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MEASUREMENT AND SCIENTIFIC METHODOLOGY, THE MEDICAL RELEVANCES
6 years ago
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SCIENTIFIC METHODOLOGY
The scientific method is a process for experimentation that is used to explore observations and answer questions. Scientists use the scientific method to search for cause and effect relationships in nature. In other words, they design an experiment so that changes to one item cause something else to vary in a predictable way.
Just as it does for a professional scientist, the scientific method will help you to focus your science fair project question, construct a hypothesis, design, execute, and evaluate your experiment.
Steps of the Scientific Method
Ask a Question: The scientific method starts when you ask a question about something that you observe: How, What, When, Who, Which, Why, or Where?
And, in order for the scientific method to answer the question it must be about something that you can measure, preferably with a number.
Do Background Research: Rather than starting from scratch in putting together a plan for answering your question, you want to be a savvy scientist using library and Internet research to help you find the best way to do things and insure that you don't repeat mistakes from the past.
Construct a Hypothesis: A hypothesis is an educated guess about how things work:
"If _____[I do this] _____, then _____[this]_____ will happen."
You must state your hypothesis in a way that you can easily measure, and of course, your hypothesis should be constructed in a way to help you answer your original question.
Test Your Hypothesis by Doing an Experiment: Your experiment tests whether your hypothesis is supported or not. It is important for your experiment to be a fair test. You conduct a fair test by making sure that you change only one factor at a time while keeping all other conditions the same.
You should also repeat your experiments several times to make sure that the first results weren't just an accident.
Analyze Your Data and Draw a Conclusion: Once your experiment is complete, you collect your measurements and analyze them to see if they support your hypothesis or not.
Scientists often find that their hypothesis was not supported, and in such cases they will construct a new hypothesis based on the information they learned during their experiment. This starts the entire process of the scientific method over again.
Communicate Your Results: To complete your science project you will communicate your results to others in a final report and/or a display board. Professional scientists do almost exactly the same thing by publishing their final report in a scientific journal or by presenting their results on a poster at a scientific meeting. In a science fair, judges are interested in your findings regardless of whether or not they support your original hypothesis.
Even though we show the scientific method as a series of steps, keep in mind that new information or thinking might cause a scientist to back up and repeat steps at any point during the process.
MEASUREMENT
Measurement is an integral part of modern science as well as of engineering, commerce, and daily life. Measurement is often considered a hallmark of the scientific enterprise and a privileged source of knowledge relative to qualitative modes of inquiry.[1] Despite its ubiquity and importance, there is little consensus among philosophers as to how to define measurement, what sorts of things are measurable, or which conditions make measurement possible. Most (but not all) contemporary authors agree that measurement is an activity that involves interaction with a concrete system with the aim of representing aspects of that system in abstract terms (e.g., in terms of classes, numbers, vectors etc.) But this characterization also fits various kinds of perceptual and linguistic activities that are not usually considered measurements, and is therefore too broad to count as a definition of measurement. Moreover, if “concrete” implies “real”, this characterization is also too narrow, as measurement often involves the representation of ideal systems such as the average household or an electron at complete rest.
Philosophers have written on a variety of conceptual, metaphysical, semantic and epistemological issues related to measurement. This entry will survey the central philosophical standpoints on the nature of measurement, the notion of measurable quantity and related epistemological issues.
TYPES OF MEASUREMENT DONE IN THE CLINIC
BLOOD SUGAR TESTS
Fasting Blood Sugar (FBS or Fasting Glucose)
This is a test that measures blood sugar levels. Elevated levels are associated with diabetes and insulin resistance, in which the body cannot properly handle sugar (e.g. obesity).
Goal values:
Less than 100 mg/dL = normal
Between 110–125 mg/dL = impaired fasting glucose (i.e., prediabetes)
Greater than 126 mg/dL on two or more samples = diabetes
Preparation
This test requires a 12-hour fast. You should wait to eat and/or take a hypoglycemic agent (insulin or oral medication) until after test has been drawn, unless told otherwise.
