Multi-section mattress pad and overlay for systematized pressure dispersion.

0001This invention concerns mattress pads or overlays in general, and in particular a mattress pad having a variety of features for providing sectioned support areas collectively functioning as a coordinated system for improved pressure dispersion for all parts of a user's body.

0002Decubitus ulcers, also known as bed sores, are a significant concern for bed-ridden patients. The problem of prolonged pressure on natural bony projections of a patient (such as the scapula, sacrum, and trochanter) is compounded in acute care settings where the patient cannot be frequently turned or moved. It is relatively common practice in hospitals in the U.S.A. for a flexible polyurethane foam mattress overlay to be used to supplement the mattresses of acute care patients. The goal generally is to provide at least some relief from bed sores during their immobilization. Simple convoluted foam pads, readily produced with known machinery, are typical of mattress overlays in present use.

0003A major thrust in recent hospital care practices has included higher-developed cost consciousness. To reduce costs, a trend has developed whereby convoluted foam pads are provided with relative taller conical peaks and thinner bases so that the pad may be produced with less foam (and hence be more cheaply provided). Many of such convoluted foam pads typically provide uniform instead of differentiated support across their entire patient support surface. Accordingly, effective pressure distribution for the prevention of decubitus ulcers is not optimized for all parts of a patient's body.

0004Other forms of cushions or pads are known. For example, Berman (U.S.-A-2,638,156) discloses a seat-type cushion having a substantially flat support surface, but utilizing density variations for different segments thereof variably to support the ischial tuberosites of a user's pelvis. Variations in density may be obtained in alternative ways, but particularly include the production of channels and cavities through the cushion (i.e., the removal of material). Rogers (U.S.-A-3,885,257) also varies support provided with a defined section of a pad by varying the amount of material removed from around projections formed thereby. However, the cross-sectional area of the external support surface of each projection is maintained constant over an entire block of his invention. Furthermore, the generally to substantially reduced cross-sectional area of such projections beneath the upward external support surface thereof can cause such projections to buckle, twist, and/or become unusually compressed, during load bearing, with possible unintended modification of the support action offered thereby.

0005Thompson (U.S.-A-,110,881) discloses a process for fabricating a mattress including the making of slots of varying depth and/or spacing therein so as to alter the support provided thereby. Removal of material is not ordinarily significant nor a design parameter. Instead, slicing is effected to provide a foamed material mattress which mimics the function of "inner spring" mattresses.

0006In addition to such cutting (i.e. slicing) and coring (i.e. producing cavities) other processing of foam products may be effected. For example, Spann (U.S.-A-4,573,456) discloses air channels which may be formed in a foam block for dissipating heat and moisture away from a person utilizing a product made from such a foam block. And, although not in all circumstances analogous to foam pads, other types of mattress supplements are generally known. For example, Douglas (U.S.-A-4,279,044) discloses a fluid support system with automatic valving for distributing the body weight of a patient received thereon.

0007It is an object of this invention to provide an improved mattress overlay or pad with coordinated support characteristics which optimize support for all parts of a patient's body. Support provided by various sections of the mattress overlay is preferably selected in accordance with the support provided by the other sections. Therefore, the present invention has aimed to establish a relationship among the support characteristics of the various sections supporting different parts of a patient's body so that optimized support may be provided for such patient. Such a relationship may be expressed in different ways in accordance with this invention, e.g. a range of support characteristics for each of the respective pad sections.

0008Typical convoluted foam mattress overlays do not provide as favorable a pressure dispersion for all parts of a patient's body to prevent decubitus ulcers as does a flat foam pad. Thus, this invention has sought to provide an effective engineered pad which has an essentially flat support surface.

0009It is a further goal to provide particular predetermined and different support for different parts of a patient's body in order most effectively to minimize or disperse pressures applied thereto. In accordance with this invention, the general mid-section of a patient's body, the scapula, the sacrum (with the patient in a supine position), and the trochanter (with the patient in a lateral position), are all provided with support geometry which is different from that provided for the head and heels of the patient. Generally, such is achieved by providing a relatively flat foam mattress overlay having a coordinated system design for optimum support of the overall body.

0010Further, the present invention seeks to provide an engineered polyurethane mattress overlay which recognizes that adjusting support for a patient's head or foot areas affects the support and pressure dispersion provided to the torso or mid-area of the patient (the reverse affect also being true). Therefore, a further aspect of this invention is to provide an engineered polyurethane mattress overlay which has at least two or more separate support sections which function as an inter-related system (i.e., in a systematized relationship).

