POPM 3240 Lecture Notes - Lecture 3: Statistical Hypothesis Testing, Net Present Value, Theoretical Definition

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ceruleanbuffalo915

12 Nov 2018

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In order to account for the limitations of imperfect tests, multiple tests are often combined in order to fully assess a health situation or disease diagnosis. These multiple tests can be combined in two main ways: 1) series or sequential testing and 2) parallel or simultaneous testing: In series testing, tests are used one after another in sequence, to determine a final decision. Only those individuals that test positive on the first test undergo testing with the second test. This method is often used when a cheap first test is available that is less invasive and uncomfortable. The second test used is often the more expensive test and may be more invasive and cause greater discomfort. In parallel testing, multiple tests are used simultaneously to determine the final decision. All tests are conducted at once and the results of the tests are combined for interpretation. This figure presents visually the difference between series and parallel use of multiple tests.

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Medical History:
Ms. PW, a 58 yr old Caucasian woman, is referred by her physician for the development of an exercise prescription. She is 6 yr postmenopausal and has never been on hormone replacement therapy. In 1987, she was diagnosed with hyperthyroidism (overactive thyroid gland), which was treated with radioactive iodine. Since the treatment, Ms. PW has been on synthroid, a drug used when the thyroid gland does not produce enough thyroid hormones. She has mild hypertension, which is regulated by blood pressureâaltering medications. Ms. PW is 5 ft 5 in. (165 cm) tall with a weight of 128 lb (58 kg), and her body mass index is in the normal range. She does not follow a regular exercise regimen but reports that she enjoys biking.

Diagnosis:
A few months ago, Ms. PW was diagnosed with osteopenia. Considering her medical history, she is likely to become osteoporotic. Her risk factors are age, sedentary lifestyle, being Caucasian, being petite in stature, loss of menstrual function, and lack of thyroid hormone production.

Exercise Test Results:
She recently underwent an exercise stress test that was normal, but no physiological testing was done other than regular blood chemistries.

Exercise Prescription:
A walking program is surely the best choice because it has the potential of improving not only her cardiorespiratory fitness, but also her bone density. However, Ms. PW is particularly fond of bicycling, and therefore the exercise prescription will incorporate some biking activities, as that is likely to increase her adherence to exercise. These cardiorespiratory activities will start slow and gradually progress over time. Ultimately, her goal would be to walk (3.5 mph [5.6 kph] or faster) or bike 30 to 45 min five times a week. In order to reach this goal, Ms. PW may need to start walking or biking at a slower pace and for a shorter distance, but she should strive to exercise five times a week. After it is determined that she can comfortably handle the speed and distance used for the first 2 wk, these two components should be gradually increased. The best choice is to increase the speed a couple of days a week and increase the distance covered on the other days of the week.
A resistance training program should also be implemented, and may be more beneficial with respect to bone than the cardiorespiratory program. Resistance training should also start slowly, with the frequency beginning at 2 d/wk and moving up to 3 or 4 d/wk. Initially, resistance should be low enough that she can easily complete 12 repetitions of an exercise without undue strain. Exercises that target all the major muscle groups should be incorporated, especially for the legs and back. However, exercises that involve spinal flexion should be avoided. In order to strengthen abdominal muscles, Ms. PW can do leg lifts or modified sit-ups, in which only the head is being lifted off the floor. Upon completion of the first 2 wk, during which the patient does one set of 12 repetitions of each exercise, she can add a second set. This same progression can be used after Ms. PW completes another 2 wk. At this point, the patient should start increasing the intensity by slowly increasing the resistance. An adequate resistance at this point would allow the patient to complete no more than 10 repetitions on the second set. All exercises should be performed with slow, controlled movements. Based on Ms. PWâs medical history, this exercise prescription should be well tolerated and should provide optimal health benefits. Individual cases vary, however, and for a woman who has suffered fragility fractures as a result of osteoporosis, even the minimal exercise described here may not be tolerated initially. Such a patient will need a more gradual, less intense program.

Questions:
1. What other information should be obtained from Ms. PW?

2. What other physiological tests might be recommended?

3. Explain the difference in benefits achieved through cardiorespiratory training versus resistance training for this patient. Why is it always important to incorporate both?

What is the difference between the study of kinematics and kinetics in regard to forces?

What three components that make up the musculoskeletal âsystemâ.

The musculoskeletal system is composed if many simple machines. There are 4 potential uses for these simple machines, list 2 of these uses.

Fill in the blank a _________ is used to alter the resulting direction of the applied force.

In the body what component acts as a lever and what acts as the axis?

When we think of a lever set up, what does FAR refer to?

Draw a basic F.A.R for each of the following and give an example of where in the body you may find each.

First class lever:

Second class lever:

Third class lever:

Which class of levers is designed best for speed and range of motion and which is best for strength?

What forces determine amount of torque in a system?

A. How much torque needs to be produced to move 60 kg (R) when the RA is 0.30 m and the FA is 0.1 meters?

b. What value could you change to decrease the torque needed to lift the SAME object.

c. Draw the F.A.R unit (say an arm lifting a bucket) label the elements and explain why what you changed in b would decrease torque needed.

12. a. What is the âcontractileâ unit of muscle called? ______________

b. what is the non-contractile element (series elastic element) in a muscle lever system?

13. in regards to âpowerâ which is more powerful, muscle fibers arranged in Parallel or bipennate muscles? ___________

Why?

14. When weight lifting with the goal of increasing strength, what physical characteristic of the muscle are you changing to bring about that increased strength? __________________

15. What is the branch of FDA that controls regulation of medical devices? ____________

16. Which of the following statements is false?

A device can be an instrument or an apparatus.

