Should a doctor stop rendering medical services? Part II – Analysis of medico-legal conduct in cases of uncertainties regarding informed consent in minors. The Polish perspective

introduction. The doctor’s decision whether to save the life of a minor who has attempted to commit suicide depends on the decision of the person who, under legal regulations, is responsible for the minor. In everyday medical practice doctors are often placed in difficult situations and often cannot make any decision. Such doubts arise when it is impossible to contact the person(s) responsible for the minor. The doctor encounters similar issues when the parents of a minor under 16 years of age express different opinions on the recommended procedures, and are against the doctor’s decision and do not want their child to be hospitalized. materials and methods. The current legislation and doctrine was analyzed and an attempt was made to determine the way of conduct with regard to suicidal minors, and algorithmize the way of conduct towards such suicidal minors. The conduct was discussed on the two examples, based on real clinical cases. results. With regard to minors in a clinical state demanding urgent procedures, who have of the decision made by the guardian, and regardless of the fact there is no contact with the guardian. If the status is stable, the physician’s modus operandi depends on various accompanying circumstances. However, he is still obliged to provide medical help. discussion. A practical algorithm is presented and all the possible legal variations discussed and clarified

Alcohol-intoxicated patients at admission room -analysis of legal aspects of rendered medical services

Zajdel J, Zajdel R, Dziki A, Wallner G. Alcohol-intoxicated patients at admission room -analysis of legal aspects of rendered medical services. Ann Agric Environ Med. 2012; 19(4): 701-706. Abstract 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 in uence 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 nally, 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

Global Geodetic Observing System in Poland 2019–2022

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¸

On the potential contribution of BeiDou-3 to the realization of the terrestrial reference frame scale

Since the release of the phase center calibrations for both the receivers and the satellites, the BeiDou Navigation Satellite System (BDS) became a new potential contributor to the realization of the terrestrial reference frame (TRF) scale of future International Terrestrial Reference Frame releases. This study focuses on the evaluation of the potential usage of the BDS-3 Medium Earth Orbit (MEO) constellation to the definition of the TRF scale. To that aim, we used ground calibrated BDS-3 satellite PCOs provided by the China Satellite Navigation Office and multi-GNSS robot calibrations for the ground antennas conducted by Geo++. Two ionosphere-free linear combinations of signals, namely B1I/B3I, and B1C/B2a, have been investigated to find out whether using different frequencies may lead to different TRF scale definitions. Differences between the z-components of the satellite phase offsets as given by manufacturer calibrations and those estimated based on IGS14 scale amount to 6.55 ± 12.56 cm and -0.32 ± 10.99 cm for B1I/B3I and B1C/B2a frequency pairs, respectively. On the one hand, the substantial deviation from the mean reflects the disparities in the quality of calibrations for the individual spacecraft, especially those manufactured by the Shanghai Engineering Center for Microsatellites (SECM). On the other hand, the difference between the two frequency pairs arises to a great extent from the doubtful quality of the SECM PCO calibrations, which certainly do not reflect the frequency dependence of the PCOs. Eventually, the mean scale bias with respect to IGS14 equals +0.546 ± 0.085 ppb, and +0.026 ± 0.085 ppb for B1I/B3I and B1C/B2a solutions, respectively, when using all 24 BDS-3 MEO satellites

Realization of the terrestrial reference frame based on integrated SLR measurements to LEO, geodetic,and Galileo satellites

Numerous active low Earth orbiters (LEOs) and Global Navigation Satellite System (GNSS) satellites, including the Galileo constellation,are equipped with laser retroreflectors used for Satellite Laser Ranging (SLR). Moreover, most LEOs are equipped with GNSS receivers for precise orbit determination. SLR measurements to LEOs, GNSS, and geodetic satellites vary in terms of registered numbers of the normal points (NPs) or registered satellite passes. In 2016-2018, SLR measurements to LEOs constituted 81% of all NPs and 59% of all registered satellite passes, whereas 10% of NPs and 30% of satellite passes, respectively,were assigned to GNSS. The remaining SLR measurements, 9% of NPs and 11% of passes, were completed by geodetic satellites, including LAGEOS-1 and LAGEOS-2. In this study, we show that the SLR observations to Galileo, passive geodetic and active LEO satellites together with precise GNSS-based orbits of LEOs and Galileocan be used for the determination of SLR station coordinates.Station coordinates, as well as the realization of the ITRF, are typically determined using SLR observations to passive geodetic satellites, such as LAGEOS-1/2. Here, we use SLR observations to Galileo, LAGEOS-1/2, LARES, Sentinel-3A, SWARM-A/B/C, TerraSAR, Jason-2, GRACE-A/B satellites to investigate whether they can be applied for the reference frame realization and for deriving high-quality station coordinates. We present various types of solutions based on different solution lengths, different SLR ground network constraining, and the combination of different sets of satellites to investigate the best solution set-up and the relative weights for the variance scaling factors of normal equations. We compare our results with the standard LAGEOS-based solutions and show the consistency level of the results with respect to the classical SLR solutions. Combination of observations improves the station coordinates especially for those stations which provide more SLR observations to LEOs, and Galileo satellites than to LAGEOS

