Daily Archives: June 28, 2021

Acute upper gastrointestinal bleeding (UGIB) is a gastroenterological emergency with a mortality of 6%-13%.[1] Despite changes in management, mortality has not significantly improved over a period of 50 years.[2] Bleeding from the upper gastrointestinal tract (GIT) is about four times as common as bleeding from the lower GIT. It is important to identify patients with a low probability of re-bleeding from patients with a high probability of re-bleeding. The size of the bleeding vessel is important in prognosis. Visible vessels are usually between 0.3 mm and 1.8 mm. Large bleeding vessels cause faster blood loss. Generally, larger vessels are found deeper in the submucosa and serosa and more specifically high in the lesser curve of the stomach and postero-inferiorly in the duodenal bulb.

Endoscopy does not reveal a cause in approximately 20% of patients presenting with apparent acute UGIB. The most common causes are peptic ulcer and oesophago-gastric varices.[3]

Rare causes include:

The incidence of acute UGIB in the UK ranges between 84-172 per 100,000 per year, causing 50-70,000 hospital admissions per year.[2]

An ageing population with associated conditions and a worse prognosis has helped maintain constant mortality figures despite advances in treatment. Mortality is about 7% in patients admitted because of bleeding but some three times higher amongst those developing UGIB whilst in hospital.[3] Peptic ulcer disease is the most common cause of UGIB. Risk factors for peptic ulcer disease are:

Although duodenal ulcers are more common than gastric ulcers, both contribute nearly equally to the incidence of UGIB. After an initial bleed the risk factors for re-bleeding, with associated higher mortality, are:

Bleeding severity can be assessed by:[4]

Initial assessment may provide an indication of the cause of UGIB:

The main aim of examination is to assess blood loss and look for signs of shock. A secondary aim is to look for signs of underlying disease and significant comorbid conditions - for example:

Endoscopy is the primary diagnostic investigation in patients with acute UGIB:[2]

Consider for admission and early endoscopy (and calculation of full Rockall score) if:

Other significant comorbidity (especially cardiac disease, malignancy) should also lower the threshold for admission.

Shocked patients should receive prompt volume replacement. It has been demonstrated that early and aggressive resuscitation reduces mortality in UGIB.[5]

Proton pump inhibitors (PPIs) should not be used prior to diagnosis by endoscopy in patients presenting with acute UGIB.[3]

Recommendations emphasise early risk stratification, using validated prognostic scales, and early endoscopy (within 24 hours).[8] The following formal risk assessment scores are recommended by the National Institute for Health and Care Excellence (NICE) for all patients with acute UGIB:[2]

The Blatchford risk assessment is designed to be used pre-endoscopy (see the full NICE Guideline for details).[2]Scores are added using the level of urea, haemoglobin, systolic blood pressure, pulse rate, presentation with melaena, presentation with syncope, hepatic disease and cardiac failure. A score of 0 is the cut-off with any patient scoring >0 being at risk of requiring an intervention.

The Scottish Intercollegiate Guidelines Network (SIGN) guideline on the management of acute upper and lower gastrointestinal bleeding recommends that an initial (pre-endoscopic) Rockall score be calculated for all patients presenting with acute UGIB. In patients with an initial Rockall score >0, endoscopy is recommended for a full assessment of bleeding risk.[3]

Adapted with permission from BMJ Publishing Group Limited. Original tables in Rockall TA, Logan RF, Devlin HB, et al; Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996 Mar; 38(3):316-21. 1996 BMJ Publishing Group Limited.

Endoscopy is now the method of choice for controlling active peptic-ulcer related UGIB.[10]Endoscopic therapy should only be delivered to actively bleeding lesions, non-bleeding visible vessels and, when technically possible, to ulcers with an adherent blood clot. Black or red spots or a clean ulcer base with oozing do not merit endoscopic intervention since these lesions have an excellent prognosis without intervention.[3]

Adrenaline (epinephrine) should not be used as monotherapy for the endoscopic treatment of non-variceal UGIB. For the endoscopic treatment of non-variceal UGIB, one of the following should be used:

Acid-suppression drugs (PPIs or H2-receptor antagonists) should not be offered before endoscopy to patients with suspected non-variceal UGIB. PPIs should be offered to patients with non-variceal UGIB and stigmata of recent haemorrhage shown at endoscopy.

