The progressive processes of globalization and changes in the global, European and local economy require integrated efforts aimed at solving problems related to development at the national regional and the local level involving the environment, energy sources, climate and technological transformation issues. European Union Member States are given right to create an individual Energy mix. Coal will continue to play a major role in Poland’s energy mix during the next decades. Polish coal reserves can provide energy security for decades.

Despite crude oil and natural gas growth in fuel consumption, coal will continue to be the stabilizer of energy security for the country and play an important role in Poland’s energy mix in the years to come. However, further coal consumption requires investments in low carbon technologies which are of high efficiency and in high-efficiency cogeneration.

The validity of the full utilization of cogeneration potential should be highlighted. Operating cogeneration plants are more expensive than power plants but they are more efficient and generate less carbon emissions. In accordance with the assumptions of the Energy policy of Poland, a low-carbon economy with renewable Energy sources and nuclear Energy should be supported and developed, however the obsolete coal generators should be replaced with low-carbon high-efficient ones.

Coal production in 2018 increased by 3.3% and amounted to 7.81 million tons. Compared to 2010, it increased by 620 million tons. The structure of coal production in the world is very stable in the analyzed period of 2010–2018. Steam coal dominates in production with a share of 77%. Since 1990, the share of coal in the consumption of primary energy carriers has fallen by 3% in the global economy. In the EU, the share of coal in the consumption of primary energy carriers is more than twice lower than in the world, and in 2018 amounted to 13%. BP estimates the sufficiency of coal proven reserves based on 2018 data for the next 132 years. For oil and gas, they are estimated at 51 years. The decline in hard coal production in the European U nion can be dated almost continuously since 1990, which has decreased by 74%. In 2018, 74 million tons of coal were produced in the EU. In 2018, hard coal consumption in EU countries dropped to 226 million tons, i.e. by 20.6%.

In 2018, global trade in steam coal amounted to 1.14 billion tons. The situation in China is crucial for the international coal market. The slight change in the import policy of this country significantly affects the situation in international trade in steam coal. In 2019, coal prices (at Newcastle, Richards Bay, ARA ports) dropped by an average of 23 U SD/ton. The average decreases for these three indices were 33%. The prices of steam coal in the forecasts presented in the paper are under pressure of the falling demand.

The determination of the content of ecotoxic elements directly in flue gas is important for determining its actual emission from coal combustion. Moreover, in the BAT for large combustion plants conclusions adopted in 2017, apart from tightening of pollutants emission standards, i.e. SO 2, NO x and dusts, and setting emission limits, among others, for mercury, the monitoring of the actual emission of toxic elements has been established with the use of specific analytical methods. The review and comparison of available methods of analyzing the content of elements in flue gases in accordance with American and European standards has been presented in the article. Moreover, the factors influencing the quality of the obtained measurement results were identified.

Coal is a naturally occurring solid fuel used, among others, for heating and for electricity production. Despite the development of the gas and heating network in our country, as well as the growing interest in the use of renewable energy sources, it still remains the most frequent fuel burned in local sources for the production of thermal energy. The article describes actual heating coal demand in the municipal and residential sector, with the distinction of different assortments, depending on the solid fuel heating source applied. Moreover, a subjective list of factors that have a key impact on the change in heating coal demand for this market was presented, taking the regulatory environment, global trends in housing heating and statistical surveys on the preferences for individual heat sources replacement into account. The confrontation of observed phenomena allowed for possible scenarios of changes in the demand for heating coal with the prospect until 2030, broken down into its individual assortments to be elaborated.

