Persistent Debate Research Articles

Prognostic Impact of Para-Aortic Lymph Node Dissection in Colorectal Cancer Patients Suspected of Para-Aortic Lymph Node Metastasis: A Retrospective Cohort Study

BackgroundPara-aortic lymph node metastasis (PALNM) is a rare occurrence in colorectal cancer (CRC), and the high risk of radical lymphadenectomy leads to persistent debate about the best treatment strategy. This study aims to evaluate the predictor for PALNM and the clinical value of para-aortic lymph node dissection (PALND) in CRC patients with radiologically suspected synchronous PALNM. MethodsPatients who has synchronous radiologically suspected PALNM and underwent primary tumor resection were included. Logistic regression and receiver operating characteristic curve analysis were used to assess the predictive value of lymph node short axis in preoperative CT, identifying the optimal cut-off value. Propensity score matching and Cox regression explored factors affecting overall and disease-free survival, while Kaplan-Meier curves and decision tree models identified patient characteristics suitable for synchronous paraaortic lymph node dissection. ResultsA total of 578 patients were enrolled, and 125 patients received synchronous PALND. We found that simultaneous PALND significantly improved overall survival (HR, 0.56; 95% CI, 0.35-0.91; P = .019) in multivariate analysis, while disease-free survival showed no significant difference (P = .41). The short axis diameter of PALN on preoperative CT is a crucial predictor of PALNM (P < .001, AUC = 0.759) with a threshold of > 7 mm. N-stage and distant metastasis were included as independent predictors in the diagnostic model to enhance accuracy. A larger short axis diameter of PALN correlated with advanced tumor stage and poorer prognosis. Subgroup analysis revealed that PALND offers survival benefits for colorectal cancer patients at all stages with a short axis diameter >10mm on preoperative CT (P = .037) and for stage III patients with a diameter between 7 to10 mm (P < .001, AUC = 0.810). ConclusionSynchronous PALND can improve overall survival in CRC patients with suspected PALNM, with the maximum short axis diameter of PALN serving as a key criterion for selecting patients for surgery.

The Ubiquitous External Ejaculation: Examining Perceptions of Sexual Images Across Cultures.

The persistent debates over pornography have often focused on differences between males and females, not only in the frequency of consumption or the type of material consumed, but also on the different ways that individuals may perceive sexually explicit images and respond to them. Some of these differences may be due to sex differences in a number of factors including sexual strategies, pathogen or sexual disgust, and own mate value as well as within sex differences in these factors. Previous studies have demonstrated that perceptions of sexually explicit images are influenced by the sex of the target in the image and the target's emotional affect, as well as sex of the respondent, their sexual orientation, short-term mating orientation, and disgust measures. However, these previous studies were conducted with participants from the United States alone. This study compared the findings from these US samples to those from non-Western ones (Philippines and Brazil) in order to examine the replicability across cultures of the US results as well as whether some variables (religiosity, for example) account for more or less of the variance in perceptions in different populations. Results indicated that there were some differences in terms of the amount of variance in perceptions explained by different variables across populations. Participant and stimuli related variables explained more variance in the Philippines while individual difference variables accounted for more variance in Brazil.

What Did Jesus Say on the Cross? A Sixteenth-Century Quest after a Biblical Transliteration

ABSTRACT Opening Matthew or Mark’s Gospels in one of the countless modern editions and translations of the Bible, one normally finds that moments before his death Jesus cried, “Eli, Eli, lema sabachthani?” which means, “My God, my God, why have you forsaken me?” (Matthew 27:46, and with minor changes in Mark 15:34). But what appears to be an unequivocal rendition of Jesus’s Aramaic vernacular was in fact an undecided question from the early Greek manuscripts up until the second half of the sixteenth century. This article follows the spelling of this transliteration in a number of consecutive editions of the Bible which appeared in the first half of the sixteenth century, thus revealing an often tacit but persistent debate regarding the representation of Jesus’s original language, the authority of the Greek ancient manuscripts, the relations between writing and oral speech, and the legitimacy of translation of the Bible.

