BME 301 Lecture Twenty-Four. TV’s hit quiz show comes to BME301. Final Exam Edition.

BME 301

Lecture Twenty-Four

TV’s hit quiz show comes to BME301.

Final ExamEdition

Rules Contestants answer multiple choice questions:

Increasing level of difficulty Increasing number of bonus points toward final

exam AUTOMATIC 100% ON FINAL!!!

Three lifelines: 50/50 – take away two incorrect answers Ask the audience – class votes Phone a friend – ask a friend in class

If contestant answers question incorrectly: Play stops Contestant loses all points

Contestant can stop at any time, even after seeing question

Rules Bonus point values:

1 bonus point 2 bonus points 3 bonus points 4 bonus points 5 bonus points 6 bonus points 10 bonus points 15 bonus points 20 bonus points 100 bonus points

Qualifying Round

Contestants selected in qualifying round Rank order

answers to question + YOUR NAME

Contestant with first correct answer pulled out of the hat gets to play

Let’s Play

Qualifying Round:Write down answer

Pass in

Qualifying Question #1 Rank the four countries in order of life

expectancy, giving the country with the longest life expectancy first: USA Botswana Canada Germany Russia

Qualifying Answer #1

Rank the four countries in order of life expectancy, giving the country with the longest life expectancy first: Canada Germany USA Russia Botswana

Question 1: 1 Bonus Point

What is the leading cause of mortality of people aged 15-44 in developing countries? Road Accidents Heart Disease HIV/AIDS Cancer

50/50Next qualifying round

HIV /AIDS

Leading Causes of Mortality Ages 15-44

Developing World1. HIV/AIDS2. Road accidents3. Inter-personal violence

Developed World1. Road accidents2. Self-inflicted injuries3. Inter-personal violence

Question 2: 2 Bonus Points

Which of the following is not a major cause of the increase in cost of health care in the U.S.? Physician income Aging population New technology development Prescription drugs


Physician income

What Drives Increased Costs?

Administrative Costs US spends 25-30% of health care budget on administrative

overhead 27% of US health care workers do “mostly paperwork”

Technology New technology can increase/reduce health care costs From 2001-2002, new technology was responsible for 22% of increase Increased utilization of technology increases costs

Aging Population “Baby boomers” will strain health care system

Felt most in 2011-2030 Greatest single demand country has ever faced for long term

care Elderly account for much of health care spending

Prescription Drugs Fastest growing category of health spending Some reasons:

Direct marketing of drugs to the general population (increased costs, increased usage)

Drug company profits


Which of the following is not one of the routinely screened types of cancer? Cervical cancer Colon and rectal cancer Prostate cancer Lung cancer


Lung cancer

Cancer Screening

We routinely screen for 4 cancers: Female breast cancer

Mammography Cervical cancer

Pap smear Prostate cancer

Serum PSA Digital rectal examination

Colon and rectal cancer Fecal occult blood Flexible sigmoidoscopy, Colonoscopy


Which of the following is defined as, “Probability that given disease, the patient tests positive”? Specificity Efficacy Sensitivity Positive Predictive Value


Sensitivity

Sensitivity & Specificity

Sensitivity Probability that given DISEASE, patient

tests POSITIVE Ability to correctly detect disease 100% - False Negative Rate

Specificity Probability that given NO DISEASE,

patient tests NEGATIVE Ability to avoid calling normal things

disease 100% - False Positive Rate

Question 5: 5 Bonus Points Which of the following statements

about the advantages of using optical technologies, in developing countries, for cervical cancer detection is NOT true? It doesn’t require highly trained

clinicians It is portable for use in remote

populations Doesn’t require a large infrastructure Doesn’t have to follow the guidelines of

the Belmont report50/50Next qualifying round

Doesn’t have to follow the guidelines of the Belmont

report

Why Use Optical Technologies for Cervical

Cancer Detection? Developed World:

Combine screening, diagnosis & treatment

Reduce Cost Reduce Loss to Follow Up

Developing World: Enable screening in resource-poor

settings Don’t require large infrastructure Portable for remote population centers Don’t require highly trained clinicians

Save lives of women

Belmont Report: 1979

From Dept. of Health, Education & Welfare

Statement of: Basic ethical principles and guidelines to

resolve ethical problems associated with conduct of research with human subjects

Three basic ethical principles: Respect for persons Beneficence Justice


The amount of blood pumped by the ventricle with each heart beat is defined as: Stroke Volume Ejection Fraction Cardiac Output Lub from Lub-Dub


Stroke Volume

Quantifying Heart Performance

Heart Rate (HR) Number of heart beats per minute Normal value is 60-90 bpm at rest

Stroke Volume (SV) Amount of blood pumped by ventricle with each heart

beat Normal value is 60-80 ml

Cardiac output (CO) Total volume of blood pumped by ventricle per minute CO = HR x SV Normal value is 4-8 L/min

Blood volume Total volume of blood in circulatory system Normal value is ~5 L Total volume of blood is pumped through our heart each

minute!!


