Physical Signs in the Chest

Part 1 of a Series of Two ArticlesThis article is a personal one, based on my own practice and techniques. The evidence of the x-ray has taught consultants modesty in the evaluation of physical signs in the chest. In the good old days when the Chief said that there were dullness and diminished breath sounds in some area of the chest, the referee had spoken and there was no appeal. Nowadays he is liable to look rather silly if the x-ray is normal or the abnormality is found on the other side he is likely, therefore, to be less dogmatic. We have also learnt, in the last few years, about “observer error”. We know how differently even skilled observers may interpret the same phenomena and how even a skilled observer may fail to notice something which may be spotted immediately by one of his colleagues, or by himself on another occasion

Physical Signs in the Chest Part II

In this section some of the causes of the common physical signs are listed.Mediastinal shift.Mediastinal shift to one or other side is detected by deviation of the trachea or of the heart.  Naturally the trachea is more often deviated be abnormalities in the upper part of the chest, or occupying the whole of one side of the chest, and the heart by abnormalities in the lower part of the chest.  If the heart is deviated to the left the apex beat will be deviated to that side.  If there is no obvious cause of enlargement of the heart one can provisionally assume, depending on the later detection of consistent physical signs, that deviation is due to mediastinal shift.  It is less easy to be sure of deviation to the right, especially if the abnormal physical signs are present in the right lower zone and dullness at the right base makes it impossible to detect the right border of the heart.  Inward deviation of the apex beat, unless it is gross, might be due to the patient having a relatively small heart.  In this case initial impressions may have to confirmed by x-ray

Annular Engine Development Status

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106479/1/AIAA2013-3892.pd

High Thrust-to-Power Annular Engine Technology

Gridded ion engines have the highest efficiency and total impulse of any mature electric propulsion technology, and have been successfully implemented for primary propulsion in both geocentric and heliocentric environments with excellent ground/in-space correlation of performance. However, they have not been optimized to maximize thrust-to-power, an important parameter for Earth orbit transfer applications. This publication discusses technology development work intended to maximize this parameter. These activities include investigating the capabilities of a non-conventional design approach, the annular engine, which has the potential of exceeding the thrust-to-power of other EP technologies. This publication discusses the status of this work, including the fabrication and initial tests of a large-area annular engine. This work is being conducted in collaboration among NASA Glenn Research Center, The Aerospace Corporation, and the University of Michigan

Development Status of High-Thrust Density Electrostatic Engines

Ion thruster technology offers the highest performance and efficiency of any mature electric propulsion thruster. It has by far the highest demonstrated total impulse of any technology option, demonstrated at input power levels appropriate for primary propulsion. It has also been successfully implemented for primary propulsion in both geocentric and heliocentric environments, with excellent ground/in-space correlation of both its performance and life. Based on these attributes there is compelling reasoning to continue the development of this technology: it is a leading candidate for high power applications; and it provides risk reduction for as-yet unproven alternatives. As such it is important that the operational limitations of ion thruster technology be critically examined and in particular for its application to primary propulsion its capabilities relative to thrust the density and thrust-to-power ratio be understood. This publication briefly addresses some of the considerations relative to achieving high thrust density and maximizing thrust-to-power ratio with ion thruster technology, and discusses the status of development work in this area being executed under a collaborative effort among NASA Glenn Research Center, the Aerospace Corporation, and the University of Michigan

Far Field Plume Distribution and Divergence for NEXT: DART Mission

In support of the Double Asteroid Redirection Test (DART) mission, laboratory measurements were made on the NEXT ion engine, which will be used for the spacecraft's in-space propulsion [1]. This study revisits a small range of mission-specific 2.7A throttle levels to understand the effect of in-flight flow rate variability, investigate intermediate throttle conditions, and improve measurement methodology. This paper specifically examines the far-field plume divergence and backflow ion flux distribution of the NEXT, while a companion paper examines the charge state distributions