0011Another aim of this invention is to provide a mattress overlay having interface pressures among support sections thereof (i.e. interface of such sections and a user's body) which are relatively independent of a user's body build. It is a further aspect of this invention to provide a mattress overlay which is effective in supporting all parts of a patient's body in all positions thereof.

0012Generally, it is recognized by this invention that at least three characteristics of pads made from foamed materials (such as foamed polyurethane) contribute to the effectiveness of the resulting pad used for supporting patients. Such characteristics are: <ul id="ul0001" list-style="none"><li>1) thickness of the foam pad;</li><li>2) indentation load deflection (ILD) of the resulting pad (defined for purposes of this disclosure as the number of pounds (or kilogrammes) of pressure needed to push a 50 square inch (323 sq. cm) circular plate into a pad so as to deflect such pad a given percentage distance of its non-loaded thickness); and</li><li>(3) density (i.e. weight per cubic foot or per cubic metre) of the material comprising the pad.</li></ul>

0013Inter alia, therefore, this invention aims to provide an engineered mattress overlay which effectively mixes and selects the foregoing characteristics of foam materials (i.e. thickness, ILD, and density) to provide a pad which optimizes pressure dispersion for all parts of a patient's body, generally without regard to the nature of the position assumed by the patient (i.e. supine or lateral) or the body build of the patient. It is also an object to devise and provide effectiveness ratings and the like which take into account the inter­relationship of all such three characteristics.

0014While numerous objects and features of the present invention will be understood by one of ordinary skill in the art upon studying the present specification, various combinations of such features and elements of this invention may be collected and provided in a given construction for comprising an exemplary embodiment in accordance with this invention. For example, one such exemplary embodiment in accordance with features of this invention is directed to a mattress pad for providing systematized pressure dispersion for a person reclined thereon, comprising a main body of resilient material; an upper support surface, defined by the main body, for receipt of a person thereon; a plurality of parallel longitudinal and parallel transverse cuts formed in the main body, and defining a plurality of rectangular-shaped elements; a plurality of sections defined in the body, with each respective section including at least two adjacent transverse rows of the rectangular-shaped elements, and having predetermined support characteristics and element cross-sections which are generally constant over the respective section but which differ among the sections; wherein the support characteristics are selected with determined relationships therebetween so as to form a support system for dispersing pressure in a desired manner for all parts of a person reclined thereon.

0015Another exemplary embodiment in accordance with this invention concerns a multi-section mattress overlay for supporting in a systematized manner all parts of a patient received thereon, the mattress comprising a generally rectangular body of foam material defining an essentially flat support surface for receiving a patient in a substantially longitudinal, prone position thereon; at least three longitudinally-spaced sections formed in the support surface, each of the sections having at least one uniform, predetermined load-bearing characteristic which is selected with respect to that of each other section for establishing the systematized support provided by the overlay; and grid-shaped cuts formed in the support surface of the body so as to define substantially rectangular projections therein, the cross-sectional area of such projections being constant over a given section but varying with the three sections so as to determine the load-bearing characteristics thereof.

0016Still another apparatus constructed as an exemplary embodiment in accordance with this invention includes a pad with systematized features for supporting a person, comprising a rectangular member of resilient material having a predetermined thickness; and a support surface formed on one side of the member, the surface defining three longitudinal areas therein generally for operative association with the head, mid-section, and feet, respectively, of a person; the head and feet areas each having 25% ILD characteristics in a range from about 17 pounds to about 22 pounds (7.7 to 10 kg) and the mid-section area having a 25% ILD characteristic in a range from about 21 pounds to about 26 pounds (9.5 to 12 kg); wherein 25% ILD stands for 25% indentation load deflection, which is defined by the number of pounds of pressure required to push a 50 square inch (323 sq. cm) circular plate into the polyurethane member so as to compress same by 25% of its predetermined thickness.

0017Numerous variations of and modifications to the presently dislcosed embodiments and respective features thereof will occur to one of ordinary skill in the art. All such variations, and equivalent substitutions therefor, are intended to be included within the scope of this invention.

0018Embodiments of the present invention will now be described by way of example only with reference to the accompanying drawings, in which: <ul id="ul0002" list-style="none"><li>Figure 1 illustrates an end plan view of an exemplary mattress overlay constructed in accordance with this invention;</li><li>Figure 2 is an enlarged, partial illustration of the right hand corner of Figure 1;</li><li>Figures 3 and 4 are top and side plan views, respectively, of the exemplary embodiment of Figure 1;</li><li>Figures 5 and 6 are enlarged side and perspective views, respectively, of a portion of the Figure 4 illustration, and</li><li>Figure 7 is a nomograph in accordance with features of this invention illustrating relative effectiveness ratings in reducing the risk of decubitus ulcers for various pad embodiments of different thickness, ILD, and density combinations.</li></ul>

0019Repeat use of the same reference characters throughout the present specification and drawings is intended to indicate same or analogous elements or features of the present invention, with the exception of the numbers on the graph lines of Figure 7 which are not intended as reference characters. In most instances, dotted line representations are intended to illustrate alternative features of the embodiment presently shown, unless otherwise indicated.

0020Referring to the figures, a mattress pad 10 includes a main body 20 comprised of resilient material. A variety of resilient materials may be used, with foam polyurethane preferred. Pad 10 is generally rectangular and provided with a predetermined thickness, typically in a range of about 2 to 4 inches (5.1 to 10 cm). The exact rectangular dimensions may also vary, but approximately 34 inches (0.86 m) wide by about 74 inches (1.88 m) long is preferred for the exemplary embodiment presently illustrated.

0021Pad 10 has a defined upper support surface 30 which is essentially flat. Surface 30 may longitudinally be divided into a plurality of sections (at least two, and preferably three), each having predetermined support characteristics which are generally constant over their respective sections, but which may typically differ among such sections. Figures 3 and 4 generally show three such sections, 40, 50, and 60. Initially main body 20 comprises uniform resilient material. Sections 40, 50, and 60 may be formed by variously adapting upper support surface 30 to tailor the support characteristics thereof. While the respective longitudinal lengths of sections 40, 50, and 60 may vary, in one preferred embodiment section 40 is about 16 inches (40 cm) long, section 50 is about 36 inches (81 cm) long, and section 60 is about 21 inches (53 cm) long.

0022One preferred method of adapting such sections for particular support characteristics is to make a plurality of cuts through, or form separations, in main body 20. Such cuts (discussed in greater detail below) may be variously placed in virtually any displacement in body 20 and in a variety of relationships to surface 30, but rectangular patterns (particularly as illustrated by Figure 3) are preferred for ease of manufacture and effectiveness in selectively altering support characteristics of main body 20. In accordance with broader aspects of this invention, whenever a main body 20 of a predetermined thickness and uniform density is initially provided, a desired indentation load deflection (ILD) may be established in sections 40, 50, and 60 by changing from one section to another the disposition and nature (eg. the spacing and number) of the plurality of parallel longitudinal and parallel transverse cuts in such main body.

0023Providing two sets of parallel cuts disposed so as to intersect one another at 90° angles (as in present Figure 3) defines independent rectangular-shaped elements or projections, up-turned sides of which form support surface 30. A plurality of such projections are formed in each of the various sections, with at least two transverse rows of such projections preferred in each respective section. In one preferred embodiment, projections 42 and 62, formed respectively in sections 40 and 60, may be approximately 1 by 2 inches (2.5 × 5 cm), and have a thickness (i.e. height) of approximately 1.5 inches (3.8 cm) (whenever a three inch (7.6 cm) main body 20 is initially provided). Projections 52 in such preferred embodiment may comprise approximately 2 inches by 2 inches (5 × 5 cm), with all projections from the different sections having substantially identical heights.

0024As generally illustrated by the figures, projections in accordance with this invention are substantially rectangular-shaped in cross-section, both in the plane of support surface 30 and at various depths therebelow. In general, the cross-sectional area of the rectangular-shaped elements is greater beneath the plane of surface 30, than in such plane. This is due to bevelled surfaces of such projections, discussed below in greater detail with reference to Figures 5 and 6.