Which of the following is not true about vaccines? Vaccines can artificially induce immunity Vaccines are a very cost effective health

intervention Vaccines are experimentally being used

to treat some types of cancer Vaccines all involve receiving an

infectious, but less virulent form, of the disease


Vaccines all involve receiving an infectious, but

less virulent, form of the disease

Types of Vaccines Non-infectious vaccines

No danger of infection Does not stimulate cell mediated immunity Usually need booster vaccines

Live, attenuated bacterial or viral vaccines Makes memory B cells, memory helper T cells, AND memory

killer T cells Usually provides life-long immunity Can produce disease in immuno-compromised host

Carrier Vaccines Makes memory B cells, memory helper T cells, AND memory

killer T cells Does not pose danger of real infection Immuno-compromised individuals can get infection from

carrier DNA Vaccines

DNA injections can produce memory B cells and memory T killer cells

Make a DNA vaccine from a few viral genes No danger that it would cause infection


In 1994, what percentage of the world’s children received basic vaccines? 100 80 50 20


80 percent

Effects of Vaccination Smallpox

First human disease eradicated from the face of the earth by a global immunization campaign

1974 Only 5% of the world’s children received

6 vaccines recommended by WHO 1994

>80% of the world’s children receive basic vaccines

Each year: 3 million lives saved


A diagnostic test is 92% sensitive and 94% specific. A test group is comprised of 500 people known to have the disease and 500 people known to be free of the disease. How many of the known positives would actually test positive? 450 people 460 people 470 people 480 people


Sensitivity

Probability that given DISEASE, patient tests POSITIVEAbility to correctly detect disease100% - False Negative Rate

SpecificityProbability that given NO DISEASE, patient tests NEGATIVEAbility to avoid calling normal things disease100% - False Positive Rate

500 x 0.92 = 460


You are designing a clinical trial of a new stent. You expect a restenosis rate in the group treated with the new drug eluting stent of 10%, while the expected restenosis rate in the group treated with the current stent is 45%. You calculate a standardized difference of 0.75. If you can tolerate a 10% risk of type II error and a 5% risk of type I error, how many patients are needed in the trial?

55 65 75 95


Qualifying Question #2 Rank the following treatments in order of

$$ spent/QALY gained, giving the treatment with the lowest $$/QALY first: PAP smear screening Childhood immunization Screening and treatment for HIV in low risk

populations Chemotherapy for 75 year old woman with

breast cancer Driver’s side air bag


Rank the following treatments in order of $$ spent/QALY gained, giving the treatment with the lowest $$/QALY first: Childhood immunization PAP smear screening Driver’s side air bag Chemotherapy for 75 year old woman

with breast cancer Screening and treatment for HIV in low

risk populations

League Table

Therapy Cost per QALY

Motorcycle helmets, Seat belts, Immunizations Cost-saving

Anti-depressants for people with major depression

$1,000

Hypertension treatment in older men and women

$1,000-$3,000

Pap smear screening every 4 years (vs none) $16,000

Driver’s side air bag (vs none) $27,000

Chemo in 75 yo women with breast CA (vs none)

$58,000

Dialysis in seriously ill patients hospitalized with renal failure (vs none)

$140,000

Screening and treatment for HIV in low risk populations

$1,500,000


What fraction of people in the United States have private health insurance? 16% 56% 74% 86%

Next qualifying round50/50

Centers for Medicare & Medicaid Services

Table 1.4Sources of Health Insurance Coverage for the

Under 65 Population, 1980-2000

Notes: ESI - Employer Sponsored Insurance. Any Private includes ESI and individually purchased insurance. Any government includes Medicare for the disabled population.

Source: Tabulations of the March Current Population Survey files by Actuarial Research Corporation, incorporating their historical adjustments.

Over the last two decades, private coverage has declined, public coverage has stayed about the same, and the uninsured have grown.

