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This paper summarizes the contribution of Polish scientific units to the development of the Global Geodetic Observing System (GGOS) in recent years. We discuss the issues related to the integration of space geodetic techniques and co-location in space onboard Global Navigation Satellites Systems (GNSS) and Low Earth Orbiters (LEO), as well as perspectives introduced by the new European Space Agency's (ESA) mission GENESIS. We summarize recent developments in terms of the European Galileo system and its contribution to satellite geodesy and general relativity, as well as ESA's recent initiative - Moonlight to establish a satellite navigation and communication system for the Moon. Recent progress in troposphere delay modeling in Satellite Laser Ranging (SLR) allowed for better handling of systematic errors in SLR, such as range biases and tropospheric biases. We discuss enhanced tropospheric delay models for SLR based on numerical weather models with empirical corrections, which improve the consistency between space geodetic parameters derived using different techniques, such as SLR, GNSS, and Very Long Baseline Interferometry (VLBI). Finally, we review recent progress in the development of Polish GGOS scientific infrastructure in the framework of the European Plate Observing System project EPOS-PL+. [ABSTRACT FROM AUTHOR]

With such a low percentage of patients having open surgery comparison with laparoscopic surgery group is difficult. Fahim et al. [1] report increased mortality after open colorectal cancer surgery (HR1.26). [Extracted from the article]

Introduction: According to the general idea a doctor can start the medical management process in an adult and not legally incapacitated patient after the patient has given consent to initiate such a process. The patient's refusal makes rendering medical services impossible, irrespective of their scope and kind. It should be emphasized that such a refusal is respected if it is expressed fully, clearly and consciously. Cases in which such a refusal is expressed by an intoxicated suicidal patient, remaining under the influence of narcotics, drugs or medicaments which characterize with a similar activity should be particularly analysed. Although such a person is able to verbally declare his objection, his ability to process the information given by the doctor before initiating medical procedures is limited, or even non-existant. The refusal therefore cannot be regarded as reliable, which results in rendering medical services to the patient., Materials and Methods: An analysis was made of Acts of Law and the opinions of the judiciar by comparing and excluding contradictory and incoherent elements., Results: Despite the lack of clear regulations of a patient rejecting procedures aimed at saving the patient's life, or the prevention of serious health impairment or sustaining injury, it should be assumed that the objection expressed by the patient who does not demonstrate the ability to process the information provided by the doctor is not reliable, and the doctor is therefore still obliged to render medical services. External factors, such as consumption of alcohol, narcotics and drugs, which characterize with a similar activity impair perception and make the taking of a conscious decision impossible. Not providing medical help and introducing direct compulsion would mean neglecting provision of due diligence in the process of treatment and, as a consequence, placing the patient's health at risk, and suffering from negative implications for the patient's life and/or health in the future., Conclusions: Current provisions should directly regulate the negligence of respecting a refusal expressed 'unconsciously' by a patient who remains under the influence of alcohol, narcotics, drugs or medicaments which characterize with a similar activity. Moreover, apart from legal provisions, the law providers should consider introducing a direct compulsion in patients who are unable to make a conscious decision in the treatment process.

Current legal regulations do not explicitly state whether the doctor should or should not ignore the patient's refusal to be provided with medical services when such refusal is given by the patients who is temporarily unable to take conscious decisions. The fact that there is no clear jurisdiction over the issue makes the relation between doctor and patient legally complicated. The doctor has no doubts whether he/she should or should not initiate the medical procedure when the patient clearly expresses the declaration of will, in which either refusal or consent is given to be provided with medical care. However, the patient remaining under the influence of alcohol, i.e. a substance which to some or great extent impairs cognitive functions, rational thinking, and the ability to evaluate incoming information. Alcohol makes the patient unable to interpret the information given by the doctor. Thus, the patient's consent or refusal to be provided with medical care is lacking in the needed elements of "informing" and "conscious declaration of will", which are considered by doctors and lawyers to be absolutely necessary to make such will valid. There are no clear, unambiguous regulations explaining how the doctor should behave in such cases. The authors of the presented study state that it is highly important to determine whether the intoxicated patient is able to understand the incoming information, evaluate it, make a conscious decision and finally, express an explicit (and therefore binding) refusal to accept recommended medical services. In the opinion of the authors, while dealing with such patients, the doctor should bear in mind the patient's right to make autonomous decisions, but that it is also the doctor's duty to provide the patient with medical services.