Abstract: There is provided a method of extracting a physiological information which comprises, for a defined time-period, extracting a plurality of signal segments in a time-domain form, selecting a subset of the plurality of signal segments according their maximum signal level, converting at least said subset to produce a plurality of transformed signal segments, and combining the at least said subset of the plurality of transformed signal segments to produce a combined signal segment. This has the advantage of reducing the influence of motion and or illumination-induced changes on the final result by removing parts of the raw signal segments which are worst affected by these.

Abstract: A method of monitoring a patient with respect to a particular medical condition includes providing a machine learning model trained to assign a weight to each of a predefined set of features so as to calculate a risk severity index of a particular medical condition. A long time interval of time-synchronized parameter data is received for each of at least two physiological parameters, and the long time interval is divided into multiple segments each containing a predefined time increment of the parameter data. A set of feature values are determined for the segment based on the parameter data therein, including a feature value for each of the predefined set of features related to the particular medical condition. With the trained machine learning model, assigning a weight to each of the predefined set of features, and then a risk severity index of the particular medical condition is calculated for the long time interval based on the set of feature values.

Abstract: Apparatus, methods and systems for displaying continuous images of a lumen while accurately depicting the curvature of the lumen, as well as evaluating and diagnosing biological objects, such as, but not limited to, gastro-intestinal, pulmonary and/or intravascular applications, which may be obtained via one or more instruments, such as, but not limited to, probes, catheters, endoscopes, capsules, and needles (e.g., a biopsy needle).

Abstract: A system, method and non-transient computer readable medium for assessing the opportunity to address either hyperglycemic or hypoglycemic risk (or both) in patients with diabetes based on historical continuous glucose monitoring (CGM) data.

Abstract: An infection sensing system includes a sensor device configured to be fastened onto the skin, the sensor device including multiple sensors and a processor coupled to the sensors. The sensors include at least a temperature sensor to read skin temperature as a proxy for body temperature and a heart rate sensor. The processor inputs data from the sensors, determines data representing body temperature and heart rate, and identifies a combination of: (i) a greater than threshold temperature fluctuation in the body temperature, and (ii) a greater than threshold heart rate, where (i) and (ii) are present for greater than a threshold time duration. Responsive to this identification the system outputs data indicating infection.

Abstract: A system for assessing and monitoring the hemodynamic condition of a patient includes a signal processor and optionally a premise processing system. Additionally, the system can include a biosignal detection device, memory, a display, and any other suitable component. A method for assessing and monitoring the hemodynamic condition of a patient includes: receiving input data; determining a set of windows based on the input data; preprocessing each of the set of windows; processing each of the set of windows; determining a set of features for each of the set of windows; determining a hemodynamic condition for each window based on the set of features; and presenting the hemodynamic condition to a user.

Abstract: Systems, methods, and apparatuses that provide alerts based on analyte data and acceleration data. An analyte sensor may generate the analyte data. An accelerometer may generate the acceleration data. A transceiver may convert the analyte data into analyte concentration values. The transceiver may convert the acceleration data into activity information. The transceiver may generate an alert based on the analyte concentration values and activity information. The alert may be communicated to a user by a mobile medical application executed on the transceiver and/or a display device (e.g., smartphone) in communication with the transceiver. The mobile medical application may display (e.g., on a display of the display device) a plot or graph of the analyte concentration values and activity information with respect to time.

Abstract: An information acquisition unit acquires at least one information item of subject information, imaging condition information, or positioning information. Next, a body movement feature derivation unit derives body movement feature information indicating a feature of body movement of a breast which occurs at the time of the tomosynthesis imaging. A storage stores correspondence information in which the derived body movement feature information corresponds to at least one information item of the subject information, the imaging condition information, or the positioning information.

Abstract: When image reconstruction by retrospective scanning is performed, the cache hit ratio is lowered due to transfer of not-used projection data to a cache memory. Accordingly, a processor generates rearranged projection data in which a first plurality of segments are extracted from original projection data written in a memory for saving original projection data 205, and stores the generated rearranged projection data into a main memory 212. The processor generates second view weights in which first view weights are made to correspond with the rearranged projection data (209). The rearranged projection data stored in the main memory 212 is previously transferred to the cache memory 213. The processor generates first tomographic image data with the rearranged projection data and the second view weights (214).