Surgical intervention is required when endoscopic techniques fail or are contra-indicated. Clinical judgement is required and consideration given to local expertise.

Helicobacter pylori eradication - see separate Helicobacter Pylori article:

The complications of UGIB are self-evident. Other complications can arise from treatments administered - for example:

Elderly patients and people with chronic medical conditions withstand acute UGIB less well and have a higher risk of death.[2] Mortality is about 7% in patients admitted with an UGIB. It is as high as 26% in patients who develop bleeding whilst in hospital having been admitted for another cause.[3] A score of less than 3 using the Rockall Score system above is associated with an excellent prognosis, whereas a score of 8 or above is associated with high mortality.[9]

Factors which affect the risk of death include:

Mortality is reported to be lower in specialist units, possibly because of adherence to protocols rather than because of technical advances. The prognosis in liver disease relates significantly to the severity of the liver disease rather than to the magnitude of the haemorrhage.

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Upper Gastrointestinal Bleeding (UGIB Bleeding) Rockall ...

WHEN SPEAKING TO fishers about why they were concerned about the proposed Brexit trade deal, about why they dont see a viable future for their industry, a flurry of various figures are usually cited to explain the decline in their industry in recent years.

A lot of figures are given as to why theyre struggling to survive, and various species of fish might be mentioned all of which can be hard to get your head around.

So heres a rundown of those figures, fishers concerns, and the post-Brexit trade deal quotas that are driving them to march on the Taoiseachs Cork office and the Dil in recent weeks, mostly based off a Seafood Sector Task Force interim report that was released last week.

This is how much the Irish seafood economy is estimated to be worth. There are around 16,400 people employed by the industry, which includes ancillary services like production, people who service fishing boats, and net producers.

Brd Iascaigh Mhara, Irelands seafood development agency, says that 400 million is generated through domestic consumption, and 263 through exports and imports.

There are 2,030 fishing vessels registered in Ireland as of 2020. France (115m), the United Kingdom (93m) and Spain (53m) are the top export areas for Irish seafood.

Quotas are complicated, so lets explain all this out:

This is to give stocks a chance to replenish and to ensure overfishing doesnt happen. Some fishers say it is easy to overfish now, because quotas are so low and they are struggling to make the same living they did before.

Quotas are different from, but are usually based on, the maximum sustainable yield (MSY) for a species of fish, which is an ecological estimation of what proportion of fish can be caught to ensure stocks are not depleted to unsustainable levels.

Stock caught above this level are classed as overfished.

It should be noted that fishers have said because quotas keep increasing, and because they are so low for certain species, it is easy to go over the line, and overfish.

In the Brexit trade deal agreed between the EU and the UK, the EU wanted to return 15-18% of the value of fish quota caught in UK waters, and the UK wanted 35%.

Instead, both settled on 25% the value of fish quotas on a five-year phased basis.

In practice, this meant that 199 million worth of EU-wide quotas will be transferred back to the UK,with Ireland contributing around 43 million of that total a drop of 26,412 tonnes of fish, representing 15% in Irelands national fishing quota.

Source: Seafood Taskforce interim report

Fish worth an annual average of 650 million had been caught by EU fishing fleets in British waters.

As our sister publication Noteworthy reported, Ireland has a system of giving the quota to those that catch the fish first, which gives an advantage to bigger vessels with greater resources.

A2019 European Commission reportcompiled a database of the entire EU fleet register and found that most Irish vessels are owned by individual Irish fishers, with only about 3.5% of the fleet registered to a foreign owner or foreign-registered company.

The top eight quota owners share 28% of the national quota between them, with the Atlantic Dawn Company topping the table, at over 7% of the total quota.

There are many small fishing vessels in Ireland that are out-financed and disadvantaged by Irelands first-come first-served system of awarding quotas, and who may be more likely to use hand-based practices that may be a more sustainable way of fishing.

Fish quotas are broken down based on the species of fish, and on where they live:

For shellfish, around 1,500 inshore vessels which target mostly non-quota shellfish will not be directly impacted by quota transfers, as they have only minimal catches of quotas.

