Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation

Introduction: Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.Methods: Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.Results: Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).Conclusion: The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock

Crop Updates 2008 - Weeds

This session covers twenty nine papers from different authors: 1. BOXER® GOLD, a new pre-emergent herbicide option for WA wheat and barley growers for the control of Annual Ryegrass and Toad Rush, Craig A. Ruchs, Syngenta Crop Protection Australia Pty Ltd 2. Efficacy of Boxer Gold in the control of annual ryegrass in wheat, Dr Abul Hashem, Dr Catherine Borger, Department of Agriculture and Food, Mr Ken McKee, Field Development Manager, Syngenta Crop Protection Australia Pty Ltd 3. Alternative herbicides to avoid trifluralin resistance, Catherine Borger and Abul Hashem, Department of Agriculture and Food 4. Exiting new herbicides for ryegrass control in wheat, Peter Newman, Department of Agriculture and Food 5. Herbicide options for resistant wild radish in wheat, Peter Newman, Department of Agriculture and Food 6. A near-complete control of wild radish with three new herbicide products, Aik Cheam and Siew Lee, Department of Agriculture and Food 7. An investigation of diflufenican resistance mechanism/s in wild radish, Meagan Pearce, Dr Michael Walsh and Prof. Stephen Powles, Western Australian Herbicide Resistance Initiative, School of Plant Biology, University of WA 8. Synergistic effects of Group C and GroupF herbicides on resistant and susceptible wild radish populations, Kent Stone, Dr Michael Walsh and Prof. Stephen Powles, Western Australian Herbicide Resistance Initiative, School of Plant Biology, University of WA 9. Precept® for the management of wild radish resistant to PDS inhibiting herbicides, Mike Clarke and Andrew Loorham, Bayer Cropscience Pty Ltd, Dr Michael Walsh, WAHRI, University of Western Australia 10. Evolution of glyphosate resistance in annual ryegrass: Effects of cutting rates, Roberto Busi and Stephen B. Powles, Western Australian Herbicide Resistance Initiative, School of Plant Biology, The University of Western Australia 11. Metribuzin and other herbicides pre-sowing of lupins, Peter Newman, Department of Agriculture and Food 12. Crop topping lupins with glufosinate gives poor control of ryegrass seed set, Peter Newman, Department of Agriculture and Food 13. Brome grass has developed multiple resistance to Group B and C herbicides, Dr Abul Hashem, Dr Catherine Borger and Dr Shahab Pathan, Department of Agriculture and Food 14. Effect of sowing methods, Logran® and Metribuzin on weeds and wheat grain yield, Alexandra Douglas and Abul Hashem, Department of Agriculture and Food 15. Effect of alternative Group K herbicides on control of on-row annual ryegrass in wide row lupins, Dr Abul Hashem1, Ray Fulwood2 and Chris Roberts1, 1Department of Agriculture and Food, 2Farmer, Meckering, Western Australia 16. Control and seed production of annual ryegrass in wide row lupins within the Western Australian wheatbelt, Abul Hashem1,6, Alex Douglas1,6, Shahab Pathan1, Glen Riethmuller1,6 and 1,6Sally Peltzer, Department of Agriculture and Food, 6CRC Australian Weed Management 17. Effective weed control in wide row lupins, Glen Riethmuller, Abul Hashem and Shahab Pathan, Department of Agriculture and Food, and CRC Australian Weed Management 18. Slender iceplant control, Lorinda Hunt1, John Borger1, Meir Altman1,4 and Dr Ed Barrett-Lennard1,4, Department of Agriculture and Food, Western Australia1, University of Western Australia and Future Farm Industries CRC4 19. Chemical and non-chemical weed control – a European perspective, Glen Riethmuller, Department of Agriculture and Food 20. Mouldboard ploughing shows promise on sand, Peter Newman, Stephen Davies and Sally Peltzer, Department of Agriculture and Food 21. Weed seed head trimming, Glen Riethmuller and Abul Hashem, Department of Agriculture and Food 22. A survey of summer weed incidence and distribution across the WA wheatbelt, Pippa Michaela, Bill McLeodb, Catherine Borgerb and Alex Douglasb, aCurtin University of Technology, bDepartment of Agriculture and Food 23. Herbicide tolerance of field pea varieties, Harmohinder Dhammu and Mark Seymour, Department of Agriculture and Food 24. Herbicide tolerance of current/new wheat varieties, Dr Harmohinder Dhammu, Department of Agriculture and Food 25. Herbicide tolerance of new oat varieties, Harmohinder Dhammu, Vince Lambert and Chris Roberts, Department of Agriculture and Food 26. Herbicide tolerance of saltbush and bluebush, Lorinda Hunt1, John Borger1, Meir Altman1,4 and Dr Ed Barrett-Lennard1,4, Department of Agriculture and Food1, University of Western Australia and Future Farm Industries CRC4 27. A review of 2,4-D formulations and vapour drift, John H. Moore, Department of Agriculture and Food 28. Movement of 2,4-D butyl ester and the dose response of three formulations of 2,4-D on canola, John H. Moore, Department of Agriculture and Food 29. Pathways to registration – Improving pesticide research outcomes, Dr Rohan Rainbow, Manager Crop Protection, Grains Research and Development Corporatio