Abstract: The present invention provides a system (100) for enhancement of the image quality of a subject with less radiation exposure and high spatial resolution using CBCT technique. For this purpose, the system (100) comprises of a high resolution movable Flat Panel Imager (101), an X-Ray Tube (102) which are mounted on the rotatable Gantry (103). The cone beam X-Ray Tube (102) is mounted on opposite side of Flat Panel Imager (101). The entire Gantry (103) is supported with Base Structure (104) along with an angle of +15 degrees or ?15 degrees tilting motion. The Patient Couch Table (105) is mounted on the floor based on the gantry reference plane.

Abstract: The collimator (3) for a radiological equipment (1) comprises shielding means (6, 7, 9, 10, 11) made of tungsten-based radiation-absorbent plastic material; such means may be proximal radiated field closure elements and/or radiated field propagation elements; such means comprise at least one radiated radiogenic field propagation element (6).

Abstract: Provided is a radiation shielding device according to various embodiments. The radiation shielding device includes: a body structure forming a receiving space receiving a user's body part, wherein a through passage penetrating an inside of the body structure is formed in the body structure; a shielding unit positioned to reciprocatively move along the through passage, wherein a shielding pad configured to shield the radiation is included in a portion of the shielding unit; and a driver configured to transfer a driving force to the shielding unit to cause the shielding unit to reciprocatively move.

Abstract: In general, radiation shielding systems that shield radiation from multiple directions are described. In one embodiment, a method of shielding radiation is provided, including supporting a shielding device on an object proximate a radiation source, positioning a first shielding portion in a vertical position relative to the object, positioning a second shielding portion to extend away from the first portion, the second shielding portion attached to the first portion, and shielding radiation from the radiation source by the first shielding portion and the second shielding portion such that the first and second shielding portions provide a radiation shielding zone for a healthcare practitioner.

Abstract: A radiation shield assembly includes a shield configured to block radiation and a rail assembly configured to position the shield in between the radiation table and a radiation source. The shield is movable between a retracted position and an extended position along a length of the rail assembly. In the extended position, the shield extends along a portion of a radiation table and blocks radiation from the radiation source to the portion of the radiation table. In the retracted position, the shield exposes at least some of the portion of the radiation table to the radiation.

Abstract: A system for assisting guiding an endovascular instrument in vascular structures of an anatomical region of interest of a patient. This system includes an imaging device for capturing three-dimensional images of parts of the body of a patient, a programmable device and a viewing unit. The imaging device captures partially superposed fluoroscopic images of the region, and the programmable device forms a first augmented image, representative of a complete panorama of bones of the region, and cooperates with the imaging device to obtain a second augmented image including a representation of the vascular structures of the region. The imaging device captures a current fluoroscopic image of a part of the region, and the programmable device registers the current fluoroscopic image with respect to the first augmented image and locates and displays, on the viewing unit, an image region corresponding to the current fluoroscopic image in the second augmented image.

Abstract: An x-ray imaging apparatus and a method of controlling the x-ray imaging apparatus are provided. The x-ray imaging apparatus includes x-ray detectors, and a user interface configured to display sizes of the x-ray detectors, and display a modality in which an x-ray detector, among the x-ray detectors, is usable, while a size of the x-ray detector is displayed.

Abstract: A method, system and computer program product for determining changes in breast density. A generative adversarial network is trained to predict an appearance of a mammogram image for a patient's current examination based on mammogram images assigned labels of a first type of density classification. An appearance of a mammogram image for a patient's current examination is predicted using the generative adversarial network based on a mammogram image(s) obtained from the patient's prior examination assigned labels of the first type of density classification. A comparison is made between the predicted and actual mammogram images for the patient's current examination to determine if there is a difference between scores assigned to the predicted and actual mammogram images, and if so, whether such difference can be attributed to the subjective assessment by different physicians or changes in the standards of density classification or is due to a real change in breast density.

Abstract: Presented herein are efficient and reliable systems and methods for calculating and extracting three-dimensional central axes of bones of animal subjects—for example, animal subjects scanned by in vivo or ex vivo microCT platforms—to capture both the general and localized tangential directions of the bone, along with its shape, form, curvature, and orientation. With bone detection and segmentation algorithms, the skeletal bones of animal subjects scanned by CT or microCT scanners can be detected, segmented, and visualized. Three dimensional central axes determined using these methods provide important information about the skeletal bones.

