Patent Publication Number: US-2022233344-A1

Title: Targeted Temperature Management Systems, Pads, and Methods Thereof for Treating Burn Wounds

Description:
PRIORITY 
     This application claims the benefit of priority to U.S. Provisional Patent Application No. 63/141,801, filed Jan. 26, 2021, which is incorporated by reference in its entirety into this application. 
    
    
     BACKGROUND 
     Targeted temperature management (“TTM”) is a treatment for maintaining a therapeutic body temperature in a patient for a period of time to improve the patient&#39;s outcome in any of a number of different medical situations. Current TTM systems and methods require TTM pads be adhered to patients during TTM to maintain sufficient contact between the TTM pads and the patients while circulating temperature-controlled fluid (e.g., cooled fluid) through the TTM pads. Due to the requirement of current TTM systems and methods to adhere the TTM pads to the patients, however, TTM is clearly not an indicated treatment for burn victims and their burn wounds—despite the potential of TTM to cool tissues of such burn wounds and mitigate any further tissue damage. Indeed, adhering the TTM pads to the burn victims could aggravate their burn wounds instead of helping them heal. What is needed then are TTM systems, pads, and methods thereof for treating the foregoing burn victims and their burn wounds to promote healing. 
     Disclosed herein are TTM systems, pads, and methods thereof for treating burn victims and their wounds to promote healing. 
     SUMMARY 
     Disclosed herein is a pad for TTM including, in some embodiments, a multilayered pad body and a backing over the pad body. The pad body includes a conduit layer, an impermeable film over the conduit layer, and a sterile, thermally conductive wound-healing layer over the impermeable film. The conduit layer includes one or more conduits configured to convey a fluid through the conduit layer. The impermeable film is configured to retain the fluid in the conduit layer when the fluid is conveyed through the conduit layer. The wound-healing layer is configured for placement on a wounded portion of a patient&#39;s body. The backing is over the wound-healing layer in a ready-to-use state of the pad. The backing is configured to maintain sterility of at least the wound-healing layer prior to use of the pad. 
     In some embodiments, the wound-healing layer includes a hydrogel. The hydrogel is selected from a poly(ethylene glycol) hydrogel, an alginate-based hydrogel, a chitosan-based hydrogel, a collagen-based hydrogel, a dextran-based hydrogel, a hyaluronan-based hydrogel, a xanthan-based hydrogel, a konjac-based hydrogel, a gelatin-based hydrogel, and a combination of two or more of the foregoing hydrogels. 
     In some embodiments, the wound-healing layer is chemically stable to sterilization via autoclave, ethanol, or ultraviolet light. 
     In some embodiments, the wound-healing layer is configured for healing a burn wound. The burn wound is selected from a heat burn, a friction burn, an electrical burn, a radiation burn, and frostbite. 
     In some embodiments, the wound-healing layer includes one or more antimicrobial agents. The one-or-more antimicrobial agents are selected from an aminoglycoside including neomycin, kanamycin, gentamycin, or tobramycin; a cyclic peptide including polymyxin B or polymyxin E; a sulfonamide including mafenide acetate or silver sulfadiazine; a tetracycline including doxycycline or minocycline; a cationic steroid antimicrobial (“CSA”) including CSA-8; a metal-based antimicrobial including an organometallic compound including silver sulfadiazine, an elemental metal including a preparation of silver or copper nanoparticles, a metal oxide including a preparation of zinc-oxide nanoparticles, or a salt including silver nitrate, a Cu(II) salt, or a Ga(III) salt; a halogen-based antimicrobial including a diatomic halogen molecule including iodine, a halophor including iodopovidone, or a salt including sodium hypochlorite; chlorhexidine; vancomycin; fusidic acid; usnic acid; bacitracin; mupirocin; nitrofurazone; nystatin; rifampicin; and a biofilm-disrupting agent including a 2-aminobenzimidazole or a D-amino acid. 
     In some embodiments, the pad further includes an inlet. The inlet is configured for charging the conduit layer with the fluid. 
     In some embodiments, the pad further includes an outlet. The outlet is configured for discharging the fluid from the conduit layer. 
