendly. Skin electrodes have at most a few percent of the weight and bulk of coils needed to deliver equivalent signal levels. Similarly, because of better coupling efficiency the signal generators to drive electrodes can be made much smaller and lighter than those for coils. After a short time, a wearer hardly notices they are there. Thirdly, skin electrodes are more economical. Unlike coils, which cost hundreds to thousands of dollars each, electrodes are “throw-away” items typically costing less than a dollar. Also, because of greater efficiency and simplicity, the signal generators and batteries to drive them can be small and inexpensive to manufacture compared with those for coils. Fourthly, skin electrodes permit simpler battery construction and longer battery life facilitating the ease and patient compliance of using the device. Lastly, skin electrodes are more versatile than electromagnetic coils. Coils must be built to match the geometric characteristics of body parts to which they will be applied, and each must be large enough to surround or enclose the part to be treated. With electrodes, on the other hand, current distribution is determined by electrode placement only and readily predictable throughout the volume between. 
     In some embodiments, the waveforms generated by the waveform generator  54  can be useful in methods to promote the growth and repair of bone tissue in vivo. For example, stimulation with A-type waveforms ( FIGS. 6 and 7 ) promotes proliferation of cells. A-type waveforms may also result in an increase in bone morphogenic proteins to promote differentiation. In some embodiments, an increase in BMP-2 and BMP-7 production is effected using A-type or to a lesser degree, B-type electrical signals. This effect is highly valuable and provides a method for enhancing the generation of sufficient tissue for proper tissue healing in vivo, or to creating tissue grafts. This signal is also valuable for providing sufficient cell mass for infiltration into a polymer scaffold for tissue engineering purposes. In another embodiment, as demonstrated by in vitro testing, stimulation in vivo provides proliferation and differentiation of osteoblasts to increase the number of osteoblasts for mineralization. Such an increase in number of cells provides a method for filling in gaps or holes in developing or regenerating bone through electrical stimulation. Cells generated through proliferation induced by A-type waveforms may be used immediately, or preserved using conventional cell preservation methods until a future need arises. 
     Stimulation with B-type waveforms ( FIGS. 8 and 9 ) promotes proliferation to a small degree, and has actions different than A-type waveforms. 
     Actions promoted by B-type waveforms include, but are not limited to mineralization, extracellular protein production, and matrix organization. The actions of B-type waveforms are also valuable and provide methods to enhance the mineralization step and ossification of new bone tissue. In one embodiment, developing or regenerating bone tissue is stimulated with B-type waveforms to enhance the rate of mineralization. It has been proposed that B-type waveforms may act through calcium/calmodulin pathways and also by stimulation of G-protein coupled receptors or mechanoreceptors on bone cells. (Bowler, Front Biosci, 1998, 3:d769-780; Baribault et al., Mol Cell Biol, 2006, 26(2):709-717). As such, methods are also provided to modulate the activity of calcium/calmodulin-mediated actions as well as G protein coupled receptors and mechanoreceptors using electrical stimulation. Modulation of these cellular pathways and receptors are valuable to promote the growth and repair of bone tissue in vitro or in vivo. 
     Stimulation with C-type waveforms promotes bone regeneration, maturation, and calcification. These waveforms are also valuable and provide methods to enhance the mineralization step and ossification of new bone tissue. 
     Stimulation using D-type waveforms promotes cartilage development and healing and bone calcification, and is useful for treating or reversing osteoporosis and osteoarthritis. Applications of these waveforms include in vivo applications such as repairing damaged cartilage, increasing bone density in patients with osteoporosis. 
     Methods are also provided for combination or sequential use of the waveforms described herein for the development of a treatment regime to effect specific biological results on developing or regenerating osteochondral tissue. 
     In some embodiments, fractures in patients with a bone disorder may be treated with signals to heal fractures and then strengthen the bone. As a non-limiting example of this embodiment, an osteoporotic patient with a fracture may be treated by first stimulating with an A-type signal to promote proliferation and release of growth factors and then a B-type waveform to promote an increase in bone density at the site of repair to increase bone mass density and prevent refracture. 
     In another embodiment, combining two or more types of waveforms described herein may be used to promote the sequential proliferation, differentiation, and mineralization of osteochondral tissues. As a non-limiting example of this embodiment, a culture of osteoblasts may be grown under the influence of a A-type signal in connection with or prior to connection with a polymeric matrix. After seeding the polymeric matrix, B-type signals are then administered to the cell-matrix construct to promote mineralization of a construct useful as a bone graft. 
