U.S.

Public Health Service

Group D7
Ashim Sarkar (11065)
Nikunj Chhaochharia (11212)
Priyanshu Dubey (11244)
Shah Rishabh Rajendrakumar (11308)
Shruti Marwaha (11321)
Vijaya Sundara Pandiyan G. (11363)





Problem Statement
The U.S. Public Health Service wants
to reduce the number of tests required
to determine whether a person called
for induction has syphilis.
It is required to determine whether
dividing the people into groups will
result in lesser number of tests. If yes
then what should be the optimum
group size.
Methods
Case 1
Every person is checked
Case 2
Blood samples are pooled in groups
Groups are tested for syphilis
If a group tests positive then every
member of the group is checked
individually for syphilis.
Variables
We define the following variables
n The total number of people to be
tested
p Probability that a person has
syphilis.
x number of people in a group
Thus the number of groups will be n/x
Binomial Distribution
The three conditions required for
binomial distribution are:
Trials must be independent
Each trial results in success or failure
Probability of success(p) must be
same

We see that in the problem the first 2
conditions are satisfied.
Binomial (cont.)
The probability p of getting syphilis
varies based on age and social
circles, it is assumed to be constant
for calculation purposes.
Thus all 3 conditions are satisfied and
we can apply binomial distribution.
Solution using Binomial
For case 2
P(a group is investigated further)
= P(at least one person has syphilis)
= 1 P(no person has syphilis)
Using binomial
=1 C
0
p
0
(1-p)
x
=P
i

P
i
is the probability that i
th
group is
investigated further.
Solution (cont.)
Expected number of groups
investigated further:

(n/x)*P
i

(since expected value of a binomial
distribution is given by N*P where N is
the number of trials and P is the
probability)
Solution (cont.)
No. of investigations to be conducted:
(n/x)*x*P
i
+ (n/x) = n*P
i
+ (n/x) (1)

If case 1 is followed(no grouping) then
number of tests will be : n (2)

Thus, reduction in tests is :(2) (1)
=n - n*P
i
- (n/x)
Solution (cont.)
Thus percentage decrease in tests is:

1 P
i
(1/x)

Based on this formula, the results are
tabulated in a data table for different
values of p and x. ps.xls

Actual Data from Reference
1,070,000 men were examined
83,000 were found to have syphilis

Thus probability of a person having
syphilis is (83,000/1,070,000) = 0.077

Reference: www.cdc.gov/stdconference/2004/Slides/B-sessions/B2/McGough.pps
Decrease in tests with group size
0.00
10.00
20.00
30.00
40.00
50.00
60.00
0 5 10 15 20 25 30
X axis: group size
Y axis: % decrease in no. of tests
4
Result
We observe from the tabulation that
as p increases, the group method will
need more tests as compared to
individual tests.
If p>0.3 then we should follow case 1.
From the graph and from the
tabulation, we observe that we get
maximum reduction when x=4, for
p=0.077(from reference).
Thus the group size should be 4.
Validation
From the tabulation we see that a
group of 4 members gives maximum
decrease for a probability of 0.077

Let the No. of people (n) be 200,000
Let there be 4 people per group (x)
Number of groups is 50,000
Probability (p) of syphilis is 0.077
Validation
If everyone is tested (case 1), No. of
tests will be 200,000
With groups of 4 (case 2), the number
of tests will be:
= n*P
i
+ (n/x)
Where, 1 C
0
p
0
(1-p)
x
= P
i
=104,843
Thus we have almost 47.5% reduction

Conclusion
The method of segregation into
groups is better for low probability of a
person having syphilis.
With increase in probability (p>0.3),
the method of testing individually is
better.
For the calculated probability of 0.077,
the most efficient group size is of 4
members.
Thank You