     Also disclosed is a system for TTM including, in some embodiments, a control module and pad. The control module includes a hydraulic system. The hydraulic system includes a chiller evaporator, a heater, one or more outlets, and one or more inlets. The chiller evaporator is configured for fluid cooling. The heater is configured for fluid heating. Together, the chiller evaporator and the heater are configured to provide a temperature-controlled fluid. The one-or-more outlets are configured for discharging the temperature-controlled fluid as a supply fluid from the hydraulic system. The one-or-more inlets are configured for charging the hydraulic system with a return fluid to continue to produce the temperature-controlled fluid. The pad includes a multilayered pad body and a backing over the pad body. The pad body includes a conduit layer, an impermeable film over the conduit layer, and a sterile, thermally conductive wound-healing layer over the impermeable film. The conduit layer includes one or more conduits configured to convey the supply fluid through the conduit layer. The impermeable film is configured to retain the supply fluid in the conduit layer when the supply fluid is conveyed through the conduit layer. The wound-healing layer is configured for placement on a wounded portion of a patient&#39;s body. The backing is over the wound-healing layer in a ready-to-use state of the pad. The backing is configured to maintain sterility of at least the wound-healing layer prior to use of the pad. 
     In some embodiments, the wound-healing layer of the pad includes a hydrogel. The hydrogel is selected from a poly(ethylene glycol) hydrogel, an alginate-based hydrogel, a chitosan-based hydrogel, a collagen-based hydrogel, a dextran-based hydrogel, a hyaluronan-based hydrogel, a xanthan-based hydrogel, a konjac-based hydrogel, a gelatin-based hydrogel, and a combination of two or more of the foregoing hydrogels. 
     In some embodiments, the wound-healing layer of the pad is chemically stable to sterilization via autoclave, ethanol, or ultraviolet light. 
     In some embodiments, the wound-healing layer is configured for healing a burn wound. The burn wound is selected from a heat burn, a friction burn, an electrical burn, a radiation burn, and frostbite. 
     In some embodiments, the wound-healing layer of the pad includes one or more antimicrobial agents. The one-or-more antimicrobial agents are selected from an aminoglycoside including neomycin, kanamycin, gentamycin, or tobramycin; a cyclic peptide including polymyxin B or polymyxin E; a sulfonamide including mafenide acetate or silver sulfadiazine; a tetracycline including doxycycline or minocycline; a cationic steroid antimicrobial (“CSA”) including CSA-8; a metal-based antimicrobial including an organometallic compound including silver sulfadiazine, an elemental metal including a preparation of silver or copper nanoparticles, a metal oxide including a preparation of zinc-oxide nanoparticles, or a salt including silver nitrate, a Cu(II) salt, or a Ga(III) salt; a halogen-based antimicrobial including a diatomic halogen molecule including iodine, a halophor including iodopovidone, or a salt including sodium hypochlorite; chlorhexidine; vancomycin; fusidic acid; usnic acid; bacitracin; mupirocin; nitrofurazone; nystatin; rifampicin; and a biofilm-disrupting agent including a 2-aminobenzimidazole or a D-amino acid. 
     In some embodiments, the pad further includes an inlet. The inlet is configured for charging the conduit layer with the supply fluid. 
     In some embodiments, the pad further includes an outlet. The outlet is configured for discharging the return fluid from the conduit layer. 
     Also disclosed herein is a method of a system for TTM. The method includes a pad-connecting step, a pad-placing step, and a fluid-circulating step. The pad-connecting step includes connecting an inlet and an outlet of a pad to a hydraulic system of a control module. The pad includes a multilayered pad body having a conduit layer configured to convey a temperature-controlled fluid provided by the control module. The pad-placing step includes placing the pad on a wounded portion of a patient&#39;s body with a sterile, thermally conductive wound-healing layer of the pad body in contact with a wound of the wounded portion of the patient&#39;s body. The fluid-circulating step includes circulating the temperature-controlled fluid through the conduit layer to cool or warm the wounded portion of the patient&#39;s body, thereby treating the wound to promote healing. 
     In some embodiments, the method further includes a backing-removal step. The backing-removal step includes removing a backing of the pad to reveal the wound-healing layer before the pad-placing step. The backing is configured to maintain sterility of at least the wound-healing layer prior to using the pad. 