Two thirds of the losses sustained by the fleet in 2021 will be incurred by the Refrigerated Seawater (RSW) segment of the fleet, which mostly fish for pelagic species.

Those post-Brexit deal losses are as follows:

Other fishing catches arealso affected, but to a lesser extent than the above group:

This estimated losses for whitefish trawlers assumes access will be given to the 12-mile limit around Rockall, which the Irish Government is currently in dispute with the UK Government over.

If access was lost permanently, the report states that the total squid fishery valued at around 6.6m (based on 2019 landings) and up to 60% of the total Rockall haddock quota, valued 1m (based on 2020 Irish quota), could potentially be lost.

This would not only impact on the 9 of these 12 vessels that fish at Rockall but also an additional 16 vessels, mostly Nephrops freezer vessels that target squid seasonally. When factoring in catches of other species monk, megrim, ling, saithe caught inside 12 miles from Rockall, the total impact of the loss of these fisheries is estimated at 7.7m.

Fishers have requested as part of their seven demands that the traditional fishing grounds at Rockall be reinstated to something similar to the 2019 arrangement.

One of the major recommendations from the Task Forces interim report is that a one-month long voluntary temporary cessation scheme be offered to 220 whitefish vessels impacted by the quota reductions, in the period from September to December.

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12% of EU waters

The Department of Agriculture and Marine said that before Breixt, Irelands Exclusive Economic Zone (EEZ) made up 10% of the EUs EEZ and the UKs EEZ made up 17%.

After Brexit, Irish waters now make up 12% of EU waters, the Department said.

The Governments Seafood Sector Task Force was set up to examine the implications for the Irish fishing industry and coastal communities following the Brexit trade deal.

Its membership includes representatives of the fishers production organisations, small fishers groups, fishers cooperatives, and dars na Gaeltachta. The taskforce is lead by barrister and former Bord Bia CEO Aidan Cotter.

With reporting from Maria Delaney.

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Quotas cut by 15%, and a 1 billion industry on the brink: The confusing figures fuelling fishers' anger - TheJournal.ie

PUMA and brand ambassador Lauren Londons highly anticipated capsule, Forever Stronger, is finally here. Rooted in authenticity, the collection is inspired by London and her hometown of Los Angeles. Given how personal this collection is, ESSENCE was happy to have had a chance to sit down with London and discuss the process, her definition of strength, and how staying firm in what you believe in is just enough.

With this being the first collection, originality and most important, intentionality was a must. When speaking of the brand, London praised them for their partnership and their ability to let her express her creativity freely. Puma was really amazing to work with, she says. Its a very respectful work environment. They allow me to be myself and they give me the creative freedom to do what I want. They feel like more of a family than a business partnershipI just love them.

Effortless is an adjective wed use to describe Londons aesthetic, especially highlighting her personal style. We asked the Without Remorse star how would she define her wardrobe, and comfort was the first word that came to mind. Featuring three pieces: a T-shirt, a hoodie and a classic black and white PUMA suede sneaker with Forever Stronger prominently embroidered in script, the entire collection is a reflection of casual. Most important, the hoodie and tee feature a tiny blue heart, a special representation of Nipsey Hussle, that serves as a reminder of where London came from and where shes going. The purpose of such a prominent detail does not go unnoticed and speaks to the type of designer London is. She explains: I like for the clothes to work for me in any moment. I spent years in uncomfortable clothing thinking I had to because of the industry I was in, Ihadto do that. As time went on I realized I didnt need to and my style just evolved.

And while shes ditched the unnecessary pieces, London made sure the things that matter most, like her love for Los Angeles, was properly portrayed. When I think of L.A. fashion I think about growing up, going to the Slauson swap meet, buying gold, buying bamboo earrings, buying a track suit and long fly nails with a good French tip. I still rock all of that to this day.

After eyeing the pieces of the capsule, ESSENCE was curious to know which one had Laurens heart. Out of the three pieces my favorite is actually the sneakers, she says. Even though Im a hoodie girl. To make the drop even more special, were being introduced to fat laces again, a return that is long overdue. London gushed about the throwback feature, stating, Growing up I used to wear the fat laces, and these sneakers are kind of like an ode to that, she shares. Every box comes with a pair of sneakers and with the fat laces. And if youre worried about durability, that shouldnt be a problem at all. I wear these sneakers everywhere, London says. I just love how comfortable they are.

