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Title:
IDENTIFICATION OF PATIENT-CONNECTED MEDICAL DEVICES
Document Type and Number:
WIPO Patent Application WO/2016/099522
Kind Code:
A1
Abstract:
An identification signal is propagated by a transmitting medical device coupled to the body of a patient (with the body acting as an electronic transmission medium for the identification signal). The identification signal is detected by a detecting medical device also coupled to the body of the patient. Once detected, the transmitting device is then associated with the detecting medical device.

Inventors:
BROUSE CHRISTOPHER J (US)
BEINART DANIEL N (US)
Application Number:
PCT/US2014/071306
Publication Date:
June 23, 2016
Filing Date:
December 18, 2014
Export Citation:
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Assignee:
DRAEGER MEDICAL SYSTEMS INC (US)
International Classes:
G06F19/00; A61B5/00; H04B13/00
Domestic Patent References:
WO2006035351A22006-04-06
WO2007096810A12007-08-30
WO2010023577A12010-03-04
WO2009107040A12009-09-03
WO2008014432A22008-01-31
WO2007028035A22007-03-08
Foreign References:
US20120172075A12012-07-05
EP1495783A12005-01-12
US20110285545A12011-11-24
Other References:
THOMAS FALCK ET AL: "Plug 'n Play Simplicity for Wireless Medical Body Sensors", MOBILE NETWORKS AND APPLICATIONS, KLUWER ACADEMIC PUBLISHERS, BO, vol. 12, no. 2-3, 25 July 2007 (2007-07-25), pages 143 - 153, XP019531916, ISSN: 1572-8153, DOI: 10.1007/S11036-007-0016-2
None
Attorney, Agent or Firm:
KUKKONEN, Carl, A. et al. (222 East 41st StreetNew York, NY, US)
Download PDF:
Claims:
WHAT IS CLAIMED IS:

1. A method comprising:

initiating, by at least one transmitting medical device coupled to a body of a patient, propagation of at least one identification signal through the body of the patient, wherein the body of the patient acts as an electronic transmission medium for the identification signal;

detecting, by at least one detecting medical device coupled to the body of the patient, the at least one identification signal; and

associating the at least one transmitting medical device with the at least one detecting medical device.

2. The method of claim 1 , wherein each propagated identification signal comprises an identifier that uniquely identifies the corresponding transmitting medical device.

3. The method as in any of the preceding claims, wherein the identification signal further comprises a patient identifier that uniquely identifies the patient associated with the transmitting medical device.

4. The method of claim 3, wherein the patient identifier is encapsulated in the identification signal.

5. A method as in any of the preceding claims further comprising:

initiating peer-to-peer communication among the associated at least one transmitting medical device and the at least one detecting medical device.

6. The method of claim 5, wherein the peer-to-peer communication is unidirectional.

7. The method of claim 5, wherein the peer-to-peer communication is bidirectional.

8. The method of as in any of the preceding claims, wherein the associating comprises transmitting data to a server that identifies each medical device coupled to the body of the patient.

9. The method of as in any of the preceding claims, wherein the

identification signal is an analog signal.

10. The method of as in any of the preceding claims further comprising: transmitting a prompt signal to cause the at least one detecting medical device to commence detection of the at least one identification signal.

11. The method of claim 10, wherein the prompt signal is propagated through the body of the patient.

12. The method of claim 10, wherein the prompt signal is propagated external to the body of the patient.

13. The method of as in any of the preceding claims, wherein the detecting medical device is coupled to the patient via a device interface comprising:

a data processor connected to a computer memory;

a contact for making a conducting connection between the device interface the patient;

a transceiver connected to the contact and the processor; and a connection interface connected to the processor and the detecting medical device.

The method of as in any of the preceding claims, further comprising querying a database server for signal parameters;

accessing, by the database server, a list of available signal parameters; retrieving, from the list of available signal parameters, the signal parameters;

transferring information identifying the signal parameters from the list of available signal parameters to a list of unavailable signal parameters;

transmitting the signal parameters to the transmitting medical device; utilizing, by the transmitting medical device, the signal parameters to limit the parameters of the identification signal to what is defined by the signal parameters; and

after the detecting, transferring information identifying the signal parameters from the list of unavailable signal parameters to the list of available signal parameters.

