1 Proxy decision making for incompetent patients Abstract The author of this thesis discusses the applicable Czech legislation on the proxy decision making for incompetent patients and the provision of medical care without informed consent. The thesis is divided into six parts, while the first part is devoted to the definition of the basic terms that are directly related to this topic and which are repeatedly used herein. These basic terms are the following: health services and healthcare, informed consent and the patient. The second chapter is devoted to sources of law, which are divided into three levels - international sources, European Union law and national sources. Within the national regulation, attention is focused mainly on Act No. 372/2011 Coll., On health services and conditions of their provision, as amended. It also outlines the issue of the duality of legal regulation, that was caused by the adoption of Act No. 89/2012 Coll., Civil Code. The third chapter deals with surrogate consent, attention is paid mainly to resolving conflicts of opinions and to the best interests pricniple, as to the key factor when granting the proxy consent. The fourth chapter is devoted to the institute of previously expressed wishes. The fifth chapter analyses the issue of providing health services to vulnerable...

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The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.

The aim of this work is to test the proposed approach of algal scavenging as a driver of sediment mercury (Hg) on different time scales and to gain a better understanding of the mechanisms of Hg accumulation in lake sediments. A 3000-year sediment record from Nylandssjön in northern Sweden was analysed for this purpose, as well as a 20-year sediment record from the seasonal sediment traps of this lake. The diatom proxy biogenic silica (bSi) was determined by Fourier transform infrared spectroscopy (FTIRS) and chlorophyll-a (Chl-a) as a proxy for primary productivity by non-destructive visible near-infrared reflectance spectroscopy (VNIRS). Silica, normalised to minerogenic matter by aluminium (Si/Al) as an indirect diatom proxy and other geochemical parameters were analysed by the non-destructive method of X-ray fluorescence spectroscopy (XRF). The Hg content in the sediment was determined using the the thermal decomposition atomic absorption spectrophotometers (TD-AAS) method. Over the different time scales, organic matter (OM) is an important control factor for Hg, which in turn was strongly associated with primary productivity. Hg was normalised against OM by determining the Hg/LOI or Hg/C ratios. No positive correlation was found between the normalised Hg ratios and the proxies of primary productivity (bSi, Chl-a and Si/Al). Negative correlations between OM and minerogenic elements coinciding with human-induced erosion events and increasing Hg levels in the sediment were found. This is true, both for the long-term record in the sediment cores and the high-resolution data from the sediment traps. Furthermore, in the seasonal sediment record of the sediment traps, in-lake processes like lake turnover in spring and autumn could be linked to precipitation of iron oxyhydroxides (FeOOH) and increasing sedimentary Hg. This may be supported by the parallel sediment accumulation of other metals like nickel (Ni) and zinc (Zn) at the time of the lake turnover.