That emphasis placed on creating a line that lasts parallels the fortitude of London herself. Often modeled as a pillar of strength, and known for her resilience and inventiveness, the actress and mother of three still understands the importance of softness, assuring us theres strength in cryingespecially as Black women. You dont always have to be super strong, she says. Its okay to say, Today is not my day, and thats still being strong, right? Today, Im just not feeling it. And theres power in saying and doing that. I want more people to realize acknowledging youre not having a good day or moment is still an act of strength.

All things considered, genuine is undoubtedly a word that could be used when describing the effort behind this collections name and overall purpose. When people wear any item from Forever Stronger, I want them to know its an embodiment of me, she says. I want them to instantly feel empowered. Whether you rock the hoodie yourself or admire it from afar, the brand-new capsule has cemented itself as not only stylish but also captivating.

Releasing today, June 25, the collection will be on PUMA.com, at the PUMA NYC Flagship store, The Marathon Clothing Store, Shoe Palace, Champs, Foot Locker and more with retail prices ranging from $30$75.

TOPICS: fashion Lauren London Nipsey Hussle PUMA

Link:

Forever Stronger: Lauren Londons First Puma Capsule Is Finally Here - Essence

Alan Bishop of underground avant-garde rock legends Sun City Girls is reflecting on Eddy Detroit, the longtime friend he lost to suicide on June 15.

"Eddy was his own scene," Bishop says when asked what made the willfully eccentric folk-punk icon stand out on the local scene.

"He was like a comedian or an actor creating his own realities and he truly understood what many never realize that unless you are a dreamer, you went absolutely nowhere in this world."

Detroit went many places in this world, whether busking on the streets of London, where he moved in the late '60s, drumming for the Church of Satan while livingin Hollywood or reading tarot cards by phone through the Psychic Friends Network, famously hostedby Dionne Warwick.

Born Edward Michael Dunn in 1952, Detroit, whose stage name is a tribute to his hometown, had been living in Phoenix since the spring of 1981.

It was in the course of recruiting musicians for 1982's "Immortal God's,"a debut album of exotica-tinged psychedelic folk, that the outsider artist met Bishop, one of several luminaries from the local underground to appear on the album.

"A friend suggested we meet up," Bishop recalls. "He saw my Tyrannosaurus Rex albums sitting in front of a speaker and we hit it off immediately."

Bishop would've worked with anyone who was unique.

"At the beginning of the '80s, the only 'progressive'music was independent or underground," Bishop says.

"So when you found someone who wasnt buying all the over-produced (expletive), well, you gravitated towards them."

A talented percussionist whose aesthetic was heavily influenced by Martin Denny and '60s exotica, Detroit was known to join Sun City Girls on stage and in the studio, appearing on several of their more than 50 albums.

The day Detroit died, Sun City Girls posted a video on Facebook, filmed in 1983,of Detroit in his element, leading his friends in an unhinged, shambolic performance of "Beelzeebub," the opening track on his first album, that at times suggests a manpossessed by Yoko Ono.

It's beyond electrifying, far more punkish and chaotic than the version on the album.

"Eddy was someone I always rooted for," Bishop says.

"He had an obsessive sincerity that ran through all his songs and his lifestyle. He never stopped believing in what he did and was always excited by a new project, usually seeing them to completion. Ill miss his crazy humor, his observations, and his stubbornness to remain off the grid."

Remembering a folk-punk legend: Andy Warpigs 'was Phoenix DIY music'

Michael Pistrui of Fat Gray Cat, another Valley band that often benefited from Detroit's percussion skills, refers to 1982's "Immortal God's" as "literally an Arizona punk-rock all-star record."

In addition to Bishop, it features the talents of Charlie Gocher ofSun City Girls, Dan Clark of the Feederz and Victory Acres, and Mary Clark, alsoof Victory Acres.

"He was part of the Mad Gardens scene," Pistrui says, referring the legendary Phoenix punk performance space that shared a name with New York City's Madison Square Garden.

