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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. Sep 2025
  3. Jan 2025
  4. Dec 2024
    1. the first one is the paradox of pronouncement. And here we recognize that language is both incredibly useful for us and is evocative and helps us create and and see and be in this reciprocal exchange. And we also are trying to open to a non dual embodied cognition that is beyond the written word and beyond the hegemony of the written word, and indeed the hegemony of the English written word

      for - paradoxes - first one - pronouncement - the written word - evocative - but also hegemonic - especially the English language - there are other oral traditions - try to open nondual embodied cognition using English - Post Capitalist Philanthropy Webinar 1 - Alnoor Ladna - Lynn Murphy - 2023

  5. Oct 2024
    1. Derailed climate action: Mr. Trump will almost certainly withdraw again from the 2015Paris Climate Agreement, dismantle domestic climate and environmental regulations(particularly those seen to hamper the fossil fuel industry), and actively oppose atransition to green energy.

      for - question - Study on 2024 Trump win on polycrisis - Cascade Institute - why is there such a small analysis on the environment and especially planetary tipping points whilst climate clock is ticking?

  6. Jan 2024
    1. Instance methods Instances of Models are documents. Documents have many of their own built-in instance methods. We may also define our own custom document instance methods. // define a schema const animalSchema = new Schema({ name: String, type: String }, { // Assign a function to the "methods" object of our animalSchema through schema options. // By following this approach, there is no need to create a separate TS type to define the type of the instance functions. methods: { findSimilarTypes(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); } } }); // Or, assign a function to the "methods" object of our animalSchema animalSchema.methods.findSimilarTypes = function(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); }; Now all of our animal instances have a findSimilarTypes method available to them. const Animal = mongoose.model('Animal', animalSchema); const dog = new Animal({ type: 'dog' }); dog.findSimilarTypes((err, dogs) => { console.log(dogs); // woof }); Overwriting a default mongoose document method may lead to unpredictable results. See this for more details. The example above uses the Schema.methods object directly to save an instance method. You can also use the Schema.method() helper as described here. Do not declare methods using ES6 arrow functions (=>). Arrow functions explicitly prevent binding this, so your method will not have access to the document and the above examples will not work.

      Certainly! Let's break down the provided code snippets:

      1. What is it and why is it used?

      In Mongoose, a schema is a blueprint for defining the structure of documents within a collection. When you define a schema, you can also attach methods to it. These methods become instance methods, meaning they are available on the individual documents (instances) created from that schema.

      Instance methods are useful for encapsulating functionality related to a specific document or model instance. They allow you to define custom behavior that can be executed on a specific document. In the given example, the findSimilarTypes method is added to instances of the Animal model, making it easy to find other animals of the same type.

      2. Syntax:

      Using methods object directly in the schema options:

      javascript const animalSchema = new Schema( { name: String, type: String }, { methods: { findSimilarTypes(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); } } } );

      Using methods object directly in the schema:

      javascript animalSchema.methods.findSimilarTypes = function(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); };

      Using Schema.method() helper:

      javascript animalSchema.method('findSimilarTypes', function(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); });

      3. Explanation in Simple Words with Examples:

      Why it's Used:

      Imagine you have a collection of animals in your database, and you want to find other animals of the same type. Instead of writing the same logic repeatedly, you can define a method that can be called on each animal instance to find similar types. This helps in keeping your code DRY (Don't Repeat Yourself) and makes it easier to maintain.

      Example:

      ```javascript const mongoose = require('mongoose'); const { Schema } = mongoose;

      // Define a schema with a custom instance method const animalSchema = new Schema({ name: String, type: String });

      // Add a custom instance method to find similar types animalSchema.methods.findSimilarTypes = function(cb) { return mongoose.model('Animal').find({ type: this.type }, cb); };

      // Create the Animal model using the schema const Animal = mongoose.model('Animal', animalSchema);

      // Create an instance of Animal const dog = new Animal({ type: 'dog', name: 'Buddy' });

      // Use the custom method to find similar types dog.findSimilarTypes((err, similarAnimals) => { console.log(similarAnimals); }); ```

      In this example, findSimilarTypes is a custom instance method added to the Animal schema. When you create an instance of the Animal model (e.g., a dog), you can then call findSimilarTypes on that instance to find other animals with the same type. The method uses the this.type property, which refers to the type of the current animal instance. This allows you to easily reuse the logic for finding similar types across different instances of the Animal model.

      Certainly! Let's go through each part and explain it in simple terms: ### 1. `this` in Mongoose: - **What is `this`?** In JavaScript, `this` refers to the current context or object. In Mongoose, particularly within methods and middleware functions, `this` represents the instance (document) the function is currently operating on. - **Why is it used?** `this` is used to access and modify the properties of the current document. For example, in a Mongoose method, `this` allows you to refer to the fields of the specific document the method is called on. ### 2. Example: Let's use the `userSchema.pre("save", ...)`, which is a Mongoose middleware, as an example: ```javascript userSchema.pre("save", async function (next) { if (!this.isModified("password")) { next(); } else { this.password = await bcrypt.hash(this.password, 10); next(); } }); ``` - **Explanation in Simple Words:** - Imagine you have a system where users can sign up and set their password. - Before saving a new user to the database, you want to ensure that the password is securely encrypted (hashed) using a library like `bcrypt`. - The `userSchema.pre("save", ...)` is a special function that runs automatically before saving a user to the database. - In this function: - `this.isModified("password")`: Checks if the password field of the current user has been changed. - If the password is not modified, it means the user is not updating their password, so it just moves on to the next operation (saving the user). - If the password is modified, it means a new password is set or the existing one is changed. In this case, it uses `bcrypt.hash` to encrypt (hash) the password before saving it to the database. - The use of `this` here is crucial because it allows you to refer to the specific user document that's being saved. It ensures that the correct password is hashed for the current user being processed. In summary, `this` in Mongoose is a way to refer to the current document or instance, and it's commonly used to access and modify the properties of that document, especially in middleware functions like the one demonstrated here for password encryption before saving to the database.

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  7. Oct 2020