Patent Publication Number: US-2021161472-A1

Title: Basket for a multi-electrode array catheter

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 15/974,339, filed 8 May 2018, which is a continuation of U.S. application Ser. No. 15/333,798, filed 25 Oct. 2016, now U.S. Pat. No. 9,986,950, which is a continuation of U.S. application Ser. No. 13/790,110, filed 8 Mar. 2013, now U.S. Pat. No. 9,474,486, all of which are hereby incorporated by reference as though full set forth herein. 
    
    
     BACKGROUND 
     a. Field 
     The present disclosure relates to electrophysiology catheters. In particular, the instant disclosure relates to an electrophysiology catheter that enables a more even distribution of electrodes both when the catheter is in contact with tissue and when the catheter is not in contact with tissue and, therefore, a more even sampling of electrical activity in the tissue. 
     b. Background 
     Electrophysiology (EP) mapping catheters are used to generate electrophysiology maps of tissue in a region of interest. The use of EP mapping data in the diagnosis and treatment of tissues within a body is well known. For example, EP maps of heart tissue can be used to guide ablation catheters which are used to convey an electrical stimulus to a region of interest within the heart and create tissue necrosis. Ablation catheters may be used to create necrosis in heart tissue to correct conditions such as atrial and ventricular arrhythmias (including, but not limited to, ectopic atrial tachycardia, atrial fibrillation, atrial flutter and ventricular tachycardias). In addition to guiding ablation catheters, EP maps can also be used to evaluate the effectiveness of ablation therapy, or locate ectopic sources or a critical isthmus. 
     An EP mapping catheter includes one or more electrodes at a distal end that sample electrical activity in tissue. Many EP mapping catheters having a relatively large number, or array, of electrodes to enable sampling over a relatively wide area of interest and reduce procedure time. Referring to  FIG. 1 , one type of EP mapping catheter  10  in use today includes a collapsible and expandable basket electrode assembly  12  disposed at the distal end of the catheter  10 . The basket electrode assembly  12  assumes a compressed state as the catheter is maneuvered through an introducer sheath to a region of interest in the body and an expanded state once the catheter reaches the region of interest and emerges from the sheath. The basket electrode assembly  12  includes a plurality of splines  14  on which electrodes  16  are disposed. The splines  14  are coupled together at proximal and distal ends and bow outward (i.e. assume a bowed shape) when the basket assembly  12  is in an expanded state. 
     The foregoing discussion is intended only to illustrate the present field and should not be taken as a disavowal of claim scope. 
     BRIEF SUMMARY 
     The present disclosure relates to an electrophysiology catheter. In particular, the instant disclosure relates to an electrophysiology catheter that may enable a more even distribution of electrodes both when the catheter is in contact with tissue and when the catheter is not in contact with tissue and, therefore, a more even sampling of electrical activity in the tissue. 
     An electrophysiology catheter in accordance with at least one embodiment of the present teachings includes an elongate, deformable shaft having a proximal end and a distal end. The catheter further includes a basket electrode assembly coupled to the distal end of the shaft. The basket electrode assembly comprises a proximal end and a distal end and is configured to assume a compressed state and an expanded state. The basket electrode assembly includes a spline having a plurality of electrodes disposed thereon. The spline is configured to assume a non-planar shape in the expanded state. The spline may, for example, assume a twisted shape and, in particular, a helical shape. 
     An electrophysiology catheter in accordance with at least another embodiment of the present teachings includes an elongate, deformable shaft having a proximal end and a distal end. The catheter further includes a basket electrode assembly coupled to the distal end of the shaft. The basket electrode assembly comprises a proximal end and a distal end and is configured to assume a compressed state and an expanded state. The basket electrode assembly includes a plurality of first splines. Each of the plurality of first splines is configured to assume a shape other than a helical shape in the expanded state. The basket electrode assembly further includes a second spline. The second spline comprises an electrode disposed thereon and is configured to assume a helical shape in the expanded state. 