Abstract: In one embodiment, a method is for calculating an examination parameter for a computed tomography examination of an area of interest of a patient. The method includes receiving a topogram of the area of interest of the patient; determining fat distribution information by applying a trained machine learning algorithm onto the topogram; and calculating the examination parameter for the computed tomography examination of the area of interest of the patient based on the fat distribution information.

Abstract: An image display apparatus includes an image obtainer, a hardware processor, and a display. The image obtainer obtains a plurality of medical images of a same target region taken through serial radiography along a time axis. The hardware processor generates a display image based on the medical images obtained by the image obtainer. The display displays the display image generated by the hardware processor. The hardware processor combines the medical images into one composite medical image as the display image.

Abstract: An image processing apparatus for processing a radiation image output from a radiation detection unit including a plurality of pixels, comprises: an imaging protocol obtaining unit configured to obtain an imaging protocol for imaging a subject; and a dose obtaining unit configured to obtain dose information of radiation based on a feature amount of the radiation image and information obtained from the imaging protocol.

Abstract: An acoustic sensor is provided according to certain aspects for non-invasively detecting physiological acoustic vibrations indicative of one or more physiological parameters of a medical patient. The sensor can include an acoustic sensing element configured to generate a first signal in response to acoustic vibrations from a medical patient. The sensor can also include front-end circuitry configured to receive an input signal that is based at least in part on the first signal and to produce an amplified signal in response to the input signal. In some embodiments, the sensor further includes a compression module in communication with the front-end circuitry and configured to compress portions of at least one of the input signal and the amplified signal according to a first compression scheme, the compressed portions corresponding to portions of the first signal having a magnitude greater than a predetermined threshold level.

Abstract: Introduced here are electronic stethoscope systems designed to simultaneously monitor sounds originating from within a body under examination and the ambient environment. An electronic stethoscope system can include one or more input units that are connected to a hub unit. Each input unit may have at least one auscultation microphone and at least one ambient microphone. To improve the quality of sound recorded by an input unit, a processor can apply a noise cancellation algorithm that considers as input the audio data produced by the auscultation microphone(s) and the audio data produced by the ambient microphone(s). The audio data may be digitized directly in the input unit, and then transmitted to the hub unit for synchronization. For example, by examining the audio data produced by the ambient microphone(s), the processor may discover which digital artifacts, if any, should be filtered from the audio data produced by the auscultation microphone(s).

Abstract: A transcranial scanning device and method of use is disclosed. The transcranial scanning device is for identifying a neurologic-injury-mechanism and comprises a sensing wand comprising a transducer that produces and receives sound waves. The sensing wand is passed over a head of a patent with cerebral malaria, and sound waves reflect off of blood cells in blood vessels in the head of the patient creating an output sound wave responsive to a blood flow of the patient. The output sound wave is received by the transducer.

Abstract: Methods and systems for imaging. For example, a system may include a breast compression paddle, an imaging detector, at least one sensor incorporated into at least one of the breast compression paddle or the imaging detector. The system performs operations including generating, at a first time point, first spatial data of the breast based on data captured by the at least one sensor; generating, at a second time point, second spatial data of the breast based on data captured by the at least one sensor; based on the first spatial data and the second spatial data, determining an amount of motion of the breast that occurred; and based on the determined amount of motion performing at least one of: generating a motion map for the breast; discarding one or more acquired projections for use in generating a tomosynthesis reconstruction; or correcting a medical image acquired the second time point.

Abstract: In one embodiment, an ultrasound imaging system is configured to receive a set of ultrasound images of a target anatomical region. The set of ultrasound images is combined to create a composite tissue frame. The ultrasound imaging system determines whether an interventional instrument is present within the ultrasound images based on a set of trained classification algorithms based on the set of ultrasound images and the composite tissue frame. If an interventional instrument is detected, the ultrasound imaging system further determines whether an additional ultrasound frame should be captured to image the interventional instrument, and the steer angle to be used for the additional ultrasound image. The ultrasound imaging system determines a linear structure corresponding to the interventional instrument, and creates a blended image showing the interventional instrument and the composite tissue frame.

