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Veins undergoing endovenous thermal ablation have little or no blood intra-luminally casting doubt on the results of many ex-vivo vein ablation studies.

Objectives: Endovenous thermal ablation (EVTA) is the first-line treatment for varicose veins. Many in-vitro models have been made to study the effects of EVTA on the vein wall. Models using explanted human great saphenous vein (GSV) use anticoagulated blood passed into the vein during treatment, either static or being pumped to simulate “physiological flow”. The objective of this study was to investigate whether there is any evidence that there is actually any blood in GSVs being treated by EVTA.

Methods: 9 consecutive patients (11 GSV’s) had their intraluminal GSV diameters measured with ultrasound on standing, lying, 10° head down (Trendelenburg position) and 10° head down with tumescence and an endovenous laser device within the vein. The size of the vein lumen was noted and the vein interrogated longitudinally with colour duplex ultrasound to look for any venous flow.

Results: There was a progressive reduction of luminal diameter from standing to lying 10° head down. When 10° head down with a 4FG endovenous laser device in position and tumescence around the vein, 10 of the 11 GSVs showed no lumen at all and 1 showed a very minor “out-pouching” on one side of the device at one level, which did not communicate with any lumen above or below, and showed no flow.

Whiteley, M. S., & Fernandez-Hart, T. J. (2023, April 4). Veins undergoing endovenous thermal ablation have little or no blood intra-luminally casting doubt on the results of many ex-vivo vein ablation studies. https://doi.org/10.31219/osf.io/vef4m

Syncope (fainting on standing from squatting) due to massive venous reflux into lower limb varicose veins.

A 42-year-old man presented with very large lower limb varicose veins bilaterally and an 8-month history of fainting when standing up from a squatting position. He had been investigated for syncope by a cardiologist with no abnormality found on ECG, Echocardiogram, 24-hour ECG or 48-hour blood pressure monitoring. Venous duplex ultrasonography showed bilaterally Great Saphenous Vein (GSV) reflux, with each vein having a diameter of 23.5 and 24.0 mm at the groin, and a similar dilation along the whole vein to ankle. These veins were successfully ablated with endovenous laser ablation, immediately following which the syncope disappeared and has not returned. We calculate that before treatment, the patient had approximately 500mls of blood refluxing passively with gravity on standing into his incompetent GSVs and associated varicosities, which would account for his postural syncope.

Whiteley, M. S., & Kiely, M. J. (2023, May 22). Syncope (fainting on standing from squatting) due to massive venous reflux into lower limb varicose veins. https://doi.org/10.31219/osf.io/me5c7

Comparison of detergent and osmotic sclerotherapy agent action on ex-vivo human vein – a histological and immunocytochemical analysis

Background: Sclerotherapy is used widely for the treatment of varicose veins. Little has been written on the mechanism of action of detergent sclerosants on the vein wall, and very little on osmotic sclerosants. We compared the damage profile inflicted by a detergent sclerosant (3% Sodium Tetradecyl Sulphate (3% STS)) to that of an osmotic sclerosant (70% dextrose) using explanted human veins.

Methods: Ten varicose vein samples were harvested during routine phlebectomy surgery. Each sample was divided into three segments that were treated for two minutes with (1) normal saline (control), 3% STS, or 70% dextrose. Treated samples were incubated for 24 hours (37℃, 5% CO2), fixed in buffered formalin, paraffin embedded, and sectioned for staining with haematoxylin and eosin (H&E) and immunohistochemical (IHC) markers (caspase-3 (C3), smooth muscle actin (SMA), and CD31).

Results: Both sclerosants produced cell death deep to the endothelium and into the tunica media of the vein. However, 3% STS exerted a significantly greater damage profile than 70% dextrose across all layers, destroying 75% more endothelial cells (P<0.0001) and 30-33% more smooth muscle cells across the tunica media (P<0.01). Efficacy of 70% dextrose in damaging peripheral cells of the tunica media was poor. Patterns of IHC reactivity were consistent with damage observed in H&E-stained sections. Minimal C3 reactivity was detected, and necrosis was the observed cell-death rather than apoptosis in all treated samples.