     An electrophysiology catheter in accordance with at least another embodiment of the present teachings includes an elongate, deformable shaft comprising a proximal end and a distal end. The catheter further includes a basket electrode assembly coupled to the distal end of the shaft. The basket electrode assembly comprises a proximal end and a distal end and a central longitudinal axis and is configured to assume a compressed state and an expanded state. The basket electrode assembly includes a first spline. The first spline comprises an electrode disposed thereon and comprises a first maximum radius relative to the axis in the expanded state. The basket electrode assembly further includes a second spline. The second spline comprises an electrode disposed thereon and comprises a second maximum radius relative to the axis in the expanded state. The second maximum radius is different than the first maximum radius. 
     An electrophysiology catheter in accordance with one or more of the present teachings may enable a more even distribution of electrodes both when the catheter is in contact with tissue and when the catheter is not in contact with tissue and, therefore, a more even sampling of electrical activity in the tissue. 
     The foregoing and other aspects, features, details, utilities, and advantages of the present disclosure will be apparent from reading the following description and claims, and from reviewing the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of a prior art electrophysiology mapping catheter. 
         FIG. 2  is a perspective view of an electrophysiology catheter in accordance with one embodiment of the present teachings. 
         FIG. 3  is an enlarged perspective view of a portion of the electrophysiology catheter of  FIG. 2 . 
         FIG. 4  is a cross-sectional drawing of the electrophysiology catheter of  FIG. 3  taken along line  4 - 4  in  FIG. 3 . 
         FIG. 5  is a diagrammatic view illustrating the arrangement of the splines of the basket electrode assembly of the catheter of  FIG. 3  when the assembly is compressed in the longitudinal direction of the catheter. 
         FIG. 6  is an enlarged perspective view of a portion of an electrophysiology catheter in accordance with another embodiment of the present teachings. 
         FIG. 7  is an enlarged perspective view of a portion of an electrophysiology catheter in accordance with another embodiment of the present teachings. 
         FIG. 8  is an enlarged perspective view of a portion of an electrophysiology catheter in accordance with another embodiment of the present teachings. 
         FIG. 9  is an enlarged perspective view of a portion of an electrophysiology catheter in accordance with another embodiment of the present teachings. 
     
    
    
     DETAILED DESCRIPTION 
     Various embodiments are described herein to various apparatuses, systems, and/or methods. Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims. 
     Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment”, or the like, in places throughout the 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. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features, structures, or characteristics of one or more other embodiments without limitation given that such combination is not illogical or non-functional. 
     It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute. 
     Referring now to the drawings wherein like reference numerals are used to identify identical components in the various views,  FIG. 2  illustrates one embodiment of an electrophysiology catheter  18  in accordance with the present teachings. Catheter  18  is provided for use in generating an electrophysiological map of tissue and, in particular, cardiac tissue. It should be understood, however, that catheter  18  may be used with tissues other than cardiac tissue. Catheter  18  may include a cable connector or interface  20 , a handle  22 , a shaft  24  having a proximal end  26  and a distal end  28 , and a basket electrode assembly  30 . Catheter  18  may also include other conventional components not illustrated herein such as deflection mechanisms, additional electrodes and corresponding conductors or leads. 
     Connector  20  provides mechanical and electrical connection(s) for cables extending from an electronic control unit (ECU) (not shown) or similar device that is configured to receive signals generated by basket electrode assembly  30 . Connector  20  may be conventional in the art and be disposed at the proximal end  26  of catheter  18 . 
     Handle  22  provides a location for the physician to hold catheter  18  and may further provides a means for steering or guiding shaft  24  within the body. For example, handle  22  may include means to change the length of a guide wire extending through catheter  18  to distal end  28  of shaft  24  to steer distal end  28  and, thus, shaft  24 . Handle  22  may also be conventional in the art and it will be understood that the construction of handle  22  may vary. 