AMBIVALENCE AND SUBVERSION IN MISSIONARY NARRATIVES

Postcolonial studies have focused much of their attention on critiquing imperialism and its repercussions. In this process charges have been levelled not only against the imperialists, who are the primary agents in establishing this colossal exploitative enterprise, but also on informal agents like missionaries who were also present at the scene during that period This study aims to analyse the persistent debate over the part played by the missionaries in the consolidation of the empire. It has been a postcolonial refrain that missionary writings played a significant role in creating a larger than life image of the missionaries as pioneer risk takers and conveniently othering the natives and representing them as barbarians passively awaiting rescue and relief. Consequently, the relation between missionaries and the empire has been the subject of much debate and deliberations, hence this paper examines this charge by analysing select missionary writings to prove whether these incriminate them or stand antithetical to colonialism as a digressive mechanism.For this purpose the paper closely scrutinizes Native Life in Travancore and The Land of Charity: A Descriptive Account of Travancore and its People, with Especial Reference to Missionary Labour – which are ethnographic accounts penned by an LMS missionary Samuel Mateer, to investigate whether or not missionary writings extend as imperialist discourses. The argument affected is that, these texts display ambivalence and hence, cannot be labelled as unequivocally imperialist. The surfacing of multiple conflicting impulses in these writings, problematise a simplistic categorisation of it as a pure imperialistic discourse.

The impact of specialised translator training and professional experience on legal translation quality assurance: an empirical study of revision performance

ABSTRACT The relevance of translation and law degrees as pathways to professional legal translation is the subject of persistent debate, but there is limited research on the relationship between legal translators’ backgrounds and competence levels in practice. This study compares the revision performance of several groups of institutional translators (44 in total) according to their academic backgrounds (legal translation specialisation, translation degrees with no legal specialisation, law degrees or other degrees) and legal translation experience (more or less than three years). The scores of justified, missing and over-corrections, among other indicators, corroborate the crucial impact of legal translation specialisation and subject-matter knowledge in ensuring legal translation quality, while experience can serve to partially fill certain training deficits. Qualified translators with a legal specialisation stood out as the most efficient revisers, followed by law graduates, translation graduates without a legal specialisation and other translators. A subsequent holistic assessment of the revised target text yielded results globally in line with the revision scores, as well as mixed perceptions of the target text as potential machine output. The findings support the added value of legal translator training, and are of relevance for translator recruitment and workflow management. They also challenge the rationale behind ISO 20771:2020 qualification requirements.

Assessing short-term and long-term security and efficacy of anterior nucleus of the thalamus deep brain stimulation for treating drug-resistant epilepsy: A systematic review and single-arm meta-analysis.

Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a widespread invasive procedure for treating drug-resistant epilepsy. Nonetheless, there is a persistent debate regarding the short-term and long-term efficacy and safety of ANT-DBS. Thus we conducted a systematic review and meta-analysis. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed, Cochrane, Embase, and Web of Science for studies treating refractory epilepsy with ANT-DBS. Short-term analysis was considered for studies with a mean follow-up of 3 years or less. The following outcomes were assessed for data extraction: procedure responders and nonresponders, increased seizure frequency, complications, and procedure-related mortality. Of 650 studies, 25 fit our inclusion criteria, involving 427 patients. Previous surgical treatments have been reported in 214 patients (50.1%) and a median average baseline seizure frequency of 64.9 monthly seizures. In the short-term analysis, we observed a proportion of 67% (95% confidence interval [CI] 54%-79%) of responders and 33% (95% CI 21%-46%) of nonresponders. In addition, 4% (95% CI 0%-9%) of the patients presented increased seizure frequency. In the long-term analysis, we observed 72% (95% CI 66%-78%) responders and 27% (95% CI 21%-34%) nonresponders. Moreover, there was a 2% (95% CI 0%-5%) increase in seizure frequency. No procedure-related mortality was reported at any follow-up. ANT-DBS effectively treats refractory epilepsy, with lasting short-term and long-term benefits. It remains safe and efficient despite complications, showing no procedure-linked fatalities, high patient responsiveness, and minimal increased seizures. Consistent results over time and low morbidity/mortality rates emphasize its worth. Further research is necessary to diminish the discrepancy among results.