Conclusion: Despite 3% STS showing more efficacy than 70% dextrose in extent and penetration of damage inflicted, both treatments were efficacious in inducing transmural cell death in this ex-vivo study. Therefore, 70% dextrose may be more appropriate for the ablation of thinner-walled veins, and 3% STS for thicker walled veins. In addition, the observation of necrotic cell death challenges the previously reported mechanism of apoptosis after sclerotherapy.

Cross, A. C., Walker, K., Setyo, L., Borkowski, E. A., La Ragione, R. M., & Whiteley, M. S. (2022, November 11). Comparison of detergent and osmotic sclerotherapy agent action on ex-vivo human vein – a histological and immunocytochemical analysis. https://doi.org/10.31219/osf.io/kgd27

Vein wall thickness (VWT) and catheter size are more important than vein diameter in optimising endovenous thermal ablation (EVTA) – results of a mathematical model of how VWT changes when veins constrict under tumescence.

Background: Catheter-based endovenous thermal ablation (EVTA) under tumescent anaesthesia is the standard treatment for truncal venous reflux. Doctors often use vein diameter alone to select treatment settings and protocols. Adequate venous ablation requires thermal energy to penetrate the vein wall deeply and probably transmurally. Hence the thicker the vein wall when constricted during treatment, the deeper the required thermal penetration. We constructed a mathematical model to predict vein wall thickness (VWT) during EVTA of veins of different diameters, initial wall thicknesses and device diameters.

Methods: A mathematical model was constructed under the simplifying assumptions that the vein is a perfect circle, that the wall has a constant volume and that it constricts uniformly without folding. A set of representative vein diameters and thicknesses, and common device diameters were applied to the model to study the variables.

Results: Numerical analysis predicted that vein walls would thicken when constricted compared to their initial state. Veins that initially had thicker walls and larger diameters, had thicker walls when constricted than thin walled or small diameter veins, using the same size EVTA devices. For each vein, as the diameter of the device decreased, the constricted VWT increased. Sensitivity analysis of the variables affecting the constricted VWT revealed that the initial VWT was most important, followed by device diameter and finally initial diameter of the vein.

Conclusion: Our model shows that for a range of vein sizes and wall thicknesses, the constricted VWT increases markedly with decreasing device size. Although doctors often use vein diameter to select treatment parameters, this model suggests that initial VWT followed by the size of EVTA device are more important variables. Furthermore, the current trend to make EVTA devices thinner may be disadvantageous, as this increases the constricted VWT at treatment, making adequate thermal penetration harder to achieve.

Fernandez-Hart, T. J., Santos, S. J. D., & Whiteley, M. S. (2023, April 10). Vein wall thickness (VWT) and catheter size are more important than vein diameter in optimising endovenous thermal ablation (EVTA) – results of a mathematical model of how VWT changes when veins constrict under tumescence. https://doi.org/10.31219/osf.io/ptfka

Participant Reported Improvement in Cellulite by Vari-pad Apparel and Objective Measurements – a “First Use” Pilot Study.

Background: Cellulite affects 80-90% of post-pubertal females and, although cosmetic, has proven adverse psychological effects. A new compression garment with patented “vari-pad” technology has been developed, aiming to stimulate lymphatic return from the buttocks and thighs. The primary aim of this small pilot study was to assess participant satisfaction after using this garment in the short term and secondarily, to look for any objective improvements.

Methods: 18 female participants (mean 47.5y, range 26-60) completed the study. There were 2 weeks of “stabilisation”, 4 weeks of wearing the garment, and 2 weeks of further assessment. With the initial assessment, there were 9 visits for each participant. At each visit, weight, participant satisfaction (0-10), 3D images (Canfield, USA) and transcutaneous water content (LymphScanner, Delfin Technologies, Finland) were recorded.