GENESIS: Co-location of Geodetic Techniques in Space

Improving and homogenizing time and space reference systems on Earth and, more directly, realizing the Terrestrial Reference Frame (TRF) with an accuracy of 1mm and a long-term stability of 0.1mm/year are relevant for many scientific and societal endeavors. The knowledge of the TRF is fundamental for Earth and navigation sciences. For instance, quantifying sea level change strongly depends on an accurate determination of the geocenter motion but also of the positions of continental and island reference stations, as well as the ground stations of tracking networks. Also, numerous applications in geophysics require absolute millimeter precision from the reference frame, as for example monitoring tectonic motion or crustal deformation for predicting natural hazards. The TRF accuracy to be achieved represents the consensus of various authorities which has enunciated geodesy requirements for Earth sciences. Today we are still far from these ambitious accuracy and stability goals for the realization of the TRF. However, a combination and co-location of all four space geodetic techniques on one satellite platform can significantly contribute to achieving these goals. This is the purpose of the GENESIS mission, proposed as a component of the FutureNAV program of the European Space Agency. The GENESIS platform will be a dynamic space geodetic observatory carrying all the geodetic instruments referenced to one another through carefully calibrated space ties. The co-location of the techniques in space will solve the inconsistencies and biases between the different geodetic techniques in order to reach the TRF accuracy and stability goals endorsed by the various international authorities and the scientific community. The purpose of this white paper is to review the state-of-the-art and explain the benefits of the GENESIS mission in Earth sciences, navigation sciences and metrology.Comment: 31 pages, 9 figures, submitted to Earth, Planets and Space (EPS

Quality assessment of the BeiDou-3 phase center offset calibrations in terms of the realization of the terrestrial reference frame scale

Thanks to the release of the phase center offset (PCO) calibrations for both, the ground (receivers) and space (satellite antennas) segment, BeiDou-3 became a new potential contributor to the realization of the terrestrial reference frame (TRF) scale of future International Terrestrial Reference Frame releases. This study focuses on the evaluation of the potential usage of the BeiDou-3 Medium Earth Orbit (MEO) constellation to the definition of the TRF scale. Firstly, we assessed the quality of the manufacturer-released PCOs within the BDS-3 MEO constellation including 24 satellites. Secondly, we evaluated the differences between the TRF scale derived from the BDS PCOs released by the China Satellite Navigation Office and the scale of IGS14. Two linear combinations of signals, namely B1I/B3I, and B1C/B2a, have been investigated. Considering that proper modeling of the direct solar radiation pressure is a prerequisite for the accurate determination of PCOs, special attention was given to the selection of the best processing strategy regarding the latest BDS-3 orbit modeling advances. Differences between the z-components of the satellite PCO as given by manufacturer calibrations and those estimated based on the IGS14 scale amount to 6.55 ± 12.56 cm and -0.32 ± 10.99 cm for B1I/B3I and B1C/B2a frequency pairs, respectively. On the one hand, the substantial deviation from the mean reflects the disparities in the quality of calibrations for the individual spacecraft, especially those manufactured by the Shanghai Engineering Center for Microsatellites (SECM). On the other hand, the difference between the two frequency pairs arises to a great extent from the doubtful quality of the SECM PCO calibrations, which certainly do not reflect the frequency dependence of the PCOs. Eventually, the mean scale bias w.r.t. IGS14 equals +0.546 ± 0.085 ppb, and +0.026 ± 0.085 ppb, for B1I/B3I and B1C/B2a solutions, respectively

Realization of Reference Frames based on Integrated SLR Measurements to LEO and LAGEOS Satellites

Numerous active Low Earth Orbiters (LEOs) are equipped with laser retroreflectors used for the Satellite Laser Ranging (SLR) and Global Navigation Satellite System (GNSS) receivers used for positioning. SLR-GNSS co-location onboard LEOs provides a space-based connection of two independent techniques to determine and validate precise LEO orbits. The increasing set of high-quality laser ranges to LEOs with high-quality microwave-based orbits generate the ability to use these observations for various purposes, such as determination of SLR station coordinates or global geodetic parameters. Station coordinates as well as the realization of the International Terrestrial Reference Frame are typically determined using SLR observations to passive geodetic satellites, such as LAGEOS-1/2. In the case of LEOs, such as Sentinel-3A/3B, TerraSAR-X, Jason-2, GRACE-A/B, Swarm-A/B/C, the SLR technique is commonly used for the validation of GNSS-based orbits. Here, we used SLR observations and precise GNSS-derived orbits of these satellites to investigate whether they can be used for the reference frame realization and deriving high-quality station and geocenter coordinates. We present various types of solutions used for the parameter determination, including different solution lengths, SLR ground network constraining, combination of satellites, including LAGEOS data and weighting of observations to investigate the best solution pattern. We compared our results with standard LAGEOS-based solution and show a high consistency of results. SLR observations to active satellites can be used separately and with the combination with geodetic satellites. Combination of observations improves the station coordinates especially for those stations which provide more SLR observations to LEO satellites than to LAGEOS