Conflict of Laws in the Era of Globalization

本稿の目的は, グローバル化に対応した抵触法の在り方を巡る近時の議論動向を採り上げ, その意義と問題点を探ることにある。社会のグローバル化 は, 抵触法の前提である, 法の抵触が国家法の間でしか生じないという国家中心的な考え方, 及び, 公法・私法の区別に基づき私法のみを準拠法選択の対象とするという考え方に対し大きな動揺を与えている。グローバル化による私人の影響力の上昇と国家の影響力の後退が主として齎すこうした新たな状況に対応するため, 近時では, 従来の抵触法の基本的枠組に替えて, 法の抵触の調整に関して新たなアプローチを主張する見解が幾つか登場している。本稿では, これらの新たなアプローチの特徴として, グローバル・ガヴァナンスのための抵触法, 普遍主義的アプローチ, 機能的アプローチ, 手続基底的アプローチという4点を幾つか指摘した上で, その意義と今後の課題について述べる。This paper discusses how the conflict of laws is trying to respond to the challenges brought by the globalization. The globalization of economy and society has brought challenges to the assumptions that the traditional conflict of laws is based on: 1) the state-centered assumption that only the state can create law, and that as a result, the conflict of laws can happen only horizontally, namely among state laws; 2) the public/private distinction. How effectively can the conflict of laws respond to these challenges brought by the globalization? Is the conflict of laws still workable under these situations? This paper describes and analyzes the new approaches of the conflict of laws.特集　「グローバル化と公法・私法の再編

High Thrust-to-Power Annular Engine Technology

Gridded ion engines have the highest efficiency and total impulse of any mature electric propulsion technology, and have been successfully implemented for primary propulsion in both geocentric and heliocentric environments with excellent ground-in-space correlation of performance. However, they have not been optimized to maximize thrust-to-power, an important parameter for Earth orbit transfer applications. This publication discusses technology development work intended to maximize this parameter. These activities include investigating the capabilities of a non-conventional design approach, the annular engine, which has the potential of exceeding the thrust-to-power of other EP technologies. This publication discusses the status of this work, including the fabrication and initial tests of a large-area annular engine. This work is being conducted in collaboration among NASA Glenn Research Center, The Aerospace Corporation, and the University of Michigan

Defining unmet clinical need across the pathway of brain tumor care: a patient and carer perspective.

OBJECTIVE: The aim of this study was to determine the experience of patients with brain tumors and their carers across distinct parts of their treatment pathway and identify their views on potential service gaps in need of addressing. METHODS: A structured survey was administered at patient workshops across the UK and online through a charity newsletter. Answers to closed questions were analyzed using descriptive statistics, and open questions were examined using techniques of inductive content analysis. RESULTS: A total of 136 survey responses were received, representing patients with a variety of diagnoses and geographical locations (30 counties). There was a wide range of opinions on the provision of current neuro-oncology services. Key themes identified included a perceived lack of information provision, a gap in postdischarge psychological and neuropsychological supports, and an unmet willingness for involvement in research. CONCLUSION: This national survey enhances our knowledge of current patient and carer experience within neuro-oncology services. A number of areas of unmet clinical need are highlighted providing a basis for informing future patient-centered service improvements and research

Meeting Report: Moving Upstream—Evaluating Adverse Upstream End Points for Improved Risk Assessment and Decision-Making

Background Assessing adverse effects from environmental chemical exposure is integral to public health policies. Toxicology assays identifying early biological changes from chemical exposure are increasing our ability to evaluate links between early biological disturbances and subsequent overt downstream effects. A workshop was held to consider how the resulting data inform consideration of an “adverse effect” in the context of hazard identification and risk assessment. Objectives Our objective here is to review what is known about the relationships between chemical exposure, early biological effects (upstream events), and later overt effects (downstream events) through three case studies (thyroid hormone disruption, antiandrogen effects, immune system disruption) and to consider how to evaluate hazard and risk when early biological effect data are available. Discussion Each case study presents data on the toxicity pathways linking early biological perturbations with downstream overt effects. Case studies also emphasize several factors that can influence risk of overt disease as a result from early biological perturbations, including background chemical exposures, underlying individual biological processes, and disease susceptibility. Certain effects resulting from exposure during periods of sensitivity may be irreversible. A chemical can act through multiple modes of action, resulting in similar or different overt effects. Conclusions For certain classes of early perturbations, sufficient information on the disease process is known, so hazard and quantitative risk assessment can proceed using information on upstream biological perturbations. Upstream data will support improved approaches for considering developmental stage, background exposures, disease status, and other factors important to assessing hazard and risk for the whole population