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CardioHEADS Lesson Summaries The CardioHEADS program was a three-year NIH/SEPA-funded, middle school health science program created by a partnership of faculty and staff from the Denver Public Schools and the University of Colorado. The CardioHEADS program had two central goals: 1) Provide new and culturally appropriate educational opportunities for urban middle school students that improve their science inquiry skills, increase their interest in science, increase their exposure to and facility with technology, increase their interest in health science careers, and assist them in making healthy lifestyle choices; 2) Provide opportunities for middle school and university faculty to learn and grow together professionally to become better science educators, particularly in the area of inquiry science. Lesson Plans – Level I: The Heart and Cardiovascular Fitness Unit Summary: The theme of this unit centers on the structure and function of the heart as well as the effects of exercise on the heart. The unit incorporates computer-based technology (as well as alternatives to using the technology), grade-appropriate math skills, and a project to achieve greater cardiovascular fitness. Time: This unit is intended to take between two and three weeks to complete, depending on how much time is spent on each activity. NOTE: These lessons do not attempt to cover every concept related to cardiovascular health. Rather, they include a series of structured and inquiry-based activities that build upon one another—a spiraled curriculum—with the early activities being more structured and the later activities being more openended). Level I Unit Activity Summary: Unit Introduction: Students are asked to complete heart related questions that assess their prior knowledge regarding the content of the unit. Students then read introductory text about the heart and learn more about heart rate. Time: One 45-minute period. Activity 1: "Organ Donation" Students are introduced to the heart through discussion about organ donation. The students express their opinions about organ donation by completing a survey. Students then chart and graph the results of the survey. Alternatively, students may be introduced to organ donation by watching the video "Flow." This video tells the story of a young man who receives a heart transplant and then meets the brother of the donor. It is an emotional story and serves to engage students in the multifaceted issue of organ donation. After watching the video, students discuss their reactions as a class. Students assemble data on opinions of all class members and graph it. Time: One or two 45-minute periods or one 90-minute block; depending upon whether the Flow video is shown. Activity 2: "Heart Parts – Heart Game” This is a structured activity in which students research and label the various heart structures. They identify the chambers, valves, and major blood vessels of the heart as well as the pathway of blood through the heart. After multiple opportunities to identify these key structures, students participate in an interactive game that allows them to demonstrate their knowledge in a fun competition with their classmates. Time: Two 45-minute periods (at least one 45-minute period to cover the heart parts and flow of blood through the heart; plus one to reinforce heart structures and flow for application of playing the game) or one 90-minute block. Activity 3: "A Measure of the Heart" Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health In this structured inquiry activity, students take measurements of various animal hearts to answer the question, “How does the size of the animal relate to the size of the heart?” Students measure mass, volume, circumference in metric units, and make conversions in the context of beginning the process of inquiry by forming a hypothesis, gathering data, analyzing the data, and forming conclusions. Time: Two 45-minute periods or one 90-minute block. Activity 4: "Pump It Up" Students are guided through the scientific inquiry process by responding to questions about a hypothetical experimental design. This hypothetical experiment walks students through the formulation of a question, the corresponding hypothesis, gathering data, analyzing the data, and forming conclusions. Using this experimental design example, students will use the scientific inquiry process in designing their own experiment to determine the affect of exercise on heart rate. Time: One-two 45-minute periods. Activity 5: "Are You In Shape?" Students are guided through the four categories of physical fitness and perform steps of different exercises as well as mathematical operations to discover their own cardiac fitness by determining their personal heart rate recovery. Time: One-two 45-minute periods. Activity 6: "Under Pressure" Students gain a working knowledge of the measurement of blood pressure and continue building the process skills of scientific inquiry by designing their own experiment to determine the affect of exercise on blood pressure. Time: One or two 45-minute periods. Activity 7: "Open Heart Inquiry" In this open inquiry exercise, students use the scientific process to design an experiment. Students select both the dependent and independent variables and design their own experiments. Students can choose to measure either heart rate or blood pressure for the dependent variable and are open to choose an independent variable that might affect their dependent variable. For the independent variable students may choose to investigate the affects of lying down versus standing; ingestion of caffeine, sugar, chili peppers, etc.; different intensities of exercise; meditation; etc. Time: Two 45-minute periods (one to design the experiment and one to do the experiment) or one 90-minute block. Activity 5: "Shaping Up” – Optional Activity Students plan a long-term physical activity project to see how they can affect their own cardiovascular fitness. Students will use inquiry process skills to design a fitness-related experiment. Time: Two-seven 45-minute periods (this project requires several weeks to complete– students should spend at least three to four weeks doing their fitness program to see any affect on their cardiovascular fitness. Two class periods are necessary for introduction, checking students’ experimental designs and wrap-up). Activity 9: "Community Connection" Students apply their learning to create a message for their community. Students have the choice of making a poster encouraging organ donation or a poster describing cardiovascular fitness – what it means to be and get “in shape.” Time: One-two 45-minute periods or one 90-minute block. Level I Assessment: Students apply their learning gains of this unit to questions associated with the experimental design process. Students are asked to identify the variables, form a question and corresponding hypothesis, decide what is kept constant in the experiment, why it is important to use more than a couple subjects, and analyze the data. Time: One 45-minute period. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health Lesson Plans – Level II: Blood, Breath, and Nutrition Unit Summary: The theme of this unit centers on the structure and function of blood as well as drawing relationships to health and nutrition. The units incorporate computer-based technology (as well as alternatives to using the technology), grade-appropriate math skills, and practical nutrition project applications. Time: This unit is intended to take between two and three weeks to complete, depending on how much time is spent on each activity. NOTE: These lessons do not attempt to cover every concept related to cardiovascular health. Rather, they include a series of structured and inquiry-based activities that build upon one another—a spiraled curriculum—with the early activities being more structured and the later activities being more openended). Level II Unit Activity Summary: Unit Introduction: Students are asked to complete blood related questions that assess their prior knowledge regarding the content of the unit. Time: One 45-minute period or less. Activity 1: "Spun Blood" Students are introduced to the components of blood as well as normal and abnormal blood by participating in a hands-on simulated blood centrifuging activity. Students begin to make predictions about what happens to components of the blood when disease or disorder causes abnormal conditions in the blood. Time: One to two 45-minute periods or one 90-minute block. Activity 2: "High Cholesterol – Not Just an Adult Problem" Students read about a young woman who has high cholesterol and other risk factors for diabetes. She is not overweight, but because of risk factors, it is important that she is careful about what she eats. Students are asked about what they know about cholesterol. Then, they conduct a WebQuest — an Internet research effort — to determine what they would advise the young woman to do about her high cholesterol and other diabetic risk factor conditions. An extension reviews spun blood and allows students to experience another hands-on simulation of normal blood versus blood with cholesterol. Time: One or two 45-minute periods, depending upon whether the extension lesson is included. Activity 3: "Raiders vs. Broncos" In this structured inquiry activity, students use the scientific process to pose a question and corresponding hypothesis about whether athletes who train at high altitude have more red blood cells compared to those who train at low altitude. Students use prepared images of blood at 400x magnification to count red blood cells in "samples" from Denver Broncos and Oakland Raiders. Each student will count the red blood cells in their image. They will compile all the data from the class to answer the question and see if their hypothesis is supported and speculate about whether training at high altitude may give athletes an advantage. Time: One to two 45-minute periods or one 90-minute block. Activity 4: "Heavy Breathing" In this activity, students are guided to create an experimental design to address the question and corresponding hypothesis they formulate about the affects of exercise on respiration rate. Hands-on methodologies are used to determine how exercise affects respiration rate. Time: One to two 45-minute periods or one 90-minute block. Activity 5: “Waiting to Exhale” In this activity, students delve deeper into the respiration process. Students create an experimental design to address the question and corresponding hypothesis they formulate about the affects of physical activity on the amount of carbon dioxide (CO2) that is expired through the respiration. Hands-on methodologies are used to determine how CO2 concentration is affected by exercise. Time: One to two 45-minute periods or one 90-minute block. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health Activity 6a: "Bread and Breath: Do Yeast Respire?" Students are introduced to yeast respiration and measure the amount of CO2 given off as a by-product from a mixture of known quantities of yeast, sugar, and warm water under anaerobic conditions. Students will collect data to determine the concentration of CO2 over time and graph their data or use alternative methods to determine a relative amount of CO2. The data collected in this part of the activity will be used as the standard to which other mixtures are compared in Activity 6b. Activity 6b: "It's the Yeast You Can Do" Students identify variables that could be changed in the standard yeast mixture and design multiple experiments that predict how the change will affect the amount of CO2 in the yeast respiration process. Students might choose to change the amount of yeast, the amount or type of sugar, or the temperature of the water. Time (Combined – 6a and 6b): One to three 45-minute periods or one and a half 90-minute blocks. Activity 7: “You Are What You Eat” The introduction of the activity reviews how the function of the blood, respiration, and other processes in our bodies are affected by what we eat, drink, and how much we exercise. Students choose a food item to research and then perform an activity to determine how many (walking) steps it will take to “burn” the calories of that food item. In addition, students determine how many calories they need per day and form conclusions about the class data. Time: One to three 45-minute periods or one and a half 90-minute blocks (depending on whether the assessments and extensions are done). Activity 8: “Building a Better Diet” Students begin this activity with a warm up which asks them to describe what types of foods and exercise might constitute a healthy lifestyle. Students are then introduced to the new food pyramid that includes both exercise and diet and compare it with the former food pyramid. Next, students are asked to journal about their food they eat and the exercise they do each day. Students are asked to compare their actual diet and lifestyle with the suggestions from the new food pyramid. Time: One to two 45-minute periods or one 90-minute block (students will need a week to journal about what they eat and what kind of exercise they do). Activity 9: "Community Connection" Students apply their learning to create a message for their community. Students have the choice of making a poster to educate people about blood or to encourage people to donate blood. Time: One to two 45-minute periods or one 90-minute block. Level II Assessment: Students apply their learning in this unit to questions associated with the experimental design process. Students are asked to identify the variables, present the question that the researchers may be trying to answer, what the corresponding hypothesis may be, and why specific aspects of the experimental design are necessary. Students are also asked to analyze and graph the data as well as make a prediction. Time: One 45-minute period. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health Lesson Plans – Level III: Cardiovascular Disease Unit Summary: The theme of this unit centers on cardiovascular disease (CVD) and the risk factors that lead to CVD. It does not attempt to cover every concept related to CVD. . These lessons are designed to prepare students for the culminating role-play activity that incorporates the process skills and knowledge gains of the previous activities. The unit incorporates computer-based technology, grade-appropriate math skills, and critical thinking application skills for role-playing an Emergency Medical Technician whose primary purpose is to differentiate CVD (and CVD risk factor symptoms) from symptoms associated with other medical conditions. Time: This unit is intended to take between two and three weeks to complete, depending on how much time is spent on each activity. NOTE: These lessons do not attempt to cover every concept related to cardiovascular health. Rather, they include a series of structured and inquiry-based activities that build upon one another—a spiraled curriculum—with the early activities being more structured and the later activities being more openended). Level III Unit Activity Summary: Unit Introduction: Students are asked questions to assess their prior knowledge regarding the heart, blood, heart disease and heart health, and health careers. Time: One 45-minute period. Activity 1: "Drugged Out Daphnia" In this activity, students are guided through the inquiry experimental design process to investigate the affect of various substances on the heart rate of Daphnia. Student groups select an independent variable (tobacco, alcohol, sleeping aids, etc.) and hypothesize how the variable will affect the heart rate of Daphnia. Time: One-two 45-minute periods. Activity 2: "Blue Genes" Students look at how genetics can contribute to risk factors for CVD. Students use a hands-on model which illustrates how genetic material is passed from generation to generation. The genetic model introduces the inheritance of high cholesterol, high blood pressure, and diabetes. Students are asked about their own medical family history and then formulate ideas about their own risk factors for developing CVD. Time: One or two 45-minute periods. Activity 3: "All Clogged Up" Students explore atherosclerosis (plaque) by doing a hands-on activity to measure how clogged arteries may affect the flow of blood. Students make predictions about how various percentages of blockage may affect the flow of a fluid through a vessel. If no pre-made blocked artery models are available, students will develop their own clogged artery models to determine if their hypotheses are supported. Time: One to two 45-minute periods (depending on whether students construct their own artery models). Activity 4: "Lethal Dose" Students conduct an experiment to investigate the affects of tobacco on Drosophila. An assessment is included at the end of the activity that reviews material from this and previous activities. Students are asked questions about what they know about the heart, blood, and risk factors associated with CVD before moving on to the next activity. Time: One or two 45-minute periods. Activity 5: "Heart Bypass Surgery” This is a structured heart dissection in which students review the parts of the heart. After students have reviewed the heart structures, they are given information about cardiologists and then perform a mock "bypass surgery" to correct blockage to the coronary artery. Time: One or two 45-minute periods. Activity 6: "Rhythm of the Beat" Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health Students review the nodes of electrical conductivity in the heart and then are introduced to electrocardiograms (EKGs). Students either research or take their own EKG. During the course of this activity, students are introduced to abnormal patterns of the EKG and the corresponding conditions those patterns represent. They are also introduced to the career of the electrocardiogram technician. Time: Two 45-minute periods or one 90-minute block. Activity 7: “EMT Training Day” In this structured activity, students are led through the rudiments of basic First Aid procedures and First Responder protocols that include checking the vital signs of a patient and determining the cause of their medical condition. Students learn about the health career of the Emergency Medical Technician (EMT) and are prepared to role-play an EMT for the next activity. Time: Three to four 45-minute periods or less than two 90-minute blocks. Activity 8: "EMT For a Day" This activity is designed as a station activity in which students role-play EMTs and patients in hypothetical scenarios. Students in the patient role act out specific medical symptoms that the students in the EMT role use to determine the patient’s medical condition. There are six patient scenarios (a diabetic, a smoker, a stroke victim, a heart burn victim, and two heart attack victims). The activity promotes a systematic problem-solving process with emphasis on risk factors for CVD. Time: Two or three 45-minute periods. Activity 9: "Community Connection" Students apply their learning to create a message for their community or to further connect with members of their community who are afflicted with risk factors associated with CVD. In this activity, students have the choice to design a poster to create awareness and of and suggest ways that people can control their risk factors for CVD or to interview a family member, neighbor, etc. who has CVD or any risk factor associated with CVD. Time: One or two 45-minute periods or one 90-minute block. Level III Assessment: Students apply what they have learned from this unit to form questions associated with the experimental design process. Students are introduced to a scenario and asked to describe what question the researchers in the scenario are trying to answer, why it is important to keep the characteristics of each experimental group the same, identifying the variables, analyzing the data, graphing the data, drawing conclusions, and forming predictions. Time: One 45-minute period. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health CardioHEADS National Science Content Standards Elaboration on each standard is available at http://newton.nap.edu/html/nses/6d.html#csa58 Content Standards As a result of activities in grades 5-8, all and Benchmarks students should develop Content Standards • Abilities necessary to do scientific A: Science as inquiry Inquiry • Understandings about scientific inquiry Content Standard B: Physical Science • Properties and changes of properties in matter • Motions and forces • Transfer of energy Content Standard C: Life Science • Structure and function in living systems • Reproduction and heredity • Regulation and behavior • Populations and ecosystems • Diversity and adaptations of organisms Content Standard E: Science and Technology • Abilities of technological design • Understandings about science and technology Content Standard F: Science in Personal and Social Perspectives • Personal health • Populations, resources, and environments • Natural hazards • Risks and benefits • Science and technology in society Content Standard E: Science and Technology • Abilities of technological design • Understandings about science and technology Content Standard G: History and Nature of Science • Science as a human endeavor • Nature of science • History of science Level I materials 4,5,6,7,8 Level II materials 1,3,4,5, 6,7,8 Level III materials 1,2,3,4, 2,3,4,6 1,2,3,4, 6,7,8 1,2,3,8 1,5,6,7,8,9 1,2,3,7,8,9 1,2,3,8,9 Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health CardioHEADS Experimental Design Background Information This document was designed to provide background information on the way the curriculum was designed and offer additional support. The following topics are discussed: 1.) The “sticky note” approach 2.) A presentation of our experimental design methodology in the context of data collection with human subjects 3.) The order of the scientific method that we selected for our experimental process 4.) Background Information - Experimental Design Concepts including vocabulary terms that are used in the scientific process and the variations of that vocabulary that may be encountered in different science texts 5.) Making the language of science explicit 6.) Blank CardioHEADS Experimental Design Worksheets A and B 1.) The “Sticky Note” Approach During the curriculum development process of CardioHEADS, our partnership teachers and University of Colorado faculty reviewed and offered critical input on our efforts to develop an inquiry-based health science curriculum. One of the recommendations for the curriculum revolved around the presentation of the scientific process. Several program teachers suggested a student-centered scientific investigation method that has been referred to as “the sticky note method” (Mears, Morris, Morris & Schiff, 1999). This method guides students through the scientific process by having students write the variables on sticky notes and move them through the various parts of the scientific process (i.e. the question, hypothesis, conclusion etc.). Students then are acutely aware of the variables and the role of the variables in the process. During the two pilot years, CardioHEADS teachers in the partnership schools tried various approaches to teach students the scientific investigation process. Teachers initially found the “sticky note” process confusing and many of them abandoned the process for a more traditional approach. However, teachers reported that the more traditional approach reduced the students’ role in the inquiry process. The final consensus among teachers was that the “sticky note” process worked best, but students and teachers need to build up to the process in smaller increments. As a result of teacher input, the finalized CardioHEADS curriculum reflects an incremental approach toward a studentcentered scientific investigative process that includes the “sticky note” methodology. Anecdotal pilot data from the implementation of the finalized curriculum suggests that the incremental approach to the “sticky note” methodology was the most successful of the various approaches attempted over the last three years. Teachers reported that the students were more successful forming their own scientific questions and final student assessments showed the identification of variables increased over previous years. 