Renewable energy, inequality and environmental degradation

The connection between income inequality and environmental degradation remains a topic of persistent debate, marked by inconsistencies in both theoretical and empirical studies. This study offers a novel contribution to this discourse by investigating the simultaneous influences of renewable energy and income inequality on environmental degradation. Utilizing data from 158 nations from 2000 to 2017, our research reveals a crucial moderating role of renewable energy in the nexus between income inequality and environmental degradation. The study's key finding is that the impact of income inequality on environmental degradation is contingent on the level of renewable energy development. In scenarios with limited renewable energy, income equality leads to increased environmental degradation. However, when renewable energy is more developed, income equality contributes to reducing environmental degradation. This novel insight suggests that renewable energy development can mitigate the trade-off between pursuing income equality and environmental sustainability, thereby enabling their simultaneous achievement. The research also highlights that a more equitable income distribution enhances the environmental benefits of renewable energy. Further analysis demonstrates the significant role played by household consumption behavior and social norms in shaping this phenomenon. By adding these new dimensions to the existing literature, the study significantly enriches the understanding of the complex interplay among economic factors, renewable energy, and environmental sustainability.

Analysis of the initial orbital MRI in aquaporin-4 antibody-positive optic neuritis (AQP4-ON): lesion location and lesion length can be predictive of visual prognosis.

Despite mounting evidence indicating that aquaporin-4 antibody-positive optic neuritis (AQP4-ON) presents a less favorable prognosis than other types of optic neuritis, there exists substantial heterogeneity in the prognostic outcomes within the AQP4-ON cohort. Considering the persistent debate over the role of MRI in assessing the prognosis of optic neuritis, we aim to investigate the correlation between the MRI appearance and long-term visual prognosis in AQP4-ON patients. We retrospectively reviewed the ophthalmological and imaging data of AQP4-ON patients admitted to our Neuro-ophthalmology Department from January 2015 to March 2018, with consecutive follow-up visits for a minimum of 3years. A total of 51 AQP4-ON patients (59 eyes) meeting the criteria were enrolled in this research. After assessing the initial orbital MR images of each patient at the first onset, we observed the involvement of the canalicular segment (p < 0.001), intracranial segment (p = 0.004), optic chiasm (p = 0.009), and the presence of LEON (p = 0.002) were significantly different between recovery group and impairment group. For quantitative measurement, the length of the lesions is significantly higher in the impairment group (20.1 ± 9.3mm) than in the recovery group (12.5 ± 5.3mm) (p = 0.001). AQP4-ON patients with involvement of canalicular, intracranial segment and optic chiasm of the optic nerve, and the longer range of lesions threaten worse vision prognoses. Timely MR examination during the initial acute phase can not only exclude the intracranial or orbital mass lesions but also indicate visual prognosis in the long term.

A Philosophical Investigation of the Context Sensitivity of Know: Contextualism versus Semantic Minimalism

A common and important question about context sensitivity is its extent in ordinary language. While words such as “I,” “this,” and “now” are known to be contextually sensitive, whether words such as know are context sensitive is debated. Contextualists believe that know is a context-sensitive word, while semantic minimalists insist it is not. The two groups have been engaged in a persistent debate on this issue and have not yet reached a consensus. Centering on this debate, this paper first briefly reviews contextualism and semantic minimalism’s debate over know, and then test whether it is context sensitive. This paper finds that the content of know displays some hierarchy, and to answer the question of whether it is context sensitive, logical inference must be distinguished from pragmatic inference. When expressing logical inference, know describes some state of affairs and factually certifies that the content of know is a fact; therefore, it involves no context sensitivity. While expressing pragmatic inference, however, know causes different pragmatic effects and indicates different levels of context sensitivity.