A device can be something used to diagnose a disease

A device can change the chemistry of your cells

A device can be something that delivers a drug to your body

17. Give one example of a..

Class I device

Class II device

Class III device

18. Which of the following is true regarding device classification?

Devices with the least risk to the patient are considered Class III

A class III device has a high risk potential to the patient

Class III devices are the easiest to get approved

Testing devices on humans is easy and follows no specific guidelines

19. Explain the difference between Harm and Risk.

20. What is a âsubstantial equivalentâ? Is it easier or harder to get approval for a Device that has an SE?

21. Which of the following would not be a priority when developing a medical device?

Cost

Ergonomics

Ease of sterilization

Material

None of the above

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Provide a peer review

(Provide feedback relating to each rubric component (Article pros and cons, course application, defense of
position, and quality of writing). 5 points each making up 20 points.

Stoichiometry is traditionally a topic that is covered in each of the different levels at Argo Community High School (Argo). While the Honors Chemistry and Advanced Placement (AP) Chemistry courses stress a mathematical approach to mass and mole relationships, the Regular Chemistry course typically receives a lighter, scaled back approach due to a lower level of math skill and achievement. In Birdâs âStoichiometric Calculations Using Equivalent Molar Expressionsâ, the argument is made for a different mathematical approach using equivalent molar expressions instead of the standard unit or dimensional analysis method (2006). While this method does have some unique benefits for all students it would be difficult to implement completely at all levels of chemistry at Argo. One of the best aspects of using âequivalent molar expressionsâ is it shows the importance of the relationship of a balanced equation to the reacting moles (Bird, 2016). Students at Argo currently have two paths into Chemistry; a traditional biology first sequence and a nontraditional physics first sequence. The teachers in the freshman physics first sequence stress dimensional analysis throughout the course. For Sophomore Honors and AP Chemistry students stoichiometry occurs early in the semester and is continued throughout the school year. Although students have had at least one previous year using dimensional analysis, their proficiency in using dimensional analysis determines the studentsâ success or failure with stoichiometry. Students often rely on rote methods to arrive at a final answer but cannot always explain the value they calculated. Using the molar expressions method, each equivalent mole of reactant or product is determined by using the relationship of the coefficient to the starting or ending moles in the reaction. Through this method the students can see that the moles are equivalent and interchangeable, thus making a stronger connection to a particle approach to stoichiometry. Instead of a rote method of a series of dimensional analysis problems the student can quickly and easily determine the moles or other quantity desired in a balanced equation. Another positive aspect of the molar expression method is its flexibility in use with various topics. This method, combined with an ICE/BCA table (Initial, Change, End or Before, Change, After) approach, can be used to quickly inform the student of how much excess remains, how much product is formed, and what is present in the reaction vessel at the end of a reaction (May, 2017). Students in Honors and AP Chemistry at Argo struggle with determining the amount of excess reactant that remains at the end of a reaction. Various wrong methods to determine excess remaining are applied as it is a different calculation than their rote processes previously developed. Using molar expressions, combined with an ICE/BCA table, students can quickly see the amount remaining and will more accurately understand the process of the limiting reactants and the reaction itself. The students can also see that at the end there are some reactants and products remaining. Combining molar expressions with an ICE/BCA table has an added benefit of introducing ICE tables earlier in the curriculum. Although using equivalent moles can simplify stoichiometry calculations while also clarifying many mathematical misconceptions, the worst argument is the inclusion of the actual molar expression to the calculations as it is an unnecessary addition and one that would be detrimental to understanding the stoichiometry of the reaction. When students see a myriad of equations for the numerator they either quickly look for a method to memorize all of these diverse equations or simply assume it is too complicated to understand. If instead the mole was used and equivalent moles was determined instead of equivalent molar expressions, the work would become less clouded with variables. High School students may lose vigor when confronted with such a problem. Instead the students should rely on their ability to convert into moles by using molarity, the ideal gas law, or simply grams to moles, and then use equivalent moles, the process of stoichiometry can be kept separate from the method of determining moles in various ways. Using equivalent molar expressions, or just equivalent moles as I have argued, a connection can be made to both Extreme Whoosh Bottle Trio and Big Time Ethyl Alcohol Explosion videos provided by Flinn (Bracken, Dombrink, & Long, 2017; Marek, 2017). To make the demonstrations quantitative you could simply measure the amount of water generated in each demonstration. The Extreme Whoosh Bottle Trio lends itself particularly to a quantitative treatment as three different concentrations of alcohol were used. By determining the amount of water that should be generated by the 70% isopropyl solution and then comparing it to the amount of water that is actually generated, students can quickly see the application of stoichiometry as well as the use of equivalent molar expressions. The same treatement can be applied to the pure ethanol as well as the 95% isopropyl, allowing several examples as either an introduction or a summation set of demonstrations. The general idea of the equivalent molar expressions is applicable and should be used in all classes at Argo, with some modification (Bird, 2016). While the AP and Honors Chemistry students can definitely use the molar expression within the ICE/BCA table described within this paper, I have argued that the students will find it simpler without the molar expression, instead just using moles in the expression. But it would be advantageous to use molar expressions at the end of the year as a mathematical summation of several topics including percent composition, molarity, and ideal gases. However, the Regular Chemistry students would see no benefit of including molar expressions into the ICE/BCA table. The complexity of several different possible numerators would prove to be too cumbersome. Instead, it would be more appropriate to implement equivalent moles in those classes.

POPM 3240 Lecture Notes - Lecture 3: Statistical Hypothesis Testing, Net Present Value, Theoretical Definition

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