15. The method of claim 14, wherein the signal parameters are a frequency range.

16. The method of claim 14, wherein the signal parameters are an amplitude range.

17. The method of claim 14, wherein the signal parameters are a waveform type.

18. A non-transitory computer program product storing instructions which, when executed by at least one data processor forming part of at least one computing device, implement a method as in any of the preceding claims.

A system comprising:

one data processor; and memory storing instructions which, when executed by the at least one data processor, implement a method as in any of claims 1 to 17.

Description:
Identification of Patient-Connected Medical Devices

TECHNICAL FIELD

[0001] The subject matter described herein relates to transmission of electrical signals through a patient's body for identifying attached medical devices.

BACKGROUND

[0002] Medical devices used for treatment, therapy, or monitoring of the state or medical condition of a person or other biological entity, are often exchanged between biological entities or persons. The inventory of medical devices present on a person can be either stored in records, or visually determined by a practitioner. However, inventory stored in records risks not being updated in the inventory system. Further, inventory visually determined can lead to errors, as medical devices can sometimes be similar in appearance or simply be missed when the inventory is taken.

SUMMARY

[0003] In one aspect, an identification signal is propagated by a transmitting medical device coupled to the body of a patient (with the body acting as an electronic transmission medium for the identification signal). The identification signal is detected by a detecting medical device also coupled to the body of the patient. Once detected, the transmitting device is then associated with the detecting medical device. [0004] In a related aspect, each propagated identification signal can have an identifier that uniquely identifies the transmitting medical device. Also, data that identifies each medical device coupled to the body of the patient can be transmitted to a server.

[0005] The identification signal can include a patient identifier that uniquely identifies the patient associated with the transmitting medical device. The patient identifier be an analog signal and can be encapsulated in the identification signal.

[0006] Peer-to-peer communication can be initiated, being either unidirectional or bidirectional, among the associated transmitting medical device and detecting medical device.

[0007] A prompt signal can be transmitted to cause the detecting medical device to commence detection of the identification signal. The prompt signal can be propagated through either the body of the patient or external to the body of the patient.

[0008] The detecting medical device can be coupled to the patient via a device interface having a data processor connected to a computer memory, a contact for making a conducting connection between the device interface and the patient, a transceiver connected to the contact and the processor, and a connection interface connected to the processor and the detecting medical device.

[0009] The transmission of the identification signal can include querying a database server for signal parameters, accessing, by the database server, a list of available signal parameters, retrieving, from the list of available signal parameters, the signal parameters, transferring information identifying the signal parameters from the list of available signal parameters to a list of unavailable signal parameters, transmitting the signal parameters to the transmitting medical device, utilizing, by the transmitting medical device, the signal parameters to limit the parameters of the identification signal to what is defined by the signal parameters, and after the detecting, transferring information identifying the signal parameters from the list of unavailable signal parameters to the list of available signal parameters.

[0010] The current subject matter provides many technical advantages. For example, the accurate identification of the medical devices that are present on a person can be used to reduce errors in utilizing devices that may work at cross-purposes or otherwise interfere with each other. Also, accurately identifying the medical devices can aid monitoring the distribution of devices across multiple persons. Identification can take the form of unique signals that can contain embedded encoding information for determination of the medical device and/or information about the person.

[0011] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

[0012] FIG. 1 is a diagram illustrating a patient connected to medical devices; [0013] FIG. 2 is a diagram illustrating the patient connected to the medical devices, illustrating the identification of detecting medical devices connected to the patient;

[0014] FIG. 3 is a process flow diagram illustrating detection and association of the detecting medical devices connected to the patient;

[0015] FIG. 4 is a process flow diagram illustrating identification of the medical devices connected to the patient initiated by network signal;

[0016] FIG. 5 is a process flow diagram illustrating identification of the medical devices connected to the patient initiated by a transmitting medical device and distributed to a network;

[0017] FIG. 6 is a process flow diagram illustrating identification of the medical devices connected to the patient initiated by an external device;

[0018] FIG. 7 is a process flow diagram illustrating identification of the medical devices connected to the patient initiated by the transmitting medical device in a LAN configuration;

[0019] FIG. 8 is a process flow diagram illustrating using frequency-based signal parameters to uniquely identify the medical devices connected to the patient;

[0020] FIG. 9 is a graphical representation illustrating the process of FIG. 7; and

[0021] FIG. 10 is a block diagram of a device interface. DETAILED DESCRIPTION

[0022] The current subject matter is directed to methods, systems, apparatus, articles / computer program products for identifying medical devices connected to a patient.

