Precipitous Delivery Research Articles

Chronic natriuretic peptide protein therapeutics

The natriuretic peptides (NP) consist of a group of genetically distinct peptides with a 17 amino acid disulfide ring structure that exert important paracrine and endocrine actions in cardiorenal homeostasis. ANP and BNP bind to the natriuretic peptide-A receptor (NPR-A), which via 3',5'-cyclic guanosine monophosphate (cGMP) mediates natriuresis, vasodilatation, renin-aldosterone inhibition, anti-mitogenesis, and positive lusitropism. CNP lacks natriuretic actions, but possesses vasodilating and important growth- and fibrotic-inhibiting actions via the guanylyl cyclase-linked natriuretic peptide-B receptor (NPR-B). CD-NP now represents the first designer NP which, unlike ANP, BNP or CNP, co-activates both NPR-A and NPR-B. In both experimental and human heart failure (HF), investigations have supported the hypothesis that the capacity of the cardiomyocytes to produce and/or release the NP may be overwhelmed in HF due to the increased demands of the system, thus leading to a state of relative deficiency of biologically active endogenous NP. Hence, giving the favorable cardiorenal and humoral proprieties of the NP, their chronic exogenous delivery is now viewed as favorable therapeutic opportunity for the treatment of cardiovascular diseases. We have previously reported that subcutaneous (SQ) administration of BNP in experimental HF resulted in improved cardiac output with reduced systemic vascular resistance and cardiac filling pressures. Importantly, we translated these studies to humans and completed a pilot study to establish safety and efficacy of 8 weeks of chronic SQ BNP administration in human symptomatic systolic HF. More importantly, we have recently completed 2 proof of concept studies to assess the biological effects of 12 weeks of SQ BNP administration in patients with preclinical systolic dysfunction and patients with preclinical diastolic dysfunction (Stage B HF). These studies demonstrated that chronic SQ BNP induced a sustained generation of cGMP, which, importantly, was associated with persistent enhanced renal natriuretic response to volume overload. Going beyond BNP, CD-NP (Cenderitide) is in clinical development as an outpatient therapy during the post-acute HF period, to be administered continuously for up to 90 days after hospital discharge via subcutaneous pump with the goals of reducing rehospitalization. Recently, a phase 1 study in HF patients was completed which demonstrated that SQ CD-NP infusion achieved desirable pharmacokinetic levels and was well tolerated. Pre-clinically, we have recently designed an in situ polymer precipitation delivery system suitable for the chronic and sustained release of CD-NP. With the appropriate polymer-gel formulation, CD-NP release could be sustained over 3 weeks, thus inducing prolonged cGMP activation and favourable biological actions. Preclinical and early phase clinical studies have demonstrated the potential beneficial actions of chronic NP therapeutics. Further studies are warranted to determine if these functional responses can be translated into improved clinical outcomes and contribute to delaying the progression of HF.

Innovation, Collaboration, and Systemness: Three Sisters Playing Nice in the Sandbox

Professional Issues Poster Presentation Purpose for the Program Patient safety is in the forefront of education in the healthcare profession. The promotion of open communication and teamwork using obstetric simulation is the purpose of an innovative program introduced to our healthcare system. A new simulation lab was constructed at the College of Nursing within the system. The sister facilities are located within a 30‐mile radius and attempt to attract the same patient population. Proposed Change An obstetric simulation planning committee was formed to include educators from the three facilities within the healthcare system. The planning committee corresponded via e‐mails and had monthly meetings to share patient safety goals and develop a comprehensive plan for incorporating simulation as an educational component for nurses working in obstetric units. Implementation, Outcomes, and Evaluation Through scheduled monthly meetings the committee shared numerous ideas to support a fiscally responsible implementation plan. The drills are designed to enhance the learning of the nurse by incorporating the use of psychomotor skills. The nurse also will role‐play and care for a woman through the stages of labor and delivery using the simulator. Responding appropriately to spontaneous obstetric emergencies, including shoulder dystocia and precipitous delivery, are the first areas covered during the implementation of simulation. Implications for Nursing Practice Meaningful implications for the simulation training include effective communication as an interdisciplinary team; safe collaborative care to the obstetric simulator in the antepartum, intrapartum, and postpartum periods; and incorporate the collaboration of facilities to increase competency in varying skill mixes. The labor and delivery staff nurses are required to participate in 4 hours of simulation training annually. The scheduling of nurses from three facilities will allow 16 nurses to participate in training per month. Learning modules on shoulder dystocia and precipitous delivery were constructed to optimize the learning experience for each nurse. The modules contain objectives for each simulation module, pertinent educational materials, and learning assessments. Confidence level scoring will be performed by the nurse to evaluate the effectiveness of the simulation.