Crop Updates 2010 - Weeds

This session covers eighteen papers from different authors: Herbicides 1. Herbicide control of slender iceplant, Lorinda Hunt, and Andrew Blake Department of Agriculture and Food 2. Herbicide tolerance of saltbush and bluebush, Lorinda Hunt, and Andrew Blake Department of Agriculture and Food 3. Chemical control of windmill grass, Catherine Borger, Glen Riethmuller and Abul Hashem, Department of Agriculture and Food 4. Use high water rates when applying pre-seeding herbicides to fields with high stubble density, Catherine Borger and Abul Hashem, Department of Agriculture and Food 5. Herbicide tolerance of lupins – influence of soil type and rainfall, Harmohinder Dhammu and David Nicholson, Department of Agriculture and Food 6. Response of new barley varieties to herbicides, Harmohinder Dhammu, Vince Lambert and Russell Quartermaine, Department of Agriculture and Food 7. Herbicide tolerance of new wheat varieties, Harmohinder Dhammu and David Nicholson, Department of Agriculture and Food Herbicide Resistance 8. Use of below label rate can lead to evolution of herbicide resistant weeds, Roberto Busi , Todd Gaines, Sudheesh Manalil and Stephen Powles, Western Australian Herbicide Resistance Initiative, School of Plant Biology, Faculty of Natural and Agricultural Sciences, The University of Western Australia 9. Herbicide mixtures can effectively kill herbicide-resistant weeds, Aik Cheam and Siew Lee, Department of Agriculture and Food 10. Selective spray-topping: Does it abort seed production of herbicide-resistant radish? Aik Cheam and Siew Lee, Department of Agriculture and Food 11. The search for a new lupin herbicide, Peter Newman, Department of Agriculture and Food Integrated Weed Management 12. Colonisation of agricultural regions in Western Australia by flaxleaf fleabane, Catherine Borger, Greg Doncon and Abul Hashem, Department of Agriculture and Food 13. Weed suppression by crop competition in barley, canola and wheat, Abul Hashem and Catherine Borger, Department of Agriculture and Food 14. Mouldboard plough continues to kick goals, Peter Newman and Dr Steve Davies, Department of Agriculture and Food 15. The answer my friend is to burn in light wind, Peter Newman, Department of Agriculture and Food, and Michael Walsh, Weeds Researcher, University of Melbourne 16. Using image analysis to detect three-horned bedstraw seed in grain samples, John Moore, Department of Agriculture and Food, Murray Gillespie, Lygil Holdings, Albany 17. Can we manage brome and barley grass in cereals? Sally Peltzer, Abul Hashem and Alex Douglas, Department of Agriculture and Food 18. Control of mature fleabane, Sally Peltzer, Department of Agriculture and Foo

Crop Updates - 2009 Katanning

This session covers seventeen papers from different authors GM canola – How will it affect the way I farm? Murray Scholz, 2008 Nuffield scholar, Southern NSW Eight years of IWM smashes tyegrass seed banks by 98% over 31 focus paddocks, Peter Newman, Glenn Adam & Trevor Bell, Department of Agriculture and Food The global economic climate and impacts on agriculture, profile on Michael Whitehead Rabobank New York Lessons from five years of cropping systems research, W.K. Anderson, Department of Agriculture and Food Case study of a 17year old agricultural lime trial, C. Gazey, Department of Agriculture and Food, J. Andrew, Precision SoilTech and R. Pearce, ConsultAg Fertilising in a changing price environment, Bill Bowden, Wayne Pluske and Jeremy Lemon, Department of Agriculture and Food Fact or Fiction: Who is telling the truth and how to tell the difference? D.C. Edmeades, agKnowledge Ltd, Hamilton Forecast disease resistance profile for the Western Australian barley crop over the next three years, JJ Russell, Department of Agriculture and Food Malting barley varieties differ in their flowering date and their response to change in sowing date, BH Paynter and JJ Russell, Department of Agriculture and Food Decimating weed seed banks within non-crop phases for the benefit of subsequent crops, Dr Davis Ferris, Department of Agriculture and Food Autumn cleaning yellow serradella pastures with broad spectrum herbicides – a novel weed control strategy that exploits delayed germination, Dr Davis Ferris, Department of Agriculture and Food Emerging weeds in changing farming systems, Dr Abul Hashen, Department of Agriculture and Food More glyphosate-resistant annual ryegrass populations within Western Australia, Dr Abul Hashem and Dr Catherine Borger, Department of Agriculture and Food Reasons to use only the full label herbicide rate, Stephen B. Powels, Qin Yu, Mechelle Owen, Roberto Busi, Sudheesh Manalil, University of Western Australia Flaxleaf fleabane – coming to a property near you! Sally Peltzer, Department of Agriculture and Food Glyphosate – the consequences of cutting rates! Sally Peltzer and David Minkey, Department of Agriculture and Food Benefits of crop rotations/break crops in managing soil moisture, soil health, weeds and disease – an overview, Raj Malik, Department of Agriculture and Foo