[0023] As used in the application, the term "patient" can refer to any biological entity, e.g. persons or animals, and is not intended to be limiting in any way to persons under medical care or in a medical treatment facility. Also, the term "medical device" can refer to any device, irrespective of the function of the device, and is not intended to be limiting in any way to medical devices, unless otherwise specified.

[0024] FIG. 1 is a diagram 100 of a patient 110 connected to medical devices. A patient 110 undergoing treatment is frequently connected to a suite of medical devices that perform either medical therapy operations, e.g. respirators, ventilators, infusion pumps, etc. or perform diagnostic and/or monitoring functions, e.g. EEG's, EKG's, EMG's, etc. The connection between the medical devices to the patient 110, in addition to the mechanical connection required, can also be electrically connected to the patient 110. As such, the medical devices can communicate with each other, via the conductive medium of the patient 110. In addition to performing their primary functions as operating devices or diagnostic devices, they can also transmit or receive signals, through the patient's body, which can be used to identify the medical devices connected to the patient 110. In one implementation, the medical devices can include a transmitting medical device 120 and a detecting medical device 130. The transmitting medical device 120 can be the medical device that transmits a signal through the patient 1 10. The detecting medical device 130 can be the medical device that receives the signal from the patient 1 10, via the abovementioned electrical connection.

[0025] FIG. 2 is a diagram 200 of the patient 1 10 connected to the detecting medical devices 130, illustrating the identification of the detecting medical devices 130 connected to the patient 1 10. There are a number of configurations of the patient 1 10, the associated medical devices, and external networks or other devices, which can be used in conjunction with the current subject matter for identifying the medical devices attached to the patient 1 10. Association with a patient can be used to associate physiological data that is generated by a medical device with that patient. This physiological data from multiple medical devices that are associated with a patient can be stored by a server or another medical device in a unified record for the patient, either as separate distinct data sets or combined into a single data set. Associating the medical device with the patient 1 10 can also indicate that the medical device, in addition to verifying the physical connection to the patient 1 10, is assigned to the patient 1 10. For example, if a medical device is assigned to a patient 1 10, then inadvertently, or intentionally, moved to another patient 1 10, the patient-medical device association will not be in agreement when the medical devices are identified. This can prompt an alert to a practitioner that there could be a mistake in the utilization of the device, or that the association needs to be updated to reflect the new patient 1 10.

[0026] One implementation is illustrated in FIG. 2, where a network 210 links the transmitting medical device 120 and the detecting medical device 130. The transmitting medical device 120 can have a transmitting connection 220 between the transmitting medical device 120 and the patient 1 10. Similarly, the detecting medical device 130 can have a receiving connection 230 between the patient 1 10 and the detecting medical device 130. The transmitting connection 220 and the receiving connection 230 can be any form of electrical connection, cables, electrodes, etc. The transmitting connection 220 and/or receiving connection 230 need not be entirely physical; for example, the transmitting connection 220 and/or receiving connection 230 can include a wireless transmitter from an electrode on the patient 1 10 to a transmitter and/or receiver on the transmitting medical device 120 and/or detecting medical device 130. To complete the circuit, there can be an internal path 240 through the patient 1 10 formed by skin, muscle, nervous system, bodily fluids, etc.

[0027] In another implementation, in the event that the detecting medical device 130 is not able to have conductive contact with the patient 1 10, a device interface 260 can be used to provide the conductive contact. The device interface 260 is described in greater detail in FIG. 9.

[0028] The network 210 can connect the medical devices with a database server 270. The database server 270 can be any computer or computer memory that can store lists of medical devices, patient associations with medical devices, etc.

[0029] External devices 280, e.g. mobile devices, tablets, smartphones, remote terminals, etc. can be connected to the network 210 and allow control of the identification process or the monitoring of the medical devices connected to the patient. [0030] FIG. 3 is a process flow diagram 300 illustrating detection and association of the detecting medical devices 130 connected to the patient 1 10. At 310, an identification signal is initiated by the transmitting medical device 120, which is coupled to the body of the patient 110. The body of the patient 110, can act as an electronic transmission medium for the identification signal.