"Tony (Victor of Placebo Records) said that Eddy just showed up one night and said that he was half man and half goat and wanted to play his bongos. So Tony started letting him play between the bands. He started playing with the Poet's Corners guys that did kind of a jazz punk-rock thing. And then he started playing with Sun City Girls."

Another Phoenix punk legend: Remembering Steve Davis

Cris Kirkwood of the Meat Puppets thinks of Detroit as a pivotal memberof the early '80s Arizona music scene.

"He called himself Eddy Detroit," Kirkwood says.

"But he really seemed to fit in with a certain kind of crusty Phoenix underground vibe that I thought Mighty Sphincter kind of embodied and us and Sun City Girls, this sort of feel that Phoenix managed to spark at a particular point."

At the same time, he says, with a laugh, Detroit was "his own unique creature."

Kirkwood points to how freely and enthusiastically Detroit would talk about his foot fetish and other points of interest people tend to downplay in casual conversation.

"You gotta love someone who's that open to break that ground of it's OK to be who you are," Kirkwoodsays. "He was just kind of fearless. That's why his albums are sought after to the degree that they are by people who like that sort of thing."

Remembering Tommy Connell: Phoenix guitarist remembered as 'one of the best' by longtime bandmate Jon Rauhouse

Kirkwood was thrilled to have an opportunity to make a record with Detroit a few years back when he produced an album by a band called Moonlight Magic, a Phoenix-based lounge actdoing instrumental '60s-style exotica, bossa nova, samba and lounge music.

By then, Detroit had done a series of exotica-themed local bands Banana Boat, the Tropical Island, Mondo Exotica and the Garden.

"What a fun record to make," he says of "Phoenixotica," an album released in 2018.

"This is part of what punk rock is, right? Just that grab bag of 'If I say it's art, it is.'"

Ruth Wilson and Jaime Paul Lamb of Moonlight Magic both say there would be no Moonlight Magic if it weren't for their desire to build a band around Detroit.

"He was such a stellar drummer in that arena," Wilson says, "with bossa novas andthose Latin beats. He was the master."

He was trained in jazz, playingtraditional grip, although his first band, in Detroit, was a rock 'n' roll cover band calledthe Premieres.

"I don't think he could even hold the sticks like your typical rock bonehead just clubbing away at the drums as hard as he can," Lamb says.

"Eddy was a realdrummer, and I mean a trap set drummer, but he was also an amazing hand percussionist. Just an incredible, incredible musician."

So incredible, in fact, that when he parted ways with Moonlight Magic, Wilson figured that might be the end for that whole project.

"I thought, 'How are you gonna find a drummer to replace Eddy Detroit?" she says.

A Phoenix guitar hero: 'Right out the gate, he had the touch': Remembering Joey Trujillo

A lot of times, when someone dies, Lamb says, you'll hear a lot of talk about how that particular person was "one in a million" or words to that effect.

"ButEddy was a one-off," Lamb says."And he sort of represents a cycle that's now ended. He hadso much of that midcentury, kind of quirky, schmaltzy, kitschy exotica thing about him, but he also had this dark Velvet Underground underbelly to his thing."

You could hear that combination play out in the songs he wrote.

"The lyrics just exemplify the love of seediness he had under that 'Leave it to Beaver' veneer," Lamb says, pointing to his shared love of that wholesome family sitcom on the one hand and less wholesome B-movies like "Trip with the Teacher" and "The Ultimate Degenerate" on the other.

"He was deeply divided because he wasthis very pure, kind of naive midcentury guy, a real child of the '50s, whosort of embracedthis kind of juvenile delinquent culture. So he had this seedy beatnik side."

Being a productof midcentury culture made it difficult at times for him to feel at home in the 21st century.

"This world is not a world for Eddy Detroit," Lamb says.

"He hated computers. He had a dumb phone. Didn't know how to text or write an email. I think he was just too visceral for that.I mean, I think he half-heartedly tried to keep a foot in the Modern World. But unsuccessfully."

In recent years, Detroit was playing in the jazz trio Escargot Jazz.

And through it all, he kept performing and occasionally making records as Eddy Detroit.

His latest album, released in 2016, was "Shock-A-Lock-A-Lickum," a compilation ofrecordings made from 1979 to 2010.