2.) Experimental Design Collection of Involving Human Subjects The experimental design presented in the CardioHEADS activities was selected to allow students to opportunity to develop the skills necessary for doing science experiments, gain an understanding of the need for keeping things constant, and answer the scientific question of the experiments. In our experimental design, the control groups/subjects/objects are those that are measured or observed under constant conditions and do not undergo the change of condition or “treatment” (independent variable) of the experiment. Thus, the control group serves as the standard for comparison to the experimental groups/subjects/objects to see whether the change of condition or “treatment” that the experimental group underwent had an affect. Typically in experiments involving human subjects, it is more common that all subjects undergo all conditions or "treatments.” Using the CardioHEADS curricula, this can be accomplished by extending the lesson over more class periods to allow all students to be both the control and experimental subjects, so that ALL students undergo ALL conditions or “treatments” of the experiment. In the first class period, the control data should be collected first. This would ensure that, each measurement (heart rate, CO2, etc.) is a baseline measurement where the conditions are held constant (i.e., students did not inadvertently exercise before getting their resting heart rate). This initial measurement of the dependent variable will serve as the control data point against which the values measured after the “treatment” (independent variable) are compared. This adaptation will enhance scientific accuracy, as all subjects will have undergone all conditions of the experiment. Further enhancements to these activities include exposing subjects to intermediary conditions (for example, subjects could begin by resting, then walking, then running) and grouping subjects according to gender, weight, ethnicity, age, etc. Regardless of experimental design methodology that you choose to use with your students, the greatest statistical significance will be obtained through the compilation of all of the class data. 3.) Scientific Method Observations in many classrooms have shown that teachers know the scientific method, but the order of the steps and the wording varies from classroom to classroom.. The order of the scientific method process used in the CardioHEADS curriculum is provided below. Teachers are encouraged to use their own series of steps. Step One: Formulate a question Step Two: Formulate a corresponding hypothesis Step Three: Identify variables Step Four: Design procedure Step Five: Collect data Step Six: Analyze data (make graphs, compute averages) Step Seven: Draw conclusions Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 4.) Science as an Inquiry Process The activities are structured to help students with inquiry process skills that include: forming and writing the scientific question, forming and writing a hypothesis, lab procedural steps, gathering data, and drawing conclusions. The steps in all three levels take an incremental approach that guide the student toward the question and, eventually, allow the students to develop their own question and even design the method of their experiment in Level III. If teachers already have a standard inquiry process, they can use their own methods in combination with the CardioHEADS inquiry process. Scientific Question: The scientific question in an experiment requires a level of background knowledge to be able to come up with a question. In the experimental design process, students are led to consider questions when given the variables, after background information is presented. These are the lab activities that are the prescribed experiments. After students gain these process skills, they are then given the freedom of identifying the variables on their own, then formulating their question. Hypothesis: In the context of the experimental design, the hypothesis is the prediction of what effect, if any, the independent variable will have on the dependent variable that is based on prior knowledge. It is helpful that the experimenter determines the independent and dependent variables so that he/she may use knowledge about the variables to make the prediction. Independent Variable (the variable that is changed): An independent variable is a factor that is intentionally varied by the person conducting the experiment. In other texts, it is also known as the treatment, manipulated variable, or the change of condition. Communicate to your students that it is the thing you change or vary in the experiment between the control subject/object and the experimental subject/object. Dependent Variable (the variable that is measure or observed): The dependent variable is the factor that you predict will change as a result of variation in your independent variable. It is easier for students to grasp if you describe the dependent variable as the thing they will measure or observe in the experiment. You can go further with your students by describing that it is the thing they will measure to see if the independent variable, or the thing that they change, causes an affect. The dependent variable relies on the parameters set by the independent variable that is why it is the “dependent” variable (i.e., the heart rate is dependent upon the amount of exercise). In other textbooks, this is also known as the responding variable or the variable that responds to the change. Control Group, Subjects, or Object(s): In a scientific experiment, the control is the group, subject, or object(s) that serves as a standard of comparison. It is exposed to the same conditions as the experimental group, except for the one condition that is different for the experimental group: the independent variable. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Experimental Group, Subjects, or Object(s): In a scientific experiment, the experimental group, subject, or object(s) will undergo the factor that is intentionally varied, changed, or experience the “treatment” (independent variable). Number of Trials: In the context of a science experiment, a trial is the number of times you run or repeat the experiment to give it statistical significance. Students should repeat the experiment as many number of times that is practically possible. Keeping Things the Same or Fair: In a scientific experiment, the “things that are the same or fair” are what is held constant in an experiment. Such items include various lengths of time that are included in the experiment, the number of trials to have more accuracy in the data, the amount of substance in a given mixture or what a student may consume to see if it increases heart rate or blood pressure, may include gender, age, etc., and all other conditions that are held constant between the control and the experimental subjects/objects. 5.) Making the Language of Science Explicit The “Valentines Day Rose Experiment Example” was created to help make the language of science more transparent to students and facilitate their understanding of the scientific process and experimental design. Procedure: A simple explanation of this experiment in both everyday and scientific language was placed on the overhead projector (see Transparency: Everyday versus Scientific Language below.) The students were asked to read both ways of describing the experiment and then, on their worksheet (below), students were to come up with their own ideas for a science experiment or just describe a science experiment that they did in class – in both their own words and using science words. Students struggled with this process, but Project teachers felt it offered students a good insight into the differences and similarities in everyday and scientific language. Students’ Examples: Juan, a sixth grader, wondered whether a bike tire kept inside would remain fully inflated longer than one kept outside. Clara, a sixth grader, asked, “Would students in my class behave better if they held class outside instead of inside?” These types of results indicated that the students were now thinking more critically about the world around them, after having gone through the inquiry process of the Level I curriculum. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 Transparency: Everyday versus Scientific Language Using Your Own Words – Rose Example: I wonder whether keeping roses in the refrigerator will make the roses last longer. I think that keeping the roses in the refrigerator will probably help them last longer. To be certain, I am going to do an experiment with roses to see if keeping roses in the refrigerator will keep them from wilting too fast. I am going to use 24 roses to see if my guess is correct. After I look at all the roses and make notes about the condition of each rose, I am going to put 12 roses in a vase with water and place them in the refrigerator. Then, I am going to put the other 12 roses in another vase with water and just leave them on the table. I will make sure that the vase of water stays full by adding more water to each vase every day. I will also make sure that the room temperature and the temperature of the refrigerator stays the same throughout the experiment. I’m going to take a look at each rose at a specific time every day for a week, and write down a description about what each rose looks like. My descriptions will be placed in two categories: 1. Roses Kept at Room Temperature, and 2. Roses Kept in the Refrigerator. After a week, I will take a final look at each rose and decide if my guess was correct: that roses will last longer if they are kept in the refrigerator. Using Words That A Scientist Would Use – Rose Example: My scientific question: Will the roses last longer if I store them in the refrigerator than roses that are kept at room temperature? My hypothesis: If the roses are stored in the refrigerator, then they will last longer than roses that are not stored in the refrigerator. I will design and perform an experiment to see if my hypothesis is correct. In my experiment, I will use a total of 24 roses. 12 roses will be my control subjects and 12 roses will be my experimental subjects. I will label each control rose with numbers (112) and each experimental rose (1-12), to keep things fair. The dependent variable is what I observe or measure. For this experiment, I will observe each control rose and each experimental rose every day for 1 week at 3 o’clock in the afternoon and write down my observations (collecting data) for each set of roses. The independent variable is the condition that is different between my control subjects and experimental subjects. The independent variable is temperature because that is the thing I am changing or doing differently to experimental roses. I will not change the temperature or do anything special to keep my control roses from wilting. After 7 days of recording my observations, I will analyze my data from my observations, form conclusions, and report whether my hypothesis was supported. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 Student Worksheet – How to Design a Science Experiment In the spaces below, tell a simple story about how you would do a specific science experiment. For example, you may describe any experiment that we conducted in class or you may create your own idea for an experiment that you would like to conduct (except for the rose example on the overhead projector). ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ In the spaces below, use language that a scientist would use to describe the steps of the same experiment that you wrote about above (i.e., independent variable, etc.). You may use a format where you list your question, then your hypothesis, discuss the difference between the control subject and the experimental subject, the variables, the experimental procedures, and how you would form your conclusions. Remember to be detailed and specific! ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 6.) Blank Experimental Design Templates This document contains worksheets that reflect the general format of the CardioHEADS version of the “sticky note” process. Worksheet A is the general format that is used when students have enough information to begin asking a question that leads to the hypothesis and corresponding experimental design. Worksheet B is the same general format, but identifies the variables first because as one considers ideas for an experiment, the variables are what, naturally, come to mind first. The experimental design process is therefore, circular between the identification of variables and forming the question. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 7 CardioHEADS Experimental Design Worksheet A. I. Formulating Your Scientific Question: To formulate your question below, it is important to recall what you have already learned about the topic under investigation. In the spaces below, write a scientific question that includes these facts. This question will set the stage for your investigation, helping you form a hypothesis, and design an experiment to answer the question. It might be helpful to look at your questions from the last couple experiments. ________________________________________________________________________ ________________________________________________________________________ _______________________________________________________________________. II. Hypothesis: A hypothesis brings together what you already know about the topic and the scientific question into a prediction about what will happen when you manipulate the independent variable. In the space below, write your hypothesis. ________________________________________________________________________ ________________________________________________________________________ III. Identifying Variables: An important component of designing an experiment is identifying variables. The independent variable is the thing that we will change in our experiment. The dependent variable is the thing that we will measure or observe that responds to the independent variable. What are the independent and dependent variables in this experiment? Independent Variable: We will change Dependent Variable: We will measure IV. Defining the Control in the Investigation: The control and experimental will vary between investigations. Refer to the activity to help you determine the control and experimental for this investigation. Control Group/Subjects/Data Point: _______________________________________________________________________ _______________________________________________________________________ Experimental Group/Subjects/Data Point: _______________________________________________________________________ _______________________________________________________________________ V. Finishing the Experimental Design: Keeping Things Fair: To be fair, you will need to keep everything the same in your experiment except for your independent variable. What things will you keep the same in your experiment? We will keep the same: The teacher has approved this experimental design. CardioHEADS Experimental Design Worksheet B. I. Selecting Your Dependent Variable: In some activities, you began by asking your scientific question that contained both independent and dependent variables. Scientists do not always think of their question first, sometimes scientists begin by identifying variables. The independent variable is the thing that we will change in our experiment. The dependent variable is the thing that we will measure or observe that responds to the independent variable. After brainstorming the possible variables for your experiment, what are the independent and dependent variables that you have selected for this experiment? Independent Variable: We will change Dependent Variable: We will measure II. Scientific Question: In this experiment, you have already selected the variable you will measure and the variable you are choosing to change. In the spaces below, write a scientific question that includes the two variables you selected. This question will set the stage for your investigation, helping you form a hypothesis, and design an experiment to answer the question. It might be helpful to look at your questions from the last couple experiments. ____________________________________________________________________ ___________________________________________________________________? III. Hypothesis: Based on what you know about the topic and your question above, what do you think will happen when you make the change? In a complete sentence, state your hypothesis. ________________________________________________________________________ _______________________________________________________________________. IV. Defining the Control in the Investigation: The control and experimental will vary between investigations. Refer to the activity to help you determine the control and experimental for this investigation. Control Group/Subjects/Data Point: _______________________________________________________________________ _______________________________________________________________________ Experimental Group/Subjects/Data Point: _______________________________________________________________________ _______________________________________________________________________ V. Finishing the Experimental Design: Keeping Things Fair: To be fair, you will need to keep everything the same in your experiment except for your independent variable. What things will you keep the same in your experiment? We will keep the same: The teacher has approved this experimental design. Bibliography Mears, C., Morris, L., Morris, M. & Schiff, S. (1999). Science Inquiry Toolkit. Consortia Addressing Statewide Systemic Issues for Leaders in Learning and the Colorado Science Cadre. CardioHEADS Pasco Scientific Equipment - Teacher Guidelines CardioHEADS has a strong technology component which serves to increase student engagement and expose student to authentic technology use. Pasco Scientific probeware1 and Apple laptops were used during the course of the pilot program, however, Pasco GLX Xplorers—a device like a graphing calculator which eliminates the need for computers—are recommended over the laptops due to their lower cost and maintenance. However, if you already have computers in a lab or your classroom, you simply need the appropriate Pasco sensors. The purpose of this document is to provide instructions for using the Pasco Sensors (heart rate sensor, CO2 sensor, and the EKG sensor) and their bundled software, Data studio within the context of the CardioHEADS curriculum (we had the best results modeling the sensor use for students with a data projector; however, clear and explicit instructions should suffice). The instructions below cover the use of Pasco Scientific sensors with both the computer and the GLX Xplorer. Measuring Heart Rate with the Pasco Sensor: The heart rate sensor is a light sensor that measures the pulse of the capillaries. The data the sensor collects is in the form of the “heart beat” and it averages the signal strength and the variation of the data to get the heart rate values. To get the best possible data for this classroom activity, it is best to set up a workbook within Pasco’s software: DataStudio. You will save the workbook and place it on computers in which you have loaded the Pasco software. To access the program and the activity, the students will only need to open the workbook file and you can begin walking them through the activity procedures. DataStudio Workbook Setup for Heart Rate Lab • Start the computer. 1 • Connect the USB Link into a USB port of the computer – the icon on the link, generally, faces upward. • Connect heart rate sensor into USB link. • A window will appear on the computer display that says, “I found a new heart rate sensor. How would you like to use it?” • Click “Launch Data Studio.” • Remove the digits window by clicking on the red dot in the upper corner of the window. Click “ok” in the message dialog box. Probeware refers to all the Pasco equipment used for data collection • Look in the “Data” window in the upper left corner of DataStudio. Grab the “heart rate (beats per minute)” with your cursor and drag it into the graph. You will get a split graph: 1 w/ “heart beat” and 1 w/ “heart rate.” • Delete the top graph by placing the cursor on the top graph and then delete. Now, you have the “heart rate” graph for your students to view. • Click on the sigma (Σ) button to open up the statistics window. • Click on the “setup” button (located near the top menu bar, next to “Start”). Change the sample rate from 50 Hz to 100 Hz and then close the window by clicking on the red dot (don’t hit the “change” button). If you hit the “change” button in the window, reopen the window and reset the sampling rate again without hitting the change button. • Connect data points which creates a continuous line graph instead of just data points by double clicking anywhere on each graph. • Click on “experiment” in the top menu, then “sampling options,” and then “automatic stop.” Set the automatic stop to 60 seconds. • Save the activity as ”heart rate lab” or some other file name that students can easily recognize to the “Desktop” of the computers they will use. Activity Procedures - Heart Rate Sensor 1. Have the students will double click on the saved workbook file, located on the desktop, to begin the heart rate measurement portion of this lab activity. Again, if you have a data projector, it will be easier to show the below procedures on a screen. If you do not have a workbook created (see above), you will need to guide students through steps 1-10 listed above. Then, skip to step #4 below. 2. After the students have opened the workbook, have students plug in the USB Link. Note: If you are familiar with using Pasco equipment, creation of this workbook eliminates the step where plugging in the sensor opens the DataStudio program because opening the workbook file opens DataStudio. Additionally, it saves going through the steps described above. 3. There are four possible places to place the clip-on heart rate sensor on the body to get a heart rate reading: 1. at the end of a forefinger, 2. the webbing of the hand between the thumb and forefinger, 3. an earlobe, or 4. the top of the ear. 4. Have the students place the sensor on one of those locations. 5. Direct the students to hit the “Start” button to begin measuring their heart rate. 6. If the mean or average heart rate data shown in the statistics window is between 50-90 beats per minute, the sensor is detecting the heart rate well in that location. Have the students, who are getting a reading within this range, continue to 2 Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health measure their heart rate. The workbook is set up with an automatic “Stop” after one minute. 7. Have the students record their mean (average) heart rate on the data table for the activity. 8. If the mean heart rate is below or above the range above, then have the student place the sensor on one of the other above-mentioned locations. Then, repeat steps 5-7. 9. When all students in each group are finished with their data collection, have them click on: “Quit DataStudio.” 10. A window will appear that asks if you want to save the data – click on: “no.” 11. Have the students disconnect the sensors and place them back in their plastic bags. 12. If a laptop MacIntosh computer is being used, the screen must be allowed to completely go blank, before shutting the lid; otherwise, it will not completely shut down. GLX Xplorer (GLX) Method Using Pasco Heart Rate Sensors 1. Turn on the GLX – button in lower right corner. Plug in the heart rate sensor into one of the sensor ports of the GLX. If the battery is not charged, you will have to connect it to the AC Adaptor. The GLX will automatically recognize the sensor and go to the “heart beat” graph. 2. For more accurate data collection, press the “home” button icon for the main menu. Press F4 and you will be taken into the specific settings associated with the heart rate sensor. 3. Skip the “Sample Rate Unit” (it should read: “samples/s”) and use the arrow keys to highlight: “sample rate.” Press “√” and scroll to 100 (this is a sampling rate of 100 HZ as described in the computer methods above) and press “√” again. Leave the “Reduce/Smooth Averaging” on “Off.” 4. Scroll past the “Reduce/Smooth Averaging.” It should read: “Off.” 5. Scroll down to “Heart Beat” and press “√” so that it reads: “Not Visible.” Leave the “Heart Rate” “Visible.” 6. Press the “home” button again and press F1 to go “Graph.” 7. Press F3 and scroll down to #4 “Σ Statistics” and press “√.” The statistics will appear at the bottom of the graph. 8. Have students place the heart rate sensor in one of the locations described in #4 of “Activity Procedures” above. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 9. Have the students push the start/stop button (f) to begin measuring their heart rates. The statistics window will not appear on the GLX while students are measuring their heart rates. After about 20 seconds, you may want to have students push the start/stop button (f) to view the statistics. If their mean (average) heart rate is between 50-90 beats per minute, then have them start the program again and measure their heart rate for a full minute. Note: The sensor does not show the line graph immediately. Inform the students to be patient – the line graph will eventually appear. 10. After one minute, have the students press the start/stop button (f) and then record their mean (average) heart rate on the data table for the activity. 