0025Referring in particular to Figures 2, 5, and 6, as a further optional feature of this invention channels may be formed in main body 20 at the base of projections 42, 52, and 62. Such channels may assume various shapes and forms, but a generally circular cross-section is preferred for combined effectiveness of their dissipation function and ease of fabrication. The channels intersect with the separations (or cuts) which define adjacent projections, and thereby receive heat and moisture from a patient or person resting on pad 10 for generally dissipating excesses of same. Excess heat and moisture may also enter such channels by filtering through the body of pad 10. By either manner, dissipation removes air from around the user so as to carry off excess heat and moisture, thereby enhancing the comfort provided by the mattress pad. Further, the channels cooperate with the cuts to promote independent action of the individual projections responsive to loads placed thereon. Also, the channels may alternatively be formed at the bottom of longitudinal cuts, lateral cuts, or virtually any combination of both (including all of both as shown by the present figures). While permitting independent action, the substantially rectangular nature of the present projections preserves a desirable up/down compression action. Instead of being easily twisted or contorted during loading, the present projections move substantially straight up and down due to cooperation with the respective presence of adjacent rectangularly-­shaped projections.

0026Figure 2 illustrates generally circular channels 64 having generally all the same diameter 66, preferably in the range of 0.5 centimeters. Channels 64 run longitudinally along the entire length of pad 10 as do the longitudinal cuts 70 with which they are associated. In general, actual lateral separation due to cuts 70 between adjacent projections will be preferably about zero. Also, it is preferred that the lateral spacing between longitudinal cuts 70 be substantially constant over the entire lateral width of pad 10.

0027The longitudinal spacing of lateral cuts made in pad 10 is generally constant in a given section but varies from one section 40, 50, or 60 to another. Similarly, the cross-sectional areas of projections 42, 52, and 62 are generally constant (at given depths thereof) in their respective sections, but differ from one section to the next. Furthermore, the longitudinal separation distance between adjacent projections and the diameter of circular channels associated therewith also typically varies from one section to another while being generally constant in a given section. Alternatively, the longitudinal spacing of cuts in body 20 could be held constant over the entire pad 10, and the lateral spacing varied in each respective support section thereof for adjusting their respective load-­bearing characteristics.

0028Figure 5 shows two dotted lines 80 and 82 for illustration purposes only which demonstrate that circular channels 44 (associated with section 40) have a generally larger constant diameter than the generally constant diameter of circular channels 54 (associated with section 50). The diameter of circular channels 54 preferably falls in a range from about 0.5 centimeters to about 0.8 centimeters, while that of channels 44 preferably fall in a higher range from about 1.0 to about 1.2 centimeters. Circular channels 68 (Figure 4), associated with lateral cuts formed in section 60, typically have diameters of approximately the same size as those of circular channels 44.

0029As illustrated particularly by present Figures 5 and 6, lateral cuts made across the width of main body 20 preferably provide some finite longitudinal separation distance between adjacent projections, instead of generally providing virtually no separation distance as do longitudinal cuts 70. While variations may be practiced in accordance with this invention, a longitudinal separation distance of approximately 0.4 centimeters between adjacent projections 42 is preferably formed by cuts 46 made therebetween. Longitudinal separations between adjacent projections 62 are preferably but not limited to distances similar to those between adjacent projections 42.

0030Projections 52 generally need not be appreciably separated, but a separation distance of approximately one-half that produced with cuts 46 (i.e., 0.2 centimeters) is preferred. Dotted lines 56 in Figures 5 and 6 represent such 0.2 centimeter preferred separation distance, while solid lines 58 illustrate an alternative embodiment of separation representing virtually no (i.e. zero) separation distance.

0031All of the foregoing variations in slot spacing, projection separation distances, and channel diameters, contribute to the inter-related systematized adaptation of sections 40, 50, and 60 for dispersing pressure from a user reclining on pad 10.

0032While the present invention generally utilizes a relatively flat support surface 30 instead of a convoluted support surface, each of projections 42, 52, and 62 may be further provided with bevelled edges which enhance independent action thereof. For example, bevelled edges 90 (Figures 5 and 6) may be selectively used on any or all of the projection edges laterally formed on upper support surface 30. Likewise, bevelled edges 92 (shown in dotted line in Figure 6) may be provided in association with the longitudinal cuts defined in upper support surface 30 for providing further independent action between adjacent projections. Lateral bevelled edges 90 and longitudinal bevelled edges 92 may be optionally used with any or all of projections 42, 52, and 62.

