Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults With Sickle Cell Disease: Protocol for the Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) Study

BACKGROUND: Patients with sickle cell disease (SCD) experience significant medical and psychological stressors that affect their mental health, well-being, and disease outcomes. Digital cognitive behavioral therapy (CBT) has been used in other patient populations and has demonstrated clinical benefits. Although evidence-based, nonpharmacological interventions for pain management are widely used in other populations, these treatments have not been well studied in SCD. Currently, there are no adequately powered large-scale clinical trials to evaluate the effectiveness and dissemination potential of behavioral pain management for adults with SCD. Furthermore, some important details regarding behavioral therapies in SCD remain unclear—in particular, what works best for whom and when. OBJECTIVE: Our primary goal is to compare the effectiveness of two smartphone–delivered programs for reducing SCD pain symptoms: digital CBT versus pain and SCD education (Education). Our secondary goal is to assess whether baseline depression symptoms moderate the effect of interventions on pain outcomes. We hypothesize that digital CBT will confer greater benefits on pain outcomes and depressive symptoms at 6 months and a greater reduction in health care use (eg, opioid prescriptions or refills or acute care visits) over 12 months. METHODS: The CaRISMA (Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications) study is a multisite comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute. CaRISMA is conducted at six clinical academic sites, in partnership with four community-based organizations. CaRISMA will evaluate the effectiveness of two 12-week health coach–supported digital health programs with a total of 350 participants in two groups: CBT (n=175) and Education (n=175). Participants will complete a series of questionnaires at baseline and at 3, 6, and 12 months. The primary outcome will be the change in pain interference between the study arms. We will also evaluate changes in pain intensity, depressive symptoms, other patient-reported outcomes, and health care use as secondary outcomes. We have 80% power to detect a difference of 0.37 SDs between study arms on 6-month changes in the outcomes with 15% expected attrition at 6 months. An exploratory analysis will examine whether baseline depression symptoms moderate the effect of the intervention on pain interference. RESULTS: This study will be conducted from March 2021 through February 2022, with results expected to be available in February 2023. CONCLUSIONS: Patients with SCD experience significant disease burden, psychosocial stress, and impairment of their quality of life. CaRISMA proposes to leverage digital technology and overcome barriers to the routine use of behavioral treatments for pain and depressive symptoms in the treatment of adults with SCD. The study will provide data on the comparative effectiveness of digital CBT and Education approaches and evaluate the potential for implementing evidence-based behavioral interventions to manage SCD pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/ct2/show/NCT04419168. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/2901

The response of tropical rainforests to drought : lessons from recent research and future prospects

Key message: we review the recent findings on the influence of drought on tree mortality, growth or ecosystem functioning in tropical rainforests. Drought plays a major role in shaping tropical rainforests and the response mechanisms are highly diverse and complex. The numerous gaps identified here require the international scientific community to combine efforts in order to conduct comprehensive studies in tropical rainforests on the three continents. These results are essential to simulate the future of these ecosystems under diverse climate scenarios and to predict the future of the global earth carbon balance. - Context: tropical rainforest ecosystems are characterized by high annual rainfall. Nevertheless, rainfall regularly fluctuates during the year and seasonal soil droughts do occur. Over the past decades, a number of extreme droughts have hit tropical rainforests, not only in Amazonia but also in Asia and Africa. The influence of drought events on tree mortality and growth or on ecosystem functioning (carbon and water fluxes) in tropical rainforest ecosystems has been studied intensively, but the response mechanisms are complex.- Aims: herein, we review the recent findings related to the response of tropical forest ecosystems to seasonal and extreme droughts and the current knowledge about the future of these ecosystems. - Results: this review emphasizes the progress made over recent years and the importance of the studies conducted under extreme drought conditions or in through-fall exclusion experiments in understanding the response of these ecosystems. It also points to the great diversity and complexity of the response of tropical rainforest ecosystems to drought. - Conclusion: the numerous gaps identified here require the international scientific community to combine efforts in order to conduct comprehensive studies in tropical forest regions. These results are essential to simulate the future of these ecosystems under diverse climate scenarios and to predict the future of the global earth carbon balance

High prevalence of household pesticides and their unsafe use in rural South India

