Characterizing COVID-19 clinical phenotypes and associated comorbidities and complication profiles

Purpose Heterogeneity has been observed in outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19). Identification of clinical phenotypes may facilitate tailored therapy and improve outcomes. The purpose of this study is to identify specific clinical phenotypes across COVID-19 patients and compare admission characteristics and outcomes. Methods This is a retrospective analysis of COVID-19 patients from March 7, 2020 to August 25, 2020 at 14 U.S. hospitals. Ensemble clustering was performed on 33 variables collected within 72 hours of admission. Principal component analysis was performed to visualize variable contributions to clustering. Multinomial regression models were fit to compare patient comorbidities across phenotypes. Multivariable models were fit to estimate associations between phenotype and in-hospital complications and clinical outcomes. Results The database included 1,022 hospitalized patients with COVID-19. Three clinical phenotypes were identified (I, II, III), with 236 [23.1%] patients in phenotype I, 613 [60%] patients in phenotype II, and 173 [16.9%] patients in phenotype III. Patients with respiratory comorbidities were most commonly phenotype III (p = 0.002), while patients with hematologic, renal, and cardiac (all p<0.001) comorbidities were most commonly phenotype I. Adjusted odds of respiratory, renal, hepatic, metabolic (all p<0.001), and hematological (p = 0.02) complications were highest for phenotype I. Phenotypes I and II were associated with 7.30- fold (HR:7.30, 95% CI:(3.11-17.17), p<0.001) and 2.57-fold (HR:2.57, 95% CI:(1.10-6.00), p = 0.03) increases in hazard of death relative to phenotype III. Conclusion We identified three clinical COVID-19 phenotypes, reflecting patient populations with different comorbidities, complications, and clinical outcomes. Future research is needed to determine the utility of these phenotypes in clinical practice and trial design

School-Based Programs to Reduce Bullying and Victimization

School bullying has serious short-term and long-term effects on children’s physical and mental health. Various anti-bullying programs have been implemented world wide and, more rarely, evaluated. Previous narrative reviews, summarizing the work done on bullying prevention, as well as previous meta-analyses of anti-bullying programs, are limited. The definition of school bullying includes several key elements: physical, verbal, or psychological attack or intimidation that is intended to cause fear, distress, or harm to the victim; an imbalance of power (psychological or physical), with a more powerful child (or children) oppressing less powerful ones; and repeated incidents between the same children over a prolonged period. School bullying can occur in school or on the way to or from school. It is not bullying when two persons of the same strength (physical, psychological, or verbal) victimize each other. This report presents a systematic review and meta-analysis of the effectiveness of programs designed to reduce school bullying perpetration and victimization (i.e. being bullied). The authors indicate the pitfalls of previous reviews and explain in detail how the present systematic review and meta-analysis addresses the gaps in the existing literature on bullying prevention

Structural mechanism of complex assemblies: Characterisation of beta-lactoglobulin and pectin interactions

Pectin and beta-lactoglobulin interact to form a hierarchical structure, which depends intimately on the tailored charge distribution on the pectin – and which causes the tertiary structure of the beta-lactoglobulin to change.</p