Empty or non-empty site? Evidence from the acquisition of Najdi Arabic sluicing

Abstract Sluicing—a clausal ellipsis in which the only pronounced part of a question is the wh-phrase—has been controversial since its emergence (Ross, 1969). I address herein the existence and nature of the ellipsis site’s content with an experimental argument from the field of first language acquisition. Using intervention effects as a diagnostic of movement, this study examines whether Najdi Arabic (NA)-speaking children show a subject advantage in sluicing and whether a mismatch in animacy features aids their interpretation of object sluices. A yes/no question task was conducted with 48 NA-speaking children. The results revealed that NA-speaking children exhibit a statistically significant subject advantage, although economy considerations constrain when this subject advantage emerges. Yet, no effect of mismatching animacy was found. Regardless, the results argue in favour of the structural-movement analysis of sluicing. This study contributes to the persistent debate on ellipsis site content by providing an experimental argument that relies on data from the acquisition of sluicing in NA.

An ongoing discussion about validity and quality in action research

&#x0D; This article unfolds a discourse on action research, illustrating its multifaceted perspectives, and engaging with the persistent debate about its validity and quality. Drawing on insights from a keynote presentation given by Kathryn Herr and Gary Anderson, renowned scholars in the field, at ICAR 2022, the article describes six possible positions within action research, from full insider to complete outsider, illuminating the potential for collaboration and transformation at each level of insider-outsider involvement. The article underscores the importance of establishing credibility, trustworthiness, and validity within action research, despite the scepticism it is often met with. It acknowledges the marginalisation of action research in academia and other organisational contexts and calls for its recognition as a rigorous methodology capable of generating context-specific knowledge and fostering change. This article serves as a critical examination of the unique dynamics of action research, its potential for impact, and the ongoing discourse surrounding its validity and quality.&#x0D;

Future responses to environment-related food self-insufficiency, from local to global

In the coming decades, communities may become exposed to local food self-insufficiency due to climate change, land degradation and land scarcity. Rapid population growth may exacerbate this. To support mitigating policies, answers are needed to the following two research questions: (i) Where and to what extent will environment-related food self-insufficiency occur or increase over the period from 2015 to 2050 and (ii) How will local communities respond to increased food self-insufficiency? Potential responses to food self-insufficiency are agricultural expansion, agricultural intensification, import, migration, starvation and violent conflict. Answering these research questions is hampered for different reasons. A persistent debate is ongoing on whether environmentally induced food deficit may cause migration and violent conflict at all. Although a clear relationship is assumed as self-evident by many scholars and politicians, as yet no convincing evidence has been found, in contrast to the relevance of socioeconomic factors. Moreover, a lack of consistent and accurate data on local food supply and demand hampers mapping of food self-insufficiency in the present and future. In this article, we explore the difficulties to find a clear relationship between environmentally induced food deficit, migration and violent conflict, and propose and test an operational methodology that does provide preliminary answers to the research questions: the necessary conditions approach. The results are presented in maps and tables of environment-related food self-insufficiency and of plausible responses for 2015 and 2050. Over that period, local food self-insufficiency roughly doubles as well as the number of people living in conditions that favour starvation, migration and violent conflict. The increase in food self-insufficiency is mostly caused by a significant population growth on the one hand—hence the demand side—and a stagnating or even slightly declining food production on the other. In contrast, food self-sufficiency stays high and constant on the global scale.

Mesopredator release among invasive predators: Controlling red foxes can increase feral cat density and alter their behaviour

Abstract1. The mesopredator release theory predicts that the density of subordinate predators will increase as dominant predators decline. Persistent debate around mesopredator release in part reflects the lack of robust, replicated experiments that test this theory, and the use of population indices that confound changes in mesopredator density and detectability. This uncertainty has immediate impacts for conservationists who are faced with managing sympatric invasive predators.2. We used replicated experimental designs and spatially explicit models to examine whether mesopredator release of the feral cat Felis catus occurs in response to targeted control of the introduced red fox Vulpes vulpes. We surveyed three Control‐Impact paired landscapes in a region with long‐term fox control (1080 poison baiting) and conducted a Before‐After Control‐Impact Paired‐Series experiment in another region. We used fox occurrence as a simple metric of fox populations and estimated feral cat density with spatial mark–resight models.3. Lethal fox control had varying effects on fox occurrence, consistent with variation in the duration and intensity of poison baiting. Correspondingly, responses in feral cat density ranged from negligible to a 3.7‐fold higher density in fox‐baited landscapes. At a fine spatial scale (200 m2), feral cat density was negatively associated with fox occurrence probability across both regions. These results were consistent with mesopredator release, although uncertainty was high in the region where fox control had only recently commenced.4. Feral cat detectability also varied across the (artificially manipulated) gradients of fox occurrence probability. In one region, nonlinear models indicated that feral cats had lower detection and increased movement rates when foxes were uncommon, giving way to density suppression at high fox occurrence probabilities.5. Synthesis and applications. Our study provides replicated, experimental evidence that dominant predator suppression can be associated with a higher mesopredator density. Mesopredator release can manifest as changes in both behaviour and density, distorting inference if these processes are not distinguished. Our results may help explain why fox control does not consistently improve native prey persistence, suggesting integrated pest management may be necessary to improve conservation outcomes.