Eating and digesting foods called carbohydrates forms glucose (blood sugar). Glucose is needed by your body to provide energy to carry out your normal activities. Insulin is needed by the body to allow glucose to go into the cells and be used as energy. Without insulin, the levels of glucose in the blood will rise. Diabetes is a disease that occurs when either the pancreas (an organ in your body) is not able to produce insulin or the pancreas makes insulin, but it does not work as it should. Fasting blood sugar is a part of diabetic evaluation and management. An FBS greater than 126 mg/dL on more than one occasion usually indicates diabetes.
CALCIUM SCORE SCREENING HEART SCAN
A test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries. State-of-the-art computerized tomography (CT) methods, such as this one, are the most sensitive approaches to detecting coronary calcification from atherosclerosis, before symptoms develop. More coronary calcium means more coronary atherosclerosis, suggesting a greater likelihood of significant narrowing somewhere in the coronary system and a higher risk of future cardiovascular events.
Your doctor uses the calcium-score screening heart scan to evaluate risk for future coronary artery disease. Those at increased risk include individuals with the following traits:
1. Family or personal history of coronary artery disease
2. Male over 45 years of age, female over 55 years of age
3. Past or present smoker
4. History of high cholesterol, diabetes or high blood pressure
5. Overweight
6. Inactive lifestyle
Because there are certain forms of coronary disease -- such as "soft plaque" atherosclerosis – that escape detection during this CT scan, it is important to remember that this test is not absolute predicting your risk for a life-threatening event, such as a Institutes & Services.
ELECTROLYTES
Electrolyte levels are useful in detecting kidney, heart and liver disease, and the effects of certain medications (such as diuretics or some heart pills).
ENZYME AND PROTEIN BLOOD TESTS
A series of blood tests that measure enzyme that is released into the bloodstream when cells are damaged.
LIPID BLOOD TESTS
Blood tests that provide information about the amount of cholesterol levels in your blood.
COMMON MEASUREMENT EQUIPMENTS IN THE CLINIC
BMI (BODY MASS INDEX)
The Body Mass Index (BMI) is a guide to whether someone is underweight, normal weight or overweight. It can be measured manually as it can be measured automatically in some clinics and hospitals.
The formula for calculating the Body Mass Index of individuals is:
BMI = Mass in KG/ height in m2
For example, the BMI of an individual with a height of 1.7 m with a body mass of 60kg will be:
60/1.72 = 60/ 2.89 = 20.8
BMI is really important in medicine because it helps us to know whether we are eating healthily or not and can help us with ways to improve our lifestyles.
IMPLICATIONS OF UNDERWEIGHT AND OVERWEIGHT
Your body weight may correlate to overall wellness. Excessively high or low body weight can trigger complications, such as infertility, bone problems and lethargy (weakness characterized by lack of energy).
FERTILITY ISSUES:
Overweight and underweight individuals are at risk of infertility. Excess body weight is associated with reduced fertility in men. Women with polycystic ovary syndrome--- a condition associated with obesity and insulin resistance--- may cause infertility. An unhealthy diet, a common contributor to excessive weight gain and loss, can negatively affect men and women’s ability to procreate.
In particular, diets deficient in vitamin C, folate (a b vitamin) and minerals selenium and zinc are associated with reduced fertility. Diets low in fruits, vegetables and whole grains and low-calorie, restricted diets may lack these nutrients. Low body weight can also cause a woman to stop menstruating, a condition known as amenorrhea. Reduced fertility is a common complication of amenorrhea.
BONE HEALTH:
Maintaining low body weight can derail nutrient intake and absorption. A restrictive diet, particularly one low in calcium and vitamin D, increase a person’s risk of osteoporosis substantially. Osteoporosis often leads to stopped posture and serious bone fractures in later life. These conditions are serious risk factors of eating disorders that involve low body weight, such as anorexia.
Overweight and obesity can also hinder bone health. Young women with high body fat exhibited to 8 to 9 percent weaker bone density than those with normal amount of body fats. Obese people’s bodies do not make sufficient amounts of bone mass for the amount of muscle and weight they carry. Thus, poor body weight density, osteoporosis and bone fractures may occur.
