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Oropharyngeal dysphagia (OD) is underdiagnosed and current screening is costly. We aimed: (a) to develop an expert system (ES) based on machine learning that calculates the risk of OD from the electronic health records (EHR) of all hospitalized older patients during admission, and (b) to implement the ES in a general hospital. In an observational, retrospective study, EHR and swallowing assessment using the volume-viscosity swallow test for OD were captured over 24 months in patients 70 yr admitted to Mataró Hospital. We studied the predictive power for OD of 25,000 variables. ES was obtained using feature selection, the final prediction model was built with non-linear methods (Random Forest). The database included 2809 older patients (mean age 82.47 ± 9.33 yr), severely dependent (Barthel Index 47.68 ± 31.90), with multiple readmissions (4.06 ± 7.52); 75.76% had OD. The psychometrics of the ES built with a non-linear model were: Area under the ROC Curve of 0.840; sensitivity 0.940; specificity, 0.416; Positive Predictive Value 0.834; Negative Predictive Value 0.690; positive likelihood ratio (LH), 1.61 and negative LH, 0.146. The ES screens in 6 s all patients admitted to a 419-bed hospital, identifies patients at greater risk of OD, and shows the risk for OD in the clinician's workstation. It is currently in use at our institution. Our ES provides accurate, systematic and universal screening for OD in real time during hospital admission of older patients, allowing the most appropriate diagnostic and therapeutic strategies to be selected for each patient.

BACKGROUND & AIMS: Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic. METHODS: This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up. RESULTS: We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 &plusmn, 8.0 years and Alzheimer&rsquo, s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p &lt, 0.007), had worse functionality (p &lt, 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p &lt, 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

http://dx.doi.org/10.5902/2179460X14639The relationship between geometry and trigonometry can go far beyond the classic problem involving the two areas in basic education, which is the resolution of triangles. Possibilities of using the geometry in the service of Trigonometry, or the Trigonometry in the service of Geometry, are many. There is a tendency to separate them by rigid boundaries, affecting cooperation among the methods and techniques of both areas in solving certain mathematical problems, not necessarily limited to one area, for example, the problems posed in the Olympics. In this paper we show some of these possibilities, working with examples where from a geometric result we obtain certain trigonometric results, or, from a trigonometric result we obtain some geometric result. We also present the solution of some geometric problems using both methods.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Nesta dissertação, apresentamos os resultados de uma ampla pesquisa bibliográfica sobre as equações diofantinas e seus métodos de solução mais utilizados. A mais simples desta classe de equações é a da forma ax + by = c, com a, b e c números inteiros e ab 6= 0, chamada equação diofantina linear nas duas incógnitas x e y. No trabalho, expomos diversos métodos de resolução destas equações, em duas e três incógnitas. Para tanto, utilizamos conceitos de divisibilidade, divisão euclidiana, máximo divisor comum, números primos, dentre outros, que formam parte do currículo do Ensino Fundamental. No Brasil, as equações diofantinas não são comumente exploradas na Educação Básica, embora sejam perfeitamente compreensíveis nesse nível, como se mostra no texto do professor A. Guelfond, consultado na redação do trabalho. Na dissertação, incluímos, também, um capítulo sobre as contribuições de Diofanto para a Aritmética, que pode ser uma fonte de motivação para o estudo das equações diofantinas; e outro capítulo, ampliando as perspectivas sobre equações diofantinas não lineares. Esperamos que o trabalho seja uma fonte bibliográfica facilmente acessível aos professores da Educação Básica, e estimule seu interesse e criatividade para a introdução elementar desses conteúdos na prática docente e na preparação dos alunos para as Olimpíadas de Matemática. In this dissertation, the results of a wide bibliographic research about Diophantine equations and their most used solution methods are exposed. The simplest equation of these class is the one in the form ax + by = c, with a, b and c integers numbers and ab 6= 0, called Diophantine linear equation in the unknowns x and y. Divers solutions methods for these equations, in two or three unknowns are discussed. Therefore, concepts like divisibility, Euclidean