Bakri Balloon in Vaginal-Perineal Hematomas Complicating Vaginal Delivery

The study aimed to evaluate the effectiveness of Bakri balloon as a hemostatic device in severe postpartum hemorrhage due to complicated vaginal-perineal hematoma not responsive to standard surgical treatments. The article discusses an effective and minimally invasive technique for resolving a case of massive vaginal-perineal bleeding after vaginal delivery complicated by ischiorectal fossa hematoma. A 36-year-old primipara white woman, 41 weeks 1 day pregnant, was admitted to our unit for beginning of labor. She experienced a precipitous delivery of a healthy male baby (3.72 kg, 51 cm in length), and spontaneous complete afterbirth of placenta and membranes. The intervention involved positioning of an hemostatic Bakri balloon device in the vagina, to compress the vaginal wall, ensuring that the draining apex was well positioned into the uterine cervix. The patient was discharged after having a puerperal course without further complications. Vaginal hemostatic Bakri balloon device shows hemostatic efficacy immediately assessable, is promptly removable, not interfering with subsequent surgical or radiological procedures, does not increase the risk of infections as other compressive procedures, allows flow of lochia, does not cause pain or discomfort in women, and permits adjustable compression when a drainage is placed during surgery. Despite the high cost, it does not show disadvantages.

In-vivo evaluation of an in situ polymer precipitation delivery system for a novel natriuretic peptide.

This study reports on the release of a novel natriuretic peptide, CD-NP, from an in situ polymer precipitation delivery system. Following extensive screening of in-vitro release profiles, an in-vivo evaluation of the efficacy of the delivery system was carried out in Wistar rats. Gel injection was performed subcutaneously on the back of the rats. A secondary messenger, cyclic Guanosine 3′5′ Monophosphate (cGMP), was tested for verification of CD-NP bioactivity, in addition to direct measurements of CD-NP levels in plasma and urine using a radio-immuno assay. Plasma evaluation showed an elevated level of CD-NP over 3 weeks' duration. Unexpectedly, plasma cGMP level followed a decreasing trend over the same duration despite high CD-NP level. Loss of drug bioactivity was ruled out as a high level of CD-NP and cGMP excretion was observed in the treatment group as compared to baseline readings. This unexpected low-plasma cGMP levels and high-urinary cGMP excretion suggest that there might be other compensatory responses to regulation of the CDNP bioactivity as a result of the high drug dosing. The results stress the importance of assessing the overall bioactivity of released drug (in-vivo) concurrently in addition to measuring its concentrations, to determine the correct release profile.

Precipitation delivery in the tropical high Andes of southern Peru: new findings and paleoclimatic implications

The Cordillera Vilcanota in the southern Peruvian Andes has been the site of significant research focused on paleoclimatic reconstructions from ice cores (Quelccaya), past glaciations, climate–glacier interactions, and ecological and human responses to climate change. In this article, we analyse precipitation patterns in the region from 2004 to 2010 using twice daily precipitation observations from six regional climate stations and hourly observations of precipitation intensity from nearby Cusco International Airport. We also analyse atmospheric fields of temperature, wind, and moisture at 700 and 200 hPa from the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis dataset and create 72-h antecedent upstream air trajectories for the heaviest precipitation events using the National Oceanic and Atmospheric Administration (NOAA) Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model. Results indicate that the majority of annual precipitation across the cordilleras and inter-montane valleys alike occurs from nocturnal, regionally coherent rainfall events, inferred to be stratiform in structure, that occur in association with deep moist convection over adjacent Amazon lowlands. Low-level moisture (as inferred from the antecedent upstream air trajectories) for precipitation events can be supplied from a number of different regions, including from the northwest and west. The trajectory analysis reveals a strong dominance (83%) of precipitation events occur under weak flow regimes from nearby Amazon basin source regions, with 50% associated with trajectories from the northwest. In addition, the El Niño-Southern Oscillation (ENSO) signal reported in previous work in the central Andes is not necessarily representative of the Cordillera Vilcanota, where La Niña years (including 2007–2008) typically experience slightly below normal precipitation and El Niño years (including 2009–2010) are considerably wetter. These results are of particular value in understanding atmospheric signals registered in Andean low latitude ice cores, and point the way towards obtaining greater climatological inference from parameters preserved in annual snow and ice stratigraphy. Copyright © 2013 Royal Meteorological Society