Effective Moisture Evolution since the Last Glacial Maximum Revealed by a Loess Record from the Westerlies-Dominated Ili Basin, NW China

Moisture variation is extremely relevant for the stability of ecosystems in Central Asia (CA). Therefore, moisture evolution and its potential driving mechanism over the region are always a hot research topic. Although much effort has been devoted to understanding the processes of moisture evolutions in CA during the Quaternary, particularly the Holocene, the associated underlying mechanisms remain in a state of persistent debate. In this study, the granulometry, clay mineral and chroma properties of a loess section (named ZSP section) in the westerlies-dominated Ili Basin, NW China are investigated. With the accelerator mass spectrometry radiocarbon dating (AMS 14C)-based Bayesian age–depth model, we provide a sensitive record of effective moisture evolution since the last glacial maximum (LGM) in the basin, and the results help enhance understanding of the possible driving mechanisms for westerly climate change. Comparisons of clay mineralogy indices shows that the study area is involved in the Northern Hemisphere dust cycle processes as a dust source, and the content of &lt;2 μm grain size fraction in the ZSP section can thereby be used to reflect the westerlies’ intensity. After deducting the complicated influencing factors for lightness changes throughout the section, the calibrated lightness is adopted to indicate the regional effective moisture. Our findings show that effective moisture is relatively abundant during the LGM and the middle–late Holocene, with dry climate conditions during the last deglaciation and early Holocene. We argue that westerlies’ intensity was the main factor for driving the effective moisture evolution in the Ili Basin since the LGM. Local and source evaporation intensity and effective intra-annual control time of the westerlies over the study area exerted a minor influence on the moisture changes.

Review of Epistemological and Methodological Debates of Educational Research and Its Links to Theoretical Perspectives in Education

Research activities are based up on research paradigms such as positivism, interpretivism, critical paradigm and pragmatism. The paradigm is based on the four components of research paradigms: such as ontology, epistemology, axiology and methodology. The research paradigms suggest different research methodologies on how to approach reality, create knowledge, and values. Epistemological questions were also forwarded from investigator that direct to contestation on the option and appeal of objectivity, subjectivity, causality, validity and generalization of research findings. Educational activities are based on distinct theoretical viewpoints that have strong linkage with the epistemological and methodological research paradigms. Therefore, this study is intended to review the epistemological and methodological debates in educational research and its links to theoretical dimensions of educational theories. The study employed qualitative research approach in reviewing the existing research paradigms, and components of research paradigms, educational theory perspectives and continuous debates existing among these divergent philosophical thoughts. However, reality, knowledge and values are perceived to be contextual rather than universally agreed particularly in the contemporary global academic scenario. The study implies that though there are persistent debates concerning research paradigms; intermingling different research paradigms are vital to suggest solutions for social researches such as in educational problems. Keywords: Epistemology, interpretivism, methodology, ontology, positivism, pragmatism, research paradigm. DOI: 10.7176/JEP/13-28-01 Publication date: October 31 st 2022

Scotland's Catholics, A Distinctive Community?