11. Repeat steps 9 & 10 for additional data collection runs (i.e., before and after -control and experimental subjects). A new graph will appear for each data run, so students will have to record their data before the next person takes their measurement. If the GLX shuts down (which it does automatically to conserve the battery), all of the steps will have to be repeated for the next data to be collected. 12. Have students shut down the GLX by pressing the on/off button in the lower right hand corner. When the question comes up about saving the file, have students press F2 – “no.” Computer Method Using the DataStudio Program and Pasco CO2 Sensors: The CO2 sensors offer an easy way for students to measure CO2 for the Level II activities. Procedures for Level II Activity 5 1. Have the students start the computers while you show the students the equipment they will using for the activity. 2. Have students connect the USB link to the computer. 3. Connect the CO2 sensor to the USB link. 4. A window will appear on the computer display that says, “I found a new CO2 sensor. How would you like to use it?” 5. Click “Launch Data Studio.” 6. Close the “Digits” window by clicking the red circle in the upper left corner. 7. Click “OK” in the message dialog box. 8. Click on “Graph” in the “Display” window on the left. 9. Double click your cursor anywhere inside the graph. You’ll get a window that allows you to “connect the data points,” so you can see a line graph. Click that box and then click “OK.” If you use four re-sealable plastic bags for this activity, use the permanent marker to label the plastic bags as shown below. If you choose to conserve resources, then use two re-sealable bags and label them: “control” and “experimental.” You will have to keep Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 track to make sure the control and experimental subjects each use their bag twice for “before” and “after” measurements. “control before” “control after” “experimental before” “experimental after” 10. Model how to inflate the re-sealable plastic bag with your exhaled breath. 11. Model how to open a small corner of the bag; keeping the majority of the bag sealed and insert the end of the CO2 sensor. 12. While modeling keeping the bag sealed around the sensor, have a student click on the “Start” in DataStudio on your computer or one of the computers the students are using. 13. Measure the amount of CO2 for one minute and have your student assistant click on “Stop.” 14. This is your “before” measurement. Discuss how ALL students will be gathering the data for their “before” measurements. 15. Have students hit the “scale graph” button, after they’ve hit the “start” button. This will help them see the graph on the best scale. 16. Click on the sigma button (Σ), on the lower menu, to get the statistics window to appear in your graph. 17. Instruct students that they will record the maximum amount of CO2 shown in the statistics window on their data tables – make sure they enter it as the “before” value. 18. Now, model how the control subject will rest while the experimental subject exercises for the duration specified in their experimental designs. Then, each subject will exhale air into the bag again, or use the “after” bag. 19. Have students repeat the above process and record their data on the data tables. To close DataStudio: 1. Click on: “Quit DataStudio.” 2. When asked if you want to save the data, click “no.” 3. Disconnect your CO2 sensor and shut down the computer Procedures for Level II Activity 6a and 6b Show your students how to place the sensor in the bottle that contains the yeast, sugar, and water mixture. Emphasize how the sensors cannot get wet and model wiping off the top of the bottle, after shaking up the mixture. Demonstrate keeping your hands on the bottle, while the sensor is in the bottle, so that students know to keep their hands on the bottle to prevent it from spilling. Because it is top heavy, students might easily knock it over if they are not careful. 1. Go through steps 1-9 above. 2. Have the students gather the materials for the yeast, sugar, and water mixture (50 ml of warm water, one vial or gram of yeast, and one vial or gram of sugar). Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 3. Have the student pour the sugar into the container with the warm water and swirl the mixture until the sugar is dissolve, then add the yeast. 4. When the yeast is mixed enough, bubbles will begin to appear. Have students wipe off the mouth of the bottle to make certain it is not wet. 5. Instruct students to place the sensor in the bottle. MODEL how they should hold the bottle, steady, on the table – not the sensor because it must not tip over and get the sensor wet. 6. Click on “Start” in DataStudio and have students measure CO2 for two minutes. 7. Follow steps 15 –17 above, but students are also required to record the amount of CO2 on a data table in their worksheets EVERY 15 SECONDS up to two minutes. They will also have to record the maximum amount (step 17 above). For Activity 6b, have students follow the same procedures and record their data on the data table in the student worksheet for Activity 6b. Have students rinse out the bottles after each experiment. CO2 Sensor Troubleshooting You may need to troubleshoot why students are not getting a CO2 line graph appearing on their screen. Troubleshooting is best done in the following order: 1. See if the students have hit the “scale graph” button, after they have hit the “start” button. 2. Make sure they have double-clicked on the graph to connect the data points. 3. Take the sensor out of the bottle and blow directly on the sensor to see if you get a CO2 concentration reading. 4. If you got a CO2 reading with your exhaled breath, then hit “stop” and make certain that the mixture has been mixed enough (cover bottle and really shake the mixture and make sure the mouth of the bottle is wiped off before placing the sensor back in the bottle). 5. If you did not get a CO2concentration reading from your exhaled breath, close down DataStudio and then restart DataStudio using the same process where you connect the sensor to open the program. Starting from scratch is sometimes best, when all other troubleshooting doesn’t seem to work. 6. Restart the computer. 7. Restart DataStudio using the above guidelines for troubleshooting once again. GLX Xplorer (GLX) Method Using Pasco Heart CO2 Sensors The GLX can be used as is for collection of CO2 data. However, it would be easier for all CardioHEADS activities that measure CO2 to get a cord that extends the CO2 sensor away from the GLX – see your Pasco representative for pricing. If the sensor is extended away from the GLX, students will have an easier time doing their measurements and are less likely to have accidents getting the CO2 sensor wet (see guidelines for Activities 6a and 6b above) when doing the yeast respiration activities. 1. Turn on the GLX – button in lower right corner. Plug in the CO2 sensor into one of the sensor ports of the GLX. If the battery is not charged, you will have to Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 connect it to the AC Adaptor. The GLX will automatically recognize the sensor and go to the “CO2” graph. 2. The set up for the CO2 data collection is fine for the purpose of all Level II activities, but students will need the statistics for their data recording. Press F3 and scroll down to #4 “Σ Statistics” and press “√.” The statistics will appear at the bottom of the graph. 3. Have students place the CO2 sensor in the corner of the Ziplock baggie for the exhale breath activity; or in the bottle for the yeast respiration activities. 4. Have the students push the start/stop button (f) to begin measuring the CO2. The statistics window will not appear on the GLX while students are measuring CO2. Let the sensor collect data for the time length provided in the activity (see above) or according to student experimental design. 5. Press the start/stop button (f), after the designated time and have students record the “maximum” amount of CO2 on the data table for the activity. 6. Repeat steps 4 & 5 for additional data collection runs (i.e., before and after -control and experimental subjects). A new graph will appear for each data run, so students will have to record their data before the next person takes their measurement. If the GLX shuts down (which it does automatically to conserve the battery), all of the steps will have to be repeated for the next data to be collected. 7. Have students shut down the GLX by pressing the on/off button in the lower right hand corner. When the question comes up about saving the file, have students press F2 – “no.” Computer Method Using the DataStudio Program and Pasco EKG Sensors: An EKG workbook can be created to eliminate student procedure steps. If you choose not to do the workbook set-up, it will be best for you to walk the students through the following steps before doing the EKG measurements because you will get clearer EKG patterns. 1. Start the computer. 2. Connect the USB link into a USB port of the computer. Generally, the USB icon on the USB link faces upward. 3. Connect the EKG sensor to the USB link (green Pasco lettering is aligned). 4. A window will appear on the computer display that says, “I found a new EKG sensor. How would you like to use it?” 5. Click “Launch Data Studio.” 6. Close the “Digits” window by clicking the red circle in the upper left corner. 7. Click “OK” in the message dialog box. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 7 8. Click on “Graph” in the “Display” window on the left. 9. Double click your cursor anywhere inside the graph. You will get a window that will open entitled: “Appearance” - - click on “connect data points”, and also unclick “show data points” to see a continuous line graph. 10. Click on: “Axis Settings.” On the bottom lower left, click on “sliding fixed range” and unclick the other two options in the “automatic scaling” part of this window. 11. Next, set the Y & X scales both from 0 to 5 for the minimum and maximum, respectively. 12. Click “OK.” Save the workbook as EKG Activity and place it on the desktops of the computers your students will be using for the activity. Procedures for Level III Activity 6 Guide students through the EKG procedures below: 1.) Start the computer. 2.) If a workbook is created, the students will double click on the workbook file located on the desktop. Otherwise, follow steps 2-12 above. 3.) Instruct the students to do the following for each member of the group: a.) Stick three EKG electrode tabs to your skin. Stick one on the inside of your left arm just below the elbow. Stick one on the inside of your right arm just below the elbow. Stick one to the inside of your right wrist. There is a diagram on the sensor itself to help guide students. Green (negative) Red (positive) Black (ground) b.) Using the diagram above to match the colors to the right locations, connect the EKG electrode clips to the tabs. Instruct students to SIT STILL TO COLLECT DATA c.) Click the “Start” button (see below). The start button is in the top left corner and has a green triangle. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 8 d.) When you begin to get a regular pattern like the one below), record for about 10-20 seconds, then click the “Stop” button. “Start” button Regular pattern e.) If you want to make your EKG pattern appear larger, place the cursor on the x-axis where you want to expand the graph. When you see a double arrow, click and hold as you drag the cursor to expand your graph. f.) Print your EKG if you have access to a printer. 9.) Repeat Step 8 for each member of the group. GLX Xplorer (GLX) Method Using Pasco Heart EKG Sensors 1. Turn on the GLX – button in lower right corner. Plug in the EKG sensor into one of the sensor ports of the GLX. If the battery is not charged, you will have to connect it to the AC Adaptor. The GLX will automatically recognize the sensor and go to the “CO2” graph. 2. The set up for the EKG data collection is fine for the purpose of Activity 6 – Level III. Students will merely look at their EKG patterns and not collect statistics. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 9 3. Instruct the students to do the following for each member of the group: a.) Stick three EKG electrode tabs to your skin. Stick one on the inside of your left arm just below the elbow. Stick one on the inside of your right arm just below the elbow. Stick one to the inside of your right wrist. There is a diagram on the sensor itself to help guide students. Green (negative) Red (positive) Black (ground) b.) Using the diagram above to match the colors to the right locations, connect the EKG electrode clips to the tabs. Instruct students to SIT STILL TO COLLECT DATA c.) Click the “Start” button (see below). The start button is in the top left corner and has a green triangle. d.) When you begin to get a regular pattern like the one below), record for about 10-20 seconds, then click the “Stop” button. 