“Did You Just Say . . . the Baby's Coming!!??”: A Nurse's Guide to Prepare for a Safe Precipitous Delivery in the Emergency Department

“Did You Just Say . . . the Baby's Coming!!??”: A Nurse's Guide to Prepare for a Safe Precipitous Delivery in the Emergency Department

Plant-wax hydrogen isotopic evidence for postglacial variations in delivery of precipitation in the monsoon domain of China

Research Article| September 01, 2011 Plant-wax hydrogen isotopic evidence for postglacial variations in delivery of precipitation in the monsoon domain of China Osamu Seki; Osamu Seki 1Institute of Low Temperature Science, Hokkaido University, N19W8, Kita-ku, Sapporo 060-0819, Japan Search for other works by this author on: GSW Google Scholar Philip A. Meyers; Philip A. Meyers 2Department of Geological Sciences, University of Michigan, Ann Arbor, Michigan 48109-1005, USA Search for other works by this author on: GSW Google Scholar Shinya Yamamoto; Shinya Yamamoto 1Institute of Low Temperature Science, Hokkaido University, N19W8, Kita-ku, Sapporo 060-0819, Japan Search for other works by this author on: GSW Google Scholar Kimitaka Kawamura; Kimitaka Kawamura 1Institute of Low Temperature Science, Hokkaido University, N19W8, Kita-ku, Sapporo 060-0819, Japan Search for other works by this author on: GSW Google Scholar Takeshi Nakatsuka; Takeshi Nakatsuka 3Graduate School of Environmental Studies, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan Search for other works by this author on: GSW Google Scholar Weijian Zhou; Weijian Zhou 4State Key Laboratory of Loess and Quaternary Geology, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an 710075, China Search for other works by this author on: GSW Google Scholar Yanhong Zheng Yanhong Zheng 5State Key Laboratory of Continental Dynamics, Department of Geology, Northwest University, Xi'an 710069, China Search for other works by this author on: GSW Google Scholar Geology (2011) 39 (9): 875–878. https://doi.org/10.1130/G32117.1 Article history received: 29 Jan 2011 rev-recd: 13 Apr 2011 accepted: 19 Apr 2011 first online: 09 Mar 2017 Cite View This Citation Add to Citation Manager Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Search Site Citation Osamu Seki, Philip A. Meyers, Shinya Yamamoto, Kimitaka Kawamura, Takeshi Nakatsuka, Weijian Zhou, Yanhong Zheng; Plant-wax hydrogen isotopic evidence for postglacial variations in delivery of precipitation in the monsoon domain of China. Geology 2011;; 39 (9): 875–878. doi: https://doi.org/10.1130/G32117.1 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGeology Search Advanced Search Abstract The Asian monsoon is a key component of the Earth's climate system that directly affects the livelihood of 60% of the world population. Reliable reconstruction of changes in monsoon precipitation during the Holocene is required to better understand the present climate conditions and to predict future climate processes in the Asian monsoon domain. Reconstruction of changes in Holocene monsoon precipitation has been done in various regions of this domain using a variety of paleoclimate proxies. However, different proxies have yielded different paleoclimate records of long-term monsoon rainfall variability. We apply compound-specific stable hydrogen isotope compositions of the plant wax n-alkanes isolated from the Hongyuan peat sequence in eastern Tibet to reevaluate the regional carbonate oxygen isotopic and lake-level records. The D/H ratios of the n-alkanes resolve the apparent discrepancy among the different paleoclimate proxies. Our result indicates that lake-level fluctuation is a reliable recorder of changes in the amount of summer monsoonal precipitation while long-term isotope records largely reflect large-scale changes in the source of water vapor rather than a local precipitation signal. Combining lake-level, biomarker, and carbonate isotopic records, we conclude that the early Holocene monsoon precipitation in southwest China has been greatly influenced by the Indian monsoon. You do not have access to this content, please speak to your institutional administrator if you feel you should have access.