Crop Updates 2007 - Weeds

This session covers thirty two papers from different authors: 1. ACKNOWLEDGEMENTS, Alexandra Douglas CONVENOR – WEEDS DEPARTMENT OF AGRICULTURE AND FOOD WILD RADISH MANAGEMENT 2. Decimate a wild radish seed bank in five years, Peter Newman, Sally Peltzer, Abul Hashem and Aik Cheam, Department of Agriculture and Food 3. High level of seed-set control in wild radish is achievable, Aik Cheam and Siew Lee,Department of Agriculture and Food 4. Wild radish: Best management practice, Aik Cheam and Siew Lee, Department of Agriculture and Food 5. Control of phenoxy resistant wild radish through the combined effects of wheat competition and phenoxy herbicides, Natalie Maguire and Michael Walsh, WAHRI, School of Plant Biology, University of Western Australia 6.Efficacy of florasulam on chlorsulfuron resistant and susceptible wild radish populations in Western Australia, Michael Walsh1 and Dan Cornally2, 1WAHRI, School of Plant Biology, University of Western Australia, 2Dow Agrosciences Australia 7. Does liming to increase soil pH limit the growth and development of wild radish (Raphanus raphanistrum)Matt Willis and Michael Walsh, WAHRI, School of Plant Biology, University of Western Australia IWM TECHNIQUES AND SEEDBANKS 8. Weed trimming – a potential technique to reduce weed seed set, Glen Riethmuller, Abul Hashem and Shahab Pathan, Department of Agriculture and Food 9. Burn narrow windrows in the wind, Peter Newman1and Michael Walsh2, 1Department of Agriculture and Food, 2Research Fellow, WA Herbicide Resistance Initiative 10. Winning the Weed War with the Weed Seed Wizard! Michael Renton, Sally Peltzer and Art Diggle, Department of Agriculture and Food HERBICIDE RESISTANCE AND GENE FLOW 11. Frequency of herbicide resistance in wild oat (Avena fatua) across the Western Australian wheatbelt, Mechelle Owen and Stephen Powles, WA Herbicide Resistance Initiative, School of Plant Biology, University of Western Australia 12. Pollen mediated gene flow of herbicide resistance can occur over long distances doe annual ryegrass (Lolium rigidum): Results of two years with different meteorological conditions, Roberto Busi, Robert Barrett-Lennard and Stephen B. Powles, Western Australian Herbicide Resistance Initiative, School of Plant Biology – University of Western Australia 13. Doublegee has developed resistance to metsulfuron-methyl within WA wheatbelt, Dr Abul Hashem1and Dr Shahab Pathan2, 1Senior Research Officer, and 2Research Officer, Department Agriculture and Food 14. Another case of glyphosate resistance in annual ryegrass confirmes within Western Australia, Dr Abul Hashem1and Dr Shahab Pathan2, 1Senior Research Officer, and 2Research Officer, Department Agriculture and Food 15. Glyphosate resistance in the northern NSW – implications for Western Australian farming systems, Andrew Storrie, Tamworth Agricultural Institute, NSW Department of Primary Industries ALTERNATIVES TO TRIFLURALIN, KNOCKDOWNS, TANK MIXES AND NOVEL USES 16. Alternative pre-emergent herbicides to trifluralin for annual ryegrass control, Mr David Minkey and Dr Abul Hashem, Department of Agriculture and Food, 17. Evaluation of a new pre-emergent herbicide alternative dor the control of trifluralin resistant Lolium rigidum Gaudin (annual ryegrass) in wheat and barley, Craig A. Ruchs, Syngenta Crop Protection Australia Pty Ltd and Dr Peter Boutsalis, University of Adelaide 18. Novel knockdown tank mixes: Results from 12 trials over four years, Shahab Pathan1, Abul Hashem2, Catherine Borger3, Nerys Wilkins and Julie Roche, Department of Agriculture and Food, Western Australia, and 3the University of Western Australia 19. Alternative herbicides for weed control in lupins, Peter Newman and Martin Harries, Department of Agriculture and Food 20. Novel use application of clopyealid in lupins, John Peirce, and Brad Rayner, Department of Agriculture and Food 21. A model to predict grass selective herbicide rates, John Moore, Department of Agriculture and Food CROP AND WEED MANAGEMENT 22. Inter-row weed control in wide row lupin using knockdown-based tank mixes, Dr Abul Hashem1, Ray Fulwood2 and Chris Roberts3, 1Senior Research Officer, Department of Agriculture and Food, 2Farmer, Meckering, WA, 3Technical Officer, Department of Agriculture and Food 23. Timing of weed removal in wide-row lupins, Sally Peltzer, Shahab Pathan and Paul Matson, Department of Agriculture and Food 24. The effect of row spacing and crop density on competitiveness of lupins with wild radish, Bob French and Laurie Maiolo, Department of Agriculture and Food 25. Is delayed sowing a good strategy for weed management in lupins? Bob French, Department of Agriculture and Food 26. Delayed sowing as a strategy to manage annual ryegrass, Department of Agriculture and Food HERBICIDE TOLERANCE 27. The effect of herbicides on nodulation in lupins, Lorne Mills1, Harmohinder Dhammu2 and Beng Tan1, 1Curtin University of Technology, and 2Department of Agriculture and Food 28. Response of new wheat varieties to herbicides, Harmohinder Dhammu, Department of Agriculture and Food 29. Herbicide tolerance of new barley varieties, Harmohinder Dhammu, Vince Lambert and Chris Roberts, Department of Agriculture and Food 30. Herbicide tolerance of new oat varieties, Harmohinder Dhammu, Vince Lambert and Chris Roberts, Department of Agriculture and Food OTHER WEEDY MATTERS 31. Research and extension need for wild radish and other cruciferous weeds, Aik Cheam, Department of Agriculture and Food 32. e-weed – an information resource of seasonal weed management issues, Vanessa Stewartand Julie Roche, Department of Agriculture and Foo