     Shaft  24  is an elongate, deformable member configured for movement within the body. Shaft  24  supports electrode assembly  30 , associated conductors, and, in some embodiments, additional electronics used for signal processing or conditioning. Shaft  24  may also be configured to permit transport, delivery, and/or removal of fluids (including irrigation fluids and bodily fluids), medicines, and/or surgical tools or instruments. Shaft  24  may be made from conventional materials such as polyurethane and defines one or more lumens configured to house and/or transport electrical conductors, fluids, medicines, guide wires or surgical tools or instruments. Shaft  24  may be introduced into a blood vessel or other structure within the body through an introducer sheath. Shaft  24  may then be steered or guided through the body to a desired location such as tissue in a region of interest using guide wires or pull wires or other means known in the art including remote control guidance systems. 
     Referring now to  FIGS. 3 and 4 , electrode assembly  30  provides a means for conducting an electrophysiological study of tissue. Assembly  30  may be coupled to a distal end of shaft  24  and includes a proximal end  32  and a distal end  34 . Assembly  30  may include a plurality of splines  36  on which electrodes are disposed and that form an electrode “basket” that is configured to assume a compressed state and an expanded state. Assembly  30  may assume the expanded state in the absence of an extraneous force acting on the assembly  30  (i.e. assembly  30  may be biased to the expanded state) or may be urged to the expanded state through mechanical means (e.g. wires that are pulled or pushed). Assembly  30  may assume the compressed state, for example, as catheter  18  is maneuvered through an introducer sheath within the body to the region of interest and assume the expanded state upon emerging from a distal end of the sheath. Splines  36  are configured to support electrodes in a predetermined configuration to allow contact and/or non-contact mapping of electrical activity in tissue. Referring to  FIG. 4 , each spline  36  may include a tubular body  38 , means, such as wire  40 , for supporting body  38  and biasing body  38  to assume a predetermined shape, one or more electrodes  42  and associated conductors  44 . Although a particular embodiment for a spline, e.g., spline  36 , is illustrated herein, it should be understood that spline(s) may be constructed in a variety of ways. In one embodiment, for example, one or more splines may include a flexible circuit as described and illustrated in U.S. patent application Ser. No. 12/958,992 (published as United States patent application publication no. 2012/0143298 A1), the entire disclosure of which is incorporated herein by reference. Additional embodiments of splines and/or basket electrode assemblies may be found described in one or more of U.S. patent application Ser. No. 13/072,357 (published as United States patent application publication no. US 2011/0213231 A1) and U.S. patent application Ser. No. 13/340,760, the entire disclosures of which are incorporated herein by reference. 
     Body  38  provides structural support for electrodes  42  and insulates conductors  44  from bodily fluids and other elements. Referring to  FIG. 4 , body  38  is tubular and may be annular in shape. It should be understood, however, that the shape of body  38  may vary. Body  38  may be made from conventional polymeric materials such as polyurethane, and nylon or thermoplastic elastomers such as the elastomer sold under the registered trademark “PEBAX” by Arkema, Inc. and reinforcements such as metallic braids. Body  38  may define a central lumen  46  extending between proximal and distal ends  48 ,  50  of body  38  and configured to allow passage of wire  40  and conductors  44 . It should be understood, however, that body  38  may alternatively define one or more channels each configured to receive one of wire  40  or a conductor  44 . In the illustrated embodiment, wire  40  is illustrated at the center of lumen  46  with conductors  44  disposed circumferentially around wire  40 . It should be understood, however, that the relative arrangement of wire  40  and conductors  44  within lumen  46  may vary. 
     Wire  40  is provided to support body  38  and bias body  38  to assume a predetermined shape. Wire may be made from a shape memory alloy such as nitinol (nickel titanium). Wire extends through lumen  46  of body  38  from proximal end  48  of body  38  to distal end  50  and may extend through the bodies  38  of multiple splines  36  to couple one or more splines together. Alternatively, or in addition, splines  36  may be coupled at distal end  50  by a hinge connector  52  or in any of the ways described and illustrated in U.S. patent application Ser. No. 13/340,760 filed Dec. 30, 2011, the entire disclosure of which is incorporated herein by reference. The distal end  34  of the basket electrode assembly  30  may be specialized to form a small, but blunt mechanical connection point so that the distal portion of the catheter  18  may safely be pressed against tissue. 