Despite persistent debate about the status and character of Scotland’s Catholic community the question of how distinctive – if at all – Scotland’s Catholics are within a wider British Catholicism is seldom asked. Utilising the newly released Catholics in Britain Survey of 2019 this short article sketches out some comparative evidence on Catholic religiosity, moral values, family, and personal networks. It concludes that Scotland’s Catholicism is closely similar, in terms of such measures, to a wider British Catholic community.

Multilevel atlas comparisons reveal divergent evolution of the primate brain

Whether the size of the prefrontal cortex (PFC) in humans is disproportionate when compared to other species is a persistent debate in evolutionary neuroscience. This question has left the study of over/under-expansion in other structures relatively unexplored. We therefore sought to address this gap by adapting anatomical areas from the digital atlases of 18 mammalian species, to create a common interspecies classification. Our approach used data-driven analysis based on phylogenetic generalized least squares to evaluate anatomical expansion covering the whole brain. Our main finding suggests a divergence in primate evolution, orienting the stereotypical mammalian cerebral proportion toward a frontal and parietal lobe expansion in catarrhini (primate parvorder comprising old world monkeys, apes, and humans). Cerebral lobe volumes slopes plotted for catarrhini species were ranked as parietal∼frontal > temporal > occipital, contrasting with the ranking of other mammalian species (occipital > temporal > frontal∼parietal). Frontal and parietal slopes were statistically different in catarrhini when compared to other species through bootstrap analysis. Within the catarrhini's frontal lobe, the prefrontal cortex was the principal driver of frontal expansion. Across all species, expansion of the frontal lobe appeared to be systematically linked to the parietal lobe. Our findings suggest that the human frontal and parietal lobes are not disproportionately enlarged when compared to other catarrhini. Nevertheless, humans remain unique in carrying the most relatively enlarged frontal and parietal lobes in an infraorder exhibiting a disproportionate expansion of these areas.

Meta-analysis of studies on the impact of mobility disability simulation programs on attitudes toward people with disabilities and environmental in/accessibility.

The reported equivocal evidence of the effectiveness of disability simulation programs in reducing ableist attitudes toward people with disabilities has led to a persistent debate about the suggested discontinuation of such simulation programs to avoid further reinforcement of ableism. The present research conducted a meta-analysis on 12 empirical studies evaluating the impact of mobility disability simulation programs on attitudes toward people with disabilities and environmental accessibility to better inform future research and practice. A citation search using keywords related to “disability” and “simulation” in the title and/or abstract in 11 major online databases (i.e., Cochrane, EBSCOhost, EMBASE, Google Scholar, IEEE Xplore, JSTOR, LearnTechLib, ProQuest, PsycINFO, Scopus, and Web of Science) was conducted to retrieve relevant empirical articles that are published within the earliest dates of each database and June 2021 for the meta-analysis. Meta-analysis using a random effects model revealed that participation in the simulation programs resulted in large effect sizes in increasing fear and anxiety [Cohen’s d = -1.51, 95% CI (-2.98, -.05), n = 2] but small effect sizes in improving conceptions of social inclusion at postsimulation [Cohen’s d = .24, 95% CI (.01, .47), n = 5] while reducing stereotypes toward people with disabilities at follow-up [Cohen’s d = .57, 95% CI (.10, 1.03), n = 3]. Inconclusive changes in the behavioral tendency of inclusion-promoting actions and stereotypes at postsimulation were found. The three exploratory moderators (i.e., the program duration, the presence of facilitators with disabilities, and the debriefing arrangement) were not statistically significantly associated with between-subgroup differences in the program’s effectiveness in reducing stereotypes toward people with disabilities. The findings informed a series of recommended reforms in the program message framing, formats of the simulation, scope and referents of outcome measures, incorporation of environmental perspectives and behavioral measures, and methodological quality of the program evaluation study.

