Running header: Screening 1

Kimberly Rhodes

Screening

Benedictine University

MPH 604
 Screening 2

In Class Exercise Screening

Exercise 1

A screening test for a newly discovered disease is being evaluated for its effectiveness and
sensitivity as a screening test in industry. In order to determine the effectiveness of the new test,
it was administered to 880 workers. Of those, 120 of the individuals diagnosed with the disease
tested positive for it. Results from the test showed a negative test finding for 50 people with the
disease. A total of 40 people without the disease tested positive for it.

Create a 2x2 table for this data:

Present Absent Total

Screen Result Positive (a)120 (b)40 (a+b)160
Negative (c)50 (d)670 (c+d)720
Total (a+c)170 (b+d)710 (a+b+c+d)880

1. What is the prevalence rate of the disease?

+
= +++
120+50
= 880
170
= 880
= .
= %

2. What is the sensitivity of the test?

= +
120
= 120+50
120
= 170
= .
= %

3. What is the specificity of the test?

= +
670
= 40+670
670
= 710
670
= 710
= .
= %
 Screening 3

4. What is the percentage of false negatives?

() = +
120
() = 120+40
120
() = 160
() =.
o The percentage of false negatives based on the (-) predictive value is 25%.

5. What is the percentage of false positives?

(+) = +
670
(+) = 50+670
670
(+) = 720
(+) =.

6. What is the accuracy of the test?

+
= +++
120+670
= 120+40+50+670
790
= 880
= .897
= 89.7%

Exercise 2

Two different tests previously developed to measure stress in individuals are selected: Stress
Test Alpha Battery (STAB) and Stress Test Uniform Battery (STUB). The sensitivity and
specificity of these two tests are:

STAB: Sensitivity = 60%

Specificity = 95%

STUB: Sensitivity = 75%

Specificity = 90%

Which test will develop the greatest proportion of:

1. False negatives? STAB

2. False Positives? STUB
3. True Positives? STUB
4. True Negatives? STAB
 Screening 4

Exercise 3

Infection with the human immunodeficiency virus (HIV) is routinely diagnosed by detecting the
presence of specific antibodies in the patient's serum. Although the presence of the virus itself
can be now be detected, these tests remain expensive and require laboratory techniques that are
not routinely available. The diagnosis of HIV infection begins with an enzyme immunoassay
(EIA). The optical density (OD) of the patient's EIA is compared to a control specimen (OD
ratio). If the OD ratio is - above the established cutoff for that control sample on repeat testing
the specimen is termed "repeatedly reactive". The EIA is relatively sensitive, fast, simple and
inexpensive which makes it an appropriate screening test. However, if one examines the ODs for
a large group of samples from patients with and without true HIV infection you can see that there
is some overlap in their EIA results if a value of A is used for the cutoff:
HIV-

HIV+

Hypothetical distribution of OD ratios for patients with and without HIV infection. Patients with
HIV infection are depicted with the BLUE, thick line, and the patients without HIV are depicted
with a thin, RED line.

1. What would be the impact of moving the cut-off line from A to B on sensitivity and
specificity?
Sensitivity would decrease while specificity increases
2. What would be the impact of moving the cut-off line from A to C on sensitivity and
specificity?
Sensitivity would increase while specificity decreases

3. Where would you suggest setting the cut-off?

I would sugeest the merging point of both HIV + and curves as the cut-off, this in turn
would provide the best balance of both specificity and sensitivity.
4. If you are the director of a blood bank, and having HIV-negative blood is vital,
where would you set the cut-off and why?
By being closer to the C line in order to increase the sensitivity and then would reduce
the possibilities of attaining any HIV+ blood.
Screening 5

5. If you are the director of an investigational drug for HIV-positive patients, which
decrease viral load and protect T cells, BUT have significant side-effects, where
would you set the cut-off and why?
The closer to the B line, this will increase specificity and demonstrate the potential of the
drug in reducing the patients viral load. \

Exercise 4

Muscle tension dysphonia (MTD) can masquerade as adductor spasmodic dysphonia

(ADSD), leading to diagnostic confusion. An investigation assessed the diagnostic
worth of acoustic analysis of phonatory breaks (PB) as a possible objective test to
distinguish ADSD from MTD.

Acoustic Analysis of Phonatory Breaks to Test for ADSD and MTD (n=100)

Reference Standard
Test Outcome Has ADSD Has MTD
Positive (PB40 ms) 27 25
True Positive (TP) False Positive (FP)
Negative (PB<40 ms) 14 34
False Negative (FN) True Negative (TN)

Calculate the sensitivity, specificity, PV+, and PV-. Interpret your results.

= +
27
= 27+14
27
= 41
= .658
= . %, The test has a 34.2% possibility of producing false
positive results.

= +
34
= 25+34
34
= 59
= .576
= . % The test has a 42.4% possibility of producing a false
negative

() = +
27
() = 27+25
Screening 6

27
() = 52
() = .519
() = . % The test was able to accurately test for
negative on 51.9% of subjects

(+) = +
34
(+) = 14+34
34
(+) = 48
(+) = .708
(+) = . % The test was able to accurately test for
positive on 70.8% of subjects.

Exercise 5

Suppose you read a research article that suggests a 70 ms cutoff is potentially more
appropriate than the 40 ms cutoff you used. You re-analyze your data and find that
TP=17, FP=15, FN=24, and TN=44. Present the revised contingency table and
calculate the new sensitivity, specificity, PV+, and PV-.

Reference Standard
Test Outcome Has ADSD Has MTD
Positive (PB70 ms) 17 15
(a)True Positive (b)False Positive (FP)
(TP)
Negative (PB<70 ms) 24 44
(c)False Negative (FN) (d)True Negative (TN)

= +
17
= 17+24
17
= 41
= .4146
= . %

= +
44
= 15+44
44
= 59
= .7457
= . %
Screening 7

() = +
17
() = 17+15
17
() = 32
() = .5312
() = . %

(+) = +
44
(+) = 24+44
44
(+) = 48
(+) = .9166
(+) = . %