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We investigated the occurrence and evolution of new particle formation (NPF) events over the southeast Atlantic. The studied region is under the influence of the long‐range transport of aerosols and gases during the southern African biomass burning season, from June to October every year. Interestingly, NPF was observed to coincide with the African biomass burning season, although wet removal of pre‐existing aerosols is needed during these NPF events. Surface and airborne measurements show that these NPF events likely occurred in the upper region of the marine boundary layer, and the newly formed aerosols were further transported to the surface via vertical air motions. Using a box model, we predicted that a large fraction of these particles could grow to sizes related to cloud condensation nuclei. Our study shows that NPF can occur over the southeast Atlantic, and the African biomass‐burning plume likely contributed to the NPF occurrence. Plain Language Summary We studied how atmospheric aerosols form in the air over the southeast Atlantic. These particles form after precipitation clears out existing particles and are generated in the upper region of the marine boundary layer, moving down toward the ocean's surface. Our model predicts that many of these particles grow large enough to influence cloud formation. Our study suggests that smoke from African biomass burning influences particle formation over the southeast Atlantic, which could further impact regional climate. Key Points New particle formation events over the southeast Atlantic coincide with the African biomass burning season These new particles are formed in the upper marine boundary layer and transported to the surface The newly formed particles can contribute significantly to cloud condensation nuclei under clean conditions

CMIP6 climate models have difficulties representing the strong absorption properties of biomass‐burning aerosols (BBA) over the Southeast Atlantic and the associated direct forcing. This study takes advantage of unique in situ and remote sensing observations to evaluate the vertical profile and chemical composition of BBA, which are key properties for modeling radiative interactions. Over land, CMIP6 models show a sharper vertical decrease in carbonaceous aerosol concentration than observed, indicating insufficient vertical mixing. Over the ocean, most models transport BBA lower, between 1 and 1.5 km, than observed. This could be due to both excessive subsidence and lack of self‐lofting of BBA. In addition, the ratio between black carbon and organic aerosol mass concentrations is underestimated by about 0.1 compared to observations. These biases limit the ability of models to capture the absorption above clouds in this region, which could have implications for the regional radiative and climatic impact of African BBA.

The first aerosol indirect effect (1AIE) is investigated using a combination of in situ and remotely-sensed aircraft (NCAR C-130) observations acquired during VOCALS-REx over the southeast Pacific stratocumulus cloud regime. Satellite analyses have previously identified a high albedo susceptibitility to changes in cloud microphysics and aerosols over this region. The 1AIE was broken down into the product of two independently-estimated terms: the cloud aerosol interaction metric ACIτ =dlnτ/dlnNa|LWP , and the relative albedo (A) susceptibility SR-τ =dA/3dlnτ|LWP, with τ and Na denoting retrieved cloud optical thickness and in situ aerosol concentration respectively and calculated for fixed intervals of liquid water path (LWP). ACIτ was estimated by combining in situ Na sampled below the cloud, with τ and LWP derived from, respectively, simultaneous upward-looking broadband irradiance and narrow field-of-view millimeter-wave radiometer measurements, collected at 1 Hz during four eight-hour daytime flights by the C-130 aircraft. ACIτ values were typically large, close to the physical upper limit (0.33), with a modest increase with LWP. The high ACIτ values slightly exceed values reported from many previous in situ airborne studies in pristine marine stratocumulus and reflect the imposition of a LWP constraint and simultaneity of aerosol and cloud measurements. SR-τ increased with LWP and τ, reached a maximum SR-τ (0.086) for LWP (τ) of 58 g m−2 (~14), and decreased slightly thereafter. The 1AIE thus increased with LWP and is comparable to a radiative forcing of −3.2– −3.8 W m−2 for a 10% increase in Na, exceeding previously-reported global-range values. The aircraft-derived values are consistent with satellite estimates derived from instantaneous, collocated Clouds and the Earth's Radiant Energy System (CERES) albedo and MOderate resolution Imaging Spectroradiometer (MODIS)-retrieved droplet number concentrations at 50 km resolution. The consistency of the airborne and satellite estimates, despite their independent approaches, differences in observational scales, and retrieval assumptions, is hypothesized to reflect the ideal remote sensing conditions for these homogeneous clouds. We recommend the southeast Pacific for regional model assessments of the first aerosol indirect effect on this basis. This airborne remotely-sensed approach towards quantifying 1AIE should in theory be more robust than in situ calculations because of increased sampling. However, although the technique does not explicitly depend on a remotely-derived cloud droplet number concentration (Nd), the at-times unrealistically-high Nd values suggest more emphasis on accurate airborne radiometric measurements is needed to refine this approach.

Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively ( p  = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality ( p  = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

Trauma-related (preventable) death is used to evaluate the management and quality of trauma care worldwide. Therefore, it is necessary to identify fatalities in the trauma care population and assess them on preventability. However, the definition on trauma-related preventable death lacks validity due to differences in terminology and classifications. This study aims to reach consensus on the definition of trauma-related preventable death by performing a Delphi procedure, thereby, improving the assessment of trauma-related preventable death and thereby enhancing the quality of trauma care. Based on the results of a recently performed systematic review Hakkenbrak (2021). The definitions used to describe trauma-related preventable death could be divided into four categories: 1) Clinical definition based on panel review or expert opinion, 2) Trauma prediction algorithm, 3) Clinical definition with an additional trauma prediction algorithm and 4) Others (e.g., errors in care or detailed clinical definition). A three round, electronic Delphi study will be performed in the Netherlands to reach consensus. Experts from the department of Trauma surgery, Neurosurgery, Forensic medicine, Anaesthesiology and Emergency medicine, of the designated Level 1 trauma centres in the Netherlands, will be invited to participate. In the first round the panel will comment on the composed categories and trauma prediction algorithms. In the second and third round a feedback report will be presented and the questions with disagreement will be retested. The identification and assessment of trauma-related preventable death is necessary to evaluate and improve trauma care. Therefore, a valid, fair, and applicable definition of trauma-related preventable death is required. The Delphi technique is utilized to reach group consensus to obtain a scientifically valid definition of trauma-related preventable death.

Postfrontal cloud regime transitions often result from strong aerosol‐cloud‐precipitation interaction. Using ACTIVATE measurements from 40 flights, we show a diurnal pattern of evolving aerosol particle size distributions (PSD) in the marine boundary layer upwind of clouds. A nucleation mode grows in size between 12 and 17 LT, likely from new particle formation (NPF), and an accumulation mode increases in concentration during daytime. Selecting the day of strongest size growth, we use quasi‐Lagrangian large‐eddy simulations to examine cloud impacts. With a morning PSD, moderate aerosol hygroscopicity aligns best with satellite and field campaign observational targets. Using a PSD near 17 LT, greater cloud droplet number concentrations delay the precipitation onset and keep albedo elevated for longer, primarily driven by increased accumulation mode concentrations, which facilitate an updraft‐limited regime and inhibit activation of smaller modes despite their growth after NPF. These results constitute a caveat for NPF‐related activation under polluted conditions.

Aircraft measurements are presented from the 27/28 October 2008 case study of the VOCALS Regional Experiment (REx) over the remote subtropical southeast Pacific (18° S, 80° W). Data from two aircraft that took measurements approximately twelve hours apart but in the same advected airmass are used to document a remarkably sharp spatial transition in marine boundary layer (MBL), cloud, and aerosol structure across the boundary between a well-mixed MBL containing overcast closed mesoscale cellular stratocumulus, and a pocket of open cells (POC) with significantly lower cloud cover. Long (~190–250 km) straight and level flight legs at three levels in the marine boundary layer and one level in the lower free troposphere permit sampling of the closed cells, the POC, and a 20–30 km wide transition zone with distinctly different structure from the two airmasses on either side. The POC region consists of intermittent active and strongly precipitating cumulus clouds rising and detraining into patches of drizzling but quiescent stratiform cloud which is optically thin especially toward its edges. Mean cloud-base precipitation rates inside the POC are several mm d−1, but rates in the closed cell region are not greatly lower than this. This latter finding suggests that precipitation is not a sufficient condition for POC formation from overcast stratocumulus. Despite similar cloud-base precipitation rates in the POC and overcast region, much of the precipitation (>90%) evaporates below cloud in the overcast region, while there is significant surface precipitation inside the POC. In the POC and transition region, although the majority of the condensate is in the form of drizzle, the integrated liquid water path is remarkably close to that expected for a moist adiabatic parcel rising from cloud base to top. The transition zone between the POC and the closed cells often consists of thick \"boundary cell\" clouds producing mean surface precipitation rates of 10–20 mm d−1, a divergent quasi-permanent cold/moist pool below cloud, a convergent inflow region at mid-levels in the MBL, and a divergent outflow near the top of the MBL. The stratiform clouds in the POC exist within an ultra-clean layer that is some 200–300 m thick. Aerosol concentrations (Na) measured by a PCASP in the diameter range 0.12–3.12 μm in the center of the ultra-clean layer are as low as 0.1–1 cm−3. This suggests that coalescence scavenging and sedimentation is extremely efficient, since Na in the subcloud layer, and droplet concentration Nd in the active cumuli are typically 20–60 cm−3. The droplet concentrations in the quiescent stratiform clouds are extremely low (typically 1–10 cm−3), and most of their liquid water is in the form of drizzle, which mainly evaporates before reaching the surface. The cloud droplet concentration in the overcast region decreases strongly as the transition region is approached, as do subcloud accumulation mode aerosol concentrations, suggesting that coalescence scavenging is impacting regions in the overcast region as well as inside the POC. Both flights show lower accumulation mode aerosol concentration in the subcloud layer of the POC (Na ∼ 30 cm−3) compared with the overcast region (Na ∼ 100 cm−3), but elevated (and mostly volatile) total aerosol concentrations are observed in the POC at all levels around 20–50 km from the transition zone, perhaps associated with some prior nucleation event. Despite the large differences in cloud and MBL structure across the POC-overcast boundary, the MBL depth is almost the same in the two regions, and increases in concert over the 12 h period between the flights.