Results: There was no significant weight change in any of the participants during the trial period. After 4 weeks of wearing the garment there was a significant improvement in participant satisfaction of their cellulite (n=15, p=0.0036) with a mean improvement of 18.5%. 3D image analysis of dimple volume showed no significant change in buttock cellulite, a significant decrease in left thigh cellulite (n=17, p=0.0123), but not on the right (p=14, p=0.6890). There was a significant decrease of localised water (n=36, p=0.0041)

Conclusion: The vari-padded compression garment produced a significant improvement in participant satisfaction after just 4 weeks of treatment. Objective measurements failed to show a significant difference in cellulite on the buttocks but showed a significant improvement in the thighs by analysis of both dimple volumes and reduced transcutaneous water measurements. Further study is suggested to demonstrate if longer timeframes for use of the apparel will lead to further significant improvement in the appearance of cellulite.

Kiely, M. J., Poulsen, A., Muschamp, S. D., Sallis, C., & Whiteley, M. S. (2023, June 14). Participant Reported Improvement in Cellulite by Vari-pad Apparel and Objective Measurements – a “First Use” Pilot Study. https://doi.org/10.31219/osf.io/a3uq9

Mathematics

Mathematics is a discipline that deals with the study of numbers, quantities, shapes, patterns, structures, and their relationships. It provides a framework for logical reasoning and precise analysis, allowing us to understand and describe the patterns and structures that exist in the world around us. Mathematics is considered a fundamental science and plays a vital role in numerous fields, including physics, engineering, computer science, economics, and many others.

Key Areas of Study in Mathematics:

Algebra: Algebra involves the study of mathematical symbols and the rules for manipulating these symbols to solve equations and represent relationships between variables. It encompasses topics such as equations, functions, polynomials, matrices, and vector spaces.
Geometry: Geometry focuses on the properties and relationships of points, lines, shapes, and their configurations. It explores concepts such as angles, triangles, circles, polygons, transformations, and the measurement of distances and areas.
Calculus: Calculus is concerned with the study of change and motion. It consists of differential calculus, which deals with rates of change and slopes, and integral calculus, which deals with accumulation and areas. Calculus is fundamental to physics, engineering, economics, and other sciences.
Number Theory: Number theory is the branch of mathematics that explores the properties and relationships of numbers, particularly integers. It includes topics such as prime numbers, divisibility, modular arithmetic, and the study of patterns in numbers.
Statistics and Probability: Statistics involves the collection, analysis, interpretation, and presentation of data. It includes methods for data organization, statistical inference, hypothesis testing, and making predictions. Probability focuses on the study of uncertainty and the likelihood of events occurring.
Discrete Mathematics: Discrete mathematics deals with structures that are fundamentally distinct and separate, such as graphs, networks, and logical systems. It is essential in computer science, cryptography, and algorithms.
Mathematical Logic: Mathematical logic examines formal systems of reasoning and inference. It explores the foundations of mathematics, the structure of mathematical proofs, and the study of formal languages and logical systems.

Mathematics employs rigorous deductive reasoning and logical proofs to establish the validity of mathematical statements. It uses symbols, equations, graphs, and mathematical models to describe and analyze complex phenomena. Mathematics not only provides tools for solving practical problems but also fosters critical thinking, problem-solving skills, and abstract reasoning.

Mathematical research often involves both pure mathematics, which focuses on the theoretical aspects of mathematics, and applied mathematics, which addresses the practical applications of mathematical concepts in various fields. Mathematical research and advancements continue to push the boundaries of knowledge and contribute to the development of new technologies and scientific understanding.

René Descartes

René Descartes (1596-1650) was a French philosopher, mathematician, and scientist who is widely regarded as one of the founders of modern philosophy. Descartes made significant contributions to various fields, including mathematics, physics, and philosophy of mind. He is best known for his philosophical work and his method of doubt.

