A Place to Call Home: Hearing the Perspectives of People Living with Homelessness and Mental Illness Through Service Evaluation.

There is an ongoing need to incorporate the perspectives of people in supported community housing to improve the provision of integrated mental health services. This study aimed to explore the satisfaction and experiences of people who have received supported housing and mental health services. We conducted a retrospective, mixed methods study using a data mining approach, analyzing consumer satisfaction survey responses collected on discharge from the service over a 7-year period. Responses from 178 consumers aged between 20 and 62 years were included. Quantitative results indicated that consumers rated the quality of services as relatively high. Analysis of qualitative responses identified seven themes describing people's views on how they had benefitted from the service. Consumers reported benefits in terms of practical and emotional supports, responsiveness of the team to their needs, socialization and community integration, personal growth and recovery, and finding 'my place'. Themes of learning and skills development were also important. These results suggest that practical support, together with emotional expressions of care and compassion are most valued by people who participated in this service. This research has implications for service evaluation and for future research, which may include focusing on the key role of connectedness, 'my place' and hope for recovery.

An unusual case of foreign body pulmonary embolus: case report and review of penetrating trauma at a pediatric trauma center.

PURPOSE: Penetrating thoracic trauma is relatively rare in the pediatric population. Embolization of foreign bodies from penetrating trauma is very uncommon. We present a case of a 6-year-old boy with a penetrating foreign body from a projectile dislodged from a lawn mower. Imaging demonstrated a foreign body that embolized to the left pulmonary artery, which was successfully treated non-operatively. METHODS: We reviewed the penetrating thoracic trauma patients in the trauma registry at our institution between 1/1/03 and 12/31/12. Data collected included demographic data, procedures performed, complications and outcome. RESULTS: Sixty-five patients were identified with a diagnosis of penetrating thoracic trauma. Fourteen of the patients had low velocity penetrating trauma and 51 had high velocity injuries. Patients with high velocity injuries were more likely to be older and less likely to be Caucasian. There were no statistically significant differences between patients with low vs. high velocity injuries regarding severity scores or length of stay. There were no statistically significant differences in procedures required between patients with low and high velocity injuries. CONCLUSIONS: Penetrating thoracic trauma is rare in children. The case presented here represents the only report of cardiac foreign body embolus we could identify in a pediatric patient.

Targeting the local tumor microenvironment with vaccinia virus expressing B7.1 for the treatment of melanoma.

Immunotherapy for the treatment of metastatic melanoma remains a major clinical challenge. The melanoma microenvironment may lead to local T cell tolerance in part through downregulation of costimulatory molecules, such as B7.1 (CD80). We report the results from the first clinical trial, to our knowledge, using a recombinant vaccinia virus expressing B7.1 (rV-B7.1) for monthly intralesional vaccination of accessible melanoma lesions. A standard 2-dose-escalation phase I clinical trial was conducted with 12 patients. The approach was well tolerated with only low-grade fever, myalgias, and fatigue reported and 2 patients experiencing vitiligo. An objective partial response was observed in 1 patient and disease stabilization in 2 patients, 1 of whom is alive without disease 59 months following vaccination. All patients demonstrated an increase in postvaccination antibody and T cell responses against vaccinia virus. Systemic immunity was tested in HLA-A*0201 patients who demonstrated an increased frequency of gp100 and T cells specific to melanoma antigen recognized by T cells 1 (MART-1), also known as Melan-A, by ELISPOT assay following local rV-B7.1 vaccination. Local immunity was evaluated by quantitative real-time RT-PCR, which suggested that tumor regression was associated with increased expression of CD8 and IFN-gamma. The local delivery of vaccinia virus expressing B7.1 was well tolerated and represents an innovative strategy for altering the local tumor microenvironment in patients with melanoma.

Pharmacokinetics of surotomycin from phase 1 single and multiple ascending dose studies in healthy volunteers.