[0031] At 320, the detecting medical device 130, which can also be coupled to the body of the patient 1 10, can detect the identification signal. The detection can be done by electrodes, probes, sensors, inductive loops, etc. operatively connected to the detecting medical device 130.

[0032] At 330, after detection by the detecting medical device 130, the transmitting medical device 120 can be associated with the detecting medical device 130, as described in FIG. 2, above.

[0033] FIG. 4 is a process flow diagram 400 illustrating identification of the medical devices connected to the patient 1 10 initiated by network 210 signal. As shown in FIG. 3, at 410, a prompt signal can be sent from the network 210 to the detecting medical device 130, initiating the detection of the medical devices attached to the patient 110.

Implementations with other points of origination of the prompt signal are described in FIGS. 4-6. Also, the prompt signal can be propagated through the body of the patient 110, or propagated external to the body of the patient 110, e.g. wirelessly or through network connections between the transmitting medical device 120 and the detecting medical device 130. [0034] At 420, once the prompt signal is received by the detecting medical device 130, the transmitting medical device 120 can transmit an identification signal to the patient 1 10 via the transmitting connection 220. Transmission of the identification signal can establish peer-to-peer communication between the transmitting medical device 120 and the detecting medical device 130. The peer-to-peer communication can be either unidirectional or bi-directional. The identification signal can be modulated by, e.g. amplitude, frequency, or phase to provide a signal that does not interfere with the patient 1 10 and any connected medical devices. For example, if the patient is connected to an electrocardiogram (ECG), electroencephalogram (EEG), electromyogram (EMG), or other electronic measurements taken at the skin surface, those diagnostics could detect the identification signal and provide an inaccurate measurement from the diagnostics. While the process of transmitting either the prompt signal or the identification signal can be intermittent or continuous, in the event that interference is unavoidable, a physician or other administrator can manually initiate the transmission of the identification signal as needed. The identification signal can be analog or digital. A digital identification signal can be similar to an analog identification signal in terms of frequency and amplitude restrictions; however a digital pulse train can also include information about the transmitting medical device 120, including any unique identifier codes needed to establish communications. Furthermore, digital signals do not require as much coordination from an independent device on the network.

[0035] Also, the identification of medical devices associated with the patient, as described above, can include the transmission of a patient identifier. The patient identifier can uniquely identify the patient associated with the transmitting medical device. For example, the patient identifier can be a medical record number, a patient name and date of birth, a hospital bed and/or room number, a hospital bed and/or room number combined with a date and time of service. This allows both the identification of the medical devices and the association of the medical devices to the patient 1 10 to be established. The patient identifier can be any digital or analog electrical signal sent either co incidentally or separately to the identification signal. The patient identifier can either be transmitted through the patient 1 10 or through any external connections between the medical devices. The patient identifier can also be encapsulated within the identification signal. The encapsulation can be discrete, e.g. temporally distinct from the identification signal, such as sending part of the identification signal, then the patient identifier, then the remainder of the identification signal. Alternatively, the encapsulation can be coincident, and frequency based, e.g. an offset from the identification signal, where both the identification signal and the patient identifier are within the allowed frequency band for transmission of the identification signal.

[0036] At 430, the identification signal propagates through the patient 1 10 along internal path 240. At 440, similarly to 420, the identification signal can be transmitted from the patient 1 10 to the detecting medical device 130 via the internal path 240. At 450, the detecting medical device 130 can transmit a receipt signal to the network 210 or the database server 270. The receipt signal can be a unique signal that contains information about the detecting device, as well as information about the transmitting medical device, and/or the patient. The receipt signal can also include a detecting device identifier, which can be a code that identifies the detecting device, and/or a patient identifier, which can be a code that identifies the patient. Therefore, the receipt signals can provide an inventory of the detecting medical devices 130 that are connected to the patient 1 10. The inventory can then be accessed by computers or caregivers to aid in the treatment of the patient 1 10.