Abstract: Provided are an ultrasound imaging apparatus and a method of controlling the same. The ultrasound imaging apparatus includes: a probe configured to transmit ultrasound signals to an object and receive echo signals corresponding to the ultrasound signals; a display; and at least one processor configured to detect a reference region of a medical tool inserted into the object in an ultrasound image generated based on the echo signals, control the display to display at least one distance-indicating line arranged with respect to the reference region in the ultrasound image, and update a position of the at least one distance-indicating line according to movement of the medical tool.

Abstract: A probe, with a distal end in proximity to a patient's internal organ tissue. A position sensor at the distal end generates position signals showing a location and an orientation of the distal end. An ultrasonic transducer transmits an ultrasound pulse along the orientation and receives ultrasound pulse reflections from the tissue. Location sensors are attached to the distal end, contact a surface of the tissue at respective locations in the distal end vicinity, and output respective location signals. A processor identifies ultrasound pulse reflections received from front and rear surfaces of the tissue. The processor processes the location signals to find a tissue front surface orientation angle. The processor then estimates a tissue thickness along an axis normal to the front surface based on a time elapsed between receipt of the reflections and an inclination of the direction of the orientation relative to the front surface orientation angle.

Abstract: A method and a system for evaluating a cardiac status, an electronic device and an ultrasonic scanning device are provided. The method includes: obtaining at least first image, wherein each of the first images is a two-dimensional image and includes a first cardiac image; training a depth learning model by the first image; and analyzing at least one second image by using the trained depth learning model to automatically evaluate a cardiac status of a user, wherein each of the second image is the two-dimensional image and includes a second cardiac image.

Abstract: A percutaneously delivered medical device and its method of use includes a catheter, at least two electromagnetic sensing coils located within the distal tip of the catheter, and at least one within the proximal handle, and a multi-element planar ultrasound transducer array located within the distal tip of the catheter and configured to transmit and receive ultrasonic energy in at least two imaging modes. The device also includes an imaging system coupled to the ultrasound transducer and is used for creating an image of tissue in a first target plane that extends orthogonally from the catheter body. The medical device also includes a backscatter evaluation system for use in receiving and evaluating the acoustic spectral characteristics of tissues within a second target area within the first target plane.

Abstract: A skin-mountable device (10) is disclosed comprising a surface (11) carrying an adhesive layer (20) for adhering the device to a skin region (1) and a removable non-adhesive cover layer (30) shaped as a loop having a first loop portion (31) covering the entire adhesive layer and a second loop portion (35) returning over the first loop portion, the second loop portion containing a pull (37) for pulling the cover layer from the adhesive layer when the skin-mountable device is positioned on said skin region. Also disclosed is a method of affixing such a skin-mountable device (10) to a skin region (1).

Abstract: There are provided an acoustic wave diagnostic apparatus and a control method of an acoustic wave diagnostic apparatus capable of easily performing measurement and preventing differences in measurement results by users. An ultrasound diagnostic apparatus includes: a display unit that displays an acquired acoustic wave image; a measurement target determination unit that determines a measurement target included in the acoustic wave image displayed on the display unit; a measurement algorithm setting unit that sets a measurement algorithm based on the measurement target; and a measurement unit that measures the measurement target in the acoustic wave image based on the measurement algorithm set by the measurement algorithm setting unit and displays a measurement result on the display unit.

Abstract: A method of ultrasound imaging that includes acquiring ultrasound data, and acquiring a target object quality parameter for a target object during the process of acquiring the ultrasound data. One or more processors determine a target object quality level for the target object based on the target object quality parameter and automatically selects a target object quality indicator based on the target object quality level. The one or more processors also generate an image based on the ultrasound data and including the target object quality indicator associated with the target object, and displays the image on a display device.

Abstract: A system and method for simultaneously presenting Doppler signals of a Multi-Gated Doppler (MGD) signal corresponding to different anatomical structures is provided. The method includes receiving an MGD signal having a plurality of Doppler signals. The method includes analyzing the MGD signal to select multiple gates, each of the gates corresponding with a Doppler signal, and each of the selected gates associated with a different anatomical structure. The method includes selecting a set of parameters for each of the selected gates and applying each selected set of parameters for each of the selected gates. The selected set of parameters for each of the selected gates may be one or both of image acquisition parameters or display processing parameters. The method includes simultaneously presenting the Doppler signal for each of the selected gates at a display system after the each selected set of parameters is applied.

