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  1. Apr 2026
    1. Treatment of superficial vein reflux (see Varicose Veins, above) has been shown to decrease the recurrence rate of venous ulcers. Where there is substantial obstruction of the femoral or popliteal deep venous system, superficial varicosities supply the venous return and should not be removed.

      Failure of venous insufficiency ulcerations to heal is most often due to inconsistent use of first-line treatment methods. Ongoing control of edema is essential to prevent recurrent ulceration; the use of compression stockings following ulcer healing is critical, with recurrence rates 2–20 times higher if compression stockings are not used

      Duplex ultrasound evaluation should assess blood flow direction, venous reflux, and venous obstruction, and include examination of the deep venous system, great saphenous vein (GSV), small saphenous vein (SSV) and its thigh extension (Giacomini vein), accessory saphenous veins, and perforating veins. Venography is recommended primarily in patients with post-thrombotic disease, especially when intervention is planned, as it provides greater anatomic detail than duplex ultrasonograph The examination also identifies patterns of disease that have treatment implications. Axial reflux is defined as uninterrupted retrograde flow from groin to calf and can occur in either superficial or deep systems. [4] Junctional reflux is limited to the saphenofemoral or saphenopopliteal junction, while segmental reflux occurs in a portion of a truncal vein. [4] Understanding whether reflux originates from superficial junctions versus deep venous incompetence fundamentally changes treatment planning, as superficial disease is amenable to ablation while deep disease typically requires conservative management Management of secondary varicose veins from post-thrombotic syndrome (PTS) is fundamentally different and more challenging. Compression therapy, lifestyle modifications, and symptom management form the cornerstone of PTS treatment. [4-8] Elastic compression stockings (20-30 mm Hg), leg elevation, weight loss, and exercise constitute the primary therapeutic approach Endovascular interventions for PTS—including percutaneous transluminal venoplasty and stenting—are reserved for select patients with significant iliofemoral obstruction who have failed conservative management. [7] These procedures require careful patient selection and standardized criteria. The role of superficial venous ablation in PTS patients with concomitant superficial reflux remains controversial and should be approached cautiously, as the underlying deep venous pathology may limit benefit

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  2. Dec 2020
  3. Jan 2020
    1. The infrastructure of Amsterdam all depends on a stone at the center of Dam Square. The stone caps a bolt that marks Amsterdam’s zero-level, or sea level, based on high tide in the summer of nearby Zuiderzee Bay. The reference point, called Amsterdam Ordnance Datum (which translates to Normaal Amsterdams Peil, or NAP), is the heart of the European network of national leveling networks. In other words, the NAP is the prime meridian of elevation. 

      Wow! I never heard of this before!

  4. Sep 2015
    1. Narratives of the lives of Jesus, Buddha, Mother Teresa, and other inspiring figures are full of stories of people who, upon meeting the saintly figure, dropped their former materialistic pursuits and devoted themselves to advancing the mission of the one who elevated them. Indeed, a hallmark of elevation is that, like disgust, it is contagious.
    2. Social disgust can then be understood as the emotional reaction people have to witness­ing others moving “down,” or exhibiting their lower, baser, less God-like nature. Human beings feel revolted by moral depravity, and this revulsion is akin to the revulsion they feel toward rotten food and cockroaches. In this way, dis­gust helps us form groups, reject devi­ants, and build a moral community. I thought about the social nature of dis­gust in this way for years, and about what exactly it means when someone moves “down” on the vertical dimension from good to evil.

      (moral) disgust and elevation are opposites

    3. . Psychologists have thought about morality primarily as a system of rules that prevents people from hurting each other and taking their possessions. But I believe that morality is much richer and more balanced. Most people don’t want to rape, steal, and kill. What they really want is to live in a moral community where people treat each other well, and in which they can satisfy their needs for love, productive work, and a sense of belonging to groups of which they are proud. We get a visceral sense that we do not live in such a moral world when we see people behave in petty, cruel, or selfish ways. But when we see a stranger perform a simple act of kindness for another stranger, it gives us a thrilling sense that maybe we do live in such a world.
    4. Here’s a puzzle: why do we care when a stranger does a good deed for another stranger? Most theories in the social sciences say that people’s actions and feelings are motivated by self-interest. So why are we sometimes moved to tears by the good deeds or heroic actions of others?

      I have to admit, I sometimes even feel this way when reading works of fiction.