ENERGY LEVEL:
Body weight often affects energy levels. People who regularly eat too much or too little are likely to experience fatigue. Since the body depends upon nutrient intake, severe calorie restriction and malabsorption of nutrients can leave too little fuel for the body needs. As a result, people with illnesses characterized by weight loss, such as Crohn’s disease, anorexia and certain types of cancer, and people who diet compulsively may experience fatigue.
Various factors and conditions contribute to fatigue, a number of which are associated with excess body weight.
IMPLICATIONS OF HYPOTHERMIA AND HYPERTHERMIA
Hypothermia is a potentially dangerous drop in body temperature, usually caused by prolonged exposure to cold temperatures. The risk of cold exposure increases as the winter months arrive. But if you're exposed to cold temperatures on a spring hike or capsized on a summer sail, you can also be at risk of hypothermia.
Normal body temperature averages 98.6 degrees. With hypothermia, core temperature drops below 95 degrees. In severe hypothermia, core body temperature can drop to 82 degrees or lower.
WHAT CAUSES HYPOTHERMIA?
1. Cold exposure
2. Much milder environments can also lead to hypothermia,
3. Other causes: medical conditions such as diabetes etc.
COLD EXPOSURE:
When the balance between the body's heat production and heat loss tips toward heat loss for a prolonged period, hypothermia can occur. Accidental hypothermia usually happens after cold temperature exposure without enough warm, dry clothing for protection. Mountain climbers on Mount Everest avoid hypothermia by wearing specialized, high-tech gear designed for that windy, icy environment.
MUCH MILDER ENVIRONMENT:
However, much milder environments can also lead to hypothermia, depending on a person's age, body mass, body fat, overall health, and length of time exposed to cold temperatures. A frail, older adult in a 60-degree house after a power outage can develop mild hypothermia overnight. Infants and babies sleeping in cold bedrooms are also at risk.
OTHER CAUSES:
Certain medical conditions such as diabetes and thyroid conditions, some medications, severe trauma, or using drugs or alcohol all increase the risk of hypothermia.
HO DOES COLD EXPOSURE CAUSE HYPOTHERMIA?
During exposure to cold temperatures, most heat loss -- up to 90% -- escapes through your skin; the rest, you exhale from your lungs. Heat loss through the skin happens primarily through radiation and speeds up when skin is exposed to wind or moisture. If cold exposure is due to being immersed in cold water, heat loss can occur 25 times faster than it would if exposed to the same air temperature.
The hypothalamus, the brain's temperature-control center, works to raise body temperature by triggering processes that heat and cool the body. During cold temperature exposure, shivering is a protective response to produce heat through muscle activity. In another heat-preserving response -- called vasoconstriction -- blood vessels temporarily narrow.
Normally, the activity of the heart and liver produce most of your body heat. But as core body temperature cools, these organs produce less heat, in essence causing a protective "shut down" to preserve heat and protect the brain. Low body temperature can slow brain activity, breathing, and heart rate.
Confusion and fatigue can set in; hampering a person's ability to understand what's happening and to make intelligent choices to get to safety.
WHAT ARE THE SYMPTOMS OF HYPOTHERMIA?
Hypothermia symptoms for adults include:
1. Shivering, which may stop as hypothermia progresses (shivering is actually a good sign that a person's heat regulation systems are still active. )
2. Slow, shallow breathing
3. Confusion and memory loss
4. Drowsiness or exhaustion
5. Slurred or mumbled speech
6. Loss of coordination, fumbling hands, stumbling steps
7. A slow, weak pulse
8. In severe hypothermia, a person may be unconscious without obvious signs of breathing or a pulse
WHAT ARE THE RISK FACTORS OF HYPOTHERMIA?
People at increased risk for hypothermia include:
1. The elderly, infants, and children without adequate heating, clothing, or food
2. People with mental illness
3. People who are outdoors for extended periods
4. People in cold weather whose judgment is impaired by alcohol or drugs
HYPERTHERMIA
Hyperthermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates/removes. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.
The most common causes include heat stroke and adverse reactions to drugs.
Hyperthermia differs from fever in that the body's temperature set point remains unchanged. The opposite is hypothermia, which occurs when the temperature drops below that required for maintaining normal metabolism.
