Donor characteristics and intraoperative total nucleated cell count influence hematopoietic progenitor cell yield of healthy donor bone marrow grafts.

BACKGROUND: Bone marrow graft cell content impacts engraftment potential after allogeneic hematopoietic cell transplantation (alloHCT). Surrogates, such as intraoperative total nucleated cell count (ioTNC), are of unclear utility in predicting final graft characteristics. In addition, demographic and clinical factors may influence graft cellular profile and recipient engraftment. PROCEDURE: We retrospectively reviewed marrow harvests at our institution performed between 2009 and 2019. During this time, an ioTNC was measured after 50% of the projected final graft volume was collected. Regression models were used to assess associations between ioTNC (cells/µL) and final graft CD34+ (cells/mL), and between graft and donor characteristics and final graft CD34+ (cells/mL). RESULTS: Fifty-three marrow harvests and donor-recipient pairs were analyzed. Median (range) donor and recipient ages were 13 (0.7-28) years and 9 (0.2-21) years, respectively. The median ratio of donor/recipient weight was 1.225 kg (range 0.31-7.13). Median total volume of harvested marrow was 15.3 mL/kg (range 4.3-20.4) of donor weight and 19.4 mL/kg (range 4.7-87.4) of recipient weight. Median ioTNC was 20 930/µL (range 6600-44310) or 2.1 × 109 /mL, corresponding to median predicted final graft TNC of 3.59 × 108 /kg recipient weight (range 1.28-19.42 × 108 ). Simple linear regression between ioTNC and CD34+ cells/mL resulted in an R2 of 0.42. Least absolute shrinkage and selection operator (LASSO) regression produced a moderately predictive model consisting of ioTNC, donor age, and donor weight (adjusted R2  = 0.7) of final graft CD34+ cells/mL. CONCLUSIONS: ioTNC and certain donor characteristics correlate moderately well with marrow product CD34+ cells/mL, potentially informing donor selection and marrow procurement strategies.

Improvements in Psychosocial Outcomes Following a Summer Camp for Youth with Bleeding Disorders and Their Siblings.

PURPOSE: Complications from bleeding episodes from hemophilia can interfere with children's lives and lead to negative psychosocial outcomes. The purpose of this study is to evaluate whether attitude toward illness, hope, perception of illness benefit and/or burden, and/or illness knowledge change for youth with bleeding disorders and their siblings following a five-day education and activity focused summer camp. We hypothesized that youth with bleeding disorders' attitude toward illness, hope, perception of illness benefit, and illness knowledge would improve after camp attendance, and perception of illness burden would decease after camp attendance. We hypothesized that siblings' hope and illness knowledge would improve after camp attendance. DESIGN AND METHODS: A total of 98 youth (M = 10.9, SD = 3.33, 61.2% male) who attended a bleeding disorder summer camp participated in this study. Fifty percent of participants were diagnosed with either Hemophilia A, Hemophilia B (5%), Von Willebrand Disease (VWD) (28.3%), or platelet deficiency (1.7%), with 38 campers consisting of healthy siblings. The camp hosted "Learning about Hemophilia" breakout sessions for campers. Participants completed self-report questionnaires on the first day and last day of camp. RESULTS: Of participants with bleeding disorders, illness knowledge, perception of illness benefit, and attitude toward their illness significantly improved from pre-camp to post-camp. Hope did not significantly improve among youth with bleeding disorders. Healthy siblings' total hope significantly improved while illness knowledge remained constant. CONCLUSIONS: Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD. CONCLUSIONS: Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD.

A student-driven mindfulness curriculum for first-year osteopathic medical students: a pilot study.

CONTEXT: Medical education is stressful and can adversely affect the health and well-being of students. Although mindfulness-based interventions (MBIs) have been successfully utilized in other settings, little is known about the use of student-led interventions in undergraduate medical education. OBJECTIVES: The objectives of this study are to assess student satisfaction with four student-selected and student-led mindfulness activities incorporated into mandatory small-group sessions, the immediate impact of these activities on student stress levels, and student use of these activities outside the mindfulness sessions. METHODS: First-year osteopathic medical students voluntarily participated in weekly student-selected and student-led mindfulness activities once a week for 8 consecutive weeks during regularly scheduled class time. Activities included yoga postures, the 4-7-8 breathing technique, progressive muscle relaxation (PMR), and values affirmation. Each activity was completed twice during the 8 weeks. After each session, students could anonymously complete an electronic survey assessing participation, change in stress level, satisfaction with the activity, and mindfulness activities practiced outside the session. Survey questions included dichotomous, Likert-like, and multiple-choice responses. A chi-square test was utilized to analyze student responses from each week about the decrease in stress level, and satisfaction with the mindfulness activity, and student use of the activities outside the classroom. Wilcoxon rank sum tests were utilized to determine associations between outcomes, and a logistic regression model was utilized to determine relationships between the change in stress levels and other outcomes. RESULTS: Of the 154 first-year medical students initially enrolled in the 2021-2022 academic year, 14 (9.1 %) to 94 (61.0 %) actively participated in the weekly mindfulness activities. Students indicated that the 4-7-8 breathing technique was the activity most practiced outside the mindfulness sessions (32.3 %, 43/133 total responses) across all weeks. The mindfulness activity with the highest percentage of reported decrease in stress level was the yoga postures in week 5 (94.8 %, 36/38), and both weeks of the yoga activities had the highest reported student satisfaction (95.7 %, 90/94 for week 1; 92.1 %, 35/38 for week 5). For students who answered the change in stress level question, the stress level decrease was related to participation in the weekly activity for weeks 1 through 7 (all p<0.03). For students who participated in mindfulness sessions, the odds of reporting a reduction in the stress level were 16.6 times (95 % CI, 6.8-47.2; p<0.001) that of students who did not participate. For those satisfied with the activities, the odds of reporting a reduction in stress level were 6.7 (95 % CI, 3.3-13.9; p<0.001). CONCLUSIONS: Results suggested that the student-selected and student-led mindfulness activities may successfully reduce medical student stress in students who actively participate. However, additional research is needed to determine how to optimize mindfulness curricula implementation.