division, grated common divisor, prime numbers, among others, that are included in the Elementary Schools curriculum. In Brazil, Diophantine equations are not commonly exploited in Basic Education, even though they are perfectly understandable at this educational level, like Professor A. Guelfond shows in his book consulted in the redaction of the dissertation. There are also a chapter about Diophantuss contributions to Arithmetic, which can be a source of motivation to study the Diophantine equations; and another chapter, extending perspectives, about nonlinear Diophantine equations. We hope that the dissertation becomes a suitable easy accessible bibliographic font for Basic Education teachers and stimulates their interest and creativity for an elemental introducing of these contents in their teaching and in the students training for Math Olympiads.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior A situação financeira econômica atual vivida por nosso país nos faz refletir sobre a importância de estudarmos a Educação Financeira desde o ensino básico, a fim de instruirmos nossos jovens para que tenhamos um país saudável financeiramente. Neste trabalho, é abordado maneiras distintas de orientar nossos discentes do ensino médio sobre como investir, financiar e acima de tudo, conhecer os fundos de investimentos mais usados em nosso país. Familiarizados com estes fundos de investimentos, os jovens aprenderão como é importante economizar e investir. Métodos como aproximação linear de Newton ajudará aos jovens nos cálculos financeiros, bem como os colocarão perante uma ferramenta fundamental nesta área. O estudo sobre sistemas de amortizações auxiliará nossos jovens quanto aos financiamentos mais usados em nosso país, principalmente na aquisição do seu primeiro carro ou imóvel. A metodologia usada foi essencialmente uma pesquisa bibliográfica a partir da qual se consegue aprofundar no assunto pesquisado. A seguir, ajustou-se as hipóteses iniciais e delineou-se a estratégia concreta para o cumprimento dos objetivos propostos. Conclui-se que, com exercícios exemplos voltados para o cotidiano das pessoas, desperta-se um maior interesse pelos alunos em aprender a Matemática Financeira e aplicá-la em diversas situações de suas vidas. Our motherlands current economic situation makes us reflect on the importance of studying the Financial Education since elementary school, so that we can educate our younger generation to make our country a healthier financially. This dissertation discusses many distinguished fashions for teaching high school students on how to invest, finance and, above all, getting them to know the investment funds that are used the most in our country. After being familiarized with these investment funds, the young students will learn the importance of saving and investing. Methods like Newtons linear approximation will help in their financial calculations, as well as making them acquainted with a fundamental tool for this field. The study of amortization systems will help students acknowledge our countrys most common financing choices, especially regarding the purchase of their first car or real estate. The methodology chosen for this dissertation was essentially a bibliographical research. In conclusion, with the help of examples and exercises with a focus on the daily life, there will be a greater interest among kids and teenagers in learning Financial Mathematics and its application in the most diverse situations.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior A relação entre a Geometria e a Trigonometria vai além da forma clássica em que estas duas áreas da Matemática são apresentadas no Ensino Básico. Existe uma tendência a separá-las por fronteiras rígidas cerceando de certa forma a cooperac~ao entre os métodos e tecnicas de uma e de outra, com o objetivo de resolver determinados problemas matem aticos, cuja solução não está obrigatoriamente inscrita numa destas áreas. Por exemplo, problemas propostos em olimpíadas. Neste trabalho mostra-se algumas dessas possibilidades trabalhando com situações em que a partir de um resultado geométrico obtem-se determinados resultados trigonométricos ou, o contrário. The relationship between Geometry and Trigonometry goes beyond the classic way in which these two areas of mathematics are presented in high school. There is a tendency to separate them by rigid boundaries, restricting somehow cooperation between the methods and techniques of one of them in the other in order to solve certain mathematical problems, whose solution is not compulsorily insured in a particular area. For example, problems proposed in the Olympics. In this work we will show some possibilities of interaction, working with situations where from geometrical results we obtain certain trigonometric results and otherwise.