Introduction Little evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands. Methods A retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014. Data on age, gender, mechanism of injury, ISS, Abbreviated Injury Scale (AIS), prehospital intubation, Revised Trauma Score (RTS), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) upon admission at the Emergency Department was collected from three Regional Trauma Registries. To determine whether gender was an independent predictor of mortality and ICU admission, logistic regression analysis was performed. Results Among 6865 trauma patients, male patients had a significantly higher ISS compared to female patients (26.3 ± 10.2 vs 25.3 ± 9.7, P =  < 0.0001). Blunt trauma was significantly more common in the female group (95.2% vs 92.3%, P  = < 0.0001). Males aged 16- to 44-years had a significant higher in-hospital mortality rate (10.4% vs 13.4%, P  = 0.046). ICU admission rate was significantly lower in females (49.3% vs 54.5%, P  = < 0.0001). In the overall group, logistic regression did not show gender as an independent predictor for in-hospital mortality (OR 1.020 (95% CI 0.865–1.204), P  = 0.811) or mortality within 24 h (OR 1.049 (95% CI 0.829–1.327), P  = 0.693). However, male gender was associated with an increased likelihood for ICU admission in the overall group (OR 1.205 (95% CI 1.046–1.388), P  = 0.010). Conclusion The current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.

The relationship between precipitation rate and accumulation mode aerosol concentration in marine stratocumulus-topped boundary layers is investigated by applying the precipitation susceptibility metric to aircraft data obtained during the VOCALS Regional Experiment. A new method to calculate the precipitation susceptibility that incorporates non-precipitating clouds is introduced. The mean precipitation rate R over a segment of the data is expressed as the product of a drizzle fraction f and a drizzle intensity I (mean rate for drizzling columns). The susceptibility Sx is then defined as the fractional decrease in precipitation variable x = R, f, I per fractional increase in the concentration of aerosols with dry diameter >0.1 μm, with cloud thickness h held fixed. The precipitation susceptibility SR is calculated using data from both precipitating and non-precipitating cloudy columns to quantify how aerosol concentrations affect the mean precipitation rate of all clouds of a given h range and not just the mean precipitation of clouds that are precipitating. SR systematically decreases with increasing h, and this is largely because Sf decreases with h while SI is approximately independent of h. In a general sense, Sf can be thought of as the effect of aerosols on the probability of precipitation, while SI can be thought of as the effect of aerosols on the intensity of precipitation. Since thicker clouds are likely to precipitate regardless of ambient aerosol concentration, we expect Sf to decrease with increasing h. The results are broadly insensitive to the choice of horizontal averaging scale. Similar susceptibilities are found for both cloud base and near-surface drizzle rates. The analysis is repeated with cloud liquid water path held fixed instead of cloud thickness. Simple power law relationships relating precipitation rate to aerosol concentration or cloud droplet concentration do not capture this observed behavior.

Synoptic and satellite-derived cloud property variations for the southeast Pacific stratocumulus region associated with changes in coastal satellite-derived cloud droplet number concentrations (Nd) are explored. MAX and MIN Nd composites are defined by the top and bottom terciles of daily area-mean Nd values over the Arica Bight, the region with the largest mean oceanic Nd, for the five October months of 2001, 2005, 2006, 2007 and 2008. The ability of the satellite retrievals to capture composite differences is assessed with ship-based data. Nd and ship-based accumulation mode aerosol concentrations (Na) correlate well (r = 0.65), with a best-fit aerosol activation value dln Nddln Na of 0.56 for pixels with Nd>50 cm−3. The adiabatically-derived MODIS cloud depths also correlate well with the ship-based cloud depths (r=0.7), though are consistently higher (mean bias of almost 60 m). The MAX-Nd composite is characterized by a weaker subtropical anticyclone and weaker winds both at the surface and the lower free troposphere than the MIN-Nd composite. The MAX-Nd composite clouds over the Arica Bight are thinner than the MIN-Nd composite clouds, have lower cloud tops, lower near-coastal cloud albedos, and occur below warmer and drier free tropospheres (as deduced from radiosondes and NCEP Reanalysis). CloudSat radar reflectivities indicate little near-coastal precipitation. The co-occurrence of more boundary-layer aerosol/higher Nd within a more stable atmosphere suggests a boundary layer source for the aerosol, rather than the free troposphere. The MAX-Nd composite cloud thinning extends offshore to 80° W, with lower cloud top heights out to 95° W. At 85° W, the top-of-atmosphere shortwave fluxes are significantly higher (~50%) for the MAX-Nd composite, with thicker, lower clouds and higher cloud fractions than for the MIN-Nd composite. The change in Nd at this location is small (though positive), suggesting that the MAX-MIN Nd composite differences in radiative properties primarily reflects synoptic changes. Circulation anomalies and a one-point spatial correlation map reveal a weakening of the 850 hPa southerly winds decreases the free tropospheric cold temperature advection. The resulting increase in the static stability along 85° W is highly correlated to the increased cloud fraction, despite accompanying weaker free tropospheric subsidence.