Joey Woo

Substituted judgement is often used in the absence of advanced directives to guide decision-making when patients lack decisional capacity. We present a remarkable case of family members exercising substituted misjudgement for a 42-year-old man hospitalized with multiorgan failure on life support. Feeling that their loved one would rather die than face severe disability, they elected to withdraw life support. Although this was done, the patient remained alive and recovered enough to clearly indicate his preference for life, even with severe disability. This case suggests that in instances of unusual quality-of-life judgements where the patient's wishes cannot be known with reasonable certainty, families and physicians should be very wary using substituted judgement to refuse life support. Unless there are strong considerations based on the patient's prior statements, actions and values to decline life support, it would seem ethically appropriate to continue treatment, even with substantial disability the likely outcome

© Author 2014.We use a 3-D regional atmospheric chemistry transport model to examine ozone dry deposition in East Asia, which is an important but uncertain research area because of insufficient observation and numerical studies focusing on East Asia. Here we compare two widely used dry deposition parameterization schemes, the Wesely and M3DRY schemes, which are used in the WRF-Chem and Community Multiscale Air Quality models, respectively. Simulated ozone dry deposition velocities with the two schemes under identical meteorological conditions show considerable differences owing to surface resistance parameterization discrepancies. Resulting ozone concentrations differ by up to 10 ppbv for a monthly mean in May when the peak ozone typically occurs in East Asia. An evaluation of the simulated dry deposition velocities shows that the Wesely scheme calculates values with more pronounced diurnal variation than the M3DRY and results in a good agreement with the observations. However, we find significant changes in simulated ozone concentrations using the Wesely scheme but with different surface type data sets, indicating the high sensitivity of ozone deposition calculations to the input data. The need is high for observations to constrain the dry deposition parameterization and its input data to improve the use of air quality models for East Asia.