74%

83%

8%

15%

10%

0

10

20

30

40

50

60

70

80

90

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

ESI

Any Private

Medicaid

Any Government Uninsured

74%

69%

16%

14%

9%

Question 2: 2 Bonus Points Which of the following is NOT one of the

five principles of the Canadian health care system: Comprehensiveness Universality Portability Accessibility Two Tiered System

Next qualifying round 50/50

Two Tiered System

Canadian Health Care System

Five Principles Comprehensiveness, Universality, Portability,

Accessibility, Public administration Features

All 10 provinces have different systems (local control)

One insurer - the Provincial government costs shared by federal & provincial govts

Patients can choose their own doctors Doctors work on a fee for service basis, fees are

capped

Question 3: 3 Bonus Points Which of the following is NOT a

characteristic of bacteria: Cells with membrane and cell wall (usually) Can survive outside host Use host intracellular machinery to reproduce Can be killed or inhibited by antibiotics


Use host intracellular machinery to reproduce

Types of Pathogens Bacteria

Cells with membrane and cell wall (usually) Can survive outside host Can reproduce without a host Can be killed or inhibited by antibiotics

Viruses Nucleic acid core with protein envelope Use host intracellular machinery to

reproduce Cannot be killed with antibiotics >50 different viruses that can infect humans

Question 4: 4 Bonus Points In 1992, there was a large increase in the

incidence of prostate cancer reported in the United States. The cause of this increase is believed to be due to: The aging population An increase in exposure to carcinogens

associated with smoking The introduction of mass spectrometry to

screen for cancer-related serum proteins The introduction of a serum PSA screening test


The introduction of a serum PSA screening test

Cancer Incidence Rates* for Men, US, 1975-2000

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

0

50

100

150

200

25019

75

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Prostate

Lung

Colon and rectum

Urinary bladder

Non-Hodgkin lymphoma

Rate Per 100,000

Question 5: 5 Bonus Points When did Margaret Heckler, Secretary of

HEW, predict we would have an HIV/AIDS vaccine? 1982 1984 1986 1988


History of HIV/AIDS Vaccines 1984:

Robert Gallo discovers virus that causes HIV Margaret Heckler, Secretary of HEW, predicts

we will have vaccine within 2 years 1997:

President Clinton declares, “an HIV vaccine will be developed in a decade’s time.”

2003: President Bush asks congress to appropriate

$15B to combat the spread of HIV in Africa and the Caribbean

Today: Where is the vaccine?

Question 6: 6 Bonus Points If they find an invader, they become

“activated”. Once activated they: send signals to recruit others, they become vicious killers, and they present the antigen to adaptive immune system. What, specifically, are they? Memory B Cells Neutrophils Macrophages Antibodies


Macrophages

Components of Innate Immune System

1) Macrophages: Sentinels that patrol periphery If they find an invader, they become

“activated” If activated, they:

Send signals to recruit other immune system cells (Neutrophils)

Become vicious killers Present antigen to adaptive immune system

(more on this later)


A diagnostic test is 92% sensitive and 94% specific. A test group is comprised of 500 people known to have the disease and 500 people known to be free of the disease. How many of the known negatives would actually test negative? 450 people 460 people 470 people 480 people


470 people

Sensitivity

Probability that given DISEASE, patient tests POSITIVEAbility to correctly detect disease100% - False Negative Rate

SpecificityProbability that given NO DISEASE, patient tests NEGATIVEAbility to avoid calling normal things disease100% - False Positive Rate

500 x 0.94 = 470

Question 8: 15 Bonus Points You design a clinical trial of

a new stent. You expect a restensosis rate in the group treated with the drug eluting stent of 10%, while the expected restenosis rate in the group treated with the current stent is 45%. You calculate a standardized difference of 0.75. If you can tolerate a 20% risk of type II error and a 5% risk of type I error, how many patients are needed in the trial?

55 65 75 95


Question 9 : 20 Bonus Points

A diagnostic test is 97% sensitive and 84% specific. The test group is comprised of 500 people known to have the disease and 500 people known to be free of the disease. How many patients would receive a false positive test result? 3 15 27 80



80 False Positives

Question 9: 20 Bonus PointsSensitivity = TP / # of people with diseaseSpecificity = TN / # of people without disease

97% or 0.97 = TP / 500 peopleTP = 0.97 * 500 people = 485 people

84% or 0.84 = TN / 500 peopleTN = 0.84 * 500 people = 420 people

420 of 500 negative people would test negative.