TEMPERATURE CLASSIFICATION
Note:
Hyperpyrexia is extremely high fever (especially in children)
The difference between fever and hyperthermia is the underlying mechanism.
Different sources have different cut-offs for fever, hyperthermia and hyperpyrexia.In humans, hyperthermia is defined as a temperature greater than 37.5–38.3 °C (99.5–100.9 °F), depending on the reference used, that occurs without a change in the body's temperature set point.
The normal human body temperature can be as high as 37.7 °C (99.9 °F) in the late afternoon. Hyperthermia requires an elevation from the temperature that would otherwise be expected. Such elevations range from mild to extreme; body temperatures above 40 °C (104 °F) can be life-threatening.
SIGNS AND SYMPTOMS
An early stage of hyperthermia can be "heat exhaustion" (or "heat prostration" or "heat stress"),whosesymptoms include heavy sweating, rapid breathing and a fast, weak pulse. If the condition progresses to heat stroke, then hot, dry, skin is typicalas blood vessels dilate in an attempt to increase heat loss. An inability to cool the body through perspiration may cause the skin to feel dry.
Other signs and symptoms vary. Accompanying dehydration can produce nausea, vomiting, headaches, and low blood pressure and the latter can lead to fainting or dizziness, especially if the standing position is assumed quickly.
In severe heat stroke, the individual may be confused, hostile, or have a seemingly intoxicated behavior. Heart rate and respiration rate will increase (tachycardia and tachypnea) as blood pressure drops and the heart attempts to maintain adequate circulation.
CAUSES
Heat stroke occurs when thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive environmental heat, and insufficient or impaired heat loss, resulting in an abnormally high body temperature. In severe cases, temperatures can exceed 40 °C (104 °F). Heat stroke may be non-exertional (classic) or exertional.
EXERTIONAL
Significant physical exertion in hot conditions can generate heat beyond the ability to cool, because, in addition to the heat, humidity of the environment may reduce the efficiency of the body's normal cooling mechanisms. Human heat-loss mechanisms are limited primarily to sweating (which dissipates heat by evaporation, assuming sufficiently low humidity) and vasodilation of skin vessels (which dissipates heat by convection proportional to the temperature difference between the body and its surroundings, according to Newton's law of cooling). Other factors, such as insufficient water intake, consuming alcohol, or lack of air conditioning, can worsen the problem.
The increase in body temperature that results from a breakdown in thermoregulation affects the body biochemically. Enzymes involved in metabolic pathways within the body such as cellular respiration fail to work effectively at higher temperatures, and further increases can lead them to denature, reducing their ability to catalyse essential chemical reactions. This loss of enzymatic control affects the functioning of major organs with high energy demands such as the heart and brain.
SITUATIONAL
Situational heat stroke occurs in the absence of exertion. It mostly affects the young and elderly. In the elderly in particular, it can be precipitated by medications that reduce vasodilation and sweating, such as anticholinergic drugs, antihistamines, and diuretics. In this situation, the body's tolerance for high environmental temperature may be insufficient, even at rest.
Heat waves are often followed by a rise in the death rate, and these 'classical hyperthermia' deaths typically involve the elderly and infirm. This is partly because thermoregulation involves cardiovascular, respiratory and renal systems which may be inadequate for the additional stress because of the existing burden of aging and disease, further compromised by medications. During the July 1995 heat wave in Chicago, there were at least 700 heat-related deaths. The strongest risk factors were being confined to bed, and living alone, while the risk was reduced for those with working air conditioners and those with access to transportation. Even then, reported deaths may be underestimates as diagnosis can be misclassified as stroke or heart attack.
DRUGS
Some drugs cause excessive internal heat production. The rate of drug-induced hyperthermia is higher where use of these drugs is higher.
Many psychotropic medications, such as selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants, can cause hyperthermia. Serotonin syndrome is a rare adverse reaction to overdose of these medications or the use of several simultaneously. Similarly, neuroleptic malignant syndrome is an uncommon reaction to neuroleptic agents.
Various stimulant drugs, including amphetamines, cocaine, PCP, LSD, and MDMA can produce hyperthermia as an adverse effect.