Descartes’ philosophical system was built upon the principle of radical doubt, seeking to establish a foundation of knowledge that could not be doubted. He famously expressed this in his statement “Cogito, ergo sum” (I think, therefore I am), which he saw as an indubitable truth that provided a starting point for his philosophy. From this foundation, Descartes aimed to construct a coherent and certain system of knowledge.

Descartes’ philosophy encompasses several key concepts and arguments:

Dualism: Descartes proposed a dualistic view of the mind and body, asserting that they are two distinct substances. He believed that the mind or soul is a non-physical, thinking entity, while the body is a physical, extended substance. This mind-body dualism formed the basis for his metaphysical and philosophical discussions.
Method of Doubt: Descartes developed a systematic method of doubt to challenge and suspend belief in any proposition that could be doubted. By subjecting all knowledge to doubt, he sought to identify foundational truths that were beyond doubt and build a solid philosophical framework upon them.
Rationalism: Descartes is considered a prominent rationalist, emphasizing the role of reason and innate ideas in acquiring knowledge. He argued that certain truths, such as mathematical and metaphysical principles, are known a priori through reason alone, independent of sensory experience.
Meditations on First Philosophy: Descartes’ most famous work, “Meditations on First Philosophy,” presents a series of philosophical meditations in which he explores his method of doubt, the existence of God, the nature of the mind and body, and the possibility of knowledge.

In addition to his contributions to philosophy, Descartes made significant advancements in mathematics, particularly in developing analytic geometry, which provides a geometric interpretation of algebraic equations. His works, including “Discourse on the Method” and “Principles of Philosophy,” had a profound influence on subsequent philosophers and scientists, shaping the course of Western philosophy and science for centuries to come.

Dualism

Dualism is a philosophical concept that posits the existence of two distinct and separate substances or entities, typically categorized as mind and body or physical and non-physical. It proposes a fundamental division between the material and immaterial aspects of reality.

In the context of mind-body dualism, the theory suggests that the mind (or consciousness) and the body are two separate entities that exist independently. The mind is often considered non-physical, subjective, and associated with mental experiences, thoughts, emotions, and consciousness. The body, on the other hand, is seen as the physical entity that occupies space, interacts with the external world, and is subject to the laws of physics.

The concept of mind-body dualism has its roots in ancient philosophy, with influential figures like René Descartes contributing to its development in the modern era. Descartes proposed that the mind and body are distinct substances that interact in the pineal gland of the brain.

Critics of dualism often raise challenges, including the question of how a non-physical mind can interact with a physical body and the lack of empirical evidence for the existence of a separate immaterial mind. Alternative philosophical views, such as monism (which asserts that there is only one fundamental substance) or various forms of materialism (which deny the existence of a non-physical mind), offer different perspectives on the nature of being.

It is important to note that dualism is just one philosophical perspective among many and continues to be a subject of debate and discussion within philosophy of mind and metaphysics.

Nature of Being

The nature of being refers to the fundamental characteristics, essence, and existence of individuals or entities. It involves questions about what it means to exist, what constitutes identity, and the underlying nature of reality. The nature of being is a complex and philosophical concept that has been contemplated and debated by various schools of thought throughout history.

Different philosophical perspectives offer different interpretations and theories regarding the nature of being. Here are a few key concepts from different philosophical traditions:

Dualism: Dualism posits that the nature of being consists of two distinct and separate substances or entities, typically categorized as mind and body or physical and non-physical. This view suggests a division between the material and immaterial aspects of existence.
Materialism: Materialism holds that the nature of being is fundamentally physical, and everything that exists can be explained by the properties and interactions of matter. Materialists reject the existence of any non-physical or metaphysical entities.
Idealism: Idealism asserts that the nature of being is primarily mental or immaterial. It posits that reality is fundamentally composed of ideas, thoughts, or consciousness. According to idealism, the physical world is dependent on or constructed by the mind.
Existentialism: Existentialism emphasizes the individual’s subjective experience and existence as the primary basis for understanding being. It explores themes such as personal freedom, responsibility, authenticity, and the search for meaning in an often chaotic and uncertain world.
Phenomenology: Phenomenology focuses on the subjective experiences and consciousness of individuals as the foundation for understanding the nature of being. It seeks to describe and analyze the structures of experience and the meanings we attribute to objects and events.
Ontology: Ontology is the philosophical study of being itself. It examines questions about the fundamental nature of existence, the categories and types of being, and the relationships between different entities. Ontology explores concepts such as existence, essence, identity, and the nature of reality.