Synoptic controls on precipitation pathways and snow delivery to high‐accumulation ice core sites in the Ross Sea region, Antarctica

Dominant storm tracks to two ice core sites on the western margin of the Ross Sea, Antarctica (Skinner Saddle (SKS) and Evans Piedmont Glacier), are investigated to establish key synoptic controls on snow accumulation. This is critical in terms of understanding the seasonality, source regions, and transport pathways of precipitation delivered to these sites. In situ snow depth and meteorological observations are used to identify major accumulation events in 2007–2008, which differ considerably between sites in terms of their magnitude and seasonal distribution. While snowfall at Evans Piedmont Glacier occurs almost exclusively during summer and spring, Skinner Saddle receives precipitation year round with a lull during the months of April and May. Cluster analysis of daily back trajectories reveals that the highest‐accumulation days at both sites result from fast‐moving air masses, associated with synoptic‐scale low‐pressure systems. There is evidence that short‐duration pulses of snowfall at SKS also originate from mesocyclone development over the Ross Ice Shelf and local moisture sources. Changes in the frequency and seasonal distribution of these mechanisms of precipitation delivery will have a marked impact on annual accumulation over time and will therefore need careful consideration during the interpretation of stable isotope and geochemical records from these ice cores.

Sedimentology of early Pliocene sandstones in the south-western Taiwan foreland: Implications for basin physiography in the early stages of collision

This work presents sedimentological observations and interpretations on three detailed sections of the Pliocene Yutengping/Ailiaochiao formations, deposited in the early stages of collision in Taiwan. Seven facies associations record paleoenvironments of deposition ranging from nearshore to lower offshore with a strong influence of tidal reworking, even in shelfal sub-tidal environments, and a pro-delta setting characterized by mass-flows. The association of shallow facies of the upper offshore to lower shoreface with pro-delta turbidite facies sourced in the orogen to the east suggests a peculiar setting in which turbidite deposition occurred below wave base but on the shelf, in water depths of probably less than 100 m. This adds to the examples of “shallow turbidites” increasingly commonly found in foreland basins and challenges the classical view of a “deep” early underfilled foreland basin. Time series analysis on tidal rhythmites allow us to identify a yearly signal in the form of periodic changes of sand-supply, energy and bioturbation that suggests a marked seasonality possibly affecting precipitation and sediment delivery as well as temperature. The Taiwan foreland basin may also present a potentially high-resolution record in shallow sediments of the early installation of monsoonal circulation patterns in east Asia. We confirm partly the paleogeography during the early stages of collision in Taiwan: the Chinese margin displayed a pronounced non-cylindrical geometry with a large basement promontory to the west in place of the modern Taiwan mountain range. Collision in Taiwan may have happened at once along the whole length of the modern mountain range, instead of progressively from north to south as classically considered.

Outcomes of different methods of induction of labour

ObjectiveTo compare outcomes of induction of labour with dinoprostone gel (Prostin), dinoprostone slow release pessary (Propess) and cervical ripening balloon.DesignProspective observational study of 78 primiparous and multiparous women induced for...

Precipitous delivery after induction of combined spinal epidural analgesia

Precipitous delivery after induction of combined spinal epidural analgesia

A 7-month-old Boy with Failure to Thrive

This 7-month-old boy was evaluated for failure to gain weight. He was the 7-lb., 7-oz. product of a full-term pregnancy to a 31-year-old gravida 2 para 2 woman. It was a precipitous vaginal delivery, but there were no perinatal problems. His mother initially nursed him every 3 hours for 20 minutes on each breast. Recently, he had been feeding once during the night. He had three normal bowel movements each day without diarrhea or vomiting. If his mother pumped, she expressed a total of 4 oz. from the combination of the two breasts. Although his parents have tried to give him solid foods, he will not eat from a spoon. He drinks pumped breast milk from a bottle, although he prefers nursing. When he drinks from a bottle, he can take 3 oz. in about 30 minutes. There is no history of choking, sputtering, or tachypnea with feeds. His past history is remarkable for a skin rash that started at 4 months. The rash was described as pruritic, red, and scaly over his entire body. He was treated with Eucerin without effect and was switched to EpiCeram. He has had no signifi cant infections, other than one episode of otitis media. Development is normal. The family history is unremarkable. On physical exam, he was a thin, uncomfortable boy who was con-