Abstract: A system may include an ultrasound probe and a controller unit configured to obtain a baseline ultrasound image of a patient's breast area using the ultrasound probe and to obtain a follow-up ultrasound image of the patient's breast area using the ultrasound probe. The controller unit may further be configured to use one or more machine learning models to compare the baseline ultrasound image with the follow-up ultrasound image; detect a change in a morphology or integrity of the patient's breast area based on the comparison of the baseline ultrasound image with the follow-up ultrasound image; and generate a recommendation for a medical intervention based on the detected change.

Abstract: A spinal image generation system based on the ultrasonic rubbing technique, comprises an acquisition unit and a processing unit. The system generates the ultrasonic rubbing based on two-dimensional spinal ultrasonic images. The image needs to include surface characteristic contour of the vertebra structure. The ultrasonic rubbing matches with a digital medical image through characteristic contour. After matching, a personalized spinal surface topographical map is established, which keeps real-time updating consistently with the intraoperative posture of the patient under surgical condition. A positioning and navigation system for spinal surgery based on the spinal image generation system, comprising a navigation module and the image generation system above. The navigation system can acquire a personalized spinal surface topographical map, which keeps real-time updating consistently with the intraoperative posture of the patient under surgical condition.

Abstract: Methods and systems for producing a visually-perceived representation of a sub-millimeter-sized blood vessel located at a depth of many centimeters in the biological tissue, in which the background clutter is suppressed (by at least 30 dB using SVT and additional 23 dB using a combination of morphology filtering and vessel enhancement filtering) as compared to an image obtained with the use of a B-mode ultrasound imaging, while at the same time maintaining the morphology of the blood vessel.

Abstract: Systems and methods for super-resolution ultrasound imaging of microvessels in a subject are described. Ultrasound data are acquired from a region-of-interest in a subject who has been administered a microbubble contrast agent. The ultrasound data are acquired while the microbubbles are moving through, or otherwise present in, the region-of-interest. The region-of-interest may include, for instance, microvessels or other microvascuiature in the subject. By isolating, localizing, tracking, and accumulating the microbubbles in the ultrasound data, super-resolution images of the microvessels can be generated.

Abstract: An automated workflow performed by software executing on at least one processor includes receiving a plurality of echocardiogram images taken by an ultrasound device. A filter separates the plurality of echocardiogram images by 2D images and Doppler modality images based on analyzing image metadata. The 2D images are classified by view type, and the Doppler modality images are classified by view type. The cardiac chambers are segmented in the 2D images, and the Doppler modality images are segmented to generate waveform traces, producing segmented 2D images and segmented Doppler modality images. Using both the sets of images, measurements of cardiac features for both left and right sides of the heart are calculated. The calculated measurements are compared with international cardiac guidelines to generate conclusions and a report is output showing the calculated measurements that fall both within and outside of the guidelines.

Abstract: An ultrasound probe is presented. The ultrasound probe includes an ultrasound probe handle. Moreover, the ultrasound probe also includes a phase change chamber monolithic with respect to a portion of the ultrasound probe handle, where the phase change chamber includes hermetic chamber walls extending around and defining an enclosed chamber and a material disposed within the hermetic chamber walls, where the material is configured to change phase in response to heat from a component of the ultrasound probe.

Abstract: The invention relates to an automatic reflection hammer system, which comprises the following components: a reflective hammer chassis, an outer side having a detachable reflection hammer head, and a pulley, a universal joint, a vertical height adjustment mechanism, and a fixing bracket. Wherein, the reflection hammer chassis links with the universal joint, the universal joint links to the vertical height adjustment mechanism, and the vertical height adjustment mechanism links with the fixing bracket.

Abstract: To include a rotating holder 30 that is rotatably arranged in an opening of a casing 10 and detachably holds a part of a sperm sampler, a motor 50 that rotates and drives the rotating holder, a control unit 60, a battery 70, a single switch 20, 67, and an angular speed sensor 61 that detects an angular speed of the casing 10, where the control unit changes a rotation direction and a rotation speed of the motor according to a change in a turning angle of the casing 10.

Abstract: The present invention presents a method of fabrication for a physiological sensor with electronic, electrochemical, and chemical components. The fabrication method comprises steps for manufacturing an apparatus comprising at least one electrochemical sensor, a microcontroller, and a transceiver. The fabrication process includes the steps of substrate fabrication, circuit fabrication, pick and place, reflow soldering, electrode fabrication, membrane fabrication, sealing and curing, layer bonding, and dressing. The physiological sensor is operable to analyze biological fluids such as sweat.