     In some embodiments, the fluid-circulating step transfers heat between the temperature-controlled fluid and the wounded portion of the patient&#39;s body by thermal conduction through the wound-healing layer. The wound-healing layer includes a hydrogel selected from a poly(ethylene glycol) hydrogel, an alginate-based hydrogel, a chitosan-based hydrogel, a collagen-based hydrogel, a dextran-based hydrogel, a hyaluronan-based hydrogel, a xanthan-based hydrogel, a konjac-based hydrogel, a gelatin-based hydrogel, and a combination of two or more of the foregoing hydrogels. 
     In some embodiments, treating the wound to promote healing further includes the pad-placing step as the wound-healing layer includes one or more antimicrobial agents for synergistically mitigating microbial growth about the wound. 
     In some embodiments, the one-or-more antimicrobial agents are selected from an aminoglycoside including neomycin, kanamycin, gentamycin, or tobramycin; a cyclic peptide including polymyxin B or polymyxin E; a sulfonamide including mafenide acetate or silver sulfadiazine; a tetracycline including doxycycline or minocycline; a cationic steroid antimicrobial (“CSA”) including CSA-8; a metal-based antimicrobial including an organometallic compound including silver sulfadiazine, an elemental metal including a preparation of silver or copper nanoparticles, a metal oxide including a preparation of zinc-oxide nanoparticles, or a salt including silver nitrate, a Cu(II) salt, or a Ga(III) salt; a halogen-based antimicrobial including a diatomic halogen molecule including iodine, a halophor including iodopovidone, or a salt including sodium hypochlorite; chlorhexidine; vancomycin; fusidic acid; usnic acid; bacitracin; mupirocin; nitrofurazone; nystatin; rifampicin; and a biofilm-disrupting agent including a 2-aminobenzimidazole or a D-amino acid. 
     In some embodiments, the fluid-circulating step includes circulating a cool fluid through the conduit layer for treating the wound. The wound is selected from a heat burn, a friction burn, an electrical burn, and a radiation burn in such embodiments. 
     In some embodiments, the fluid-circulating step includes circulating a warm fluid through the conduit layer for treating the wound. The wound being frostbite in such embodiments. 
     These and other features of the concepts provided herein will become more apparent to those of skill in the art in view of the accompanying drawings and following description, which describe particular embodiments of such concepts in greater detail. 
    
    
     
       DRAWINGS 
         FIG. 1  illustrates a TTM system in accordance with some embodiments. 
         FIG. 2A  illustrates TTM pads for a torso of a patient in accordance with some embodiments. 
         FIG. 2B  illustrates TTM pads for legs of a patient in accordance with some embodiments. 
         FIG. 3  illustrates a multilayered pad body of a TTM pad in accordance with some embodiments. 
         FIG. 4  illustrates a hydraulic system of a control module in accordance with some embodiments. 
     
    
    
     DESCRIPTION 
     Before some particular embodiments are disclosed in greater detail, it should be understood that the particular embodiments disclosed herein do not limit the scope of the concepts provided herein. It should also be understood that a particular embodiment disclosed herein can have features that can be readily separated from the particular embodiment and optionally combined with or substituted for features of any of a number of other embodiments disclosed herein. 
     Regarding terms used herein, it should also be understood the terms are for the purpose of describing some particular embodiments, and the terms do not limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps in a group of features or steps, and do not supply a serial or numerical limitation. For example, “first,” “second,” and “third” features or steps need not necessarily appear in that order, and the particular embodiments including such features or steps need not necessarily be limited to the three features or steps. In addition, any of the foregoing features or steps can, in turn, further include one or more features or steps. Labels such as “left,” “right,” “top,” “bottom,” “front,” “back,” and the like are used for convenience and are not intended to imply, for example, any particular fixed location, orientation, or direction. Instead, such labels are used to reflect, for example, relative location, orientation, or directions. Singular forms of “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. 
     Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art. 
     As set forth above, current TTM systems and methods require TTM pads be adhered to patients during TTM to maintain sufficient contact between the TTM pads and the patients while circulating temperature-controlled fluid (e.g., cooled fluid) through the TTM pads. Due to the requirement of current TTM systems and methods to adhere the TTM pads to the patients, however, TTM is clearly not an indicated treatment for burn victims and their burn wounds—despite the potential of TTM to cool tissues of such burn wounds and mitigate any further tissue damage. Indeed, adhering the TTM pads to the burn victims could aggravate their burn wounds instead of helping them heal. What is needed then are TTM systems, pads, and methods thereof for treating the foregoing burn victims and their burn wounds to promote healing. 