Bond markets are crucial for the stability and efficiency of the national financial system. Low liquidity prevents market developments and makes investors reluctant to trade actively. It is therefore crucial to maintain liquidity in bond markets. This thesis aims to investigate investor activity and liquidity in the Swedish government and mortgage bond markets. By creating indices using a combination of public trading data (actual trades) and private trading data (potential trades) to measure investor activity, a new liquidity proxy is created. The indices capture two aspects of investor activity, both the quantity of the bonds as well as the trading frequency. High levels of activity imply a liquid market and low levels of activity imply a lack of liquidity. Since Swedish and international investors are exposed to different risks even when investing in the same market, this thesis has segmented investors into four groups: Swedish investors in the government bond market, Swedish investors in the mortgage bond market, foreign investors in the government bond market and foreign investors in the mortgage bond market. To further understand the driving factors of market activity, regression analysis is conducted. From the existing literature a total of 11 potential explanatory variables have been identified. Due to the various market conditions in each investor group, it is no surprise that the variables influence the groups differently. Bond market return, short term interest rate and term risk structure are found to be highly significant for all investor groups. Moreover, stock market return and macroeconomic news are identified to be relevant variables when explaining shifts in investor behaviour. Positive developments in bond and stock market returns boost investor activity, while negative developments halt activity. Short term interest rate and the term risk spread are found to have similar effects, positive influence in the government bond market and negative influence in the mortgage bond market. For international investors, two spreads reflecting Swedish market conditions in relation to international benchmarks are included in the analysis. Both spreads are found to be highly significant, indicating that foreign investors choose to trade in the bond markets with the most desirable conditions. / En välfungerande obligationsmarknad är avgörande för ett lands finansiella stabilitet. Brist på likviditet hindrar marknadsutveckling och medför att investerare blir ovilliga att handla aktivt. Det är därför viktigt att behålla likviditeten i obligationsmarknader. Den här uppsatsen undersöker aktiviteten och likviditeten i de svenska marknaderna för statsobligationer och bostadsobligationer. För att mäta aktiviteten har en kombination av offentlig handelsdata (utförda transaktioner) och privat handelsdata (potentiella transaktioner) använts. Den uppmätta aktiviteten avspeglar storleken på transaktionerna såväl som frekvensen av transaktionerna. Hög aktivitet i marknaden indikerar att likviditeten på marknaden är hög, låg aktivitet indikerar att det råder brist på likviditet i marknaden. Svenska och internationella investerare kan uppleva olika marknadsförhållanden och utsättas för olika risker även när man handlar i samma marknad. Därför har den här studien valt att dela upp investerarna i fyra olika grupper; svenska investerare av statsobligationer, svenska investerare av bostadsobligationer, utländska investerare av statsobligationer och utländska investerare av bostadsobligationer. För att förstå de underliggande faktorerna som driver dessa investerargruppen att vara aktiva på marknaden har regressionsanalys med 11 förklarande variabler använts. På grund av de olika marknadsförhållandena för svenska och utländska investerare, skiljer sig även de drivande faktorerna. Avkastning på obligationsmarknaderna, kortfristiga räntesatsen samt löptidsstrukturen för obligationer visar sig vara signifikanta för alla investerargrupper. Dessutom tyder resultaten på att avkastningen på aktiemarknaden och makroekonomiska nyheter också har betydande inflytande på aktivitet. Positiv utveckling i obligationsmarknaden och aktiemarknaden stimulerar marknadsaktivitet. Den kortfristiga räntan och löptidsstrukturen visar sig ha liknande effekter, positivt inflytande på marknaden för statsobligationer och negativt inflytande på marknaden för bostadsobligationer. För internationella investerare har även två spreadar som återspeglar svenska marknadsförhållanden i relation med utländska marknadsförhållanden inkluderats i regressionsanalysen. Båda spreadarna visar sig vara betydande för utländska investerare. Detta tyder på att utländska investerare väljer att vara aktiva i den marknaderna som de anser ha de mest önskvärda handelsförhållandena.