     In another embodiment, two or more signals may be administered simultaneously to promote concomitant proliferation, differentiation, and mineralization of osteochondral tissue in vivo or in vitro. Different signals may also be applied sequentially to osteochondral tissue in order to yield a greater effect than delivering either signal alone. The sequential process may be repeated as needed to produce additional tissue (such as bone) by cycling through the two-step process enough times to obtain the desired biological effect. As a specific non-limiting example, A-type signals may be applied first to produce more bone cells by proliferation and then B-type signals may be applied to induce the larger number of bone cells to produce more bone tissue (matrix, mineral and organization) and then repeated if needed. The amount of bone produced using repetition of a sequential stimulation protocol would be greater than that produced by either signal alone or in combination. 
     In some embodiments, the least first electrode  56  and a second electrode  58  are carried by the support structure  54  and coupled (for example, electrically, wirelessly, and/or inductively coupled or connected) to the waveform generator  54 , the first electrode  56  being sufficiently spaced apart from the second electrode  58  so as to generate a first non-transcranial therapeutic electric stimulus operable to flow through a region within the biological subject in response to a generated electrical waveform from the at least one waveform generator  54 , at least one of the first electrode  56  or the second electrode  58  having a first electrically conductive contacting surface  70 . In some embodiments, the first electrically conductive contacting surface  70  is adapted to contact a surface of the biological subject and to provide the first non-transcranial therapeutic electric stimulus to the biological subject. In some other embodiments, the first electrically conductive contacting surface conforms to a biological surface proximate to a temporomandibular joint  10  of the biological subject. For example, in some embodiments, the first electrically conductive contacting surface is adapted to conform to the outer contours of a biological surface such as an ear, a skin region proximate and/or overlying a temporomandibular joint  10 , and the like. In some embodiments, the first electrically conductive contacting surface is adapted to lie over and/or press against one or more acupuncture points found on a biological surface (e.g., an outer surface of an ear, regions proximate a temporomandibular joint, and the like). 
     In some other embodiments, at least part of the first electrode  56 , the second electrode  58 , or both comprises at least one electrically conductive material selected from, silver plated textiles, textiles interwoven with conductive materials, textiles interwoven with silver threads, semiconductor materials, graphite fibers, carbon nanotubes, conductive plastics, conductive polymers, and the like. 
     Referring to  FIGS. 3 and 4 , in some embodiments, the apparatus  50  takes the form of a wearable electrotherapy system  50   a  adapted to be worn on a head of the biological subject and to provide non-transcranial therapeutic electric stimulus. The wearable electrotherapy system  50   a  is configured to retain at least a first plurality of electrodes  80  proximate to at least one temporomandibular joint  10  of the biological subject when the wearable electrotherapy system  50   a  is worn. In some embodiments, the first plurality of electrodes  80  is sufficiently spaced apart so as to generate an electric field  82  within the biological subject in response to a first electric current. In some embodiments, the wearable electrotherapy system  50   a  includes electrodes  56   a ,  58   b  configured to surround an ear, for providing a non-transcranial electrical stimulus to the user according to another illustrated embodiment. In some embodiments, the wearable electrotherapy system  50   a  provides the user convenient walk around freedom while receiving non-transcranial therapeutic electric stimuli. 
       FIG. 10  shows a block diagram of a system  100  suitable to provide, for example, a non-transcranial electrical stimulus to a biological subject. The system  100  may include one or more controllers  102  such as a microprocessor  102   a , a central processing unit (CPU), a digital signal processor (DSP), an application-specific integrated circuit (ASIC), a field programmable gate array, or the like, or combinations thereof, and may include discrete digital and/or analog circuit elements or electronics. 
     The system  100  may further include one or more memories that store instructions and/or data, for example, random access memory (RAM)  104 , read-only memory (ROM)  106 , or the like, coupled to the controller  102  by one or more instruction, data, and/or power buses  108 . The system  100  may further include a computer-readable media drive or memory slot  110 , and one or more input/output components  112  such as, for example, a graphical user interface, a display, a keyboard, a keypad, a trackball, a joystick, a touch-screen, a mouse, a switch, a dial, or the like, or any other peripheral device. The system  100  may further include one or more databases  114 . The system  100  may further include at least one waveform generator  116 , and a first plurality of electrodes  118   a  including at least a first electrode  120  and a second electrode  122 . In some embodiments, the system  50  may further include a second plurality of electrodes  118   b  including at least a third  124  and a fourth electrode  126 . In some other embodiments, the system  100  may further include at least one power source  128 ,  130  electrically coupleable to at least one of the first  120  and the second electrodes  122 . 
     In some embodiments, the problem of providing an electrical stimulus to a region associated with a temporomandibular joint  10  of a biological subject without providing an appreciable electrical stimulus to a brain of a biological subject is solved by providing a wearable electrotherapy system  100  adapted to be worn on a head of the biological subject. The wearable electrotherapy system  100  is configured to retain at least a first plurality of electrodes  118   a  proximate to at least one temporomandibular joint  10  of the biological subject when the wearable electrotherapy system  100  is worn, and is operable to deliver a non-transcranial electrical stimulus. 