0033Furthermore, any of either type of bevelled edges (90 or 92) may be generally straight-lined, as illustrated, or alternatively provided generally with a radius of curvature such as illustrated by such sides 94 of Figure 5. More rounded sides 94 further enhance independent movement of associated projections without adversely affecting other beneficial features and aspects of this invention.

0034While the foregoing describes in detail various structural aspects of the present invention which may be observed from a visual inspection thereof, further features of this invention concern support characteristics of pad 10 not immediately discernible.

0035Support characteristics defined by sections 40, 50, and 60 of upper support surface 30 may be varied so as to define a system of patient support for optimized pressure dispersion. Adjusting the support provided in any one of sections 40, 50, and 60 affects the patient support and dispersion of pressure in each of the other sections. Such is particularly the case whenever a subject patient is supported in a prone position (either supine or lateral) over all three support sections of upper support surface 30.

0036It is thus one further aspect of this invention that the support provided by each section should be selected so as to define an interface relationship among all three sections, which results in a system of support for a patient, and hence optimized pressure dispersion. The three separate sections 40, 50, and 60, with their particularly selected support characteristics, collectively function as a system to achieve such optimized dispersion of pressure for all parts of a user's body in generally all positions thereof.

0037Assuming that section 40 is disposed adjacent a patient's head, section 50 would generally support the scapula, torso, sacrum, and trochanter sections of an adult user of pad 10, while section 60 would support the lower legs, feet, and heels of such patient. In such configuration, a range of support characteristics may be stated wherein such optimized pressure dispersion may be provided. Alternatively, the orientation of a user on pad 10 may be changed so that section 40 is associated with the user's feet and section 60 associated with the head, while section 50 of course continues to be associated generally with the user's mid-section.

0038An indentation load deflection (ILD) character­istic may be defined as the number of pounds of pressure, or thrust, needed to push a 50 square inch (323 sq. cm) circular plate into a pad a given percentage deflection thereof. For example, a 25% ILD of 30 pounds (13.6 kg) would mean that this force or pressure is required to push a 50 square inch circular plate into a four inch (10.2 cm) pad a distance of 1 inch (2.5 cm) (i.e. 25% of the original, unloaded thickness). Using a main body 20 of given thickness and density (which is assumed initially constant over such body), controlled and described variations in the ILD characteristics of selectively defined sections may be achieved by forming cuts in such sections 40, 50 and 60. In general, for a given cut size and depth, selection in the spacing of such cuts permits selection of the ILD characteristic in a given section.

0039Generally, it is preferred that an ILD characteristic in the range of 17 to 22 pounds (7.7 to 10 kg) be provided in each of sections 40 and 60 (at 25% compression), while section 50 is preferably provided with a 25% ILD in the range of 21 to 26 pounds (9.5 to 11.8 kg). Sections 40 and 60 are not limited to having the same ILD characteristics even though they generally preferably share the same range of such. Such ILD characteristics are preferably formed in a main body member 20 initially having an uncut, uniform (i.e. constant) ILD characteristic of 30 pounds (13.6 kg) for 25% ILD. Of course, a variety of initial characteristics and modifying cuts may be practiced to achieve the above-stated ranges or their equivalents.

0040By providing pads with a systematized support profile of ILD's in the preferred ranges stated above, average pressure readings at various points on a person's body (such as heels, scapula, sacrum, trochanter) can be reduced by as much as 25 to almost 50% from average pressure readings for the same points taken for convoluted foam overlays. In fact, convoluted pads in general have reduced ILD support characteristics in comparison with support pads having relatively flat support surfaces, and may have effectiveness as much as 50% less than such flat support surfaces. In general, whenever a relatively flat, sectioned support surface in accordance with the present invention is provided with a relationship of support characteristics for its sections, the engineered support for all parts of the user's body (and in virtually all positions thereof) surpasses support by convoluted foam overlays, as well as jell and water overlays, or even air-filled overlays presently available.

0041While various features of this invention have been described with reference to ILD characteristics alone, further definition of an optimal set of foam properties may be obtained from considering ILD and density support characteristics together in a multi-variable approach. A range of optimized performance can be obtained whenever all three basic characteristics of the foam material utilized (i.e., thickness, density, and ILD) are collectively adjusted and inter-related. Using a calculation of the square root of the product of ILD times density (where ILD is given in pounds and density is given in pounds per cubic foot), an optimized range for best performance numerically falls in a range of about 5.7 to about 6.9 for approximately a 4 inch (10.1 cm) thickness of foam, and in the range of about 7.5 to 9.3 for approximately a 2 inch (5 cm) thickness of foam.