Relation of Bicuspid Aortic Valve Morphology to the Dilatation Pattern of the Proximal Aorta: Focus on the Transvalvular Flow

Whether the dilatation of proximal aorta in patients with bicuspid aortic valve is secondary to hemodynamic effects related to the abnormal aortic valve or a primary manifestation of the genetic disorder remains controversial. We discuss in this paper the recent data on the BAV function and transvalvular flow patterns in relation with the dilatation type of the proximal aorta. Different morphological forms of bicuspid aortic valve in relation with the specific transvalvular blood flow patterns are focus of the first paragraph of this paper. In the second part of this paper we present the pathogenetic insight into the different clinically observed phenotypes of bicuspid aortic valve disease (i.e., association of proximal aortic shapes with the specific cusp fusion patterns), based on the data from recent rheological studies

Evaluation of risk factors for a fulminant Clostridium difficile infection after cardiac surgery: a single-center, retrospective cohort study

Abstract Background Clostridium difficile (CD) is the most common pathogen causing nosocomial diarrhea. The clinical presentation ranges from mild diarrhea to severe complications, including pseudomembranous colitis, toxic megacolon, sepsis, and multi-organ failure. When the disease takes a fulminant course, death ensues rapidly in severe and complex cases. Preventive screening or current prophylactic therapies are not useful. Therefore, this study was conducted to detect risk factors for a fulminant CD infection (CDI) in patients undergoing cardiac surgery. Methods Between April 1999 and April 2011, a total of 41,466 patients underwent cardiac surgery at our institution. A review of our hospital database revealed 1256 patients (3.0%) with post-operative diarrheal disease who tested positive for CD; these patients comprised the cohort of this observational study. A fulminant CDI occurred in 153 of these patients (12.2%), which was diagnosed on the basis of gastrointestinal complications, e.g. pseudomembranous colitis, and/or the need for post-cardiac surgery laparotomy. Demographic, peri-operative, and survival data were analyzed, and predictors of a fulminant CDI were assessed by binary logistic regression analysis. Results The 30-day mortality was 6.1% (n = 77) for the entire cohort, with significantly higher mortality among patients with a fulminant CDI (21.6% vs. 4.0%, p  130 min (OR 1.93, CI 1.12–3.33, p = 0.017). Conclusions We identified several independent risk factors for the development of a fulminant CDI after cardiac surgery. Close monitoring of high-risk patients is important in order to establish an early onset of therapy and thus to prevent a CDI from developing a fulminant course after cardiac surgery