Malignant hyperthermia is a rare reaction to common anesthetic agents (such as halothane) or the paralytic agent succinylcholine. Those who have this reaction, which is potentially fatal, have a genetic predisposition.
The use of anticholinergics, more specifically muscarinic antagonists are thought to cause mild hyper thermic episodes due to its Para sympatholytic effects. The sympathetic nervous system a.k.a. the "Fight or Flight Response" dominates by raising catecholamine levels by the blocked action of the Rest and Digest System.
Drugs that decouple oxidative phosphorylation may also cause hyperthermia. From this group of drugs the most well-known is 2, 4-Dinitrophenol which was used as a weight loss drug until dangers from its use became apparent.
PERSONAL PROTECTIVE CLOTHING OR EQUIPMENT
Those working in industry, in the military, or as first responders may be required to wear personal protective equipment (PPE) against hazards such as chemical agents, gases, fire, small arms and even Improvised Explosive Devices (IEDs). PPE includes a range of hazmat suits, firefighting turnout gear, body armor and bomb suits, among others. Depending on design, the wearer may be encapsulated in a microclimate,] due to an increase in thermal resistance and decrease in vapor permeability. As physical work is performed, the body’s natural thermoregulation (i.e., sweating) becomes ineffective. This is compounded by increased work rates, high ambient temperature and humidity levels, and direct exposure to the sun. The net effect is that desired protection from some environmental threats inadvertently increases the threat of heat stress.
The effect of PPE on hyperthermia has been noted in fighting the 2014 Ebola virus epidemic in Western Africa. Doctors and healthcare workers were only able to work 40 minutes at a stretch in their protective suits, fearing heat strokes.
OTHERS
Other rare causes of hyperthermia include thyrotoxicosis and an adrenal gland tumor, called pheochromocytoma, both of which can cause increased heat production. Damage to the central nervous system, from brain hemorrhage, status epilepticus, and other kinds of injury to the hypothalamus can also cause hyperthermia.
DIAGNOSIS
Hyperthermia is generally diagnosed by the combination of unexpectedly high body temperature and a history that supports hyperthermia instead of a fever. Most commonly this means that the elevated temperature has occurred in a hot, humid environment (heat stroke) or in someone taking a drug for which hyperthermia is a known side effect (drug-induced hyperthermia). The presence of signs and symptoms related to hyperthermia syndromes, such as extrapyramidal symptoms characteristic of neuroleptic malignant syndrome, and the absence of signs and symptoms more commonly related to infection-related fevers, are also considered in making the diagnosis.
If fever-reducing drugs lower the body temperature, even if the temperature does not return entirely to normal, then hyperthermia is excluded.
PREVENTION
When ambient temperature is excessive, humans and many animals cool themselves below ambient by evaporative cooling of sweat (or other aqueous liquid; saliva in dogs, for example); this helps prevent potentially fatal hyperthermia. The effectiveness of evaporative cooling depends upon humidity. Wet-bulb temperature, which takes humidity into account, or more complex calculated quantities such as wet-bulb globe temperature (WBGT), which also takes solar radiation into account, give useful indications of the degree of heat stress and are used by several agencies as the basis for heat-stress prevention guidelines. (Wet-bulb temperature is essentially the lowest skin temperature attainable by evaporative cooling at a given ambient temperature and humidity.)
A sustained wet-bulb temperature exceeding 35 °C is likely to be fatal even to fit and healthy people unclothed in the shade next to a fan; at this temperature, environmental heat gain instead of loss occurs. As of 2012, wet-bulb temperatures only very rarely exceeded 30 °C anywhere, although significant global warming may change this.
In cases of heat stress caused by physical exertion, hot environments, or protective equipment, prevention or mitigation by frequent rest breaks, careful hydration, and monitoring body temperature should be attempted. However, in situations demanding one is exposed to a hot environment for a prolonged period or must wear protective equipment, a personal cooling system is required as a matter of health and safety.