     Disclosed herein are TTM systems, pads, and methods thereof for treating burn victims and their wounds to promote healing. That said, the TTM systems, pads, and methods set forth herein are not limited to burn victims and their burn wounds. Indeed, other trauma victims and their wounds (e.g., lacerations, abrasions, skin infections, etc.) can also benefit from the TTM systems, pads, and methods set forth herein. 
     TTM Systems 
       FIG. 1  illustrates a TTM system  100  in accordance with some embodiments. 
     As shown, the system  100  can include a control module  102 , one or more TTM pads  104  such as those set forth below, and one or more fluid conduits  103  therebetween. Description for the control module  102  is set forth immediately below. Description for the one-or-more pads  104  is set forth in the following section. 
     The control module  102  can include a console  106  with an integrated display screen configured as a touchscreen for operating the control module  102 . The console  106  can include one or more processors, primary and secondary memory, and instructions stored in the primary memory configured to instantiate one or more processes for TTM with the control module  102 . 
       FIG. 4  illustrates a hydraulic system  108  of the control module  102  in accordance with some embodiments. 
     The control module  102  can also include the hydraulic system  108 , which can include a chiller circuit  110 , a mixing circuit  112 , and a circulating circuit  114 . 
     The chiller circuit  110  can be configured for cooling a fluid (e.g., water, ethylene glycol, a combination of water and ethylene glycol, etc.) to produce a cooled fluid, which cooled fluid, in turn, can be for mixing with the mixed fluid in the mixing tank  122  set forth below to produce a supply fluid for TTM. The chiller circuit  110  can include a chiller evaporator  116  configured for the cooling of the fluid passing therethrough. The fluid for the cooling by the chiller evaporator  116  is provided by a chiller tank  118  using a chiller pump  120  of the chiller circuit  110 . 
     The mixing circuit  112  can be configured for mixing spillover of the cooled fluid from the chiller tank  118  with a mixed fluid in a mixing tank  122  of the mixing circuit  112 . The mixing circuit  112  can include a heater  126  in the mixing tank  122  configured for heating the mixed fluid to produce a heated fluid if needed for mixing with the cooled fluid to provide a supply tank  124  of the circulating circuit  114  with the supply fluid of a desired temperature for TTM. The mixing circuit  112  can include a mixing pump  128  configured to pump the fluid from the mixing tank  122  into the chiller tank  118  for producing the cooled fluid as well as the spillover of the cooled fluid for the mixing tank  122 . 
     The circulating circuit  114  can be configured for circulating the supply fluid for TTM, which includes circulating the supply fluid provided by the manifold  130  through the one-or-more pads  104  using a circulation pump  132  directly or indirectly governed by a flow meter  134  of the circulating circuit  114 . The manifold  130  can include one or more outlets  136  configured for discharging the supply fluid (e.g., a cooled fluid or a warmed fluid as indicated) from the hydraulic system  108  and one or more inlets  138  configured for charging the hydraulic system  108  with return fluid from the one-or-more pads  104  to continue to produce the supply fluid. 
     A thermoelectric TTM system is an alternative to the system  100  set forth above. The thermoelectric system can include a control module, one or more thermoelectric pads, and one or more electrical cables therebetween. Like the control module  102 , the control module of the thermoelectric system can include one or more processors, primary and secondary memory, and instructions stored in the primary memory configured to instantiate one or more processes for thermoelectric TTM with the control module. Notably, the control module of the thermoelectric system need not have a hydraulic system. 
     TTM Pads 
       FIGS. 2A and 2B  illustrate left and right pads of the one-or-more pads  104  respectively for a torso and legs of a patient in accordance with some embodiments.  FIG. 3  illustrates a multilayered pad body  140  of a pad of the-one-or-more pads  104  in accordance with some embodiments. 
     A pad of the one-or-more pads  104  can include the pad body  140  and a backing  141  over the pad body  140 . 
     The pad body  140  can include a conduit layer  142 , an impermeable film  144  over the conduit layer  142 , and a sterile, thermally conductive wound-healing layer  146  over the impermeable film  144 . 
     The conduit layer  142  includes a perimetrical wall  148  and one or more inner walls  150  extending from the conduit layer  142  toward the impermeable film  144 . Together, the perimetrical wall  148  and the one-or-more inner walls  150  form one or more conduits  152  configured to convey the supply fluid through the conduit layer  142 . 