It’s important to note that these perspectives represent different philosophical viewpoints, and no single viewpoint provides a definitive answer to the nature of being. The nature of being is a deeply philosophical and existential inquiry that has sparked ongoing debates and contemplation among philosophers, theologians, and scholars across different cultures and disciplines.

Industrial and Organizational Psychology

Industrial and Organizational (I/O) psychology is a branch of psychology that applies psychological principles and research methods to study human behavior in the workplace. It focuses on understanding individual, group, and organizational dynamics to improve productivity, job satisfaction, and overall well-being in work settings. I/O psychologists work in various organizational contexts, including businesses, government agencies, non-profit organizations, and consulting firms.

Key Aspects of Industrial and Organizational Psychology:

Personnel Selection and Assessment: I/O psychologists develop and implement selection processes and assessments to identify the best candidates for job positions. They design and validate selection tools, such as interviews, tests, and assessment centers, to assess knowledge, skills, abilities, and other relevant characteristics.
Training and Development: I/O psychologists design and evaluate training programs to enhance employee knowledge, skills, and performance. They conduct needs assessments, develop training materials, and implement training initiatives to address organizational needs and promote employee growth and development.
Performance Management: I/O psychologists develop performance management systems to set performance standards, measure employee performance, and provide feedback. They design appraisal processes, performance metrics, and feedback mechanisms to align individual and organizational goals and improve performance outcomes.
Leadership and Organizational Behavior: I/O psychologists study leadership styles, organizational culture, and employee attitudes and behaviors to enhance leadership effectiveness and promote a positive work environment. They investigate factors that influence employee motivation, job satisfaction, organizational commitment, and work-life balance.
Workplace Diversity and Inclusion: I/O psychologists examine issues related to diversity, equity, and inclusion in the workplace. They develop strategies to promote diversity, minimize biases, and create inclusive work environments that value and leverage individual differences.
Occupational Health and Well-being: I/O psychologists focus on employee well-being, work-life balance, and occupational health. They address stress management, workplace safety, work-family conflict, burnout prevention, and employee wellness programs to promote a healthy and supportive work environment.
Organizational Development and Change: I/O psychologists assist organizations in managing organizational change, facilitating teamwork, and improving communication. They provide consultation and guidance in areas such as organizational structure, strategic planning, change management, and team dynamics.

Applications of Industrial and Organizational Psychology:

Industrial and Organizational psychology has practical applications in various areas, including:

Human Resources: I/O psychologists contribute to human resource management practices, including recruitment, selection, training, performance management, and employee engagement initiatives.
Consulting and Organizational Development: I/O psychologists work as consultants, helping organizations improve processes, enhance team dynamics, and navigate change. They provide expertise in areas such as organizational culture, leadership development, and employee satisfaction.
Employee Assessment and Development: I/O psychologists conduct assessments, such as personality assessments and 360-degree feedback, to identify employee strengths, development areas, and career paths. They offer guidance and interventions to support employee growth and career advancement.
Work-Life Balance and Wellness Programs: I/O psychologists assist organizations in promoting work-life balance, implementing wellness programs, and fostering employee well-being. They help create policies and initiatives that enhance employee satisfaction, health, and productivity.
Research and Academia: I/O psychologists engage in research to advance knowledge in the field and contribute to evidence-based practices. They teach and mentor students pursuing careers in I/O psychology or related fields.

Industrial and Organizational psychology aims to enhance the well-being and effectiveness of individuals and organizations in work settings. By applying psychological principles, research, and interventions, I/O psychologists strive to create positive work environments, improve employee satisfaction, and optimize organizational performance.