     Referring again to  FIG. 3 , electrodes  42  may be configured to diagnose, sense, and measure electrical activity in tissue such as cardiac tissue. One or more of electrodes  42  may also be used to provide ablation therapy to tissue. Electrodes  42  may comprise ring electrodes disposed about body  38  and may be made from platinum or other conductive materials. Each electrode  42  is coupled to a corresponding conductor  44 . In accordance with one aspect of the present teachings, electrodes  42  may be unevenly spaced along spline  36 . Referring to  FIG. 5 , for example, the distance d 1  between a pair of adjacent electrodes  42  such as electrodes  42   A1 ,  42   A2 , on a spline  36 A may be different than a distance d 2  between another pair of adjacent electrodes such as electrodes  42   A2 ,  42   A3  on the same spline  36 A. In accordance with one embodiment the distances between adjacent electrodes  42  on a spline  36  may be smallest at or near the midpoint of the spline  36  and increase moving towards the ends of each spline  36 . This configuration allows a relatively uniform distribution of the electrodes  42  when the basket electrode assembly  10  is fully expanded. In particular, the spacing between electrodes  42  on adjacent splines  36  is greater near the midpoints of the splines  36  when assembly  10  is in the expanded state and less near the ends of the splines  36  when assembly  10  is in the expanded state. By reducing the spacing between adjacent electrodes  42  on each spline  36  near the midpoints of the spline  36  and increasing the spacing between adjacent electrodes on each spline  36  near the ends of the spline  36 , the varied spacing between adjacent electrodes  42  on an individual spline  36  compensates for the relative spacing between electrodes  42  on adjacent splines  36  when assembly  10  is in the expanded state. The placement of electrodes  42  along different splines  36  in assembly  30  may also differ. In particular, a distance d 3  between the distal most electrode  42   A1  on a spline  36 A and the distal end  50  of spline  36 A may differ from a distance d 4  between the distal most electrode  42   B1  on another spline  36 B and the distal end  50  of spline  36 B. Similarly, the distances for corresponding electrodes  42  on splines  36  from either the proximal or distal ends  48 ,  50  of the splines  36  may vary (such that, for example, the distance between the proximal end  48  of a spline  36  and the third electrode  42  from the proximal end  48  of the spline  36  differs from the distance between the proximal end  48  of another spline  36  and the third electrode  42  from the proximal end  48  of the other spline  36 ). 
     Referring again to  FIG. 4 , conductors  44  may be configured to transmit electrical signals from electrodes  42  through shaft  24  of catheter  18  to an electronic control unit or similar device. Conductors  44  may comprise wires or cables or other means for conducting signals and may be disposed with the lumen  46  of a body  38  of a given spline  36 . Each conductor  44  may be coupled at a distal end to a corresponding electrode  42  and extend through lumen  46  to the proximal end  32  of basket electrode assembly  30 . 