     The conduit layer  142  can include a plurality of protrusions  154  extending from the conduit layer  142  toward the impermeable film  144 . The protrusions  154  are configured to promote even flow of the supply fluid when the supply fluid is conveyed through the conduit layer  142 . 
     The conduit layer  142  can be of an insulating foam. The insulating foam can be configured to prevent heat loss into an ambient environment. 
     The impermeable film  144  can be configured to retain the supply fluid in the conduit layer  142  when the supply fluid is conveyed through the conduit layer  142 . In addition, the impermeable film  144  can be configured to allow efficient energy transfer between the conduit layer  142  and the wound-healing layer  146 . 
     The wound-healing layer  146  can be configured for placement on skin S of wounded portion (e.g., torso, leg, etc.) of a patient&#39;s body for direct thermal conduction through the wound-healing layer  146 . While the wound-healing layer  146  can be configured to conformably adhere to the wounded portion of the patient&#39;s body for better thermal conduction, adherence of the wound-healing layer  146  to the wounded portion of the patient&#39;s body can be optimized to avoid further wounding the wounded portion of the patient&#39;s body upon removal of the pad. 
     The wound-healing layer  146  can be configured for healing a burn wound. The burn wound can be one requiring cooling to mitigate further tissue damage such as a heat burn, a friction burn (e.g., a heat burn from an abrasion such as from sliding across the ground in a motorcycle accident), an electrical burn, or a radiation burn (e.g., a sunburn) Alternatively, the burn wound can be one requiring warming to mitigate further tissue damage such as frostbite. However, as set forth above, the wound-healing layer  146  can be configured for healing wounds other than burn wounds such as lacerations, abrasions, skin infections, or the like. 
     The wound-healing layer  146  can include a hydrogel or hydrogel matrix. The hydrogel can be selected from a poly(ethylene glycol) hydrogel, an alginate-based hydrogel, a chitosan-based hydrogel, a collagen-based hydrogel, a dextran-based hydrogel, a hyaluronan-based hydrogel, a xanthan-based hydrogel, a konjac-based hydrogel, a gelatin-based hydrogel, and a combination of two or more of the foregoing hydrogels. 
     The wound-healing layer  146  can be chemically stable to terminal sterilization by a physical or chemical method of sterilization such as sterilization by heat (e.g., steam heat), radiation (e.g., non-ionizing radiation such as ultraviolet light, ionizing radiation such as gamma radiation, etc.), a liquid (e.g., an alcohol such as ethyl alcohol, isopropyl alcohol, etc.), or a gas (e.g., an electrophile such as ethylene oxide, an oxidant such as hydrogen peroxide, ozone, etc.). For example, the wound-healing layer  146  can be chemically stable to terminal sterilization by autoclave, one or more washes with ethanol, or irradiation with ultraviolet light. 
     The wound-healing layer  146  can include one or more therapeutic agents to synergistically treat the wounded portion of the patient&#39;s body and promote healing. The one-or-more therapeutic agents can include one-or-more antimicrobial agents (e.g., antibacterial agents, antifungal agents, etc.). The one-or-more antimicrobial agents can be selected from an aminoglycoside such as neomycin, kanamycin, gentamycin, or tobramycin; a cyclic peptide such as polymyxin B or polymyxin E; a sulfonamide such as mafenide acetate or silver sulfadiazine; a tetracycline such as doxycycline or minocycline; a cationic steroid antimicrobial (“CSA”) such as CSA-8; a metal-based antimicrobial including an organometallic compound such as silver sulfadiazine, an elemental metal such as a preparation of silver or copper nanoparticles, a metal oxide such as a preparation of zinc-oxide nanoparticles, or a salt such as silver nitrate, a Cu(II) salt, or a Ga(III) salt; a halogen-based antimicrobial including a diatomic halogen molecule such as iodine, a halophor such as iodopovidone, or a salt such as sodium hypochlorite; a biofilm-disrupting agent including a 2-aminobenzimidazole or a D-amino acid; chlorhexidine; vancomycin; fusidic acid; usnic acid; bacitracin; mupirocin; nitrofurazone; nystatin; and rifampicin. For example, the one-or-more antimicrobial can be a combination of neomycin, bacitracin, and polymyxin B. 