Symptomatic Congenital Vallecular Cyst in a Neonate

A term infant was born by precipitous vaginal delivery to a multiparous woman. From birth, the infant presented with respiratory distress and an inspiratory stridor requiring commencement of continuous positive airway pressure. The stridor, respiratory distress, and cyanosis were more prominent when the infant was agitated. The clinical examination result was normal except for edema of the face and bruising. A direct laryngoscopy was performed and showed the presence of a vallecular cyst (Figure, A).

Nurses' Comfort Level With Emergency Interventions in the Rural Hospital Setting

One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. The purpose of this study was to determine the influence of registered nurses' certifications and years of experience on comfort level in emergencies. Data were collected using a survey design. The questionnaire gathered demographic data, number and type(s) of certifications held, and comfort level with 7 emergency interventions. The sample was recruited from registered nurses (RNs) working in 10 Critical Access Hospitals that represented different geographic locations and different distances to larger, more comprehensive hospitals in an upper Midwestern state. Mean comfort level of all respondents with the 7 selected emergency interventions ranged from 2.3 for assisting with thoracentesis to 3.6 for assisting with precipitous vaginal delivery, indicating only a moderate comfort level with the selected emergency interventions. While 70% of the 86 respondents answered "yes" when asked if they felt comfortable in emergency situations, the percentage of respondents who reported being comfortable ranged from 33% to 83%. Number and type(s) of certifications and years of experience as an RN were associated with higher comfort levels. Responses to open-ended questions provided insight into the realities of rural emergency nursing and strategies for improving comfort levels of rural nurses in emergency situations.

Preparing for Precipitous Vaginal Deliveries in the Emergency Department

Preparing for Precipitous Vaginal Deliveries in the Emergency Department

Identification and characteristics of surge-type glaciers on Novaya Zemlya, Russian Arctic

AbstractWe present a comprehensive new inventory of surge-type glaciers on the Novaya Zemlya archipelago, using high-resolution (up to 4 m) satellite imagery from 1976/77 (Hexagon), 1989 (Landsat TM), 2001 (Landsat ETM+) and 2006 (ASTER). A total of 692 glaciers and their forelands were observed for glaciological and geomorphological criteria indicative of glacier surging (e.g. looped moraines, heavy surface crevassing, surface potholes, thrust-block moraines, concertina eskers). This enabled the identification of 32 potential surge-type glaciers (compared with four previously identified) representing 4.6% of the total but 18% by glacier area. We assess the characteristics of surge-type glaciers. Surge-type glaciers are statistically different from non-surge-type glaciers in terms of their area, length, surface slope, minimum elevation, mid-range elevation and terminus type. They are typically long (median length 18.5 km), large (median area 106.8 km2) outlet glaciers, with relatively low overall surface slopes (median slope 1.7°) and tend to terminate in water (marine or lacustrine). They are predominantly directed towards and located in the more maritime western region of the Russian Arctic, and we suggest that surge occurrence might be related to large and complex catchment areas that receive increased delivery of precipitation from the Barents Sea.

Clinical significance of cervical length shortening before 31 weeks' gestation assessed by longitudinal observation using transvaginal ultrasonography

To elucidate the clinical significance of progressive cervical length (CL) shortening before 31 weeks' gestation. Transvaginal ultrasonography was used for longitudinal measurements of CL in 114 singletons. CL shortening groups were defined as having a CL of <25 mm at <26 weeks (early shortening group, 20 cases) and <31 weeks (late shortening group, 19 cases). The control group (75 cases) was defined as having a CL of >or=25 mm at <31 weeks. The CL values at 16-20, 21-25, 26-30 and 31-35 weeks, the age-related CL changes, the treatments for preterm labor, and the outcomes were compared between groups. In 78 cases with spontaneous delivery at >or=36 weeks, we investigated cervical dilatation velocity in the active phase of labor. At 16-20 weeks, CL values for the early group were smaller than those of the late and control groups. Rapid CL shortening occurred between 16-20 and 21-25 weeks in the early group and between 21-25 and 26-30 weeks in the late group. In the early group, all cases received cerclage and/or tocolysis or bedrest, and one case delivered prematurely. In the late group, 10 cases required tocolysis or bedrest, and one case delivered prematurely. In nulliparous women, cervical dilatation velocity in the early and late groups was more rapid than in the controls. CL shortening to <25 mm before 31 weeks is a risk factor for preterm delivery, as well as for preterm labor in cases who had tocolysis and bedrest, and precipitate delivery.

