Comorbidities and medical complexities of mobility device users: a retrospective study.

OBJECTIVE: To determine the medical complexities and comorbidities of individuals who utilise wheeled mobility devices. As well as, to examine costly events including the number of urinary tract infections (UTIs), hospitalizations, urgent care(UC)/emergency department (ED) visits that are commonly seen in this population over a period of time one year prior to and one year post receiving their wheeled mobility equipment. DESIGN/SETTING: A retrospective data review of 857 individual medical charts at a Level 1 Trauma Hospital and Clinic System. PARTICIPANTS: 330 male and female (24-92 years old) mobility device users with a wide range of diagnoses, of which: 56 used manual wheelchairs (MWC),138 scooters (POV), 123 power wheelchairs without integrated standing (PWC), and 13 power wheelchairs with integrated standing (iS-PWC). RESULTS: Overall, 92% (n = 304) had at least three medical comorbidities and medical complexities. The most common comorbidity was pain (91%). A change was noted in a lower incidence of UTIs in those using an iS-PWC, respectively 23% with at least 1 UTI in the year prior to and 8% in the year after the mobility device evaluation. CONCLUSIONS: The large number of comorbidities and medical complexities amongst all mobility device users is concerning. The burden and the accompanying healthcare costs of this population is high. The potential that iS-PWC and other interventions could have on reducing these issues should be explored further.Implications of rehabilitationRegardless of a person's primary diagnosis or the wheeled mobility device they use, 100% have at least one and 92% have at least three comorbidities and medical complexities if they spend the majority of their day sittingThe high healthcare cost situations such as Emergency Department visits, Urgent Care visits, hospitalizations, and Urinary Tract Infections are present across those that use all mobility device types and the means to potentially reduce these incidences should be further exploredThe introduction of integrated standing within a power wheelchair, as a means to minimize the frequency of comorbidities and medical complications, should also be investigated further.

Policy Analysis on Power Seat Elevation Systems.

In the early 2000s the Centers for Medicare and Medicaid Services determined that power seat elevation systems did not meet the definition of durable medical equipment, and therefore are non-covered items. Yet, power seat elevation systems are covered by other funding sources, and many power wheelchair users utilize these systems regularly when performing tasks such as transferring, reaching, and looking at objects in environments designed for ambulatory people. Adjusting for height when performing these tasks may reduce the onset of pain and comorbidities. To improve access to power seat elevation systems, a clinical team of 4 Clinician Task Force members investigated applicable literature, compiled evidence, and evaluated existing policies to explain the medical nature of power seat elevation systems as a part of a greater interprofessional effort. This manuscript aims to analyze Medicare's policy decision that power seat elevation systems are not primarily medical in nature using Bardach's 8-step framework. As a special communication, this will inform health care professionals of the medical nature of power seat elevation systems and the evidence-based conditions under which power wheelchair users may need power seat elevation systems, as well as empower clinicians to engage in policy directives to affect greater change.

Positron Emission Tomography Tracer Design of Targeted Synthetic Peptides via 18F-Sydnone Alkyne Cycloaddition.

Chemically synthesized, small peptides that bind with high affinity and specificity to CD8-expressing (CD8+) tumor-infiltrating T cells, yet retain the desirable characteristics of small molecules, hold valuable potential for diagnostic molecular imaging of immune response. Here, we report the development of 18F-labeled peptides targeting human CD8α with nanomolar affinity via the strain-promoted sydnone-alkyne cycloaddition with 4-[18F]fluorophenyl sydnone. The 18F-sydnone is produced in one step, in high radiochemical yield, and the peptide labeling proceeds rapidly. A hydrophilic chemical linker results in a tracer with favorable pharmacokinetic properties and improved image contrast, as demonstrated by in vivo PET imaging studies.

Policy analysis on power standing systems.

Power wheelchairs provide people with mobility disabilities opportunities for independence in mobility and repositioning themselves. However, current power wheelchair power options covered by Medicare limit the person to a horizontal plane. In the home, access to the vertical plane is also required for mobility related activities of daily living. Power standing systems on power wheelchairs are one option for providing access to the vertical environment, although currently these systems are not covered by Medicare. Power standing systems also aid in medical management and in preventing common comorbidities associated with chronic neurological and congenital healthcare conditions. Therefore, a legal group led an interdisciplinary effort to change Medicare policy on power standing systems. A policy analysis using Bardach's Eightfold policy framework was conducted to analyze a clinical groups' action within this interdisciplinary team. The clinical team considered three viable options to address the problem and evaluated these options against five criteria. Ultimately, a national coverage determination reconsideration would provide a needed opportunity for the coverage of power standing systems. Suggested coverage criteria for power standing systems, based on existing literature and expert clinical experience, are proposed.

Epitope-Targeted Macrocyclic Peptide Ligand with Picomolar Cooperative Binding to Interleukin-17F.

The IL-17 cytokine family is associated with multiple immune and autoimmune diseases and comprises important diagnostic and therapeutic targets. This work reports the development of epitope-targeted ligands designed for differential detection of human IL-17F and its closest homologue IL-17A. Non-overlapping and unique epitopes on IL-17F and IL-17A were identified by comparative sequence analysis of the two proteins. Synthetic variants of these epitopes were utilized as targets for in situ click screens against a comprehensive library of synthetic peptide macrocycles with 5-mer variable regions. Single generation screens yielded selective binders for IL-17F and IL-17A with low cross-reactivity. Macrocyclic peptide binders against two distinct IL-17F epitopes were coupled using variable length chemical linkers to explore the physical chemistry of cooperative binding. The optimized linker length yielded a picomolar affinity binder, while retaining high selectivity. The presented method provides a rational approach towards targeting discontinuous epitopes, similar to what is naturally achieved by many B cell receptors.

Rhodium(II)-Catalyzed Annulation of Azavinyl Carbenes Through Ring-Expansion of 1,3,5-Trioxane: Rapid Access to Nine-Membered 1,3,5,7-Trioxazonines.

The rhodium(II)-catalyzed denitrogenative coupling of N-alkylsulfonyl 1,2,3-triazoles with 1,3,5-trioxane led to nine-membered-ringed trioxazonines in moderate-to-good yields. 1,3,5-Trioxane, acting as an oxygen nucleophile, reacted with the α-aza-vinylcarbene intermediate, giving rise to ylide formation, which was probably the key step in the reaction. Triazoles that contained aryl substituents with various electronic and steric features on the C4 carbon atom were well-tolerated. The synthesis of trioxazonine derivatives was achieved through a one-pot, two-step procedure from 1-mesylazide and a terminal alkyne by combining Cu(I)-catalyzed 1,3-dipolar cycloaddition and rhodium-catalyzed transformations.

Nickel-catalyzed Csp2-Csp3 bond formation by carbon-fluorine activation.

We report herein a general catalytic method for Csp(2)-Csp(3) bond formation through C-F activation. The process uses an inexpensive nickel complex with either diorganozinc or alkylzinc halide reagents, including those with ß-hydrogen atoms. A variety of fluorine substitution patterns and functional groups can be readily incorporated. Sequential reactions involving different precatalysts and coupling partners permit the synthesis of densely functionalized fluorinated building blocks.