The aim of the study is to determine the mercury content in hard coal, randomly taken from the USCB and in by-products of hard coal mining (fresh mining waste), i.e. aggregates (gangue) and hard coal sludge and mining waste from the Siersza dump (weathered waste). The 34 samples were intended for analysis. The total mercury content and the amount of mercury leaching from solid samples was determined. The percentage of the leaching form in the total element content, i.e. the level of mercury release from the material (leaching level), was also calculated. The amount of mercury leaching was determined by a static method using a batch test 1:10. The highest possibility of leaching mercury is characterized by weathered waste from the Siersza dump and slightly lower analyzed hard coal from the U pper Silesian Coal Basin (USCB). For hard coal samples, the total mercury content is between 0.0275–0.1236 mg/kg. However, the amount of mercury leaching from coal samples is 0.0008–0.0077 mg/kg. The aggregate is characterized by a higher total mercury content in the finest fraction 0–6 mm, within 0.1377–0.6107 mg/kg and much lower in the 80-120 mm fraction, within 0.0508–0.1274 mg/kg. The amount of elution is comparable in both fractions and amounts to 0.0008–0.0057 mg/kg. Coal sludge has a total mercury content of 0.0937–0.2047 mg/kg. L ow leaching values of 0.0014–0.0074 mg/ kg are also observed. Weathered mining waste has a total mercury content of 0.0622–0.2987 mg/kg. However, leaching values from weathered waste are much higher than from fresh mining waste. This value is 0.0058–0.0165 mg/kg. In the hard coal extracted from U SCB, the leaching level is 4.7% on average. Mining waste is characterized by a large variation in the proportion of mercury leaching form and the differences result from the seasoning time of the samples. Waste or by-products of hard coal production, such as aggregates and coal sludge, show a mercury washout form at an average level of 1.7%. The proportion of leachable form in weathered waste increased strongly to 7.3%. Elution characteristics vary for different groups of materials tested. Factors such as the type and origin of samples, their granulometric composition and the seasoning time of the material are of fundamental importance and demonstrated in the work.

The article presents selected issues from the Polish Energy Policy draft until 2040. From many issues, the authors chose the ones they considered the most revolutionary. Firstly, the National Power System should be restructured to meet the challenges of a changing environment, be adapted to the growing demand for electricity, and at the same time have the least impact on the natural environment. These goals can be achieved through reforms to reduce the importance of coal in the energy mix and the development of renewable energy sources, especially offshore wind energy. The next tasks are the development of electromobility, enabling the reduction of pollution caused by transport, and, in the longer term, after 2030, the development of nuclear energy in place of the withdrawn coal power.

The article presents current state of the structure of hard coal enrichment plants in Poland, taking the capacity, the range of grain enrichment and the type of equipment used into account. This data were presented in a tabular format for each Polish Coal Company operating on the Polish market. The article was also present simplified: flow sheet of the steam and coking coal enrichment system. Based on the presented data, the planned needs and trends were described in terms of increasing production efficiency, minimizing water consumption and safety of work. A list of research and development works which must be undertaken were also presented as well as factors determining the technological development of the processing plants.

Węgiel kamienny wydobywany w kopalni (węgiel surowy) tworzy substancja organiczna i mineralna. Przed bezpośrednim wykorzystaniem urobek musi być poddany procesom wzbogacania. Stosowane procesy wzbogacania mają na celu usunięcie skały płonnej, pirytu, a także przerostów. Do wzbogacania węgla kamiennego stosowane mogą być zarówno metody wzbogacania na mokro, jak i na sucho. W pracy przedstawiono wybrane ekologiczne i ekonomiczne aspekty procesu suchego odkamieniania węgla kamiennego przy wykorzystaniu separatora powietrzno-wibracyjnego i separatora optyczno-rentgenowskiego. Zastosowanie nowoczesnych urządzeń do suchego odkamieniania, tj. separatory powietrzno-wibracyjne i separatory optyczno-rentgenowskie, umożliwią obniżenie emisji pierwiastków ekotoksycznych ze spalania węgla kamiennego. Wydzielenie pirytu pozwala na obniżenie zawartości siarki, a także innych pierwiastków ekotoksycznych, m.in. rtęci, arsenu, talu, czy ołowiu. Generalnie pod względem ekonomicznym technologia suchego odkamieniania cechuje się niższymi nakładami inwestycyjnymi i kosztami eksploatacyjnymi w porównaniu do metod wzbogacania na mokro. Instalacje suchego odkamieniania są dobrym rozwiązaniem dla inwestycji o krótkim okresie planowanej eksploatacji i/lub dla instalacji o małej wydajności, a także w przypadku ograniczonej dostępności do wody. Dla instalacji o dłuższym okresie eksploatacji i o wyższych wydajnościach, efektywność inwestycji jest wyższa dla metod wzbogacania na mokro. Istnieje również możliwość suchego odkamieniania węgla na dole w kopalni przy użyciu tzw. kruszarek Bradforda. Wydzielony produkt w postaci grubych kamieni może znaleźć zagospodarowanie na dole kopalni, np. do podsadzania wyrobisk.

A ccording to the Polish Geological and Mining Law the granting of a concession for the exploration of a hydrocarbon deposit and the production of hydrocarbons from a deposit, or a concession for the production of hydrocarbons from a deposit in Poland is proceeded according to a tender procedure or open door procedure (upon a request of an entity). O n June 28, 2018 the Polish Minister of the Environment announced 5 tender areas. These areas (promising for discoveries of conventional and unconventional oil and gas deposits) were selected by the geologists of the Polish Geological Institute-NRI and Department of Geology and Geological Concessions of the Ministry of the Environment based on the geological data resources stored in the National Geological Archive. These are: Bestwina-Czechowice, Królówka, Pyrzyce, Złoczew i Żabowo. The main exploration target on the areas located in central and north-western Poland (Pyrzyce, Żabowo and Złoczew) is related to Permian Rotliegend sandstones and carbonates of the Zechstein/Main Dolomite. The Bestwina-Czechowice and Królówka areas (southern Poland) are prospective for conventional and hybrid-type accumulations of gas in the Miocene of the Carpathian Foredeep below the Carpathian Overthrust and in the Paleozoic-Mesozoic basement. The beginning of the 4th bidding round for hydrocarbon concessions is planned in Q4 2019. The entity can also choose the area and apply for a license submitting an application to the Ministry of the Environment. The area indicated by the entity cannot be the subject of a tender or any other concession, and the maximum acreage is 1,200 km2.

The efficient, stable and reliable operation of the blast furnace secures the proper quality of coke, which is one of the basic components of the blast furnace charge. In modern blast-furnace technology, when using substitute fuels, i.e. coal dust, the role of coke is extremely important. For this reason, the demands placed on its quality increase. Domestic coking plants have a limited base of Polish high quality coking coals at their disposal, therefore the full use of their coking properties is extremely important. The grain composition of the coal blend is one of the basic factors affecting the quality of the produced coke. This influence depends on the quantity and quality of coal components that make up the blend. In the conducted research, 21 coking coals, differing significantly in the degree of rank and origin (Polish and overseas coals), it was shown that the separated grain classes differ in properties, both coking properties and the degree of devolatalization during heating. In analyzing the obtained results, it was observed that the grain volume growth occurs essentially in the temperature range between the beginning and the maximum of fluidity. It has been shown that there is a linear correlation between the temperature corresponding to maximum fluidity and the temperature at which the maximum rate of evolution of volatiles enters. The presented phenomena accompany the emergence of coal expansion pressure during the coking process and they are its primary causes. The presented results can be an important guide for preparing the milling of coal for the coking process.

Volatility is one of the most characteristic features in the all market types. In the raw material market, including the bituminous coal market, volatility is visible in the supply and demand variations, in consequence in the prices fluctuations. Market actors usually having opposite interests, for example buy low, sell high, are vitally interested in identifying the causes of these fluctuations.

Some of the factors causing the market fluctuations are quite common, others are more complicated because of circumstances complexity. This article attempts to examine the relationships between bituminous coal fines prices and the economic situation. Given the complexity of the issue, the research area has been narrowed down – territorially to Poland and temporarily – to the present decade.

The average prices of coal fines in Poland are presented by the Industrial Development Agency (Agencję Rozwoju Przemysłu SA) in the form of two indices: PSCMI 1 and PSCMI 2. Both indices are calculated based on the prices of pattern bituminous coal, produced by domestic manufacturers and sold on domestic markets, the energy and heat market respectively.

Statistical methods, because of their quantitative nature, are important in identifying the correlations between the coal fines prices and economic conditions. Therefore, the article presents examples of relatively strong linear correlations between the PSCMI 1 and/or PSCMI 2 and some indicators of the economic situation.

Municipal waste management has been an area of special interest of the European Commission (EC) for many years. In 2018, the EC pointed out issues related to municipal waste management as an important element of the monitoring framework for the transition towards a circular economy (CE), which is currently a priority in the economic policy of the European Union (EU). In the presented monitoring framework, 10 CE indicators were identified, among which issues related to municipal waste appear directly in two areas of the CE – in the field of production and in the field of waste management, and indirectly – un two other areas – secondary raw materials, and competitiveness and innovation. The paper presents changes in the management of municipal waste in Poland in the context of the implementation of the CE assumptions, a discussion of the results of CE indicators in two areas of the CE monitoring framework in Poland (production and waste management), and a comparison of the results against other European countries.

In Poland, tasks related to the implementation of municipal waste management from July 1, 2013 are the responsibility of the municipality, which is obliged to ensure the conditions for the system of selective collection and collection of municipal waste from residents, as well as the construction, maintenance and operation of regional municipal waste treatment installations (RIPOK). The municipality is also committed to the proper management of municipal waste, in accordance with the European waste management hierarchy, whose overriding objective is to prevent waste formation and limiting its amount, then recycling and other forms of disposal, incineration and safe storage. The study analyzed changes in the value of two selected CE indicators, i.e. (1) the municipal waste generation indicator, in the area of production and (2) the municipal waste recycling indicator, in the area of waste management. For this purpose, statistical data of the Central Statistical Office (GUS) and Eurostat were used. Data has been presented since 2014, i.e. from the moment of initiating the need to move to the CE in the EU. In recent years, there has been an increase in the amount of municipal waste generated in Poland as well as in the EU. According to Eurostat, the amount of municipal waste generated per one inhabitant of Poland increased from 272 kg in 2014 to 315 kg in 2017. It should be noted that the average amount of municipal waste generated in Poland in 2017 was one of the lowest in EU, with a European average of 486 kg/person. Poland has achieved lower levels of municipal waste recycling (33.9%) than the European average (46%). The reason for Poland’s worse results in the recycling of municipal waste may be, among others, the lack of sufficiently developed waste processing infrastructure, operating in other countries such as Germany and Denmark, and definitely higher public awareness of the issue of municipal waste in developed countries. Municipal waste management in Poland faces a number of challenges in the implementation of GOZ, primarily in terms of achieving the recycling values imposed by the EC, up to a minimum of 55% by 2025.

The article presents an analysis of Russia’s participation in international steam coal trade, which has been its important participant for years. The research covered the years 2014–2018. The geographical location on two continents and the availability of coal deposits, favors its presence on both the Pacific and Atlantic markets. The article also discusses the main coal producers in Russia and the prices of Russian steam coal directed to the spot market. Due to the significant share of coal exports for the Russian economy, the focus was also on analyzing Russian seaports.

In recent years, Asian exports have dominated in Russian steam coal exports. The share of export to this market in the years 2014–2018 was in the range of 49–57% (60–87 million tons). Currently, three countries play an important role among Asian countries: South Korea, China and J apan. They purchased a total of 38–52 million tons of Russian coal. Although in the years under analysis Russia exported 52–67 million tons of steam coal to the European market, the share of this market dropped from almost half to around 40%. T he slow departure from coal energy contributes to reducing the share of recipients from this direction. Among European countries, in 2014 the main direction of export was Great Britain with 19% (24 million tons) of total export share. In 2018, exports fell to 9 million tons (5%).

Among European destinations for Russian coal, Poland’s share is growing in importance. In the years 2014–2018, steam coal exports to Poland varied in the range of 5.6–16.2 million tons. In the years 2014–2018 it changed in the range of 5.6–16.2 million tons. The dynamic growth achieved in the last three years is noteworthy. In relation to 2016, imports increased by 10.0 million tons and in 2018 amounted to as much as 16.1 million tons. The article also discusses the geographical structure of coal imports to Poland by railway border crossings and seaports.

The officials behind the Soviet onomasticon development campaign chose desktop calendars, a publicly available and widely circulated printed medium, to serve as a vehicle for the propagation of the new revolutionary anthroponomy. The paper looks into the masculine names recommended for general use by Universal Desktop Calendars issued by the State Publishing House in 1924–29. Mimicking the Russian Orthodox Church Calendars, its editors proposed their readers from up to six (in 1924–1926) to three (in 1927–1929) masculine names for each day. Based on a comprehensive analysis of the total body of the existing calendar material, the paper proceeds to classify the proper names by their actual source, including: Orthodox Church calendars, Catholic canons, antique mythology, later world literature and folklore sources, celebrated names of the past, toponyms, the Slavic name corpus, and, of course, ideologized sovietisms. The general picture of the sovietisized name list is accompanied with a description of its five-year dynamics refl ecting annually introduced modifications.

The author analyses neologisms of M. Sholokhov in relation to their translation into the German language. Then the quality of the translation is determined. In order to evaluate the translations three criteria are adopted: the degree of semantic closeness between the newly created units and their translation equivalents, their expressiveness and vividness. Based on these criteria the author evaluates the accuracy of the German translations.

O b j e c t i v e s: Patient-centered care (PCC) is associated with better doctor-patient relationships, resulting in a decrease in symptoms, hospitalizations and health costs. However, studies analyzing factors infl uencing patient-centered attitudes show ambiguous results. The purpose was to assess the impact of the Clinical Communication Course (CCC) in Jagiellonian University, Cracow and other factors on Patient-Centered Attitudes (PCA) and Attitude toward Clinical Skills Learning (CSLA).

M e t h o d s: We retrospectively compared Polish-speakers (CCC+, n = 160), English-speakers (CCCen+, n = 55) aft er the CCC and upperclassmen Polish-speakers without it (CCC–, n = 122). Validated questionnaires to measure PCA (Leeds Attitude Toward Concordance II and Patient-Practitioner Orientation Scale (PPOS)) and for CSLA (Communication Skills Attitude Scale with negative subscale (CSAS-N)) were used. The higher the scores, the more PCA, and negative CSLA respectively. Students completed questionnaires and answered questions regarding age, sex, motivation to study (coded as humanitarian — MotHUM, financial — MotFIN, combination — MotMIX) and considered specialization — coded as with more human contact (family medicine, psychiatry, pediatrics — SpecHUM) and others (SpecNHUM). Statistics were prepared in R.

R e s u l t s: CCC+ scored higher in PPOS (2.91 vs. 2.74; p = 0.003) than CCC– and higher in CSAS-N than CCCen+ (31.22 vs. 28.32; p = 0.004). In CCC+ SpecHUM scored lower than SpecNHUM in PPOS (2.65 vs. 2.94, p = 0.012). MotFIN scored higher then MotMIX in PPOS (3.01 vs. 2.7, p = 0.036). Correlations were statistically significant.

C o n c l u s i o n: CCC improved PCA in CCC+. Th ey showed more negative CSLA than CCCen+. Among CCC+, surprisingly, SpecNHUM presented more PCA than SpecHUM as well as MotFIN compared to MotMIX.

B a c k g r o u n d: Echocardiography is the first exam to establish the myocardial function in patients with takotsubo syndrome (TTS). However, ECG-Gated Myocardial Single-Photon Emission Tomography (G-SPECT) also allows to calculate left ventricular ejection fraction (LVEF) and can be useful in early stadium of TTS.

A i m: To compare LVEF obtained from 99mTc-MIBI G-SPECT and echocardiography in patients with TTS.

M a t e r i a l a n d M e t h o d s: Study population: 20 patients in medium age 77 (62–89) with TTS were included. In all patients 99mTc-MIBI G-SPECT and echocardiography was performed on the same day.

R e s u l t s: LVEF measured by G-SPECT and echocardiography ranged from 34 to 83% and 38 to 69%, respectively. The LVEF values for ECHO were significantly lower than for SPECT. The correlation between the LVEF was r = 0.76. The calculated correlation coefficient (r) for linear regression analysis was 0.64. The following equation shows the approximate interdependence of both LVEF calculations: LVEF GSPECT = 10.35 + 0.93 * LVEF Echo.

C o n c l u s i o n s: G-SPECT tends to overerestimate LVEF compared to echocardiography so these imaging techniques should not be used interchangeably. Calculated equation should be used for comparison of LVEF.

B a c k g r o u n d: Heart failure (HF) is a life-threatening condition which aff ects up to 2% of contemporary populations. Generally, it is a chronic and progressive disease, however in many cases it can be prevented or treated. Nevertheless, effective control of this disease requires awareness of symptoms in the society.

A i m s: The aim of the study was to assess the level of HF knowledge in the Polish population.

M e t h o d s: The questionnaire concerning knowledge about HF prepared by the Competence Network HF under the patronage of the European Heart Failure Association of the ESC, was used. The survey included 534 contributors who formed three groups: medical students — in vast majority at fi rst half of the study course (MS) — 198 (37.1%), HF Awareness Day participants (HFDP) — 134 (25.1%) and other (OP) — 202 (37.8%).