     In some embodiments, the waveform generator  116  comprises at least one of a processor, a wave-shaping circuit, a digital signal processor based waveform generator, and the like, or combinations thereof. In some embodiments, the controller  102  is electrically coupled to the at least one waveform generator  116  and operable to control the waveform generator  116 . In some embodiments, a processor is electrically coupled to the at least one waveform generator  116  and operable to control the waveform generator  116 . 
     The computer-readable media drive or memory slot  110  may be configured to accept computer-readable memory media. In some embodiments, a program for causing the system  100  to execute any of the disclosed methods can be stored on a computer-readable recording medium. Examples of computer-readable memory media include CD-R, CD-ROM, DVD, data signal embodied in a carrier wave, flash memory (e.g., SD cards, compact flash cards, USB flash drives, memory sticks, multimedia cards, or the like), floppy disk, hard drive, magnetic tape, magnetooptic disk, MINIDISC, non-volatile memory card, EEPROM, optical disk, optical storage, RAM, ROM, system memory, web server, or the like. 
     In some embodiments, the system  100  is configured to deliver a non-transcranial electrical current that passes through tissue associated with a temporomandibular joint  10  of the biological subject in response to a generated electrical waveform from the at least one waveform generator  116  when in use. 
     In some embodiments, the first electrode  120  is sufficiently spaced apart from the second electrode  122  so as to induce a non-transcranial electrical current that passes through tissue associated with a temporomandibular joint  10  of the biological subject in response to a generated electrical waveform from the at least one waveform generator  116 . In some other embodiments, the first electrode  120  is sufficiently spaced apart from the second electrode  122  so as to generate a non-transcranial electrical current to a region of the biological subject such that a major portion of the generated non-transcranial electrical current is spaced apart from the brain of the biological subject and passes through tissue associated a temporomandibular joint  10 . In some other embodiments, the first and the second electrodes  120 ,  122  are spatially separated so as to deliver a pulsed electrical current to a region of the biological subject including a temporomandibular joint  10 , when activated. 
     In some embodiments, the system  100  may further include one or more transducer  132  operable to output an audio signal. In some embodiments, the system  100  may further include an ambient noise cancelling component coupled to a noise cancelling-circuit  134 . In some embodiments, the ambient noise cancelling component is operable to provide a noise cancelling signal to the transducer to provide active acoustic noise cancellation when the system  100  is worn by the biological subject. 
     Referring to  FIGS. 11 through 15 , in some embodiments, the first and the second electrodes  120 ,  122  are sufficiently spaced apart so as to generate a substantially prolate spheroidical electric field  190  encompassing a temporomandibular joint  10  of the biological subject in response to a generated electrical waveform from the at least one waveform generator  116 . In some other embodiments, the first and the second electrodes  120 ,  122  are positioned with respect to one another so as to generate a non-transcranial electrical field  190  occupying a substantially prolate spheroidical region proximate to an ear of the biological subject, when the first and the second electrodes  120 ,  122  are activated. In some other embodiments, the first and the second electrodes  120 ,  122  are sufficiently spaced apart so as to transdermally deliver a non-transcranial electrical current to a temporomandibular joint  10  of the biological subject, when a potential is applied to the first and the second electrodes  120 ,  122 . 
     In some embodiments, the non-transcranial electrical field  190  generated between the first electrode  120  and the second electrode, includes the temporomandibular joint  10  while having its endpoints located on Acupuncture points TW 21   192   a  and G 82   192   b  (collectively  192 ). 
     Referring to  FIG. 15 , in some embodiments, one or more over-the-ear structures  70  can be configured to lie over, press against, and/or electrically stimulate one or more acupuncture points found on or proximate the ear and/or the temporomandibular joint  10  of the biological subject. For example, the apparatus  50  can include one or more over-the-ear structures  70  ( FIG. 3 ) that are operable to electrically stimulate auricular acupuncture points of a user to relive a condition associated with a temporomandibular joint  10  disorder. For example, as shown in  FIG. 13 , in some embodiments, electrode  122  can be placed in contact with a region immediately in front of the ear and electrode while electrode  120  can be made to conform to the rear curve of the ear and contact a region immediately behind the ear, such the each electrode  120 ,  122  encompasses one or more acupuncture points  192   a ,  192   b  (e.g., acupuncture points associated with the Gall bladder (G 82 ), Triple Warmer points (TW  18 ,  19 ,  20  and  21 ), the small intestine points (SI  18 , and  19 ,), and the like). According, when activated, the spaced apart electrodes  120 ,  122  would generate an electric field  190  encompassing a temporomandibular joint  10 , and one or more acupuncture points  192 . 