BACKGROUND: Surotomycin, a novel, orally administered, cyclic, lipopeptide antibacterial in development for the treatment of Clostridium difficile-associated diarrhea, has demonstrated minimal intestinal absorption in animal models. METHODS: Safety, tolerability, and plasma pharmacokinetics of single and multiple ascending oral doses (SAD/MAD) of surotomycin in healthy volunteers were characterized in two randomized, double-blind, placebo-controlled, phase 1 studies. RESULTS: Participants were sequentially enrolled into one of four SAD (500, 1000, 2000, 4000 mg surotomycin) or three MAD (250, 500, 1000 mg surotomycin twice/day for 14 days) cohorts. Ten subjects were randomized 4:1 into each cohort to receive surotomycin or placebo. Surotomycin plasma concentrations rose as dose increased (maximum plasma concentration [Cmax]: 10.5, 21.5, 66.6, and 86.7 ng/mL). Systemic levels were generally low, with peak median surotomycin plasma concentrations observed 6-12 h after the first dose. In the MAD study, surotomycin plasma concentrations were higher on day 14 (Cmax: 25.5, 37.6, and 93.5 ng/mL) than on day 1 (Cmax: 6.8, 11.0, and 21.1 ng/mL for increasing doses), indicating accumulation. In the SAD study, <0.01% of the administered dose was recovered in urine. Mean surotomycin stool concentration from the 1000 mg MAD cohort was 6394 µg/g on day 5. Both cohorts were well tolerated with all adverse events reported as mild to moderate. CONCLUSION: Both SAD and MAD studies of surotomycin demonstrated minimal systemic exposure, with feces the primary route of elimination following oral administration; consistent with observations with similar compounds, such as fidaxomicin. Results of these phase 1 studies support the continued clinical development of surotomycin for the treatment of Clostridium difficile-associated diarrhea. TRIAL REGISTRATION: NCT02835118 and NCT02835105 . Retrospectively registered, July 13 2016.

Cardiac fibroma, anomalous pulmonary venous course, and persistent pneumonia in a patient with Gorlin syndrome.

We report the unusual case of a child referred for persistent pneumonia and possible pulmonary nodules who was found to have a cardiac fibroma and diagnosed with Gorlin syndrome. Pulmonologists should be aware of the potential for vascular anomalies associated with this syndrome as well as the risk for pulmonary metastases from primary skin tumors.

Single-dose pharmacokinetics and tolerability of daptomycin 8 to 10 mg/kg in children aged 2 to 6 years with suspected or proved Gram-positive infections.

A pharmacokinetic analysis was performed for single intravenous doses of daptomycin 8 or 10 mg/kg in subjects aged 2 to 6 years. Proportional increases in maximum plasma concentration (68.4 µg/mL, 79.2 µg/mL) and area under the curve (429.1 µg · h/mL, 549.7 µg · h/mL) were observed for each dose cohort, respectively. Half-life, clearance, and distribution volume were similar between groups. Both doses were well tolerated.

Assessment of in-stent stenosis in small children with congenital heart disease using multi-detector computed tomography: a validation study.

OBJECTIVES: Our purpose was to investigate the diagnostic reliability of multi-detector computed tomography (MDCT) in assessing in-stent stenosis compared to digital angiography (DA) in small children. BACKGROUND: Little is known about the feasibility of using MDCT to assess stents placed to treat children with congenital heart disease (CHD). METHODS: Twenty-two children (median age [range], 2(3/4) [(1/2) to 12] years) with 42 transcatheter placed stents (median diameter: 7.2 [3.4-16.3] mm) in the pulmonary arteries (n = 36), aorta (2), PDA (1), and SVC (3) underwent both MDCT and DA due to suspected hemodynamic problems. RESULTS: Independent "blinded" observers were able to measure stent and minimal luminal diameters in 115 out of 124 (93%) stent segments on MDCT and DA. The interobserver variability was low (mean difference: 0.5, SD 0.8 mm) with high correlation (r = 0.97; P < .0001). The percent stenosis by MDCT correlated well with DA (r = 0.89, P < .0001; mean error 2.7, SD 10.4%). For all grades of stenosis, the sensitivity and specificity for MDCT were 58% and 97%, respectively. At a threshold of approximately > or =20% stenosis sensitivity became >98%. All stent associated complications [fracture (4), vascular narrowings (11)] were diagnosed by MDCT. As the stent diameter increased, there was significantly reduced variability between MDCT and DA for in-stent stenosis (P < .0001). CONCLUSION: In small children, MDCT is a feasible and promising method for assessing stent associated complications in the treatment of CHD. Cardiac surgeons and interventional cardiologists might rely on this imaging modality to plan specific interventions more precisely and to assess the results upon follow up.