Eastern Antarctic Peninsula precipitation delivery mechanisms: process studies and back trajectory evaluation

AbstractThe atmospheric circulation patterns that result in precipitation events at a site on the eastern Antarctic Peninsula (AP) are investigated using back trajectories (BTs) driven by ERA‐40 data. Moisture delivery occurs from the east and west depending on the location of blocking events in the South Atlantic and Pacific Oceans. Observations are sparse in this region, so our process studies compare the trajectories (and the ERA‐40 fields from which they were derived) with advanced very high resolution radiometer (AVHRR) satellite images. It is found that the trajectories represent these transport mechanisms very well and that they are relatively insensitive to the initial trajectory elevation. Copyright © 2008 Royal Meteorological Society

Growing season energy and water exchange from an oil sands overburden reclamation soil cover, Fort McMurray, Alberta, Canada

AbstractThe oil sands mining industry in Canada is required to return mining areas to a land capability equivalent to that which existed prior to mining. During the reclamation process, ecosystems are created that bear little similarity to boreal forests that existed prior to mining. Quantifying the water balance of reclaimed ecosystems is critical in establishing whether there is sufficient moisture for vegetation growth and in the fate of salts, which can be toxic when drawn to the surface or leached out of the covers. At Syncrude Canada Ltd's Mildred Lake mine north of Fort McMurray, Alberta, the surface energy balance was measured atop a reclaimed saline‐sodic overburden pile during three growing seasons using eddy covariance. At the onset of the study, the dominant vegetation was foxtail barley, which changed to sweet clover in 2004, and a low‐density species mix in 2005, including some aspen and white spruce seedlings. The 2005 growing season was cooler and wetter than 2003 and 2004, and there were seasonal differences in the delivery of precipitation among years. There were distinct differences in the surface energy balance among the study years related to weather, soil moisture, vegetation and stage of growth. Latent heat was the largest consumer of energy in 2003, and mid‐day fluxes of sensible and latent heat were approximately equal. In 2004, sensible heat became the dominant flux, primarily due to prolonged dry periods, whereas the wet 2005 season had the greatest latent heat flux density of any year. Ground heat flux declined throughout the growing season and ranged between 3 and 17% of net radiation. Total evapotranspiration was 246, 224 and 283 mm for 2003, 2004 and 2005, respectively. A total derivative analysis of the Penman‐Monteith equation reveals the influence of available energy, vapour pressure deficit and surface conductance in controlling evapotranspiration. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Late Quaternary glaciation in the Kyrgyz Tien Shan

The Tien Shan of Kyrgyzstan contains multiple moraines and drift from late Quaternary glaciations. The spatial/temporal distribution of the glaciers inferred from the moraines suggests that the main factor controlling glacier advance here was the availability of moisture. The dominant modern climatic signatures in northern Central Asia include orographic thunderstorms in summer, cold and dry Siberian high-pressure cells in winter, and westerly cyclonic storms from the North Atlantic and eastern Mediterranean in spring and fall. Changes in any of these systems during the late Quaternary would have varied precipitation delivery to, and glacier growth in the Kyrgyz Tien Shan. Geomorphic mapping and reconnaissance-level 10Be cosmic-ray exposure dating of moraine sequences in six drainages indicate that there were multiple “maximum” advances of similar extents and equilibrium-line depressions across the range. Glaciers in the north and east of the Kyrgyz Tien Shan last advanced to their maximum positions during marine oxygen isotope stage (MIS) 5 and again during MIS 4, while in the south and west of the range advance occurred during MIS 3. In contrast to maritime Europe and North America, there is no evidence of a major glacial advance during MIS 2. Glacier advances during MIS 2 and since were restricted to the vicinity of modern glaciers, allowing the older glacial record to be preserved well.