Abstract: In an illustrative embodiment, a surgical system is provided for removing adipose buildup from epidural space of a patient spine including a surgical apparatus including a handle portion and a catheter assembly having a steerable distal tip configured for navigating epidural space of the spine; an endoscopic camera system configured to capture images from the epidural space and to identify a tissue of interest; and a vacuum source in communication with the catheter assembly of the surgical apparatus and configured to provide a negative pressure through a lumen of the catheter assembly to the tissue of interest; a discharge tank configured to capture suctioned tissue from the catheter assembly; and where the surgical apparatus further includes at least one fiber optic cable in communication with the endoscopic camera system.

Abstract: A soluble needle (100) for hair transplantation, wherein the soluble needle (100) comprises a fixing plate (30) and a plurality of micro-needles (20) made of water-soluble polymers arranged on the fixing plate (30), wherein each of said micro-needle (20) comprises a needle wall (21) to penetrate scalps and a needle cavity (22) confined by the needle wall (21) and configured for accommodating a hair follicle. A method of manufacturing a soluble needle (100) for hair transplantation, wherein the method includes: dissolving water-soluble polymers in water to prepare a molding solution (S101); delivering the molding solution into a mold (S102); letting the molding solution settle in the mold to shape (S103); and separating and removing the mold to produce the soluble needle (S104). The soluble needle (100) effectively shortens the time of surgery, reduces the pain of the patients, and increases the viability rate of transplanted hair follicles.

Abstract: An insertion instrument is configured to eject at least one anchor body into respective target locations, and subsequently apply a predetermined tensile force at least one actuation member of the at least one anchor member so as to actuate the at least one anchor body from a first configuration to a second expanded configuration. The insertion instrument can include a tension assembly that applies the predetermined tensile force to the at least one actuation member. The predetermined tensile force can be defined by a distance of travel, a predetermined failure force of a fuse, or a combination of distance of travel and a predetermined failure force of a fuse.

Abstract: Improved methods and devices for performing an endoscopic surgery are provided. Systems are taught for operatively treating gastrointestinal disorders endoscopically in a stable, yet dynamic operative environment, and in a minimally-invasive manner. Such systems include, for example, an endoscopic surgical suite. The surgical suite can have a reversibly-expandable retractor that expands to provide a stable, operative environment within a subject. The expansion can be asymmetric around a stabilizer subsystem to maximize space for a tool and an endoscope to each be maneuvered independently to visualize a target tissue and treat the target tissue from outside the patient in a minimally invasive manner.

Abstract: A surgical access assembly includes a sleeve assembly, a base member, and a sealing assembly. The sleeve assembly includes a proximal ring, a distal ring, and a sleeve defining a passage therethrough. The base member includes an annular body including a coupling member. The annular body defines an opening in communication with the passage of the sleeve, and a circumferential groove configured to support the proximal ring of the sleeve assembly. The sealing assembly includes an annular frame and a seal dimensioned to cover the opening of the base member in a sealing relation. The coupling member of the base member releasably secures the sealing assembly to the base member. The annular frame of the sealing assembly is configured to be in registration with the annular body of the base member such that the proximal ring is interposed between the base member and the sealing assembly.

Abstract: Suture constructs and methods for soft tissue to bone repairs. The suture construct is a soft, suture-based anchor which is self-cinching and has a specific, accordion-type configuration (i.e., with the ability to fold from a first, extended position to a second, folded or compressed position). The suture-based anchor may be formed essentially of a flexible material such as a high strength surgical suture, suture chain, or suture.

Abstract: A suture anchor for fixation within an anatomical structure includes an actuation member in contact with an anchor body at a first location thereof. The anchor body is elongate along a direction of elongation and defines a central axis. In a neutral configuration, the anchor body is flat and defines a thickness along a transverse direction and a width along a lateral direction, the width being greater than the thickness. The anchor body has first and second tails that are braided together along a portion of the actuation member from the first location to a second location of the anchor body. The actuation member is configured to apply a force to the braided anchor body so as to actuate the anchor body in a manner increasing its maximum thickness along a second direction that is angularly offset from the direction of elongation.