Objective: To estimate the prevalence of usage, unsafe practices and risk perception regarding household pesticides in a rural community of Tamil Nadu, India. Materials and Methods: In a cross-sectional survey we used a pre-tested questionnaire and trained interviewers to collect information on household pesticide use for the past 6 months from any adult member of randomly selected households. Results: Out of 143 households, 95% used at least one household pesticide (95% CI: 93.5-99.5) and 94% used at least one household pesticide specifically for mosquito control. The most commonly used pesticides were mosquito coils (75%), mosquito liquid vaporizers (36%), ant-killing powder (24%) and moth/naphthalene balls (18%). The major non-chemical methods of pest control were rat traps (12%) and mosquito bed nets (7.5%). Out of the mosquito coil users, 61% kept the windows and doors closed while the coil was burning. Out of the moth ball users, 88% left them in the place of use till they fully vaporized. Nearly half of the users did not know that household pesticides were harmful to their health and the health of their children. Conclusions: The use of household pesticides was highly prevalent in this rural community. The prevalence of unsafe practices while handling them was also high. We recommend that the users of household pesticides be educated about the health hazards and about safe practices and non-chemical methods of pest control be promoted

Clinico-epidemiological profile and outcomes of adults with COVID-19: A hospital-based retrospective study in Kerala, India

Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies

Autologous and Allogeneic Stem Cell Transplantation for T-Cell Lymphoma: The M.D. Anderson Cancer Center Experience

Abstract Abstract 4118 BACKGROUND: Despite the advent of novel agents, outcomes of T cell Lymphoma (TCL) with conventional chemotherapy are poor. We have previously reported (Rodriguez J, JCO 2001) encouraging results with autologous stem cell transplantation (ASCT). Others have advocated allogeneic transplants (Allo-SCT). Herein, we report our long-term experience in 196 TCL patients (pts) who had either ASCT (n=119) or Allo-SCT (n=77). METHOD and PATIENTS: This is a retrospective analysis of TCL pts treated with SCT at our institution between 1986 and 2009. We adopted WHO 2008 classification for TCL and divided pts accordingly into Nodal TCL (N-TCL), extra nodal TCL (EN-TCL), and T cell lymphoblastic Lymphoma (T-LBL). Sixty one pts (31%) had peripheral t-cell not otherwise specified (PTCL), 50 (26%) had anaplastic large cell (ALCL), 19 (10%) angioimmunoblatic (AITL), 34 (17%) EN-TCL, and 32 (16%) had T-LBL. ASCT and Allo-SCT pts were balanced for Ann-Arbor stage, gender distribution and time from initial diagnosis. However, Allo-SCT pts were younger (median age 41 vs. 49 yrs, respectively, (p=0.002), more heavily pretreated (p=0.01), were more likely to have extranodal (p CR1 (p=0.001), Prognostic Index for TCL(PIT) >0 (p=0.009), IPI>1 (p=0.03), refractory disease (p=0.001) were associated with worse OS and PFS (Figure 1). The 3-year OS and PFS for CR1 pts (n+33) were 90% and 70%, respectively. A subset of pts (n= 11) within the CR1 group received induction chemotherapy with Hyper-CVAD before ASCT. The 3-year OS and PFS rates for these pts were both 100%. We were not able to detect any difference in outcomes between the different histologies studied, including ALK(+) and ALK (−) ALCL. B. [Allo-SCT] Most pts (75%) received myeloablative conditioning. There was a trend for better outcomes for transplants > year 2000. With a median follow-up of 65 months (range, 5–235), the OS and PFS rates were 43% and 30%, respectively. OS and PFS rates for EN-TCL(n=18) were 49% and 36%, respectively. Among the N-TCL (n=33) group, unlike ASCT, most pts (87%) were >CR1. The 3-year OS and PFS rates for these pts were 38% and 23%, respectively. Both IPI and PIT >0 were determinants for worse PFS, whereas IPI >0 and marrow involvement were predictors for worse OS. No plateau however was observed in these pts, unlike those with T-LBL, where a clear plateau of 40 % was observed. CONCLUSION: This is the largest single institution analysis to investigate the role of SCT for TCL. Our review demonstrates that ASCT can induce long-term remissions in CR1 pts with N-TCL. Prospective studies comparing ASCT in this setting to other conventional treatments are warranted. Although allo-SCT was found to be effective in T-LBL, its role in other forms of TCL is yet to be determined. Innovative strategies remain needed for pts with relapsed disease. Disclosures: No relevant conflicts of interest to declare