IMPORTANCE Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.OBJECTIVE To investigate the effect of home NIV plus oxygen on time to readmission or death in patients with persistent hypercapnia after an acute COPD exacerbation.

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Transdiaphragmatic pressure can be measured in the critically ill to give a nonvolitional assessment of diaphragm contractility, but not all patients can be studied. At present, the relationship of twitch endotracheal tube pressure to transdiaphragmatic pressure is too variable to reliably represent a less invasive measure of diaphragm strength.

A toolbox for the automated calculation of glacier equilibrium-line altitudes (ELAs) using the Accumulation Area Ratio, Area-Altitude Balance Ratio, Area-Altitude and Kurowski methods is presented. These are the most commonly-used methods of ELA calculation in palaeo-glacier reconstructions. The toolbox has been coded in Python and runs in ArcGIS requiring only the reconstructed surface of the palaeo-glacier (a DEM) as input. Through fast and automatic calculation this toolbox simplifies the process of ELA determination and can successfully work both for a single glacier and for large datasets of multiple glaciers

Glacial and periglacial landforms are widespread in the mountains of the Mediterranean region. The evidence for glacial and periglacial activity has been studied for over 120 years and it is possible to identify three phases of development in this area of research. First, a pioneer phase characterized by initial descriptive observations of glacial landforms; second, a mapping phase whereby the detailed distribution of glacial landforms and sediments have been depicted on geomorphological maps; and, third, an advanced phase characterized by detailed understanding of the geochronology of glacial sequences using radiometric dating alongside detailed sedimentological and stratigraphical analyses. It is only relatively recently that studies of glaciated mountain terrains in the Mediterranean region have reached an advanced phase and it is now clear from radiometric dating programmes that the Mediterranean mountains have been glaciated during multiple glacial cycles. The most extensive phases of glaciation appear to have occurred during the Middle Pleistocene. This represents a major shift from earlier work whereby many glacial sequences were assumed to have formed during the last cold stage. Glacial and periglacial deposits from multiple Quaternary cold stages constitute a valuable palaeoclimatic record. This is especially so in the Mediterranean mountains, since mountain glaciers in this latitudinal zone would have been particularly sensitive to changes in the global climate system.

Recent research in the mountains of the Mediterranean has attempted to establish the timing of the maximum extent of glaciers during the last cold stage. Several dating methods have been utilised and new dating frameworks have emerged in key areas. In several places, multiple dating techniques (radiocarbon, optically stimulated luminescence, U-series) applied to glacial and associated sediments suggest that local glacier maxima preceded the global Last Glacial Maximum (LGM, ca. 18 14 C ka BP/ 21 cal. ka BP) by at least several thousand years. Studies in Spain, the Pyrenees, the Maritime Alps and Turkey utilising cosmogenic isotope analyses ( 10 Be and 36 Cl), have yielded glacial geochronologies with maxima that correlate closely with the marine isotope record of ice volume and the global LGM. In some cases, the use of different geochronological techniques has led to conflicting evidence for the timing of the local last glacier maxima in the same area. From a palaeoclimate perspective, glacier-climate reconstructions for the local last glacier maxima in the mountains of central Italy, northern Greece and western Turkey indicate that climate was wet and cold. In Italy and Greece the local glacier maxima preceded the driest part of the last cold stage -as indicated by palaeoecological records -by several thousand years. For western Turkey, however, recent cosmogenic exposure ages combined with glacier modelling suggest a local last glacier maximum characterised by cold and wet conditions coinciding with the global LGM. The available evidence indicates that a dichotomy is emerging, not only in our understanding of the timing of glaciation across the Mediterranean, but also in the palaeoclimatic interpretations derived from glacial and palaeoecological records.

Mt Chelmos in the Peloponnesus was glaciated by a plateau ice field during the most extensive Pleistocene glaciation. Valley glaciers radiated out from an ice field over the central plateau of the massif. The largest glaciations are likely to be Middle Pleistocene in age. Smaller valley and cirque glaciers formed later and boulders on the moraines of these glacial phases have been dated using 36Cl terrestrial cosmogenic nuclide exposure dating. These ages indicate a Late Pleistocene age with glacier advance/stabilization at 40–30 ka, glacier retreat at 23–21 ka and advance/stabilization at 13–10 ka. This indicates that the glacial maximum of the last cold stage occurred during Marine Isotope Stage 3, several thousand years before the global Last Glacial Maximum (Marine Isotope Stage 2). The last phase of moraine-building occurred at the end of the Pleistocene, possibly during the Younger Dryas.