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Because explosive gases continue to expand from their point of origin , a longer negative underpressure ( relative vacuum ) follows the peak positive overpressure . Finding a low pleural fluid pH ( < 7.30 ) in malignant pleural effusions is associated with a poorer prognosis , a higher positive yield for malignant cells on cytology and pleural biopsy , and less success with chemical pleurodesis than when the pH is > 7.30.35 However , a meta-analysis of more than 400 patients with malignant effusions demonstrated that , even when the pH was in the range of 6.70 to 7.26 , 46 % of the patients were still alive at 3 months from the time of initial pleural fluid analysis.75 Furthermore , 65 % of patients in the lowest quartile of pH ( 6.70 to 7.26 ) had successful pleurodesis , compared with 88 % of patients who had a pH of > 7.27.76 Although pH directly correlates with survival and less successful pleurodesis , the relationships are not strong , and therefore pH should not be used as the sole criterion for whether or not to recommend pleurodesis ; other factors , such as performance status77 and primary tumor ,75 also need to be considered . ( A less positive vision involves more incremental reform ) . Stage 3 students confirmed this experience of taking the module at Stage 2 , but add that their Stage 3 work allowed a more positive retrospective of the module . I will close on a final positive note .