     As mentioned hereinabove, the body  38  of each spline  36  may be biased to assume a predetermined shape when assembly  30  is in an expanded state. In accordance with one aspect of the present teachings, each of splines  36  may be configured to assume a non-planar shape, such as a twisted shape (e.g., a helical shape), when assembly  30  is in the expanded state. The use of a helical shape, for example, enables a more even distribution of electrodes, and therefore more even sampling of electrical activity in tissue, in both contact and non-contact mapping. The use of a helical shape may also enable controlled shifting of assembly  30  between the compressed and expanded states using, for example, wires that may be pulled or pushed by the physician. In the illustrated embodiment, catheter  18  includes eight helical splines  36 . Referring to  FIG. 5 , when assembly  30  is compressed in the longitudinal direction of assembly  30  and catheter  18 , assembly  30  may form a flower-shaped pattern. As a result, the electrodes  42  on splines  36  are dispersed more evenly throughout the pattern and, therefore, dispersed more evenly throughout the area of contact with the tissue as compared to the prior art design in  FIG. 1  in which the electrodes  16  are closely spaced near the proximal and distal ends of the splines  14 , but relatively distantly spaced near the midpoints of each spline  14  when the assembly  12  in  FIG. 1  is compressed in the longitudinal direction. The illustrated catheter  18  may prove useful, for example, in generating a map of a pulmonary vein which is currently done using spiral or hoop electrode assemblies. Similarly, when assembly  30  is compressed laterally due to the contact with tissue (e.g. perpendicular to the longitudinal direction of the catheter), the helical shape of splines  36  reduces the tendency for certain splines nearest the point of contact to move away from one another (and towards other adjacent splines) as in the design illustrated in  FIG. 1  because a portion of each spline  36  is located on a diametrically opposite side of the assembly  30  relative to the point of contact. Referring again to  FIG. 5 , electrodes  42  may be unevenly spaced along each individual spline  36  or located at different relative locations along any two splines as described hereinabove to further facilitate a more even distribution of electrodes  42 . One methodology for locating the electrodes  42  on multiple helical splines  36  is to locate an electrode  42  on one spline  36  at a first distance from the end  48  or  50  of the spline  36 . The next electrode  42  may be located on a different spline—either adjacent to the first spline  36  or on a non-adjacent spline  36  with the spacing between the splines defining a fixed angle of rotation—at a second distance from the common end  48  or  50  of the splines  36  different than the first distance. Subsequent electrodes  42  may be located on splines  36  by (i) rotating the same fixed angle of rotation relative to the spline  36  having the most recently placed electrode  42  and (ii) increasing the distance from the common end  48  or  50  relative to the spline  36  having the most recently placed electrode  42 . Another methodology may involve locating electrodes  42  on a subset of splines  36  (e.g., every other spline  36  as shown in  FIG. 5  or another combination of non-adjacent splines  36 ) at a first distance from the common end  48  or  50  of splines  36  and then locating electrodes  42  on another subset of splines  36  at a second distance from the common end  48  or  50  of splines  36  different than the first distance and locating subsequent electrodes in a similar manner to that described hereinabove. 
     Referring again to  FIG. 3 , in accordance with one aspect of the present teachings, catheter  18  may further includes means, such as central post  54 , for rotating one end  32 ,  34  of basket electrode assembly  30  relative to the other end  32 ,  34 , of basket electrode assembly  30 . Post  54  may comprise a wire or cable in some embodiments. Post  54  may be rigidly coupled to the distal end  50  of basket assembly  30  and may be coupled to connector  52 . Post  54  extends through shaft  24  and may be rotatable relative to shaft  24 . Handle  22  may include means, such as a rotary actuator, through which the physician or a robotic controller may cause rotation of post  54  to thereby cause rotation of distal end  34  of assembly  30  relative to the fixed proximal end  32  of assembly  30 . In this manner, the physician may control the helical pitch of splines  36 , the mechanical stiffness of assembly  30 , and the spacing of electrodes  42 . Post  54  may move axially relative to shaft  24  so that the length of post  54  will vary with the compression or expansion of basket electrode assembly  30 . 
     As discussed hereinabove, electrodes  42  may be unevenly spaced along splines  36  to achieve a more even distribution of electrodes  42  when assembly  30  is in an expanded state. Referring to  FIG. 6 , however, an electrophysiology catheter  56  in accordance with another embodiment of the present teachings is illustrated. Catheter  56  is substantially similar to catheter  18 , but the electrodes  42  on each spline  36  are evenly spaced along the spline  36  and/or placed at identical locations on each spline  36  such that one, or a limited number, of splines  36  may be used for more efficient manufacture of catheter  56 . Although catheter  56  may not achieve the optimal location of electrodes  42  achieved in catheter  18 , the use of helical splines  36  on catheter  56  provides an improved distribution of electrodes  42  in contact and non-contact mapping relative to prior art designs. 
