137 resultados para Western Pennsylvania Hospital.
Resumo:
In a 2-yr multiple-site field study conducted in western Nebraska during 1999 and 2000, optimum dryland corn (Zea mays L.) population varied from less than 1.7 to more than 5.6 plants m(-2), depending largely on available water resources. The objective of this study was to use a modeling approach to investigate corn population recommendations for a wide range of seasonal variation. A corn growth simulation model (APSIM-maize) was coupled to long-term sequences of historical climatic data from western Nebraska to provide probabilistic estimates of dryland yield for a range of corn populations. Simulated populations ranged from 2 to 5 plants m(-2). Simulations began with one of three levels of available soil water at planting, either 80, 160, or 240 mm in the surface 1.5 m of a loam soil. Gross margins were maximized at 3 plants m(-2) when starting available water was 160 or 240 mm, and the expected probability of a financial loss at this population was reduced from about 10% at 160 mm to 0% at 240 mm. When starting available water was 80 mm, average gross margins were less than $15 ha(-1), and risk of financial loss exceeded 40%. Median yields were greatest when starting available soil water was 240 mm. However, perhaps the greater benefit of additional soil water at planting was reduction in the risk of making a financial loss. Dryland corn growers in western Nebraska are advised to use a population of 3 plants m(-2) as a base recommendation.
Resumo:
Background: Gestational trophoblastic disease is a fascinating group of pregnancy disorders characterised by abnormal proliferation of trophoblast, ranging from benign to malignant. Because the disease is uncommon, there is a need to formulate management with the assistance of collective information. Methodology: A review of available information from English written literature was undertaken especially data reported by registries around the world (Charing Cross Hospital in England, the North-western University and the New England area in the USA as well as our own experience in Queensland, Australia). Where possible, collated data from relevant studies were analysed to answer some of the questions posed in clinical practice, with reference to metastatic disease to liver and brain, twinning of molar gestation and coexisting fetus, and placental-site tumour. Results: We found that molar gestation can be classified according to its clinical presentation which influences the time taken to reach human chorionic gonadotropin (HCG) 'negativity' and the risk of persisting disease. Categorisation of risk is the basis for choice of chemotherapy to achieve good outcomes. Metastases to liver and brain remain problems in management; the development of 'new' metastases during chemotherapy is a very poor prognostic factor. In the variant of twinning with molar gestation and coexisting fetus, it is important to elucidate the fetal karyotype in planning management: a 69XXX fetus is not salvageable but a normal 46XX or 46XY fetus faces the prospect of early preterm delivery. The placental-site tumour is very rare; localised disease is curable by surgery; chemotherapy is less effective in disseminated disease. From collated worldwide data, the recurrence rate after one mole is 1.3% and after two or more is 20%. Reproductive outcome in subsequent pregnancies, even after multidrug chemotherapy, is not different from the general population. Because of the increased risk long-term of second tumours after multidrug chemotherapy a closer surveillance of these patients is necessary Conclusion: In general, the disease in its persisting or malignant form is 'a cancer model par excellence' because of an identifiable precursor condition, a reliable HCG marker, and sensitivity of the disease to cytotoxic drugs. With current management, retention of fertility is possible and normal reproductive outcome assured.