[0037] FIG. 5 is a process flow diagram 500 illustrating identification of the medical devices connected to the patient 1 10 initiated by a transmitting medical device 120 and distributed to a network 210. At 510, another implementation can allow the transmitting medical device 120 to transmit the prompt signal independently, or by a user operating the transmitting medical device 120. This is similar to FIG. 4, but without transmitting the prompt signal from the network 210. However, at 450, the results of the

identification can still be passed to the network 210 to allow dissemination of the inventory of medical devices connected to the patient 1 10.

[0038] FIG. 6 is a process flow diagram 600 illustrating identification of the medical devices connected to the patient 1 10 initiated by the external device 280. At 610, the prompt signal is transmitted from the extemal device to the network 210. The identifying can then be performed similarly to the manner described in FIG. 3. At 620, an analyzed signal can be sent from the network 210 to the external device 280. The analyzed signal can be raw data or any form of processed data that includes the inventory of medical devices connected to the patient 1 10. There can also be applications on the external device 280 to interpret and display analyzed signal in the form of a list, table, etc.

integrated into a graphical user interface, webpage, etc. [0039] FIG. 7 is a process flow diagram 700 illustrating identification of the medical devices connected to the patient 1 10 initiated by the transmitting medical device in a LAN configuration. In another implementation, in the event that there is no network 210 available or desired, the identification can still be performed by, instead of transmitting the receipt signal to the network 210, transmitting the receipt signal for each detected device back to the transmitting medical device 120. In this implementation, the transmitting medical device 120 can include software and display functions for determining what devices are currently connected to the patient 1 10.

[0040] FIG. 8 is a process flow diagram 800 illustrating using frequency-based signal parameters to uniquely identify the medical devices connected to the patient 1 10. FIG. 9 is a graphical representation 900 illustrating the process of FIG. 8. In the implementation illustrated in FIGs 8 and 9, the receiver (not shown) connected to the network 210 can be centralized and therefore possibly receive the identification signal simultaneously from more than one patient, for example if two patients were in physical contact during the transmission of the identification signal. To at least insure that we are detecting devices only on one patient at a time, the transmitting medical device 120 can be restricted to a particular frequency or frequency band defined by signal parameters as shown by fl and f2 in FIG. 9. The signal parameters can be in terms of frequency, amplitude, specific waveforms, or any combination thereof. In this way, the identification signals received by the network 210 from a particular detecting medical device correspond only to the transmitting medical device operating on the frequency of the transmitting medical device 120 connected to the patient 1 10. During the identification process, should a second transmitting medical device 120 request to send out an identifying signal, it must do so on a different frequency band, as described below.

[0041] At 810, the transmitting medical device 120 transmits a prompt signal to the network 210, which is then transmitted at 820, to the database server 270. In addition to storing information about the medical devices and their associations to patients, the database server 270 can manage the distribution of allowed frequencies to the transmitting medical devices 120. At 830, a table, list, or other memory structure within the database server 270 can be accessed to retrieve signal parameters, which are not in use, to be sent to the transmitting medical device 120. At 840, once signal parameters are found from the collection of available signal parameters, a flag or other designation can be set to take the signal parameters out of the collection of available signal parameters. Alternatively, there can be an allowed list or table of signal parameters and a list or table of signal parameters in use, where signal parameters are passed between them as they are used or made available. At 850, the signal parameters are transmitted to the transmitting medical device 120, specifying what identifying signal the transmitting medical device 120 will transmit to the patient 1 10. At 860, the identification can be made, as described by any of the methods in FIGS. 3-6. At 870, a terminal signal can be sent from the transmitting medical device 120 to the database server 270. The terminal signal can be a signal that indicates the transmitting medical device 120 is no longer transmitting the identifying signal. At 880, the flag that was set in 840 is removed, allowing the signal parameters used by the transmitting medical device 120 to be used by other transmitting medical devices. [0042] FIG. 10 is a block diagram 1000 of the device interface 260. The device interface 260, as briefly discussed in FIG. 1 , can allow an electrical contact to be made between the patient 1 10 and the detecting medical device 130. This can be necessary when the detecting medical device 130 has an insulating material such as plastic or paper preventing a good electrical contact. Also, the device interface 260 can facilitate enabling or disabling the system without interfering with the medical functions of the detecting medical device 130. The device interface 260 can include a contact 1020, a transceiver 1030, a processor 1040, a connection interface 1050, and a memory 1060. The contact 1020 can be used to provide the electrical contact with the patient 1 10 and can be any kind of metal, copper, silver, etc. or be an electrode, bare wire, wire mesh, etc. The transceiver 1030 can be used to transmit, receive, or both, identification signals or receipt signals. The processor 1040 can be any sort of computer processor used to execute the operation of the device interface 260. The connection interface 1050 can be used to connect the device interface 260 to the detecting medical device 130. The connection interface 1050 can be a wired connection, ribbon cable, coaxial cable, etc. The memory 1060 can be any sort of computer memory, RAM, ROM, Flash, etc. that can be used to store instructions or data used in the operation of the device interface 260. The memory 1060 can also store data on the prompt signals or identification signals received by the detecting medical device 130.

