Joint analysis of duration of ventilation, length of intensive care, and mortality of COVID-19 patients: a multistate approach

BACKGROUND: The clinical progress of patients hospitalized due to COVID-19 is often associated with severe pneumonia which may require intensive care, invasive ventilation, or extracorporeal membrane oxygenation (ECMO). The length of intensive care and the duration of these supportive therapies are clinically relevant outcomes. From the statistical perspective, these quantities are challenging to estimate due to episodes being time-dependent and potentially multiple, as well as being determined by the competing, terminal events of discharge alive and death. METHODS: We used multistate models to study COVID-19 patients’ time-dependent progress and provide a statistical framework to estimate hazard rates and transition probabilities. These estimates can then be used to quantify average sojourn times of clinically important states such as intensive care and invasive ventilation. We have made two real data sets of COVID-19 patients (n = 24* and n = 53**) and the corresponding statistical code publically available. RESULTS: The expected lengths of intensive care unit (ICU) stay at day 28 for the two cohorts were 15.05* and 19.62** days, while expected durations of mechanical ventilation were 7.97* and 9.85** days. Predicted mortality stood at 51%* and 15%**. Patients mechanically ventilated at the start of the example studies had a longer expected duration of ventilation (12.25*, 14.57** days) compared to patients non-ventilated (4.34*, 1.41** days) after 28 days. Furthermore, initially ventilated patients had a higher risk of death (54%* and 20%** vs. 48%* and 6%**) after 4 weeks. These results are further illustrated in stacked probability plots for the two groups from time zero, as well as for the entire cohort which depicts the predicted proportions of the patients in each state over follow-up. CONCLUSIONS: The multistate approach gives important insights into the progress of COVID-19 patients in terms of ventilation duration, length of ICU stay, and mortality. In addition to avoiding frequent pitfalls in survival analysis, the methodology enables active cases to be analyzed by allowing for censoring. The stacked probability plots provide extensive information in a concise manner that can be easily conveyed to decision makers regarding healthcare capacities. Furthermore, clear comparisons can be made among different baseline characteristics

The voices of seduction: cross-gender effects in processing of erotic prosody

Gender specific differences in cognitive functions have been widely discussed. Considering social cognition such as emotion perception conveyed by non-verbal cues, generally a female advantage is assumed. In the present study, however, we revealed a cross-gender interaction with increasing responses to the voice of opposite sex in male and female subjects. This effect was confined to erotic tone of speech in behavioural data and haemodynamic responses within voice sensitive brain areas (right middle superior temporal gyrus). The observed response pattern, thus, indicates a particular sensitivity to emotional voices that have a high behavioural relevance for the listener

Gehirn, Gesichtsschädel und Hals

Die MRT ist aus mehreren Gründen die zurzeit beste radiologische Untersuchungsmethode für Kopf und Hals: Die äußere Morphologie und innere Struktur des in der Schädelkapsel verborgenen Gehirns werden überhaupt erst mit tomographischer Technik in vivo direkt sichtbar [1,6]. Die hohe räumliche und gute Kontrastauflösung der MRT erlauben eine genaue Abbildung der makroskopischen Anatomie und Pathologie und ist hierbei der CT weit überlegen. Die komplexen Strukturen des Gehirns, der Schädelbasis, des Gesichtsschädels und der Halsweichteile können in einem Untersuchungsgang dargestellt werden. Krankheitprozesse, die sich von extrakraniell nach intrakraniell und umgekehrt ausbreiten, werden in ihrer Kontinuität erfasst. Hierbei kommt dem Untersucher entgegen, dass Atembewegungen die Untersuchung von Kopf und Hals kaum stören

Tissue mimicking materials for a multi-imaging modality prostate phantom

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