80 of 500 negative people would test FP.


A test with 99.9% sensitivity and 99% specificity is used to screen a population of 100,000 people for a disease with .1% prevalence. What would be the positive predictive value of this test? 99% 50% 9% .01% 50/50Next qualifying round

Question 10 : 100 Bonus Points

# of people w/disease = (# people)(prevalence) = (100,000)(.001) = 100# of people w/o disease = 100,000 – 100 =

99,900

Sensitivity = 0.999 = TP / 100 peopleTP = 99.9 people

Specificity = 0.99 = TN / 99,900 peopleTN = 98,901 people

FP = Number of people w/o disease – TN FP = 99,900 people – 98,901 people = 999

people

PPV = TP / (TP + FP) PPV = 99.9 people / (99.9 people + 999 people)

= .0909 or about 9%

Qualifying Question #3 List the steps in the engineering design

method in the proper order: Evaluate solutions Communicate results Develop solutions Identify a need Define the problem (goals, constraints) Gather information


List the steps in the engineering design method in the proper order: 1. Identify a need 2. Define the problem (goals,

constraints) 3. Gather information 4. Develop solutions 5. Evaluate solutions 6. Communicate results

Engineering Design Method Fashioning a product made for a

practical goal in the presence of constraints

Six design steps: 1. Identify a need 2. Define the problem (goals, constraints) 3. Gather information 4. Develop solutions 5. Evaluate solutions 6. Communicate results

Papers, patents, marketing

Refine Design

SPECS

FMEA


What are the components of blood? Plasma, red blood cells, platelets Plasma, red & white blood cells,

platelets Plasma, pluripotent cells Erythrocytes


Plasma, red & white blood cells, platelets

Blood Plasma Cells

Red blood cells White blood cells Platelets

Cells made in bone marrow from pluripotent hematopoeitic stem cells

Question 2: 2 Bonus Points What is the primary cause of the swelling

when you get a splinter? 1. Recruitment of phagocytes 2. Increase in permeability of local blood vessels 3. Rapid cloning of memory cells 4. Increase in temperature of the localized

tissue


Increase in the permeability of the local blood vessels

What happens when you get a splinter?

Macrophages eat bacteria on splinter Phagocytosis Produce chemicals which:

Increase local blood flow Redness Heat

Increase permeability of blood vessels Swelling

Recruit other phagocytes to site of infection Pus



In Love in the Driest Season, Neely Tucker adopts a baby from Zimbabwe. What is her name? Vita Chipo Emily Mugabe

Chipo (means Hope)


Which of the following is NOT true about B cells? Make antibodies Have no nucleus Have a wide variety of receptors on cell

surfaces Can rapidly clone to increase numbers


Have no nucleus

Antibodies How are antibodies made?

B cells Lymphocytes that make antibodies Have B cell receptors on surface 100 million different types of B cells, each

with different surface receptors B cell receptors are so diverse they can

recognize every organic molecule When a B cell binds antigen:

Proliferates - In one week, clone of 20,000 identical B cells

Secretes antibody

Question 5: 5 Bonus Points Which of the following is NOT a

reason for new technologies being abandoned? Poor technical performance High cost Ethics, legal and social issues Inventor perceived as weird, maverick


Inventor perceived as weird, maverick


Which of the following is NOT true about laparoscopic cholecystectomy? Rapid diffusion rate Increased overall rate of

cholecystectomy Reduced hospital stay of patients Causes a side effect of the surgery

called “pump head”


Causes a side effect of the surgery called “pump head”

Diffusion of Lap Choly Diffusion of laparoscopic cholecystectomy

in health care is unprecedented Since its introduction in 1989:

the laparoscopic procedure has rapidly become the most widely used treatment for gallstone disease

By 1992: laparoscopic cholecystectomy accounted for

50% of all cholecystectomies in Medicare populations

75% to 80% of all cholecystectomies in younger populations

Increased overall rate of cholecystectomy: Increase observed in fee-for-service, Medicare,

and for-profit HMO systems. Ranged from 28% to 59%


Which of the following is NOT true of pancreatic cancer? Fourth leading cause of cancer deaths in

men and women One year survival is less than 20% The incidence and mortality are very

similar The incidence and mortality are very

different


The incidence and mortality are very different

Pancreatic Cancer

Incidence: 31,860 people in the US will be found to

have pancreatic cancer in 2004 Mortality:

31,270 will die of the disease in 2004 Fourth leading cause of cancer death in

men and women Survival:

One year survival: 15-20% Five year survival: few percent

Question 8: 15 Bonus Points Which of the following sequences is a

correct order for the progression of heart disease? Arteriosclerosis, ischemia, stroke, high

blood pressure Heart failure, heart attack, stroke,

ischemia High blood pressure & high cholesterol,

atherosclerosis, heart attack, heart failure Heart failure, stroke, high cholesterol,

high blood pressure50/50Next qualifying round

High blood pressure & high cholesterol, atherosclerosis, heart attack, heart failure

Progression of Heart Disease

High Blood PressureHigh Cholesterol Levels

Atherosclerosis

Ischemia

Heart Attack

Heart Failure


Amniocentesis can detect fetal chromosomal abnormalities. The sensitivity of amnio is 89% and its specificity is 99.3%. The prevalence of chromosomal abnormalities is 0.28% in children born to 20 yo mothers. If a 20 yo woman has a positive amnio, what is the likelihood that the fetus has a chromosomal abnormality? 2% 26% 38% 50%


Possible Test Results

Test Positive

Test Negative

Disease Present

2.5 .3 # with Disease = 2.8

Disease Absent

6.98 990.2 #without Disease =

997.2

# Test Pos = 9.48

# Test Neg = 990.5

Total Tested = 1,000

Se = 2.5/2.8 = 89.3% Sp 990.2/997.2= 99.3%

PPV = 2.5/9.48 = 26.3% NPV =990.2/990.5 = 99.97%


In heart failure, the ejection fraction typically drops from a normal value of 60% to approximately 15%. If the heart rate remains constant at 80 bpm, by what fraction does the end diastolic volume need to increase in order to maintain a cardiac output of 5 L/min? 10% 60% 200% 350% 400% 50/50Next qualifying round

CO = HR x SV EF = SV/EDV CO = HR x (EF)(EDV) Normal:

5L = 80 bpm x (0.6)(EDV) EDV = 0.1L

Heart Failure: 5L = 80 bpm x (0.15)(EDV) EDV = 0.4L 400% increase

Qualifying Round Four

Put the following vaccines in order of when they were first developed, starting from the earliest to the latest. Influenza vaccine Pneumonia vaccine Rabies vaccine Smallpox vaccine Rotavirus vaccine

Qualifying Round Four: Answer

Put the following vaccines in order of when they were first developed, starting from the earliest to the latest. Smallpox vaccine - 1796 Rabies vaccine - 1882 Influenza vaccine - 1945 Pneumonia vaccine - 1977 Rotavirus vaccine - 1998


Of the following which is not a standard method used in the testing of vaccines? Lab/Animal testing Post-licensure surveillance Phase I-III human testing Hope and pray

50/50

Hope and pray

Vaccines How do vaccines work?

Stimulate immunity without causing disease How are vaccines made?

Non-infectious vaccines Live, attenuated bacterial or viral vaccines Carrier Vaccines DNA Vaccines

How are vaccines tested? Lab/Animal testing Phase I-III human testing Post-licensure surveillance


Which of the following is not one of the three basic ethical principles laid out in the Belmont report? Get them before they get you Beneficence Justice Respect for Persons

50/50

Get them before they get you

Belmont Report: 1979

From Dept. of Health, Education & Welfare

Statement of: Basic ethical principles and guidelines to

resolve ethical problems associated with conduct of research with human subjects

Three basic ethical principles: Respect for persons Beneficence Justice


It was in this year that Robert Gallo discovered the virus that causes HIV/AIDS. 1979 1984 1990 2001

50/50

History of HIV/AIDS Vaccines 1984:

Robert Gallo discovers virus that causes HIV Margaret Heckler, Secretary of HEW, predicts

we will have vaccine within 2 years 1997:

President Clinton declares, “an HIV vaccine will be developed in a decade’s time.”

2003: President Bush asks congress to appropriate

$15B to combat the spread of HIV in Africa and the Caribbean

Today: Where is the vaccine?