[0043] One or more aspects or features of the subject matter described herein may be realized in digital electronic circuitry, integrated circuitry, specially designed ASICs (application specific integrated circuits), computer hardware, firmware, software, and/or combinations thereof. These various implementations may include implementation in one or more computer programs that are executable and/or interpretable on a

programmable system including at least one programmable processor, which may be special or general purpose, coupled to receive data and instructions from, and to transmit data and instructions to, a storage system, at least one input device (e.g., mouse, touch screen, etc.), and at least one output device.

[0044] These computer programs, which can also be referred to as programs, software, software applications, applications, components, or code, include machine instructions for a programmable processor, and can be implemented in a high-level procedural language, an object-oriented programming language, a functional programming language, a logical programming language, and/or in assembly/machine language. As used herein, the term "machine-readable medium" (sometimes referred to as a computer program product) refers to physically embodied apparatus and/or device, such as for example magnetic discs, optical disks, memory, and Programmable Logic Devices (PLDs), used to provide machine instructions and/or data to a programmable data processor, including a machine-readable medium that receives machine instructions as a machine-readable signal. The term "machine -readable signal" refers to any signal used to provide machine instructions and/or data to a programmable data processor. The machine-readable medium can store such machine instructions non-transitorily, such as for example as would a non-transient solid state memory or a magnetic hard drive or any equivalent storage medium. The machine -readable medium can alternatively or additionally store such machine instructions in a transient manner, such as for example as would a processor cache or other random access memory associated with one or more physical processor cores.

[0045] To provide for interaction with a user, the subject matter described herein can be implemented on a computer having a display device, such as for example a cathode ray tube (CRT) or a liquid crystal display (LCD) monitor for displaying information to the user and a keyboard and a pointing device, such as for example a mouse or a trackball, by which the user may provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well. For example, feedback provided to the user can be any form of sensory feedback, such as for example visual feedback, auditory feedback, or tactile feedback; and input from the user may be received in any form, including, but not limited to, acoustic, speech, or tactile input. Other possible input devices include, but are not limited to, touch screens or other touch-sensitive devices such as single or multi-point resistive or capacitive trackpads, voice recognition hardware and software, optical scanners, optical pointers, digital image capture devices and associated interpretation software, and the like.

[0046] The subject matter described herein may be implemented in a computing system that includes a back-end component (e.g., as a data server), or that includes a middleware component (e.g., an application server), or that includes a front-end component (e.g., a client computer having a graphical user interface or a Web browser through which a user may interact with an implementation of the subject matter described herein), or any combination of such back-end, middleware, or front-end components. The components of the system may be interconnected by any form or medium of digital data communication (e.g., a communication network). Examples of communication network include a local area network ("LAN"), a wide area network ("WAN"), and the Internet.

[0047] The computing system may include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other.

[0048] The subject matter described herein can be embodied in systems, apparatus, methods, and/or articles depending on the desired configuration. The implementations set forth in the foregoing description do not represent all implementations consistent with the subject matter described herein. Instead, they are merely some examples consistent with aspects related to the described subject matter. Although a few variations have been described in detail above, other modifications or additions are possible. In particular, further features and/or variations can be provided in addition to those set forth herein. For example, the implementations described above can be directed to various combinations and subcombinations of the disclosed features and/or combinations and subcombinations of several further features disclosed above. In addition, the logic flow(s) depicted in the accompanying figures and/or described herein do not necessarily require the particular order shown, or sequential order, to achieve desirable results. Other implementations may be within the scope of the following claims.