It is well documented that adverse or traumatic events in childhood can lead to increased incidences of serious mental and physical health diseases and disorders. It is also well documented that medical treatment, especially during childhood can be stressful and potentially traumatic, leading to Post-Traumatic Stress Disorder or Symptoms after treatment. This is especially true for lengthy and invasive medical treatment such as Hematopoietic Stem Cell Transplant (HSCT). A single music therapy intervention has been shown to effectively improve resilience in pediatric HSCT patients. But additional research is needed to understand the contribution music therapy interventions make to traumatic and stressful experiences and building resilience across time. This longitudinal two-phase multi-case study examined the patterns of potential trauma, toxic stress, and resilience during the HSCT process as well as the potential roles, functions, and contributions of music therapy interventions to the mitigation and prevention of toxic stress and trauma. The first phase, a retrospective multi-case study, resulted in the construction of a preliminary model of music therapy which identified patterns of stress and trauma and how the music therapy process interacts with these patterns. In the second phase, a purposeful sample of cases was used to confirm, clarify, and challenge the model utilizing Template Analysis. The outcome is the Music Therapy for Pediatric Medical Trauma, a proposed model of music therapy to focus treatment with the intention of mitigating toxic stress and trauma and build resilience in pediatric HSCT patients. / Music Therapy

Background: The history of transplantation goes back a long time and has been the last resort as a treatment to save a person's life. The availability of organs does not correspond to the need, there are also limited studies on how the patient's health processes are affected during the waiting time for a new organ. Aim: The aim of this study was to describe patientexperiences of waiting for an organ transplant. Method: This literature-based study was based on qualitative research to describe patient experiences of managing the waiting time for an organ transplant. 11 articles were analyzed according to Friberg's (2017) five step model. Results: The article analysis resulted in two main themes and six sub-themes. The main theme New Challenges highlighted that the patients are in need for both support and information during the time that they are waiting for an organ transplant. The second main theme, Emotional stress highlighted what feelings the patient can endure during the waiting time for a transplantation. The feelings of both hope and uncertainty are described by the patients. Conclusion: When nurses take responsibility for the caring and the six areas of competence, which means that patients who are on the waiting list for an organ transplant have their nursing needs met.

Indiana University-Purdue University Indianapolis (IUPUI) / Many persons with cirrhosis and eventually end stage liver disease (ESLD) are unable to meet the eligibility criteria for becoming a candidate for a liver transplant (LT). Currently, approximately 17,000 persons in the United States (U.S.) need a LT to survive, though only about 8,000 LT’s are performed each year; a LT is the only option for survival. The genesis of ESLD is most typically attributed to alcohol abuse, chronic hepatitis B or C, non-alcoholic fatty liver disease, autoimmune hepatitis, biliary atresia (new-born liver disease), or metabolic disorders. The etiology of adult LT recipients in 2017 for the U.S. were non-alcoholic fatty liver disease (31%) and alcoholic liver disease (25.1%). This study is guided by the Critical Social and Stress Coping Theories to assist in exploring potential health disparities prevalent in LT recipients. The aim of this study is to explore the psychological and demographic characteristics of 1297 LT recipients between 2010-2020 in an Indiana transplant center and identify potential disparities impacting 10-year survival rates. This exploratory, cross-sectional secondary analysis found that race/ethnicity, histories of mental illness, substance use/abuse, social support networks, education, marital status, and insurance sources held no statistical significance for 10-year survival rates. To date the screening process for each of those demographics appears to be effective and efficient. A Cox regression analysis revealed having a history of criminality significantly impacts 10-year survival rates. To address these findings the consideration for increased support and follow-up for patients with a history of criminality may positively impact 10-year survival rates.

Semi-arid native plant communities worldwide are often disturbed either intentionally or incidentally by human activity. In order to restore ecological function after human activities cease, native plant communities need to be restored. Woody plants are important to ecological function for many reasons including reducing erosion and providing food and shelter for wildlife. Unfortunately, woody plant establishment in these areas has proven to be challenging. Direct seeding efforts can be hindered by poor germination and low seedling emergence. To overcome this, seedling transplants are often used in harsh sites. However, transplanted woody seedlings often experience high mortality during the first year, predominantly as a result of stress during the summer. The Waterboxx® device is a tool that collects precipitation and condensates into a polypropylene reservoir, slowly releasing the water into the soil next to the seedling. Low soil fertility can also limit seedling establishment. In two studies, we evaluated the use of Waterboxx® devices with one wick or two wicks, and/or fertilizer as tools for establishing seedlings on a reclaimed waste rock pile. We also looked at the effects of either placing the Waterboxx® on the soil surface or burying the Waterboxx® partway into the ground. The first study focused on different species in the Waterboxx®. Species planted in the first study were Atriplex canescens, Cercocarpus ledifolius, Pinus edulis, Purshia tridentata and Rhus glabra. The second study focused on number of wicks, addition of fertilizer, and method of Waterboxx® instillation. This study was conducted with only one species: C. ledifolius. In both studies, the Waterboxx® device improved survival and vigor. In the second study, fertilizer was detrimental to seedling survival, and Waterboxx® devices installed on top of the soil had no difference in survival or vigor compared to the control, but partially buried devices were better than the control and Waterboxx® devices with two wicks had the best C. ledifolius seedling survival. Based on the results obtained, Waterboxx® devices were a viable method for most of these species in improving their establishment on mine land overburden sites in the semi-arid mountain west and additional research is merited for other areas of the world.

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Alloreactivity between donor cells against disparate host tissue is a natural and normal physiologic phenomenon after engraftment. Consequently, GVHD is a universally expected side effect after allogeneic HSCT. An effective strategy to prevent severe or fatal acute GVHD is require if the transplant is to be successful. The HSCT field has witnessed significant progress in the prevention and treatment of acute GVHD. However, select interventions come at the cost of losing the alloimmune activity that prevents relapse, the GVL effect, as many of the mechanisms which cause GVHD are shared with those responsible for GVL. Current efforts are focused on therapeutic interventions that not only alleviate the burden of acute GVHD but does so in a way that maintains the GVL effect. This review will provide an up-to-date overview of our current understanding of the diagnosis, risk stratification, immunobiology of acute GVHD, summarize efforts to prevent and treat the disease, and provide a perspective on future directions.

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