Because of the broad variety of operating conditions, these devices must meet specific requirements concerning their rate and duration of cooling, their power source, and their adherence to health and safety regulations. Among other criteria are the user's need for physical mobility and autonomy. For example, active-liquid systems operate by chilling water and circulating it through a garment; the skin surface area is thereby cooled through conduction. This type of system has proven successful in certain military, law enforcement, and industrial applications. Bomb-disposal technicians wearing special suits to protect against improvised explosive devices (IEDs) use a small, ice-based chiller unit that is strapped to one leg; a liquid-circulating garment, usually a vest, is worn over the torso to maintain a safe core body temperature. By contrast, soldiers traveling in combat vehicles can face microclimate temperatures in excess of 65 °C and require a multiple-user, vehicle-powered cooling system with rapid connection capabilities. Requirements for hazmat teams, the medical community, and workers in heavy industry vary further.
TREATMENT
Mild hyperthermia caused by exertion on a hot day may be adequately treated through self-care measures, such as increased water consumption and resting in a cool place. Hyperthermia that results from drug exposure requires prompt cessation of that drug, and occasionally the use of other drugs as counter measures. Antipyretics (e.g., acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs) have no role in the treatment of heatstroke because antipyretics interrupt the change in the hypothalamic set point caused by pyrogens; they are not expected to work on a healthy hypothalamus that has been overloaded, as in the case of heatstroke. In this situation, antipyretics actually may be harmful in patients who develop hepatic, hematologic, and renal complications because they may aggravate bleeding tendencies.
When body temperature is significantly elevated, mechanical cooling methods are used to remove heat and to restore the body's ability to regulate its own temperatures. Passive cooling techniques, such as resting in a cool, shady area and removing clothing can be applied immediately. Active cooling methods, such as sponging the head, neck, and trunk with cool water, remove heat from the body and thereby speed the body's return to normal temperatures. Drinking water and turning a fan or dehumidifying air conditioning unit on the affected person may improve the effectiveness of the body's evaporative cooling mechanisms (sweating).
Sitting in a bathtub of tepid or cool water (immersion method) can remove a significant amount of heat in a relatively short period of time. It was once thought that immersion in very cold water is counterproductive, as it causes vasoconstriction in the skin and thereby prevents heat from escaping the body core. However, a British analysis of various studies stated: "this has never been proven experimentally. Indeed, a recent study using normal volunteers has shown that cooling rates were fastest when the coldest water was used."[21] The analysis concluded that cool water immersion is the most-effective cooling technique for exertional heat stroke.[21] No superior cooling method has been found for non-exertional heat stroke.[22] Thus, aggressive ice-water immersion remains the gold standard for life-threatening heat stroke.[23][24]
When the body temperature reaches about 40 °C, or if the affected person is unconscious or showing signs of confusion, hyperthermia is considered a medical emergency that requires treatment in a proper medical facility. In a hospital, more aggressive cooling measures are available, including intravenous hydration, gastric lavage with iced saline, and even hemodialysis to cool the blood.
EPIDEMIOLOGY
The frequency of environmental hyperthermia can vary significantly from year to year depending on factors such as heat waves. Statistically, outdoor workers, including agricultural workers, are at increased risk of experiencing heat stress and the resulting negative health effects. Between 1992 and 2006 in the United States, 68 crop workers died from heat stroke, representing a rate 20 times that of US civilian workers overall.
In India, hundreds die every year from summer heat waves, including more than 2,500 in the year 2015.
RESEARCH
Hyperthermia can also be deliberately induced using drugs or medical devices and is being studied as a treatment of some kinds of cancer.
Posttraumatic hypothermia reduced myeloperoxidase activity in the injured and non-injured cortical and subcortical segments compared to norm thermic values (P < 0.05). In contrast, posttraumatic hyperthermia significantly elevated myeloperoxidase activity in the posterior cortical region compared to norm thermic values at both 3 hours and 3 days (473.5 ± 258.4 and 100.11 ± 27.58 U/g of wet tissue, respectively, P < 0.05 versus controls). These results indicate that posttraumatic hypothermia decreases early and more prolonged myeloperoxidase activation whereas hyperthermia increases myeloperoxidase activity. Temperature-dependent alterations in PMNL accumulation appear to be a potential mechanism by which posttraumatic temperature manipulations may influence traumatic outcome..
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