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Les techniques informatiques ont gagné un rôle primordial dans le développement et l'exploitation des ressources d'hydrocarbures naturelles ainsi que dans d'autres opérations liées à des réservoirs souterrains. L'un des problèmes cruciaux de la modélisation de réservoir et les prévisions de production réside dans la présélection des modèles de réservoir appropriés à la quantification d'incertitude et au le calage robuste des résultats de simulation d'écoulement aux réelles mesures et observations acquises du gisement. La présente thèse s'adresse à ces problématiques et à certains autres sujets connexes.Nous avons élaboré une stratégie pour faciliter et accélérer l'ajustement de tels modèles numériques aux données de production de champ disponibles. En premier lieu, la recherche s'était concentrée sur la conceptualisation et l'implémentation des modèles de proxy reposant sur l'analyse de la connectivité, comme une propriété physique intégrante et significative du réservoir, et des techniques avancées du partitionnement de données et de l'analyse de clusters. La méthodologie développée comprend aussi plusieurs approches originales de type probabiliste orientées vers les problèmes d'échantillonnage d'incertitude et de détermination du nombre de réalisations et de l'espérance de la valeur d'information d'échantillon. Afin de cibler et donner la priorité aux modèles pertinents, nous avons agrégé les réalisations géostatistiques en formant des classes distinctes avec une mesure de distance généralisée. Ensuite, afin d'améliorer la classification, nous avons élargi la technique graphique de silhouettes, désormais appelée la "séquence entière des silhouettes multiples" dans le partitionnement de données et l'analyse de clusters. Cette approche a permis de recueillir une information claire et compréhensive à propos des dissimilarités intra- et intre-cluster, particulièrement utile dans le cas des structures faibles, voire artificielles. Finalement, la séparation spatiale et la différence de forme ont été visualisées graphiquement et quantifiées grâce à la mesure de distance probabiliste.Il apparaît que les relations obtenues justifient et valident l'applicabilité des approches proposées pour améliorer la caractérisation et la modélisation d'écoulement. Des corrélations fiables ont été obtenues entre les chemins de connectivité les plus courts "injecteur-producteur" et les temps de percée d'eau pour des configurations différentes de placement de puits, niveaux d'hétérogénéité et rapports de mobilité de fluides variés. Les modèles de connectivité proposés ont produit des résultats suffisamment précis et une performance compétitive au méta-niveau. Leur usage comme des précurseurs et prédicateurs ad hoc est bénéfique en étape du traitement préalable de la méthodologie. Avant le calage d'historique, un nombre approprié et gérable des modèles pertinents peut être identifié grâce à la comparaison des données de production disponibles avec les résultats de... / Computer-based workflows have gained a paramount role in development and exploitation of natural hydrocarbon resources and other subsurface operations. One of the crucial problems of reservoir modelling and production forecasting is in pre-selecting appropriate models for quantifying uncertainty and robustly matching results of flow simulation to real field measurements and observations. This thesis addresses these and other related issues. We have explored a strategy to facilitate and speed up the adjustment of such numerical models to available field production data. Originally, the focus of this research was on conceptualising, developing and implementing fast proxy models related to the analysis of connectivity, as a physically meaningful property of the reservoir, with advanced cluster analysis techniques. The developed methodology includes also several original probability-oriented approaches towards the problems of sampling uncertainty and determining the sample size and the expected value of sample information. For targeting and prioritising relevant reservoir models, we aggregated geostatistical realisations into distinct classes with a generalised distance measure. Then, to improve the classification, we extended the silhouette-based graphical technique, called hereafter the "entire sequence of multiple silhouettes" in cluster analysis. This approach provided clear and comprehensive information about the intra- and inter-cluster dissimilarities, especially helpful in the case of weak, or even artificial, structures. Finally, the spatial separation and form-difference of clusters were graphically visualised and quantified with a scale-invariant probabilistic distance measure. The obtained relationships appeared to justify and validate the applicability of the proposed approaches to enhance the characterisation and modelling of flow. Reliable correlations were found between the shortest "injector-producer" pathways and water breakthrough times for different configurations of well placement, various heterogeneity levels and mobility ratios of fluids. The proposed graph-based connectivity proxies provided sufficiently accurate results and competitive performance at the meta-level. The use of them like precursors and ad hoc predictors is beneficial at the pre-processing stage of the workflow. Prior to history matching, a suitable and manageable number of appropriate reservoir models can be identified from the comparison of the available production data with the selected centrotype-models regarded as the class representatives, only for which the full fluid flow simulation is pre-requisite. The findings of this research work can easily be generalised and considered in a wider scope. Possible extensions, further improvements and implementation of them may also be expected in other fields of science and technology.

The presence of the sea ice diatom biomarker IP25 in Arctic marine sediments has been used in previous studies as a proxy for past spring sea ice occurrence and as an indicator of wider palaeoenvironmental conditions for different regions of the Arctic over various timescales. The current study describes a number of analytical and palaeoceanographic developments of the IP25 sea ice biomarker. First, IP25 was extracted and purified from Arctic marine sediments. This enabled the structure of IP25 to be confirmed and enabled instrumental (GC-MS) calibrations to be carried out so that quantitative measurements could be performed with greater accuracy. Second, palaeo sea ice reconstructions based on IP25 and other biomarkers were carried out for a suite of sub-Arctic areas within the Greenland, Norwegian and Barents Seas, each of which represent contrasting oceanographic and environmental settings. Further, an evaluation of some combined biomarker approaches (e.g. the PIP25 and DIP25 indices) for quantifying and/or refining definitions of sea ice conditions was carried out. Temporally, particular emphasis was placed on the characterisation of sea ice conditions during the Younger Dryas and the Holocene. Some comparisons with other proxies (e.g. foraminifera, IRD) were also made. A study of a sediment core from Andfjorden (69.16˚N, 16.25˚E), northern Norway, provided unequivocal evidence for the occurrence of seasonal sea ice conditions during the Younger Dryas. The onset (ca. 12.9 cal. kyr BP) and end (ca. 11.5 cal. kyr BP) of this stadial were especially clear in this location, while in a study from the Kveithola Trough (74.52˚N, 16.29˚E), western Barents Sea, these transitions were less apparent. This was attributed to the presence of colder surface waters and the occurrence of seasonal sea ice both before and after this stadial at higher latitudes. Some regional differences regarding the severity of the sea ice conditions were also observed, although an overall general picture was proposed, with more severe sea ice conditions during the early-mid Younger Dryas and less sea ice observed during the late Younger Dryas. A shift in the climate towards ice-free conditions was recorded in northern Norway during the early Holocene (ca. 11.5 – 7.2 cal. kyr BP). Milder conditions were also observed during the Holocene in the western Barents Sea, with three main climate periods observed. During the early Holocene (ca. 11.7 – 9.5 cal. kyr BP), the position of the spring ice edge was close to the study area which resulted in high productivity during summers. During the mid-late Holocene (ca. 9.5 – 1.6 cal. kyr BP), sea ice was mainly absent due to an increased influence of Atlantic waters and northward movement of the Polar Front. During the last ca. 1.6 cal. kyr BP, sea ice conditions were similar to those of the present day. In addition to the outcomes obtained from the Norwegian-Barents Sea region, comparison of biomarker and other proxy data from 3 short cores from Kangerdlugssuaq Trough (Denmark Strait/SE Greenland) with historical climate observations allowed the development of a model of sea ice conditions which was then tested for longer time-scales. It is suggested that the IP25 in sediments from this region is likely derived from drift ice carried from the Arctic Ocean via the East Greenland Current and that two main sea surface scenarios have existed over the last ca. 150 yr. From ca. AD 1850 – 1910, near perennial sea ice conditions resulted in very low primary productivity, while from ca. AD 1910 – 1986, local sea ice conditions were less severe with increased drift ice and enhanced primary productivity. This two-component model was subsequently developed to accommodate different sea surface conditions that existed during the retreat of the Greenland Ice Sheet during the deglaciation (ca. 16.3 – 10.9 cal. kyr BP).

