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Initially, terrestrial evidence formed the foundation for the division of Quaternary time. However, since the 1970s there has been an abandonment of the terrestrial stage chronostratigraphy, which is based on locally dominated successions, in favour of the marine oxygen isotope stratigraphy which largely records global-scale changes in ice volume. However, it is now clear that glacial records around the world are asynchronous, even at the scale of the continental ice sheets which display marked contrasts in extent and timing in different glacial cycles. Consequently, the marine isotope record does not reflect global patterns of glaciation, or other terrestrial processes, on land. This has led to inappropriate correlation of terrestrial records with the marine isotopic record. The low resolution of the latter has led to a preferential shift towards high-resolution ice-core records for global correlation. However, even in the short term, most terrestrial records display spatial variation in response to global climate fluctuations, and changes recorded on land are often diachronous, asynchronous or both, leading to difficulties in global correlation. Thus, whilst the marine and the ice-core records are very useful in providing global frameworks through time, it must be recognized that there exist significant problems and challenges for terrestrial correlation. [ABSTRACT FROM AUTHOR]

Background: Since 1988 the author has used only endoscopic injection of Teflon (polytetrafluoroethylene) paste in the correction of ureteric reflux, in adults and children.
Methods: The present paper reports a series of 32 patients, 18 children and 14 adults, with 45 refluxing ureters so treated. Intra-operative cystogram was carried out and a second Teflon paste injection was given under the same anaesthetic where persistent reflux was demonstrated after the initial Teflon injection, to reduce the number of anaesthetics given.
Results: In those patients who consented to a delayed cystogram after the first injection of Teflon, there was a cure rate of 83.3% in children and 70% in adults from that first injection.
Conclusion: Endoscopic retro-ureteric injection of Teflon paste is done as a day case under general anaesthesia and causes the patient no pain postoperatively. It gives a high cure rate and is an option that should be offered to every patient where a decision has been made to correct ureteric reflux.

BackgroundInspiratory muscle weakness is a recognised cause of unexplained dyspnoea. It may be suggested by the finding of a low static inspiratory mouth pressure (MIP), but MIP is a difficult test to perform, with a wide normal range; a low MIP may also occur if the patient has not properly performed the manoeuvre. Further investigation conventionally requires balloon catheters to obtain oesophageal (Poes) and transdiaphragmatic pressure (Pdi) during sniffs or phrenic nerve stimulation. Two non-invasive tests of inspiratory muscle strength have recently been described - nasal pressure during a maximal sniff (Sn Pnas) and mouth pressure during magnetic stimulation of the phrenic nerves (Tw Pmo). The use of these two tests in combination might identify patients without inspiratory muscle weakness who are unable to produce a satisfactory MIP, therefore avoiding the need for investigation with balloon catheters. MethodsThirty consecutive patients with clinically suspected inspiratory muscle weakness and a low MIP underwent both conventional (Sn Poes and Tw Pdi) and non-invasive testing (Sn Pnas and Tw Pmo). Weakness was considered to be excluded by a Sn Poes of ≥80cm H₂O or a Tw Pdi of ≥20cm H₂O. The limit values used to test the hypothesis were Sn Pnas ≥70cm H₂O or Tw Pmo ≥12cm H₂O. ResultsInspiratory muscle weakness was excluded in 17 of the 30 patients. Fifteen of these would have been identified using Sn Pnas and Tw Pmo, with better results when the two tests were combined. The cut off values selected for Sn Pnas and Tw Pmo were shown by ROC plots to indicate normal strength conservatively, avoiding failure to detect mild degrees of weakness. No patient with global weakness was considered normal by Sn Pnas or Tw Pmo. ConclusionsIn most patients with normal inspiratory strength and a low MIP, Tw Pmo and Sn Pnas used in combination can reliably exclude global inspiratory muscle weakness, reducing the number of patients who need testing with balloon catheters.

Exploring the mode and tempo of millennial-scale climate variability under evolving boundary conditions can provide insights into tipping points in different parts of the Earth system, and can facilitate a more detailed understanding of climate teleconnections and phase relationships between different Earth system components. Here we use fossil diatom and stable carbon and oxygen isotope analysis of lake sediment deposits (core I-284) from the Ioannina basin, NW Greece, to explore in further detail millennial-scale climate instability in southern Europe during Marine Isotope Stage 6 (MIS 6; ca. 185–130 ka). This interval correlates with the Vlasian Stage in Greece and the Late Saalian Substage in northern Europe, which were both characterised by extensive glaciations. The new dataset resolves at least 18 discrete warmer/wetter intervals, many of which were associated with strong Asian Monsoon events and North Atlantic interstadials. A number of cooler/drier intervals are also identified in the I-284 record, which are typically associated with weaker Asian Monsoon events and North Atlantic stadials, consistent with a variable Atlantic Meridional Overturning Circulation. Unlike the subdued changes in tree populations that are observed at Ioannina during mid-to-late MIS 6, the diatom record contains frequent high-amplitude oscillations in species assemblages, pointing to its sensitivity at a time when the lake system must have been close to environmental thresholds. Millennial-scale variability in diatom species assemblages continues into late MIS 6 at Ioannina, contributing important evidence for an emerging picture of frequent and persistent climate instability even at times of high global ice volume.