4. Have the students push the start/stop button (f) to begin measuring the EKG. Let the sensor collect data for about 10-20 seconds. 5. Press the start/stop button (f). Students will only be able to see a basic EKG pattern. If a printer is available, you can hook the GLX to the printer to allow students to have a print out of their EKG patterns. Note: There is no way to expand the graph to have the appearance of the EKG patterns become more spread out and visible as on the computer. 6. Have students shut down the GLX by pressing the on/off button in the lower right hand corner. When the question comes up about saving the file, have students press F2 – “no.” Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 10 CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Unit Introduction: “Heart Disease – What Do You Know?” Grade Level: 6-9 National Science Content Standards: N/A Purpose: The student prior knowledge assessment (PKA) is designed to elicit students’ existing knowledge related to the material that will be covered in this unit. Use this PKA to determine students’ areas of strength and weakness (and thereby use this information) when you introduce topics and to determine the level of coverage needed to introduce the various topics in the unit. Using the PKA as a pre- and post-test is a useful assessment tool and can help illustrate to students how much they have learned throughout the course of the unit. Suggested Time: One 45 minute Period Materials: Refer to Level I to offer students more support on the heart Refer to Level II to offer students more support on blood, breath, and nutrition Transparency – Heart Introduction Transparency – Blood Introduction Special Needs Considerations: For students’ who have difficulty copying off of overheads, provide those students with hard copies. Introduction: Explain to students that you will be spending the next ___________ (week, month…) studying the heart, heart related health problems, and health careers. Offer students a glimpse of what you have planned for them. Activity Procedures: Student Prior Knowledge Assessment Instruct students that you want to find out what they already know about the topics they will be covering in this unit. They should, therefore, try their best to answer the PKA questions as fully as possible. Give students the student document - Unit Introduction, Level III. The answer key is included in this document under resources and the material from the transparency presentation should answer most of the student questions Presentation – Unit Introduction When students have had enough time to finish the questions, present the transparencies to the class. Most of the answers to the questions are within the content on the transparency. Use the transparencies to guide you through a unit introduction. The information contained on these transparencies is helpful basic knowledge for the activities in the unit. You may ask your students to correct their answers on their PKA as you go through the material. Wrap Up: To illustrate how hard the heart works, have students squeeze a tennis ball 60 times in one minute. Assessments: Use this as a unit pre assessment. Give this again at the end of the unit to assess student learning. Resources: Use CardioHEADS instructional material from Level I or II to provide greater detail on particular topics. CardioHEADS Level I focuses on the heart structure. CardioHEADS Level II focuses on the blood, breath, and nutrition. Teacher Information - Level III – Prior Knowledge Assessment Key Heart and Heart Attacks – What do you know? Look at the answers below and see how they compare to what you answered. Make corrections and additions to your answers as necessary. 1. What is a heart? The heart is a muscular organ with 4 chambers. 2. Draw and label a picture of a heart. A possible heart drawing is shown below. Aorta (bloodflow to body) Left atrium Right atrium Right ventricle Left ventricle 3. What is the function of the heart (what does the heart do)? The heart pumps blood to all parts of our body. 4. What is blood? Blood is a liquid containing 4 major component: Red blood cells, White blood cells, Plasma, Platelets Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 5. What is the main function of blood (what does blood do)? Blood carries oxygen to all the cells or our body. 6. Why do our cells need oxygen? Our cells need oxygen in order to convert the food we eat into energy we can use. 7. What are blood vessels? Blood vessels are semi-flexible tubes. 8. What is the function of blood vessels (what do blood vessels do)? Blood vessels carry blood from our heart to all the parts of our body and back to the heart. 9. Do you know anyone who has had a heart attack? Answers will vary. 10. What do you think a heart attack is? A heart attack occurs when a blood vessel that provides blood to a part of the heart is blocked. When the blood vessel is blocked, that part of the heart does not receive fresh blood. Without blood the heart has no oxygen and that part of the heart dies since it cannot make the energy it needs to survive. 11. What do you think causes heart attacks (list all the contributing factors you can think of)? There are many different factors that contribute to heart attacks. These factors include age, family history, smoking, high blood pressure, diabetes, high cholesterol, diet, and the immune system. We will be exploring many of these factors in more detail in this unit. 12. What do you think you can do to decrease your chances of having a heart attack? • • • • Don’t smoke Eat a healthy diet and maintain a healthy weight Exercise Maintain healthy blood pressure and blood cholesterol levels 13. What does an EMT do? EMTs are medical professionals who respond to accidents or other emergency medical situations. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Transparency – Heart Introduction Aorta Left atrium Left coronary artery Right coronary artery Right atrium Cardiac vein Left ventricle Right ventricle The heart is an organ made of muscle tissue. Most of the cells of the heart are muscle cells. The heart’s function is to pump blood throughout the body. It is located in the center of chest, behind the breastbone or sternum. This location allows the heart to be protected by both the sternum and the ribcage. The center of the chest is also a good location for the heart because it is located near the middle of the body. Thus, the blood does not have to travel as far to get to body’s extremities like the hands and feet. The heart sits slightly above the center of the body. This is a good location because it is harder to pump the blood up than to pump the blood down. The human heart is about the size of a clenched fist. It has four chambers and is attached to several major blood vessels, which carry blood to and from the body. On average, the human heart beats about 60-80 times per minute. This is called the heart rate. Every time the heart beats, it has to generate enough force to move blood through the entire body. A heart attack occurs when a blood vessel that provides blood to a part of the heart is blocked. When the blood vessel is blocked, that part of the heart does not receive fresh blood. Without blood, the heart has no oxygen and that part of the heart dies. There are many different factors that contribute to heart attacks. These factors include age, family history, smoking, high blood pressure, diabetes, high cholesterol, diet, and the immune system. Transparency – Blood Intro What is Blood? Blood is an essential liquid that is pumped by the heart through arteries, veins, and capillaries. Blood is made up of water, protein, and cells (mostly red blood cells). The picture below shows what blood looks like under a microscope. Blood is made up of four major components: Red blood cells White blood cells Plasma Platelets Blood carries nutrients from the digestive tract and oxygen from the lungs to body tissues. It carries waste matter (ureic acid, etc.) to the kidneys and liver for disposal, and carbon dioxide (CO2) from the cells of the body to the lungs. Blood also transports hormones, electrolytes, immune system components, and heat to the body. The average adult body contains five liters of blood. To get a sense of how much that is, it is the same as two and a half two liter bottles of soda. As you recall from learning the circulatory systems, the heart pumps blood to all the cells of the body. Blood travels through the body in blood vessels like arteries, veins and capillaries. Arteries take blood away from the heart. Veins take blood to the heart. Capillaries connect arteries and veins. CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 1: “Drugged out Daphnia” Grade Level: 6-9 National Science Content Standards: A, C, F Purpose: To illustrate the effects of various substances on the heart. Objectives: After completing this exercise students should be able to: • Design and conduct a simple experiment. • Describe how different substances affect heart rate Suggested Time: Two 45 minute periods Prerequisite Skills: Prior use and knowledge of microscopes is helpful. The ability to use a clock or timer. Prior experience with the scientific process is helpful (if students do not have experience with the scientific process, plan on allowing more time to go through the experiment.) Materials: Prepare the solutions for the independent variable the day before the lab. • Microscopes (dissecting or light) • Slides w/ cover slip • Droppers • Daphnia – Carolina Biological $6.75 for 30 $32.00 to raise your own culture. • Clock or watch with a second hand • 1.5" x 2" Sticky Notes (8 per group) Materials for the Independent Variable: • Water (room temp/ cold/ warm) • Alcohol- mix 10 ml of alcohol in 300 ml of water. • Caffeine- dissolve 5-6 tablets of No-Doz or other brand in 300 ml of water • Nicotine- soak cigarette or chewing tobacco in water for at least 2 hours, and filter through filter paper (to make approx 300 ml) • Aspirin- dissolve 8 tablets of aspirin in 300 ml of water • Sleeping aids- dissolve 5 tablets of sleeping pills (over the counter) in 300 ml of water Vocabulary: Compound eye - \COM • pound eye\ A visual organ found in certain arthropods such as insects and crustaceans which tiny sensors distinguish between brightness and darkness, and sometimes can detect color. Control Group - \con • TROLL groop\ In an experiment, the group that does not receive any treatment or change. Crustacean - \krus tay shun\ Any of various predominantly aquatic arthropods of the class Crustacea, including lobsters, crabs, shrimps, and barnacles, characteristically having a segmented body, a chitinous exoskeleton, and paired, jointed limbs. Daphnia - \daff nee ahhh\ Any of various water fleas of the genus Daphnia, some species of which are commonly used as food for aquarium fish. Dependent Variable – \DEE• pen • dent VAIR • ee • ah • bul\ The thing that we measure and/or observe in our experiment to see if it was affected. Fair Test - \fayr test\ When all variables and conditions are held the same throughout the experiment, only changing your independent Heart Rate - \heart rayt\Tthe number of times the heart beats at for a set mount of time. Hypothesis – \hy• PAHTH • eh • sis\ An educated guess. A prediction or possible explanation based on known facts. Independent Variable – \in • dee • PEN • dent VAIR • ee • ah • bul\ The thing that we change in an experiment or the thing that differs between the control and experimental group. Trial - \TRI • all\ The process of testing something in an experiment more than once. Variation - \vair • ee • AYE • shun\ A repetition with its essential features intact and other features modified. Misconceptions: • Students may not make a connection between diet and long-term health of their bodies. • Students may not make a connection that substances like caffeine and nicotine are chemicals that directly affect bodily functions such as heart rate and blood pressure. • Students may think the experiment is over after they collect the data. Have questions ready to prompt answers for conclusions and consider allowing the students to have time to finish the lab as homework. Special Needs Considerations: Heterogeneous grouping may allow sharing of ideas for completion of the procedure steps of a similar inquiry lab. Background: Daphnia, or water fleas, are crustaceans and are related to freshwater and brine shrimp. Daphnia can be purchased from science suppliers and be kept alive for many months. See suppliers for directions on care of Daphnia. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 Introduction and Warm Up: General Activity Information By observing how Daphnia respond to chemical changes in their environment, this activity is designed to help students gain an understanding of how our diet and environment may affect our heart function. This experiment is designed to illustrate the short-term affect of substances on the heart. Students will be asked to make a connection between short-term effects and long-term effects of substances on the body. Guidance Through Student Introduction The entire unit is focused on the idea that how we treat of our bodies has either a positive or a negative impact on our heart function. In the student introduction, they read about Daphnia and the experiment they will perform. To prompt students to begin considering the connection between their own heart function and what the put in their body, ask them: “What are some things that you can put into your body that will affect heart function? How can putting different chemicals in your body have a negative affect on your body?” Explain to students that the Daphnia and their reaction to the different solutions are meant to be a representation of heart function that can be generalized to other animals. NOTE: You may wish to inform your students that the Daphnia do not feel pain. Activity Procedures: Divide your students into groups of four. Inform your students that each group will be designing an experiment; but first, all groups will participate in a brainstorming session about possible independent and dependent variables for the experiment. Remember, in each step it may be necessary for you to review how it relates to the steps of the scientific method and designing their experiments. Proceed with brainstorming a list of common drugs, foods, chemicals or things one could do to affect one’s heart rate. To begin, the following questions are suggested: “Based on your past experiences, what are some things that may increase heart rate? What are some things that might decrease the heart rate? What are some things that might not affect the heart rate?” Below, is a list of independent variables that may affect heart rate. Independent Variables for Experiment • Aspirin • Alcohol • Nicotine • Caffeine • Sleep Aids (over the counter) • Sugar • Capsaicin (active ingredient in chili peppers) Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Scientific Process Procedures: I. Selecting Your Dependent Variable: As students begin the experimental design process, students will decide how they want to measure the heart rate. One way that may work is for the students to count the number of times a heart beats in 15 seconds and multiply by four to get beats/minute. Instruct the students whether they will use sticky notes or write in the squares. II. Determining Things You Can Change (Independent Variable) That May Affect A Dependent Variable: Students are now presented with four sticky note spaces or four boxes to write their top selections of independent variables to consider. Make sure their lists are things that are in the list on this document or other items that are attainable for the experiment. If the students design their experiments on one day and do the experiment on the next, have them bring in items that they will use for their independent variable to make the experiment “their own.” You should, however, have some of the materials available for back up in case students forget to bring them. III. Experimental Design - Identifying Variables: From list of the four top independent variables, each student group will select their variables by moving the sticky notes or rewriting each selected variable. IV. Question: Students are requested to write their question in a complete sentence. To assess their questions, make sure that it is a question that contains both the independent and dependent variables. A question that contains both variables will have the following structure: Will Aspirin (independent variable) cause the heart rate (dependent variable) to decrease [may include: relative to a normal Daphnia heart rate]? The structure of the question and the corresponding hypothesis (below) are sometimes difficult for students because they are quite different than everyday talk. Make sure to allow enough time to model the structure and thought processes of the question and the hypothesis. V. Hypothesis: Students are now asked to write a hypothesis that is based upon what they think might happen to the dependent variable when the change is made relative to the control subject(s). Complete sentence hypotheses will have the following structure: If Daphnia are exposed to Aspirin (independent variable), then the heart rate (dependent variable) will decrease in comparison to the normal heart rate of a Daphnia not exposed to aspirin (how it will affect a Daphnia relative to the control subject). Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 VI. Defining the Control: Discuss the idea of a control group with students. This is the Daphnia heart rate under normal conditions. Emphasize that the control group receives no treatment and is what students will be using to compare with their experimental groups. VII. Finishing the Experimental Design: Keeping Things Fair: The students are asked to respond to what they will keep the same or fair in their experiments. Assess their responses to determine if more review is necessary. One aspect of keeping things fair is by repeating or running the experiment multiple times to reduce experimental error through taking the average of the trials. Inquiry Lab Procedures: 1. The students will gather the materials needed for their experiments. If necessary, review and/or model how to use the microscopes, glass slides, and cover slips. If the students’ experimental designs are adequate and your students know how to do their measurements, they are ready to gather materials and begin. If not, review and model any procedures that seem unclear. Then, proceed to step 2. 2. There are blanks in the data tables that need to be filled out so that the tables are specific to each experiment. Instruct each group to fill in those blanks and check student work. 3. Emphasize that students must follow their experimental design as they record their data. 4. Conclusions – have students answer the questions in the conclusion section. They may have difficulty forming a complete sentence for the conclusion. Again, make sure you allow enough time to model the thought processes of the data analysis and the corresponding structure of the conclusion. Asking if the hypothesis was “supported” is intended to help the students begin to understand there is no right or wrong answer, but rather is based on the data of the experiment. Wrap Up: Have students present their findings to the class. Extensions and Optional Substitutions: Make a class table for different substances and their effects. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 2: “Blue Genes” Grade Level: 6-9 National Science Content Standards: F Purpose: To introduce the concept of genetic inheritance related to risk factors for CVD. Objectives: After completing this exercise students will be able to: • Understand that some of the risk factors (high cholesterol, high blood pressure, diabetes) for development of cardiovascular disease (CVD) are genetic. • Understand that the genetic factors contributing to CVD are multiple and their inheritance complex. • Describe their own genetic background and risks for CVD (when applicable). Suggested Time Period: One or two 45-minute periods Prerequisite Skills: • Genetics: Probability of Inheritance – helpful • Probability - Math Materials: - Laminated squares, circles, and triangles (see color scheme in table below). Bag Label Type 2 Diabetes Mother Type 2 Diabetes Father Cholesterol Levels Mother Cholesterol Levels Father Blood Pressure Mother Blood Pressure Father - Bag Contents (shape and color) 5 red circles 1 blue circle 2 red circles 4 blue circles 1 red triangle 3 blue triangles 4 red triangles 0 blue triangles 0 red squares 4 blue squares 2 red squares 2 blue squares Colored pencils, crayons or markers (blue and red) 2 Labeled bags per group (one labeled father and one labeled mother) containing shapes Transparency – Type 2 Diabetes & High Cholesterol Transparency – Blood Pressure Transparency – Genetic Counselor (optional) Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Note: Additional vocabulary is provided for your background information and labeled teacher vocabulary. Student Vocabulary Cardiovascular Disease - \CARD • eeo • vas •cue • lar DIZ • eaz\ Refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). Cholesterol - \coe • LES • ter • al\ A chemical found in all fats and oils. Also produced by the body. Daphnia - \DAFF • nee • ahhh\ Any of various water fleas of the genus Daphnia, some species of which are commonly used as food for aquarium fish. Diabetes - \ di • uh • BEE • tees\ A disease in which the body produces little or no insulin or the body is unable to use the insulin made efficiently. Can lead to extremely high levels of sugar in blood. Genetic - \JEN • et • ick\ In biology, the science of genes, heredity, and the variation of organisms. Heart Attack - \hart AH • tack\ A serious, sudden heart condition usually characterized by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. A heart attack occurs when the blood supply to a part of the heart is interrupted, causing death and scarring of the local heart tissue. Since the area affected may be large or small, the severity of heart attacks vary, but they are often a life-threatening medical emergency which demand both immediate attention and activation of the emergency medical services. High Blood Pressure - \hy blud PRES • sure\ A medical condition wherein the blood pressure is chronically elevated. Plaque - \plack\ A stick or pasty substance made from dead cells, fats, and calcium. Can be found on the inside of arteries and can lead to a very serious reduction or stoppage of blood flow. Stroke – \strohk\ A dangerous medical condition caused by a blockage or breakage of an artery in the brain. Teacher Vocabulary Cholesterol - \coe • LES • ter • al\ A chemical found in all fats and oils. Also produced by the body. Diabetes - \di • uh • BEE • tees\ A disease in which the body does not produce enough insulin or is unable to respond to insulin. Diastolic Blood Pressure – \dy• uh • STAHL • ik blud PRESH • ur\ The pressure in the arteries when the heart relaxes between beats. It is the lower number in the measurement of a person's blood pressure. For example, in the measurement 120/75, 75 is the diastolic blood pressure. Heart Disease - \heart Diz• eaze\ A structural or functional abnormality of the heart, or of the blood vessels supplying the heart, that impairs its normal functioning. High Density Lipoprotein (HDL) - The “good” cholesterol. HDLs prevent fat buildup in arterial walls, carrying it away from the arteries to the liver where it is processed and eliminated. Hormones – \HOR • mohnz\ Chemicals that are produced by the body to carry “messages” between cells. Hypertension - \hy • per • TEN • shun\ Arterial disease in which chronic high blood pressure is the primary symptom. Insulin - \in • SOO • lin\ A hormone produced in the pancreas to regulate the amount of sugar in the blood. 