     Advantageously, delivery rates of certain therapeutic agents of the one-or-more therapeutic agents can be modulated by way of temperature of the supply fluid to either increase or decrease the rates of delivery to the wounded portion of the patient&#39;s body. 
     The backing  141  can be over the wound-healing layer  146  in a ready-to-use state of the pad. The backing  141  is configured to maintain sterility of at least the wound-healing layer  146  prior to use of the pad. 
     In addition to the foregoing, the pad can include an inlet  162  and an outlet  164 . The inlet  162  is configured for charging the conduit layer  142  with the supply fluid, while the outlet  164  is configured for discharging the return fluid from the conduit layer  142 . 
     As set forth above, the alternative thermoelectric TTM system includes the one-or-more thermoelectric pads. Because TTM is not effectuated with the supply fluid provided by the control module  102 , the one-or-more thermoelectric pads need not have the conduit layer  142 ; instead, the one-or-more thermoelectric pads can include a thermoelectric layer including one or more thermoelectric devices (e.g., an array of thermoelectric devices). The one-or-more thermoelectric devices can be configured to undergo a temperature change upon application of a voltage difference across the one-or-more thermoelectric devices. 
     Methods 
     Methods of the systems and pads include methods of use. For example, a method of using the system  100  can include a backing-removal step, a pad-connecting step, a pad-placing step, and a fluid-circulating step. 
     The backing-removal step can include removing the backing  141  of a pad of the one-or-more pads  104  to reveal the wound-healing layer  146 . As set forth above, the backing  141  can be configured to maintain sterility of at least the wound-healing layer  146  prior to using the pad. 
     The pad-connecting step can include respectively connecting the inlet  162  and the outlet  164  of the pad to an outlet of the one-or-more outlets  136  and an inlet of the one-or-more inlets  138  of the hydraulic system  108  of the control module  102 . The pad-connecting step can further include connecting one or more other pads of the one-or-more pads  104  to the hydraulic system  108  in parallel with the foregoing pad. 
     The pad-placing step can include placing the pad on a wounded portion (e.g., torso, leg, etc.) of a patient&#39;s body with the sterile, thermally conductive wound-healing layer  146  of the pad body  140  in contact with a wound of the wounded portion of the patient&#39;s body. 
     The fluid-circulating step can include circulating a temperature-controlled fluid (i.e., the supply fluid) provided by the control module  102  through the conduit layer  142  to cool or warm the wounded portion of the patient&#39;s body, thereby treating the wound to promote healing. The fluid-circulating step can transfer heat between the temperature-controlled fluid and the wounded portion of the patient&#39;s body by thermal conduction through the wound-healing layer  146 , which, as set forth above, includes a hydrogel or hydrogel matrix. The fluid-circulating step can include circulating a cool fluid as the temperature-controlled fluid through the conduit layer  142  for treating the wound if it requires cooling to mitigate tissue damage. In such embodiments, the wound can be a heat burn, a friction burn, an electrical burn, or a radiation burn. Alternatively, the fluid-circulating step can include circulating a warm fluid as the temperature-controlled fluid through the conduit layer  142  for treating the wound if it requires warming to mitigate tissue damage. In such embodiments, the wound can be frostbite. 
     In an alternative to the fluid-circulating step, the method can include a voltage-applying step when using the thermoelectric TTM system. The voltage applying step includes applying by way of the control module of the thermoelectric TTM system a difference in voltage across the one-or-more thermoelectric devices to effectuate TTM with the one-or-more thermoelectric pads. 
     Treating the wound to promote healing can further include the pad-placing step set forth above. Indeed, placing the pad on the wounded portion of the patient&#39;s body with the wound-healing layer  146  in contact with the wound thereof can result in administering to the wound of the wounded portion of the patient&#39;s body the one-or-more antimicrobial agents of the wound-healing layer  146  for synergistically mitigating microbial growth about the wound. 
     While some particular embodiments have been disclosed herein, and while the particular embodiments have been disclosed in some detail, it is not the intention for the particular embodiments to limit the scope of the concepts provided herein. Additional adaptations and/or modifications can appear to those of ordinary skill in the art, and, in broader aspects, these adaptations and/or modifications are encompassed as well. Accordingly, departures may be made from the particular embodiments disclosed herein without departing from the scope of the concepts provided herein.