Developments and Perspectives Regarding the Impact of Digital Transformation on the Banking System in Romania

To understand the impact of digital technologies on the banking system, it is necessary to know the defining features and functioning of the banking system, as well as the particularities of banking services and products. This article intends to clarify these issues and identify the changes that have occurred over time in the banking system. Digital transformation is a priority for every bank. Investments in technology and innovation are objectives to be achieved for any bank and that's because the competitive environment is growing, and the mentality of consumers is changing. Digitalization is no longer a choice, but a necessity for both, society, and banks equally

Sistema de resposta dinâmica distribuída para consumos domésticos de eletricidade, em habitações com autoprodução e armazenamento elétrico

este protejo integra um sistema de optimização de consumo de energia domésticos de electricidade com integração de um sistema de resposta dinâmica distribuída. começamos por optimizar uma habitação independente, tendo sempre em conta a preferência do utilizador. depois é alargada e aplicada a uma produção distribuída

Cognitive Impairment in Chronic Lung Diseases

The increase in life expectancy has been accompanied by an escalation of age-related disease incidence. Mild cognitive impairment (MCI) is a decline of cognitive function higher than expected for a certain age, but not severe enough to meet the criteria for dementia. Hypoxemia, smoking history, ageing and several comorbidities are risk factors for both chronic respiratory diseases and cognitive deficit. Up to 70% of patients with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA) or idiopathic pulmonary fibrosis (IPF) have a form of cognitive impairment. Furthermore, a low neuropsychological performance is an independent predictor of disability and mortality in these populations. Efficient tools for cognitive assessment have been validated for these patients and should be used for better clinical outcomes. The physiopathological mechanisms, clinical impact and prevention strategies for cognitive dysfunction in chronic respiratory diseases will be detailed in the following chapter

Otimização do despacho de mini-hídricas para integração em ambiente de mercado

Tese de mestrado integrado. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 201

Gestão da dor da pessoa em situação paliativa: intervenções especializadas do enfermeiro

Relatório de Estágio de Natureza Profissional no âmbito do Mestrado em Enfermagem à Pessoa em Situação Paliativa apresentada na Escola Superior de Saúde do Instituto Politécnico de Viana do CasteloOs cuidados paliativos visam a redução do sofrimento das pessoas em situação paliativa, e família, proporcionando-lhes qualidade de vida. Neste processo de cuidados, a monitorização e intervenção adequada para o controlo dos sintomas são fundamentais. Neste domínio a gestão da dor afigura-se um dos maiores desafios para o enfermeiro, devido à elevada prevalência e sofrimento que causa à pessoa em situação paliativa. No âmbito do Mestrado em Enfermagem à Pessoa em Situação Paliativa, realizou-se o Estágio de Natureza Profissional com o objetivo de desenvolver competências comuns e específicas de enfermeiro especialista na área da enfermagem à pessoa em situação paliativa. A elaboração do presente relatório consiste na exposição analítica, crítica e reflexiva do percurso efetuado, relativamente às atividades desenvolvidas e competências adquiridas. Ao longo do estágio foram desenvolvidas diversas atividades, das quais se evidencia a realização do estudo documental descritivo sobre as intervenções do enfermeiro na gestão da dor da pessoa em situação paliativa numa unidade de cuidados paliativos. Analisados os registos de enfermagem, referentes à dor, obtiveram-se como principais resultados: os planos de cuidados com diagnóstico de enfermagem de dor apresentam um conjunto de intervenções padronizadas e iguais para todas as pessoas; a avaliação da dor circunscreve-se essencialmente à monitorização da intensidade; a escala de avaliação utilizada foi a escala numérica da dor; as intervenções para alívio da dor são maioritariamente centradas nas medidas farmacológicas; os registos de enfermagem revelam ser escassos face às intervenções executadas; constatou-se, contudo, que a intensidade de dor da pessoa quando elevada à admissão esta diminui significativamente ao longo do internamento, atingindo alivio total ao 4º dia, o que revela uma gestão eficaz. Com este estudo pretende-se contribuir para um conhecimento mais aprofundado sobre a gestão da dor, permitindo a reflexão sobre a ação, por forma a elaborar planos de cuidados cada vez mais eficazes na gestão da dor da pessoa em situação paliativa. Destacam-se ainda, neste relatório, as aprendizagens no âmbito do cuidado especializado à pessoa em situação paliativa e família, no que respeita ao controlo de sintomas, apoio a família e comunicação com equipa, doente em situação paliativa e respetiva família. Salienta-se o desenvolvimento de competências especializadas na área da formação e da gestão de cuidados. Em conclusão assumindo o enfermeiro um papel fundamental no cuidado da pessoa em situação paliativa considera-se ter desenvolvido competências especializadas sustentadas em conhecimento científico e visão humanista.Palliative care aims to reduce the suffering of people in palliative situations and families, providing them with quality of life. In this care process, adequate monitoring and intervention for symptom control are essential. In this domain, pain management seems to be one of the greatest challenges for nurses due to the high prevalence and suffering it causes to the person in a palliative situation. Within the scope of the Master's Degree in Nursing to the Person in Palliative Situation, the Professional Nature Internship was carried out with the objective of developing common and specific competencies of nurse specialist in the area of nursing to the person in palliative situation. The preparation of this report consists of the analytical, critical and reflective exposition of the path taken, in relation to the activities developed and skills acquired. Throughout the internship, several activities were developed, which evidences the accomplishment of the descriptive documentary study on the interventions of the nurse in the management of the pain of the person in palliative situation in a palliative care unit. After analyzing the nursing records related to pain, the main results were obtained: the care plans with nursing diagnosis of pain present a set of standardized and equal interventions for all people; pain assessment is essentially limited to monitoring intensity; the assessment scale used was the numerical pain scale; interventions for pain relief are mostly focused on pharmacological measures; nursing records reveal to be scarce in relation to the interventions performed; It was found, however, that the intensity of pain of the person when elevated at admission decreases significantly throughout the hospitalization, reaching total relief on the 4th day, which reveals an effective management. This study intends to contribute to a more in-depth knowledge about pain management, allowing reflection on the action, to elaborate care plans increasingly effective in the management of pain of the person in palliative situation. Also noteworthy in this report are the learnings in the scope of specialized care to the person in palliative situation and family, with regard to symptom control, family support and communication with the team, palliative patient and their family. The development of specialized skills in the area of training and care management is highlighted. In conclusion, assuming the nurse a fundamental role in the care of the person in a palliative situation, it is considered to have developed specialized competencies based on scientific knowledge and humanistic vision

Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases

Although these conditions are rare, a proportion of patients with interstitial lung diseases (ILDs) may develop a progressive-fibrosing phenotype. Progressive fibrosis is associated with worsening respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, decreased quality of life and, potentially, early death. Idiopathic pulmonary fibrosis may be regarded as a model for other progressive-fibrosing ILDs. Here we focus on other ILDs that may present a progressive-fibrosing phenotype, namely idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g. rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures. Differential diagnosis of these ILDs can be challenging, and requires detailed consideration of clinical, radiological and histopathological features. Accurate and early diagnosis is crucial to ensure that patients are treated optimally

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts