Goals of care changes after acute ischaemic stroke: decision frequency and predictors.

Little is known about the factors leading to a change in goals of care (CGC) in patients with an acute ischaemic stroke (AIS). Our aim was to analyse the proportion and outcome of such patients and identify medical predictors of a CGC during acute hospitalisation. We retrospectively reviewed all patients who had an AIS over a 13-year period from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne. We compared patients with a CGC during the acute hospital phase to all other patients and identified associated clinical and radiological variables using logistic regression analysis. A CGC decision was taken in 440/4264 (10.3%) consecutive patients who had an AIS. The most powerful acute phase predictors of a CGC were transit through the intensive care unit, older age, pre-existing disability, higher stroke severity and initial decreased level of consciousness. Adding subacute phase variables, we also identified active oncological disease, fever and poor recanalisation as predictors. 76.6% of the CGC patients died in the stroke unit and 1.0% of other patients, and 30.5% of patients with a CGC received a palliative care consultation. At 12 months, 93.6% of patients with CGC had died, compared with 10.1% of non-CGC patients. Over three-quarters of AIS patients with CGC died in hospital, but less than a third received a palliative care consultation. The identified clinical and radiological predictors of a CGC may allow physicians to initiate timely the decision-making process for a possible CGC

Electrodynamic balance–mass spectrometry reveals impact of oxidant concentration on product composition in the ozonolysis of oleic acid

The chemical and physical properties of atmospheric aerosol particles change upon oxidative ageing, influencing their interaction with radiation, their propensity to serve as nuclei for cloud condensation and ice formation, and their adverse effects on human health. The investigation of atmospheric aerosol oxidation processes is complicated by low oxidant concentrations and long timescales, which are difficult to represent in laboratory studies. Experimental work often attempts to compensate for short timescales with elevated concentrations of oxidative agents, assuming that the ageing progress depends only on the oxidant exposure, i.e. on the product of oxidant concentration and time, [Ox] × t, and not on [Ox] or t independently. The application of electrodynamic balance–mass spectrometry of single particles allows the validity of this assumption to be investigated, since it provides information on the molecular composition of aerosol particles for a wide range of reaction durations under well-defined oxidation conditions. Here, we demonstrate the capabilities of a new setup on levitated oleic acid droplets reacting with ozone at mixing ratios of 0.2 and 15 ppm, i.e. spanning almost two orders of magnitude in [Ox]. We show that the reactive removal of oleic acid can be accurately expressed as a function of ozone exposure [Ox] × t, whereas the product concentrations depend on [Ox] and t independently. As the underlying reason for the breakdown of the exposure metric, we suggest a competition between evaporation of volatile first-generation products and their accretion reactions with reactive Criegee intermediates, converting them into low-volatility dimers and oligomers. This hypothesis is supported by kinetic model simulations using the aerosol process model KM-SUB, which explicitly resolves the competition between evaporation and secondary chemistry as a function of the experimental timescale and ozone mixing ratio. The model successfully reproduces final product distributions. The findings are further supported by the recorded changes of droplet sizes during oxidation. As a heuristic, the breakdown of the exposure metric in a chemical reaction system is possible, when competition between first- and second-order processes of reactive intermediates determines important system properties

Kinetic simulations and reduced modeling of longitudinal sideband instabilities in non-linear electron plasma waves

Kinetic Vlasov simulations of one-dimensional finite amplitude Electron Plasma Waves are performed in a multi-wavelength long system. A systematic study of the most unstable linear sideband mode, in particular its growth rate gamma and quasi- wavenumber delta k, is carried out by scanning the amplitude and wavenumber of the initial wave. Simulation results are successfully compared against numerical and analytical solutions to the reduced model by Kruer et al. [Phys. Rev. Lett. 23, 838 (1969)] for the Trapped Particle Instability (TPI). A model recently suggested by Dodin et al. [Phys. Rev. Lett. 110, 215006 (2013)], which in addition to the TPI accounts for the so-called Negative Mass Instability because of a more detailed representation of the trapped particle dynamics, is also studied and compared with simulations. (C) 2014 AIP Publishing LLC

Particle backscatter and relative humidity measured across cirrus clouds and comparison with microphysical cirrus modelling

Advanced measurement and modelling techniques are employed to estimate the partitioning of atmospheric water between the gas phase and the condensed phase in and around cirrus clouds, and thus to identify in-cloud and out-of-cloud supersaturations with respect to ice. In November 2008 the newly developed balloon-borne backscatter sonde COBALD (Compact Optical Backscatter and AerosoL Detector) was flown 14 times together with a CFH (Cryogenic Frost point Hygrometer) from Lindenberg, Germany (52° N, 14° E). The case discussed here in detail shows two cirrus layers with in-cloud relative humidities with respect to ice between 50% and 130%. Global operational analysis data of ECMWF (roughly 1° × 1° horizontal and 1 km vertical resolution, 6-hourly stored fields) fail to represent ice water contents and relative humidities. Conversely, regional COSMO-7 forecasts (6.6 km × 6.6 km, 5-min stored fields) capture the measured humidities and cloud positions remarkably well. The main difference between ECMWF and COSMO data is the resolution of small-scale vertical features responsible for cirrus formation. Nevertheless, ice water contents in COSMO-7 are still off by factors 2–10, likely reflecting limitations in COSMO's ice phase bulk scheme. Significant improvements can be achieved by comprehensive size-resolved microphysical and optical modelling along backward trajectories based on COSMO-7 wind and temperature fields, which allow accurate computation of humidities, homogeneous ice nucleation, resulting ice particle size distributions and backscatter ratios at the COBALD wavelengths. However, only by superimposing small-scale temperature fluctuations, which remain unresolved by the numerical weather prediction models, can we obtain a satisfying agreement with the observations and reconcile the measured in-cloud non-equilibrium humidities with conventional ice cloud microphysics. Conversely, the model-data comparison provides no evidence that additional changes to ice-cloud microphysics – such as heterogeneous nucleation or changing the water vapour accommodation coefficient on ice – are required