In Uganda the average life span has decreased by approximately how many years since the emergence of HIV? 5 10 20 30

50/50

Health Data: Uganda Stable political situation African country most willing to openly confront HIV Adult HIV infection rate:

Ten years ago: 20% Today: 6% Each of the past 10 yrs: Fewer infections than yr before

Life Expectancy: Before HIV: 64 years Today: 42 years

Annual Income: $300 per person

Annual Health Expenditures: $6 per person

Vaccination rate 1995: 47% 2002: 37%

Question 5: 5 Bonus Points About what percentage of cancers

are caused by infectious agents in developing countries worldwide? 12% 25% 40% 65%

50/50

Worldwide Burden of Cancer

23% of cancers in developing countries caused by infectious agents Hepatitis (liver) HPV (cervix) H. pylori (stomach)

Vaccination could be key to preventing these cancers


The mission of the World Health Organization is: “Attainment by all peoples of the

highest possible level of health” Provide epidemiologic information to

countries Develop international standards for

vaccines Identify and track outbreaks of new

disease50/50

“Attainment by all peoples of the highest

possible level of health”

World Health Organization

Established by charter of the UN after World War II

Headquartered in Geneva Mission:

“Attainment by all peoples of the highest possible level of health”

Website: http://www.who.int/en/

Functions of the WHO Services to governments:

Epidemiologic intelligence International standardization of vaccines Reports of expert committees Data on world health problems

Member countries must provide certain info in regular reports Disease outbreaks Health of population Steps to improve health


In 1937 this was added to Sulfanilimide to make it easier for children to take. It was tested for appearance, taste, and fragrance but not toxicity. Within weeks many children had died. What was it? Turpentine Ethylene glycol Ethanol Ether 50/50

Ethylene glycol

History of Supplements 1937:

Sulfanilimide, antibiotic for streptococcal infections, used safely as a pill for years

Most children can’t swallow pills One company in Tennessee found they

could dissolve drug in ethylene glycol (antifreeze)

Tested for flavor, appearance, fragrance, NOT for toxicity

Shipped it all over the country Within weeks, scores of children were

dead

Question 8: 15 Bonus Point Medical device classes were established

by the device amendments to the FD&C Act. Which class of medical device does this describe:

Not life sustaining, but must meet performance standards Examples include blood pressure monitors, guide wires Includes 60% of devices

Class I Class II Class III Class IV

50/50

Class II

1976: Device amendments to FD&C Act

Three classes of devices: Class I:

Pose least risk to patient Not life sustaining GMP, proper record keeping required 30% of devices X-ray film, tongue depressors, stethoscopes

Class II: Not life sustaining, but must meet performance

standards Blood pressure monitors, Catheter guide wires 60% of devices

Class III: Pose greatest risk to patient For use in supporting or sustaining human life 10% of devices Stents, heart valves, LVADs Require GMP, failure modes analysis, animal tests,

human clinical studies under IDE


A clinical trial of a new automated mammography system was carried out in 50,000 women known to have breast cancer. If 37,500 women received a positive test result, what would the specificity of the new test be? 50% 75% 85% Cannot determine from this trial

50/50

Cannot determine from this trial

Sensitivity = TP/# of people with disease

Specificity = TN/# of people without disease

Since we do not know what happens when this test is used on women without disease we cannot evaluate its specificty.


How many licks does it take to get to the center of a tootsie-pop? 1 2 3 The world may never know

50/50


Vitamin C was initially used to prevent scurvy in 1601. How many years later did the British Navy adopt this intervention? 1 year later 25 years later 265 years later 500 years later

50/50

265 years later

Diffusion is historically slow…. 1497: Vasco Da Gama lost 100 out of 160 crew

members to scurvy sailing around Cape of Good Hope

1601: British Navy Captain James Lancaster was in command of 4 ships traveling from England to India Required sailors to take 3 tsp of lemon juice daily on 1

ship The other 3 ships served as the control Results:

110/278 sailors died in control group 0 deaths in the experimental group

1747: British Navy Physician James Lind repeated study with similar results

1865: British Navy finally adopted innovation, 264 years after first recorded evidence

Berwick, Donald M., Disseminating Innovations in Health Care. JAMA April 16, 2003 – Vol 289, No. 15

Final Exam Rules May 18th:

Comprehensive Designed for two hours Final Exam 9 am – Noon Room Assignment: WELCH 2.308 Can bring one 8.5 x 11” sheet with anything you

want TA Availability:

Regular office hours + Appt. RRK Availability:

Office hours today, 5/11, + Appt. Out of town 5/13-5/17

BME 301 Lecture Twenty-Four. TV’s hit quiz show comes to BME301. Final Exam Edition.

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Transcript of BME 301 Lecture Twenty-Four. TV’s hit quiz show comes to BME301. Final Exam Edition.