     In the embodiment illustrated in  FIG. 3 , each of splines  36  has the same helical pitch. Referring now to  FIG. 7 , another embodiment of an electrophysiology catheter  58  in accordance with the present teachings is illustrated. Catheter  58  is substantially similar to catheter  18 , but includes a different basket electrode assembly  60 . As in basket electrode assembly  30  of catheter  18 , assembly  60  includes splines  62 ,  64  configured to assume a helical shape when assembly  60  is in an expanded state. In assembly  60 , however, splines  62  have a different helical pitch than splines  64 . As a result, splines  62  define one circumferential or spherical envelope (indicated by the dashed line  66 ) when assembly  60  is in an expanded state while splines  64  define another circumferential or spherical envelope (indicated by the dashed line  68 ). Stated another way, the maximum radial distance of splines  62  from a central longitudinal axis  70  of basket electrode assembly  60  is different than a maximum radial distance of splines  64  from axis  70  when basket electrode assembly  60  is in an expanded state. Catheter  58  may provide advantages in, for example, non-contact mapping. In particular, lateral contact of assembly  60  with tissue may cause splines  64  to bend and deform from their ideal expanded state—particularly near the midpoint between the proximal and distal ends of the splines  64  which may comprise an important location for sampling electrical activity. Splines  62 , however, may maintain their ideal expanded state and continue to provide sampling in the desired location. In the illustrated embodiment, splines  62 ,  64  rotate about axis  70  in the same direction. In an alternative embodiment, however, splines  62 ,  64  may rotate about axis  70  in opposite directions. Rotation of splines  62 ,  64  (through, for example, the use of post  54  shown in  FIG. 3 ) would cause the pitch of one of splines  62 ,  64  to increase while decreasing its maximum radial distance from axis  70  and would cause the pitch of the other of splines  62 ,  64  to decrease while increasing its maximum radial distance from axis  70 . A basket electrode assembly in accordance with this embodiment would enable a physician to change the distribution of the electrodes with respect to the radius from the centroid of the basket. 
     Referring now to  FIG. 8 , another embodiment of an electrophysiology catheter  72  in accordance with the present teachings is illustrated. Catheter  72  is substantially similar to catheters  18  and  58 , but includes a different basket electrode assembly  74 . As in basket electrode assembly  60  of catheter  58 , assembly  74  includes two different types of splines  76 ,  78 . Splines  76  are configured to assume a helical shape when assembly  74  is in an expanded state. Splines  78 , however, are configured to assume a shape other than a helical shape when assembly  74  is an expanded state. In particular, splines  78  may assume a bowed “longitude line” or planar shape similar to splines  14  in the embodiment of  FIG. 1 . Splines  76  and splines  78  again define different circumferential or spherical envelopes  80 ,  82  when assembly  74  is an expanded state. As shown in the illustrated embodiment, the maximum radial distance of splines  76  from a central longitudinal axis  84  of assembly  74  may be less than the maximum radial distance of splines  78  from axis  84  when assembly  74  is an expanded state. In the embodiment show in  FIG. 8 , splines  76 ,  78  both include electrodes. Referring to  FIG. 9 , another embodiment of an electrophysiology catheter  86  in accordance with the present teachings may be substantially similar to electrophysiology catheter  72 , but may include a different basket electrode assembly  88 . Assembly  88  is substantially similar to assembly  74 , but includes splines  90 . Splines  90  are substantially similar to splines  78 , but do not include electrodes. 
     Although several embodiments of a system in accordance with present teachings have been described above with a certain degree of particularity, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the scope of this disclosure. All directional references (e.g., upper, lower, upward, downward, left, right, leftward, rightward, top, bottom, above, below, vertical, horizontal, clockwise and counterclockwise) are only used for identification purposes to aid the reader&#39;s understanding of the disclosed embodiments, and do not create limitations, particularly as to the position, orientation, or use of the disclosed embodiments. Joinder references (e.g., attached, coupled, connected, and the like) are to be construed broadly and may include intermediate members between a connection of elements and relative movement between elements. As such, joinder references do not necessarily infer that two elements are directly connected and in fixed relation to each other. It is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative only and not as limiting. Changes in detail or structure may be made without departing from the present teachings as defined in the appended claims. 
     Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.