The press materials accompanying the release said the songs "run the gamut of Detroit's musical landscape, from the UK acid-folk ofTyrannosaurus RexandThe Incredible String Bandthrough bongo-fueled satanic calypso to his new phase as a troubadour recounting tales of hobos, whores, and one-eyed jacks from the old west."

Lamb accompanied Detroit when he toured Europein support of that release and got to see him treated like a rock star, including a performance at the U.K. TUSK Festival.

"When you see an Eddy Detroit show in Phoenix, there are like five people there a couple punkers from Mad Gardens and whatever barflies just happen to be there," Lamb says.

"When we went to Europe, we played to enraptured arthouse venues. There were a bazillion people there, and many of them knew his entire catalogue, even words to tunes, if you can believe that. And Paris. We killed it in Paris."

Detroit, who was billed on a lot of the posters for that tour as 'US Tiki weirdo outsider,'was elated.

"He came back from that tourand he was on top of the world," Lamb says.

"That trip really made him feel loved and feel as though his work has had some sort of impact.So that wasa good way for him to sort of end his run in a lot of ways."

After that, he went back to what Lamb refers to as "workaday gigs" with his jazz comboand Moonlight Magic,doing an Eddy Detroit gig here and there.

"But there was nothing like that European tour," Lamb says. "He was so just really blown away with the response that he got over there."

About a week before his death, Detroit seemed really down about his health in his last conversation with Lamb. He'd been struggling with acute insomnia, chronic depression and diverticulitis.

"The only thing he was excited about in that phone call was he just picked up an old Les Baxter record that he didn't have before," Lamb recalls. "The exotica bandleader. Yeah. All of a sudden, he was back to old Eddy for a couple minutes."

A memorial held at a Knights of Columbus hall in Glendale on June 21 was packed with members of the local musicscene.

"It was so Eddy Detroit," Pistruisays.

"Hehad a unique way of living and breathing in all sorts of different musical circles. There were people there from the folk musicscene that play in parks and little coffee houses. There were people from the jazz side of things. There were punk rockers there. Bam Bam was there from JFA."

Lamb says theGin Blossoms mentioned him during their halftime performance at the Phoenix Suns game on Tuesday night.

"It doesn't take too much digging to know that Eddy was iconic here, despite hanging on a long time and being sort of low-key throughout on a simmer," Lamb says. "There was some true desert-fried originality in there."

He even ran his own performance space here in the '90s, a coffee house that lasted five years called the Grotto.

He was alsosomething of a raconteur, retelling stories of hisrun-ins with the rich and famous as a drummer for the Church of Satan when he lived in Hollywood around the same time he was playing all the legendary L.A. punk clubs as part of the Permanent Wave Band.

"He was just so full of stories," Wilson says. "And a lot of times, you'd heard these stories before, but he just insisted on telling them again and again. That was just Eddy."

There was the story of how he was there to witnessIggy Pop's first gig when Pop was still James Osterberg and drummingfora band called the Iguanas. Or he'd talk about joiningthe White Panther Party withthe MC5 and John Sinclair.

He even had a story about dropping off a demo tape at Apple Records just as Ringo Starr was finding out his band had broken up.

"Eddy liked to talk," Pistrui says.

"And a lot of people would be like, 'Yeah, right.' Then all of a sudden, there's a picture of Iggy Pop and there's Eddy in the picture."

Detroit was thrilled to find himself the subject of a Phoenix New Times cover story last year, Bishop says, seeing the cover treatment as a validation of his legacy.

"But all the crazy stories and wild times he experienced shouldnt cloud the fact that he wrote so many great songs, was a master percussionist and kept reinventing himself, learned to play the mandolin, continued his craft of performing and songwriting," Bishop says.

"And perhaps most importantly, he had the gift of being able to entertain or command attention without a prop, without an instrument, without electricity or a gimmick to fall back on as security. He was a real storyteller in a world where a vast majority pretend to be."

Reach the reporter at ed.masley@arizonarepublic.com or 602-444-4495. Follow him on Twitter @EdMasley.

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'Eddy was his own scene': A pivotal member of the Phoenix underground remembered - The Arizona Republic