The potential of Arctica islandica, a long lived marine bivalve with a lifespan of over 300 years, to reconstruct a high resolution (sub-annual) climate record is explored in this thesis. Fluctuations in trace element and isotopic data from live-collected specimens from Irvine Bay, NW Scotland are compared to instrumental (particularly temperature) data. X-ray absorption spectroscopy data demonstrate the coordination state of Sr and Mg within the shell. These are consistent with models in which Sr substitutes ideally for Ca in aragonite, and Mg is bound predominantly to organic molecules. Sr/Ca incorporation may be influenced by changes in the crystal nucleation, propagation and growth rate as well as vital effects. However any effect of seawater temperature on Sr/Ca incorporation was obscured by these other factors. Mg concentration is not a linear function of a single environmental variable or organic content within the shell, indicating that Mg uptake is biologically mediated. Ba variation shows sporadic increases (of >500% above baseline) in both shells, the timing of which is similar between the prismatic layer and umbo region. The maxima are, however, not synchronous between the two shells analysed. The controls on Ba uptake require further research, but low Ba/Ca may reflect Ba/Ca concentrations within the seawater. Aliquots taken from cod otoliths show that micromilling has negligible effect on δ¹⁸O. The range of reconstructed temperature from δ¹⁸O profiles Arctica islandica shows good agreement with the sea surface temperature data from the nearby Millport marine station to within 2.1 °C. However, both the interannual and intra-annual variation appears to be sensitive to changes in temporal resolution resulting from changes in growth rates. Modelling of δ¹⁸O highlights dependence on changes in temporal resolution of the sampling, in addition to temperature and salinity. Results from the radiocarbon pilot study show that Arctica islandica is a suitable archive for changes in radiocarbon associated with anthropogenic ¹⁴C fluxes.

Measuring knowledge management performance was one of, if not the most challenging knowledge management activities. This study suggested using intellectual capital as a proxy for knowledge management performance in evaluating its impact on organizational performance. The Value Added Intellectual Coefficient model was employed to measure intellectual capital. Although being used widely in research, the model had its limitations. Also, for intellectual capital measurement, there was a lack of guidelines supported by empirical evidence or best practices. The present study aimed to test the classic and a modified version of this model, and based on the results, shed light on whether the classic version was good enough or the modified one should be highly recommended. The financial fundamental and market data of 425 randomly selected publicly listed firms were collected, and the structural equation modeling technique was employed to test the models. Chi-square difference test was performed to determine whether there was a statistically significant difference between these two models. The results of the tests indicated that the difference between them was insignificant. Therefore, it was concluded that the classic model is adequate, and it can be used effectively to measure intellectual capital. Adding two new efficiency elements – research and development efficiency and relational capital efficiency – in the model did not provide any significant benefit.