Pontifícia Universidade Católica do Rio de Janeiro

Severe community-acquired pneumonia (sCAP) strains ICU resources, demands efficient allocation and robust performance metrics for value-based care. Current ICU assessment methods often lack the necessary detail and risk adjustment for effective resource management, especially for complex patient populations such as those with sCAP.

This study investigated whether the machine learning-based Standardized Length of Stay Ratio (SLOSR) could reliably measure risk-adjusted LOS for sCAP patients, enabling benchmarking. SLOSR is calculated as the sum of observed length of stay (LOS) divided by the sum of predicted LOS, enabling ICU benchmarking for resource use.

We conducted a multicenter retrospective cohort study of 16,985 adult sCAP admissions across 220 ICUs in 57 Brazilian hospitals (January-December 2023). Data included demographics, comorbidities, SAPS 3, and ventilatory support. The machine learning model predicted LOS and calculated SLOSR. Rigorous validation included cross-validation, calibration plots, funnel plot analysis, RMSE, MAE, and R².

Hospital mortality was 9.3 %, ICU mortality 6.4 %, median ICU LOS 4 days, mean SAPS 3 score 50; 28.1 % received ventilatory support. The SLOSR demonstrated a robust grouped R² of 0.89. The model achieved RMSE = 4.57 and MAE = 3.10, with excellent calibration. Funnel plot analysis revealed a median SLOSR of 1.13 (Q1 = 0.9; Q3 = 1.34), underscoring its potential for benchmarking.

SLOSR shows promise as tool for assessing adjusted LOS as a surrogate of resource use in sCAP patients in the context of Brazilian ICUs. Further research is needed to validate its performance in other settings.

Data from clinical studies implicate adenosine in different types of anxiety disorders. Pharmacological and genetic manipulation of A1 and A2A adenosine receptors (A1R and A2AR) suggest that each contributes separately to regulating anxious states. This study aimed to perform a comparative neurochemical analysis of these receptors in animal models with a genetic basis of anxiety. Male Wistar rats previously selected through the freezing paradigm and characterized as high (CHF) and low (CLF) anxiety-like responses were compared to the control group (CTL). Animals were submitted to behavioral tests to evaluate anxiety-like behavior and declarative memory, and to biochemical and immunohistochemical analyses to evaluate the level and localization of A1R and A2AR in the hippocampus. In the elevated plus-maze, the CHF group was more anxious than the control and CLF groups. No statistical differences were found in the object recognition task among groups. Biochemical analyses showed a significant increase in A1R content for CHF in the dorsal hippocampus compared to the control group. On the other hand, the ventral hippocampus presented a decrease in A1R level for CHF and an increase for CLF compared to the control group. Concerning A2AR, data showed that the CLF group presented an increase in the dorsal hippocampus and a decrease in the ventral hippocampus compared to the control group. Together, these results support the hypothesis that the differential level of adenosine receptors in the hippocampus may modulate different aspects of anxiety-like behavior.

Early childhood experiences are critical for brain development and functioning throughout life, directly impacting socioemotional development. The COVID-19 pandemic presented significant challenges to development, many of which were previously unknown. This study examined the pandemic's impact on socioemotional development, with 2 questions: (1) what are the trends of risk status in the years before, during, and after the pandemic? and (2) which are the most related sociodemographic characteristics of children at risk across 2019-2023?

The sample included 25,050 children, aged 2-60 months. Male children comprised 56.0% of the sample. Mothers had an average age of 29.05 (SD=5.64) years, and 45.0% held a college degree. Risk for socioemotional delays was defined by the Ages & Stages Questionnaires: Social-Emotional, Second Edition. Analyses included the Cochran-Armitage test for trend, regression models, and propensity score matching.

A mixed pattern was found in the risk status: an initial period of stability or decline in 2020-2021, followed by a sharp increase in 2022 and 2023. Family income, maternal age, and level of education were consistently associated with an increased risk across all years. Children with younger mothers or mothers with a high-school education or less were more likely to be classified as at risk, with male children showing higher vulnerability.

This serial cross-sectional study indicates that the pandemic significantly affected the risk of socioemotional development in young children, especially from vulnerable environments. The pronounced effects, particularly evident 2 years after its onset, may reflect its cumulative negative impact.