R e s u l t s: Study groups diff ered in terms of gender, age and level of education. As predicted, MS achieved the highest score (22.5 [20.0–24.0]), compared to HFDP (20.0 [17.0–22.0], P <0.001) and OP (19.0 [16.0– 21.0], P <0.001). Knowledge on typical HF symptoms was alarmingly low in the analyzed groups — dyspnea (MS — 96.0%, HFDP — 78.4%, OP — 74.6%), ankle edema (MS — 79.8%, HFDP — 50.6%, OP — 32.2%), body weight gain (MS — 14.1%, HFDP — 17.2%, OP — 4.5%). By multivariate model medical education (β 3.372, 95% CI 2.738–4.005) and own illness or having relatives or friends with HF (β 0.654, 95% CI 0.066–1.242) independently aff ected the score of awareness questionnaire.

C on c l u s i o n s: The basic knowledge on HF in Poland is not sufficient. It is moderately better among MS. Further campaigns improving HF awareness are necessary.

Bogumił Jasinowski (1883–1969), a Polish philosopher and specialist in Russian culture, was also interested in the issues of Gnosticism and Manichaeism. Although he had dealt with this subject for around forty years, however he did not devote any separate publication to it. For this reason, the author of this paper has to reconstruct Jasinowski’s views on mentioned issue on the basis of his texts on Russian and philosophical topics. The Polish philosopher regarded Gnosticism and Manichaeism as one of the most important phenomena in the history of religion, and particularly in the history of Christianity. Jasinowski, using the original method, juxtaposed Gnosticism with Neoplatonism and with Indian philosophical and religious systems; he also proposed his own characteristics of Gnosticism. For the Polish philosopher, the Gnostic and Manichaean worldview was the important factor in interpreting Russian spirituality and culture, and even such a phenomenon as the Bolshevik Revolution. This interpretation caused a polemic on the part of Marian Zdziechowski and Nikolay Lossky.

On the example of selected works by Oksana Zabuzhko, Volodymyr Lys, and Vasyl Shklar, I discuss the narrations of memory and ways of writing about history in Ukrainian contemporary prose. Historical topics concerning the traumatic experiences of the twentieth century appear in Ukrainian prose along with the regaining of independence and develop after 2000. The authors refer primarily to those issues which in the Soviet era were silenced, erased, censored. An important place in literary narratives of memory is occupied by the threads of OUN-UPA fi ghts, the Ukrainian-Bolshevik war, UNR times, Soviet terror, Great Hunger, the demythologization of World War II is also important, as well as an uncensored description of post-war Soviet reality. In the text, I do not carry out a detailed analysis of selected novels, but only highlight the main problems and ways in which authors write about history.

The article is a presentation of the subject of a lawyer in the Russian literature of two eras – the second half of the nineteenth century and the beginning of the twenty-first century. The object of comparative analysis are two literary texts: the first is the story by Leo Tolstoy – “Father Sergius” (1911), the second is a novel by the modern Russian writer – Evgeny Vodolazkin, which entitled “Laurus” (2012). The author of the article concludes that the multifariousness of the life of lawyers in both writers underlines their life experience on the way to holiness. An important element of the characters’ description is their sinfulness, in particular the fi ght against their own pride and human passion. In the case of Leo Tolstoy, the image of his literary right-wing was influenced by the writer’s views on the essence of holiness and the complex human-God relationship. In their portraits of heroes striving for spiritual perfection, both Tolstoy and Vodolazkin show a connection with the genre of hagiography.

Ectopic pregnancy constitutes 2% of all pregnancies. In the last decades, due to the rising amount of caesarean sections, new localization of ectopic pregnancy has been observed — caesarean scar pregnancy (CSP). Cesarean scar pregnancy is an iatrogenic disease and a life-threatening condition which frequency will systematically rise. Because of possible serious complications, CSP should be swift ly diagnosed and treated. Th e purpose of this retrospective study was to demonstrate diff erent methods of CSP treatment performed between 2015–2018 in the Clinic of Endocrinological Gynaecology and Gynaecology Jagiellonian University Medical College in Cracow. Th e clinical characteristics, diagnosis, various methods of treatment and clinical outcomes were analysed. Defi nitive algorithm of CSP treatment is still not established. Pharmacological and operative methods are approved while expectant observation is considered unsafe due to possible risk of complications for the patient, including death.