0042Of course, it is possible to calculate such arbitrary numerical numbers with alternative expressions than those presently stated. For example, instead of calculating the square root of the product of the given ILD and density for a particular embodiment (as done above), the product of the ILD and the square root of the density may be a preferable calculation in a given circumstance. In general, either expression accurately predicts the combined influence of the two variables (ILD and density) upon the effectiveness of particular embodiments.

0043Further, in accordance with features presently disclosed, all three variables of thickness, ILD and density may be judged on an effectiveness scale hereinafter arbitrarily referred to as the Span Index. Figure 7 illustrates a nomograph which represents the complex relationship among such three characteristics and an effectiveness rating (Span Index number).

0044In brief summary, the Span index predicts the performance (i.e. effectiveness) of a particular substantially flat polyurethane foam mattress of given thickness, ILD, and density characteristics for reducing the risk of decubitus ulcers for relatively immobile patients using such mattress. In general, the higher the Span index rating, the more effective the given mattress will likely be in reducing the incidence of such ulcers.

0045Referring to Figure 7, three vertical columns are established with a given, specifically determined relationship therebetween. Each column has discrete markings, but expresses continuously variable information between such discrete markings In general, columns A and B are linear, while column C is non-linear generally as marked thereon. Column A is generally the thickness of a particular pad embodiment, expressed in inches. Column B is the square root of the product of a given ILD and density for a particular pad embodiment.

0046Column C is the Span Index, which is a compilation of ratings for various combinations of the afore­mentioned characteristics in reducing the risk of decubitus ulcers. To determine the Span Index for a given combination of characteristics, the particular appropriate numbers are located in Columns A and B and joined by a straight line. Where the continuation of such line intersects Column C determines the Span Index for that given embodiment.

0047For example, lines 100 and 110 demonstrate the resulting Span Index for the two extremes stated above with respect to the preferred range for the combined ILD and density characteristics for a pad of approximately 4 inch (10.1 cm) thickness. In other words, line 100 connects a 4 inch (10.1 cm) indication on Column A and a 5.7 indication on Column B for a resulting Span index of about 50 (a relatively high rating). Similarly, line 110 is directed to the same thickness but a Column B characteristic of about 6.9, again resulting in a Span index of about 50. It should be apparent from Figure 7 that other 4 inch (10.1 cm) embodiments falling within the stated preferred range of 5.7 to 6.9 will have an even higher Span index.

0048Line 120, on the other hand, demonstrates the foregoing general statement that generally lower Span index numbers have relatively reduced effectiveness. Line 120 connects a Column A two inch (5 cm) indication with a Column B combined ILD/density characteristic of 7.5 (one extreme of the preferred range stated above). The resulting Span index number falls below 14 (a relatively low number). As is evident from the Figure 7 nomograph, in general a two inch (5 cm) thick pad with a given combined ILD/density characteristic of 7.5 can be improved with respect to preventing the risk of decubitus ulcers by increasing its thickness.

0049In general, development and disclosure of the Span Index permits direct comparison of the effectiveness of different mattresses in reducing the risk of decubitus ulcers. The Span Index provides an absolute number which obtains meaning when compared with other absolute rating numbers, in a manner analogous to APR (annualized percentage rates) ratings for loan interest rates.

0050While the Figure 7 nomograph is particularly established for support pads having generally flat support surfaces, both the general Span Index concept and the specific Figure 7 nomograph may be adapted for different basic types of pads. For example, convoluted pads may be judged directly on the graph of Figure 7 simply by dividing the appropriate ILD and density data product by one half before taking its square root. The resulting calculation is then used in conjunction with Column B as in previous examples. The appropriate pad thickness is entered on Column A, and intersection in Column C of the resulting straight line running from Columns A and B predicts the effectiveness of that particular generally convoluted pad.

0051While particular embodiments and exemplary constructions have been discussed in detail above, numerous modifications and variations to this invention will occur to one of ordinary skill in the art. All such variations (for example, including substitution of various materials, use of characteristics within and without stated ranges, and other alternatives, substitutions, and equivalents) come within the spirit and scope of the present invention. Further, language used above directed to the exemplary embodiments is descriptive and exemplary only, and not language of limitation, which appears only in the appended claims.