Diachronous initiation of Arabia–Eurasia collision from eastern Anatolia to the southeastern Zagros Mountains since middle Eocene time

ABSTRACT The persistent debate over the timing of initial Arabia–Eurasia collision has eluded consensus for decades, with most estimates ranging widely from ~50 to 10 Ma along both the Anatolian and Zagros segments of the orogen. Here, we independently evaluate the timing and location of initial collision using a quantitative plate tectonic reconstruction that is the first to include the entire Arabian microcontinent and regions to the north in eastern Anatolia, northwestern Iran, and the Caucasus. The reconstruction combines new kinematic constraints from recent global plate models with a synthesis of available constraints on crustal shortening and continental and back-arc subduction to restore the pre-collisional geometries of the Arabian and Eurasian continental margins and to track their interaction through time. Our preferred model suggests that initial continental underthrusting, or soft collision, of the relatively thin Arabian passive margin with Eurasia occurred by ca. 42 Ma along the eastern Bitlis suture zone and began transmitting strain across central and eastern Anatolia, the Caucasus, and northwestern Iran. Collision inception then propagated westward into central Anatolia and southeastward into the northwestern Zagros Mountains by late Eocene time (ca. 40–35 Ma), the central Zagros by latest Eocene to early Oligocene time, (ca. 35–25 Ma), and finally the southeastern Zagros by latest Oligocene to middle Miocene time (ca. 25–15 Ma). The diachroneity of Arabia collision led to widespread upper-plate (Eurasian) contraction and a similarly time-transgressive magmatic lull that lagged behind the onset of collision by ~2–12 Myr. By incorporating the entire Arabian microcontinent and regions to the north, this new tectonic reconstruction highlights the diachronous nature of Arabia–Eurasia collision that occurred first along the Bitlis suture zone in eastern Anatolia during late middle Eocene time and became progressively younger to the southeast along strike of the Zagros suture zone.

A significant proportion of current endovascular aortic aneurysm repair practice fails to meet Society for Vascular Surgery clinical practice guideline recommended abdominal aortic aneurysm diameter treatment thresholds in the Vascular Quality Initiative

BackgroundThere is mounting controversy surrounding the appropriate use of endovascular aortic aneurysm repair (EVAR) in contemporary practice. Persistent debate hinges on durability, cost, and survival. Accordingly, guidelines have attempted to clarify appropriate EVAR indications. The purpose of this analysis was to examine trends in EVAR practice throughout the United States and measure compliance with Society for Vascular Surgery (SVS) clinical practice diameter guidelines (CPGs). MethodsWe analyzed all elective repairs in the SVS Vascular Quality Initiative (VQI) EVAR registry from 2015 to 2019 (n = 25,112) and included patients with aneurysms confined to the infrarenal abdominal aorta. Center and surgeon variation with CPG diameter compliance was examined. Using a previously validated logistic regression model for risk adjustment, patients were stratified into predicted 1-year mortality risk tertiles and comparisons were made between patients meeting diameter guidelines (men ≥5.5;women ≥5.0 cm) and those who did not. ResultsNon-diameter-compliant EVAR occurred in 38.5% (n = 9675; diameter compliant, 61.5% [n = 15,437]). There was significant variation in CPG diameter compliance when stratified by VQI participating centers (range, 21%-95%; median, 61%; P < .001). This observation was amplified when categorized at the surgeon level (range, 0-100%; median, 63%; P < .0001). Notably, 82% of VQI surgeons (n = 852 of 1048) were non-diameter-compliant in more than 20% of their repairs. Moreover, among the 38.5% of patients failing to meet CPG diameter thresholds, 22.4% (n = 2171) were at high physiologic risk as determined by the validated SVS-VQI 1-year mortality calculator. Notably, the 1-year survival for the high-physiologic risk patients receiving non-guideline-compliant EVAR was worse compared with low- to intermediate-risk patients who were treated within recommended CPGs (92 ± 2% vs 97 ± 1%; log-rank P < .0001). ConclusionsA significant percentage of current US EVAR practice fails to adhere to the SVS diameter guidelines, as highlighted by the tremendous variation among VQI centers and surgeons. Furthermore, as noted by the 22% of patients undergoing noncompliant repair deemed to be at high physiologic risk, patient selection for EVAR seems to be suboptimal. Surprisingly, these findings are observed among the majority of VQI surgeons performing EVAR. In light of issues surrounding durability and cost, efforts to constrain observed deviation from recommended therapeutic size threshold guidelines would likely serve to improve abdominal aortic aneurysm care throughout the United States.