[1] A microwave radiometer is described that provides continuous thermodynamic (temperature, water vapor, and moisture) soundings during clear and cloudy conditions. The radiometric profiler observes radiation intensity at 12 microwave frequencies, along with zenith infrared and surface meteorological measurements. Historical radiosonde and neural network or regression methods are used for profile retrieval. We compare radiometric, radiosonde, and forecast soundings and evaluate the accuracy of radiometric temperature and water vapor soundings on the basis of statistical comparison with radiosonde soundings. We find that radiometric soundings are equivalent in accuracy to radiosonde soundings when used in numerical weather forecasting. A case study is described that demonstrates improved fog forecasting on the basis of variational assimilation of radiometric soundings. The accuracy of radiometric cloud liquid soundings is evaluated by comparison with cloud liquid sensors carried by radiosondes. Accurate high-resolution three-dimensional water vapor and wind analysis is described on the basis of assimilation of simulated thermodynamic and wind soundings along with GPS slant delays. Examples of mobile thermodynamic and wind profilers are shown. Thermodynamic profiling, particularly when combined with wind profiling and slant GPS, provides continuous atmospheric soundings for improved weather and dispersion forecasting.

IMPORTANCE Transferring patients with large-vessel occlusion (LVO) or intracranial hemorrhage (ICH) to hospitals not providing interventional treatment options is an unresolved medical problem. OBJECTIVE To determine how optimized prehospital management (OPM) based on use of the Los Angeles Motor Scale (LAMS) compares with management in a Mobile Stroke Unit (MSU) in accurately triaging patients to the appropriate hospital with (comprehensive stroke center [CSC]) or without (primary stroke center [PSC]) interventional treatment. DESIGN, SETTING, AND PARTICIPANTS In this randomized multicenter trial with 3-month follow-up, patients were assigned week-wise to one of the pathways between June 15, 2015, and November 15, 2017, in 2 regions of Saarland, Germany; 708 of 824 suspected stroke patients did not meet inclusion criteria, resulting in a study population of 116 adult patients. INTERVENTIONS Patients received either OPM based on a standard operating procedure that included the use of the LAMS (cut point Ն4) or management in an MSU (an ambulance with vascular imaging, point-of-care laboratory, and telecommunication capabilities). MAIN OUTCOMES AND MEASURESThe primary end point was the proportion of patients accurately triaged to either CSCs (LVO, ICH) or PSCs (others).RESULTS A predefined interim analysis was performed after 116 patients of the planned 232 patients had been enrolled. Of these, 53 were included in the OPM group (67.9% women; mean [SD] age, 74 [11] years) and 63 in the MSU group (57.1% women; mean [SD] age, 75 [11] years). The primary end point, an accurate triage decision, was reached for 37 of 53 patients (69.8%) in the OPM group and for 63 of 63 patients (100%) in the MSU group (difference, 30.2%; 95% CI, 17.8%-42.5%; P < .001). Whereas 7 of 17 OPM patients (41.2%) with LVO or ICH required secondary transfers from a PSC to a CSC, none of the 11 MSU patients (0%) required such transfers (difference, 41.2%; 95% CI, 17.8%-64.6%; P = .02). The LAMS at a cut point of 4 or higher led to an accurate diagnosis of LVO or ICH for 13 of 17 patients (76.5%; 6 triaged to a CSC) and of LVO selectively for 7 of 9 patients (77.8%; 2 triaged to a CSC). Stroke management metrics were better in the MSU group, although patient outcomes were not significantly different. CONCLUSIONS AND RELEVANCEWhereas prehospital management optimized by LAMS allows accurate triage decisions for approximately 70% of patients, MSU-based management enables accurate triage decisions for 100%. Depending on the specific health care environment considered, both approaches are potentially valuable in triaging stroke patients.

When applied centrally to animals, growth hormone-releasing hormone (GHRH) stimulates slow-wave sleep (SWS), whereas somatostatin (SRIF) increases REM sleep. We investigated whether these peptides also affect the sleep EEG in humans when given intravenously by comparing polysomnographically the effects of four boluses of (1) placebo, (2) 50 µg GHRH or (3) 50 µg SRIF administered at 22.00, 23.00, 24.00 and 1.00 h to 7 male controls. In addition, we collected blood samples through a long catheter every 20 min from 22.00 to 7.00 h and measured plasma cortisol and growth hormone (GH) levels. In comparison with SRIF and placebo, GHRH produced a significant increase in plasma GH concentration throughout the night (mean ± SD: 10.8 ± 2.0 ng/ml after GHRH; 3.0 ± 1.7 ng/ml after SRIF and 3.2 ± 2.0 ng/ml after placebo). SRIF failed to substantially attenuate the nocturnal GH release. Nocturnal cortisol secretion was blunted after GHRH but remained unaffected by SRIF (61.4 ± 12.9 ng/ml after placebo; 46.6 ± 19.7 ng/ml after GHRH and 70.8 ± 12.6 ng/ml after SRIF). Quantitative sleep EEG staging showed a significant increase in SWS after GHRH administration but no change after SRIF (percent spent in SWS per night: 14.0 ± 5.6 after placebo, 20.2 ± 6.6 after GHRH and 15.1 ± 8.2 after SRIF). Application of SRIF was accompanied by a trend toward increased REM density. The effects of episodic GHRH administration upon SWS, GH and cortisol secretion were opposite to those previously reported for corticotropin-releasing hormone, which supports the view that neuroregulation of human sleep involves an interaction of central GHRH and corticotropin-releasing hormone.

First results are presented of 18 months' experience with a microwave profiler that has been in operation in an unattended mode. Profiles of temperature and water vapor were retrieved without bias by a statistical regression method that was more accurate as opposed to a neural network approach, in particular for water vapor. Cloud liquid water was estimated by a neural network. The accuracy of the retrieved profiles estimated against quasisimultaneous radiosonde measurements are of comparable quality to that of the retrievals of ground-based Fourier transform infrared (FTIR) measurements. For temperature, the accuracy is about 0.6 K near the surface and less or equal to 1.6 K up to 7 km in summer and 4 km in winter. For water vapor, the corresponding values are 0.2-0.3 g m Ϫ3 near the surface and 0.8-1.0 g m Ϫ3 from 1-to 2-km altitude. The vertical resolution, however, is worse than that of FTIR measurements.Two case studies-a 1-week anticyclonic situation and 1 day with a cold front passage-demonstrate the capacity of microwave radiometry to sense the thermodynamic structure of the lower troposphere up to 3-4 km quasi-continuously with reasonable accuracy and height resolution, interrupted only during precipitation events. The diurnal course of temperature and humidity as well as the weakening of the amplitudes and decay with altitude was traced up to 4 km. Considerable structure was found, too, in the liquid water profile during the passage of the cold front. The cloud base retrieved from the microwave data corresponded well with collocated ceilometer measurements.

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