       FIG. 16  shows an exemplary method  300  for treating a condition associated with a temporomandibular joint disorder. 
     At  302 , the method  300  includes delivering a first non-transcranial electric current from a first electrode assembly located proximate to a first temporomandibular joint of a biological subject. 
     At  304 , the method  300  includes delivering a second non-transcranial electric current from a second electrode assembly located proximate to a second temporomandibular joint of the biological subject. 
     In some embodiments, delivering the first non-transcranial electric current includes providing a sufficient current to transdermally deliver an electrical current to the first temporomandibular joint of the biological subject, and delivering the sufficient amount of the second non-transcranial electric current includes providing a sufficient current to transdermally deliver an electrical current to the second temporomandibular joint of the biological subject. In some embodiments, delivering the first non-transcranial electric current and delivering the second non-transcranial electric current includes alternating between delivering the first non-transcranial electric current and delivering the second non-transcranial electric current for a selected time period. 
     In some embodiments, delivering the first non-transcranial electric current includes supplying a sufficient amount of current to generate a non-transcranial electrical current field encompassing the first temporomandibular joint, and delivering the second non-transcranial electric current includes supplying a sufficient amount of current to generate a non-transcranial electrical current encompassing the second temporomandibular joint. In some embodiments, delivering the first non-transcranial electric current, and delivering the second non-transcranial electric current includes delivery of the first non-transcranial electric current for a first time period, followed by delivery of the second non-transcranial electric current for a second time period. 
       FIG. 17  shows an exemplary method  350  for method for providing a non-transcranial electrical stimulus to a biological subject. 
     At  352 , the method  350  includes providing a wearable electrotherapy system adapted to be worn on a head of the biological subject. In some embodiments, the wearable electrotherapy system is configured to retain at least a first plurality of electrodes  118   a  ( FIG. 10 ) proximate to at least one temporomandibular joint  10  of the biological subject when the wearable electrotherapy system is worn, the first plurality of electrodes  118   a  ( FIG. 10 ) being sufficiently spaced apart so as to generate an electric field within the biological subject in response to a first electric current. 
     At  354 , the method  350  includes applying a sufficient amount of an electrical current to the first plurality of electrodes  118   a  ( FIG. 10 ) so as to generate a non-transcranial electric field in a region that encompasses at least one temporomandibular joint  10  ( FIGS. 1 and 2 ) of the biological subject. 
     In some embodiments, applying the sufficient amount of the electrical current to the first plurality of electrodes  118   a  ( FIG. 10 ) comprises transdermally delivering an electrical current to the at least one temporomandibular joint  10  ( FIGS. 1 and 2 ) of the biological subject. In some embodiments, applying the sufficient amount of the electrical current to the first plurality of electrodes  118   a  ( FIG. 10 ) comprises generating a substantially prolate spheroidical electric field encompassing the at least one temporomandibular joint  10  ( FIGS. 1 and 2 ) of the biological subject. 
     In some embodiments, applying the sufficient amount of the electrical current to the first plurality of electrodes  118   a  ( FIG. 10 ) comprises providing an electrical current flow that occupies a region proximate to an ear of the biological subject. In some embodiments, applying the sufficient amount of the electrical current to the first plurality of electrodes comprises providing a sufficient amount of current to generate a non-transcranial electrical current encompassing the temporomandibular joint  10  ( FIGS. 1 and 2 ), wherein a major portion of the non-transcranial electrical current is space apart from the brain of the biological subject. 
     The various embodiments described above can be combined to provide further embodiments. All of the U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications, and non-patent publications referred to in this specification and/or listed in the Application Data Sheet, including but not limited to: 
     U.S. Pat. No. 5,273,033 issued on Dec. 28, 1993; U.S. Pat. No. 6,011,994 issued Jan. 4, 2000; U.S. Pat. No. 6,321,119 issued Nov. 20, 2001; U.S. Pat. No. 6,535,767 issued Mar. 18, 2003; U.S. Pat. No. 7,117,034 issued Oct. 3, 2006; U.S. Patent Pub. No. 2004/0267333 published Dec. 30, 2004; U.S. Patent Pub. No. 2006/0293724 published Dec. 28, 2006; and U.S. Patent Pub. No. 2008/0039901 published Feb. 14, 2008; are each incorporated herein by reference, in their entirety. Aspects of the embodiments can be modified, if necessary to employ concepts of the various patents, applications and publications to provide yet further embodiments. 
     These and other changes can be made to the embodiments in light of the above-detailed description. In general, in the following claims, the terms used should not be construed to limit the claims to the specific embodiments disclosed in the specification and the claims, but should be construed to include all possible embodiments along with the full scope of equivalents to which such claims are entitled. Accordingly, the claims are not limited by the disclosure.