2 Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health Low density lipoproteins (LDL) – The “bad” cholesterol. LDLs are responsible for clogging up and blocking arteries. Risk Factors - \risk • FACT • ors\ Factors such as high cholesterol, high triglycerides, and family history of a given condition that make an individual more susceptible for getting a medical condition. Systolic Blood Pressure – \sis • STAHL • ik blud PRESH • ur\ Describes the surge of pressure in the arteries as the heart pumps blood out of the left ventricle. It is the upper number in the measurement of a person's blood pressure. For example, in the measurement 120/75, 120 is the systolic blood pressure. Type 2 Diabetes - \typ too di • uh • BEE • tees\ This form of diabetes used to be called adult-onset diabetes because it begins later in an individual’s life, but can still happen in children. It usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly to regulate the amount of sugar in the blood. Misconceptions: • If both parents are diabetic, their children will also be diabetic. • That brown-eyed parents cannot have blue-eyed children. • That dominant traits are more common than recessive traits. • Students view genetics as more like chaos than probability. • Healthy people cannot get any of these disorders. Special Needs Considerations: Heterogeneous grouping may allow sharing of ideas to help understand the concept of probability. Background Information: There are many different genetic factors leading to the development of cardiovascular disease (CVD). Conditions that contribute to the development of CVD include diabetes, high cholesterol, and high blood pressure. If your students need more background information pertaining to diabetes, cholesterol, or blood pressure, present the transparencies: “High Cholesterol & Type 2 Diabetes” and “Blood Pressure.” Additional information, pertaining to these conditions, is provided below. Diabetes Diabetes is a disease in which the body does not produce enough insulin or is unable to respond to insulin. Insulin is a hormone that causes the cells of our body to take up glucose. When there is not enough insulin present, or we are unable to respond to insulin, glucose from the food we eat remains in our blood rather than entering our cells. Our cells do not get the food they need to generate energy, and the glucose remains in the blood, resulting in high blood glucose levels. High levels of glucose in blood are one cause of minor injuries to our blood vessels that leads to plaque buildup. Thus, diabetes is a condition that can lead to the development of CVD. Type 2 diabetes is one type of diabetes where people lose their ability to respond to insulin. This type of diabetes has a strong genetic component, although it is also influenced by weight, exercise and diet. This activity will address the genetic contribution to the development of type 2 diabetes. There are many different inherited factors that influence the development of diabetes, so the inheritance of type 2 diabetes is complex. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 High Cholesterol Cholesterol is a fat or lipid. You cannot live without it. Cholesterol is an essential part of your cell membranes and hormones such as estrogen and testosterone are made from cholesterol. However, too much cholesterol in the blood can lead to CVD. Cholesterol is found in two forms in the bloodstream. One form, low-density lipoprotein (LDL), is known as “bad” cholesterol since high LDL levels cause plaque buildup. When LDL levels are too high, LDLs will enter and build up within the blood vessel walls. Once LDLs have accumulated in the blood vessel wall, they can cause damage to the blood vessels causing further plaque buildup in the area. The other form of cholesterol, high-density lipoprotein (HDL) does not enter the blood vessel walls and is known as “good” cholesterol. Our body is able to make cholesterol. We also eat cholesterol in meats, eggs, and other foods. Total cholesterol levels, as well as the balance between the LDL and HDL forms of cholesterol, are controlled by genetic factors as well as environmental factors such as weight, diet, and exercise. This activity will look at the genetic factors only. As was the case with type 2 diabetes, there are several different genetic components that influence cholesterol levels in the blood and the inheritance of these factors is complex. High blood pressure Yet another inherited condition that leads to CVD is high blood pressure. Blood pressure measurements have two numbers. One number represents the pressure within your arteries when the ventricles of your heart are contracting. The second number represents the pressure within your arteries when you heart is relaxed. High blood pressure puts stress on the blood vessel walls, causing minor injuries that start or increase the plaque buildup process. Blood pressure tends to increase with age as your arteries become less flexible and thus less able to expand when the heart contacts and forces blood into the arteries. High blood pressure is caused by both genetic factors, and environmental factors such as weight and diet. High blood pressure can be influenced by several different genetic factors. Warm Up: 1. In Activity 1, which substances caused the Daphnia heart rate to increase significantly? Answers may include: caffeine and tobacco. 2. From which parent do you get your eye color? Students will state whether they get their eye color from their mother or father. 3. Do you know anyone that has CVD? Answers will vary. 4. If you were to inherit CVD, what could you do to improve your health? Exercise, eat healthy food, and do not smoke. Introduction and Scientific Question: This activity is prescribed, but lends itself to considering probabilities of genetic inheritance. Students with knowledge of probability and genetic inheritance may be able to consider the probable outcomes and form a hypothesis, but the activity guides students through that process. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 Activity Procedures: Review the “Experimental Design” text with the class and distribute the “Mother” and “Father” shape bag to students. The genes influencing the development of the different conditions leading to CVD are represented by different shapes. The round shapes represent genes influencing the development of type 2 diabetes. Each parent will have six of these shapes. The triangle shapes represent genes influencing the development of high cholesterol. Each parent will have four of these shapes. The square shapes represent genes influencing the development of high blood pressure. Each parent will have four of these shapes. 1. Direct the students to draw an equal number of the same shapes (genes) from the both the bags containing the mother’s and the father’s genes. This will be the genetic makeup of the children. 2. Please note that groups will have different outcomes from what they draw which will lead into discussion of probability. Wrap Up: Have students present their results. Discuss with students the nature of probability (for example, that just because a child has a parent that is diabetic, it does not mean that the student is destined to have that condition. The potential is there for the disease, but this does not guarantee the person will definitely will acquire the condition). Extensions and Optional Substitutions: • To extend this lesson, present the Transparency - “Genetic Counselor.” • Have students measure their own blood pressure. • Invite someone with type 2 diabetes, high cholesterol or high blood pressure to talk in class. • Have a doctor come and discuss possible ways to prevent/control type 2 diabetes, high cholesterol or high blood pressure. • Have students research ways to prevent/control type 2 diabetes, high cholesterol, or high blood pressure. Resources: American Heart Association has a variety of pages on heart structure, heart attacks, strokes, genetic and environmental contributors to CVD, and suggested healthy habits Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 http://www.americanheart.org National Institutes of Health also has a page summarizing CVD, complete with diagrams, and discusses both genetic and environmental contributors to CVD. http://www.nhlbi.nih.gov/health/public/heart/other/chdfacts.htm Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 Transparency – Type 2 Diabetes & High Cholesterol Type 2 Diabetes Type 2 diabetes is one type of diabetes. Diabetes is a disease in which the body does not produce enough insulin or is unable to respond to insulin. In type 2 diabetes, people lose their ability to respond to insulin. This type of diabetes has a strong genetic component, although it is also influenced by weight, exercise and diet. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly to regulate the amount of sugar in the blood. At first, the body keeps up with the added demand by producing more insulin to help regulate the body’s sugars, but eventually, it loses the ability to secrete enough insulin in response to food. High levels of glucose in blood are one cause of minor injuries to our blood vessels that leads to plaque buildup. Thus, diabetes is a condition that can lead to the development of heart disease. High Cholesterol Cholesterol is a fat that is transported through the bloodstream. High density lipoproteins (HDLs) are considered “good” cholesterol and the low density lipoproteins (LDLs) are considered “bad” cholesterol. LDLs are responsible for clogging up and blocking arteries; increasing the risk for heart disease. HDLs prevent fat buildup in arterial walls, carrying it away from the arteries to the liver where it is processed and eliminated. In fact, most of your blood cholesterol is produced in the liver. Cholesterol may be obtained from food, but the liver produces all your body needs. These good cholesterols help certain parts of our bodies, such as tissues and hormones to function normally. Transparency - Blood Pressure Blood pressure is measured using a stethoscope, pressure gauge, and cuff around the patient’s arm. Two measurements are taken: the systolic pressure and the diastolic pressure. The systolic number is the amount of pressure your heart uses to pump blood through the vessels. The diastolic number is the pressure exerted when you heart is at rest. Systolic Blood Pressure Diastolic Blood Pressure 120 75 mm Hg The higher the blood pressure, the greater the chance a person will have serious problems such as heart attacks and strokes. High blood pressure cannot be cured, but there are things one can do to prevent it – or to control it if a patient has high blood pressure. The National Institutes for Health tell us that: • Blood pressure is less than 120/80 is the most desirable. • Blood pressure from 120/80 to 129/84 is normal. • Blood pressure from 130/85 to 139/89 is high normal. • Blood pressure of 140/90 and higher is definitely hypertension (which simply means elevated pressure of the blood in the arteries). It is a disease in which chronic high blood pressure is the primary symptom. Transparency - Genetic Counselor Duties and Responsibilities: Genetic Counselors work with patients and families who have genetic, or inherited, disorders and birth defects. They also counsel people who are at risk for these problems. Genetic counselors often: • Educate patients and families about their conditions and how they might best manage their problems. • Examine family histories to determine the likelihood of genetic problems. • Assist patients and families in reaching decisions about genetic disorders that do not conflict with their religious or ethical values. • Conduct research about genetic disorders. • Educate medical professionals and the general public about genetic disorders. Average Salary: $25,000 - $55,000 Educational Requirements: Students interested in becoming genetic counselors should take a challenging high school curriculum that emphasizes science and mathematics. A college degree and a master's degree are required, and most graduate programs require a strong undergraduate background in biology, chemistry, and behavioral science. Many states require genetic counselors to be certified. CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 3: “All Clogged Up” Grade Level: 6-9 National Science Content Standards: A, C, F Purpose: To design structural models of clogged arteries and to design an experiment that demonstrates how atherosclerosis affects the flow of blood. Objectives: After completing this exercise students will be able to: • Describe how different levels of vessel blockage lead to a reduction of blood flow. • Design structural models of clogged arteries. • Design a simple experiment. Suggested Time Period: Two 45-minute periods Prerequisite Skills: - Blood vessel structure and function - Calculating the mean Materials: -Clay or putty -Something to represent the arteries like a paper towel tube. -Graduated cylinders -Water (with red food coloring added to simulate blood color – optional) -Containers for collecting liquid after it flows through the tube -Stopwatch or clock with second hand where students in the classroom can see it (Other materials that you come up with as a class to create clogged artery models.) -1.5" x 2" Sticky Notes (8 per group) Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Artery - \ ART err eee\ The muscular vessels that carry blood away from the heart. Atherosclerosis - \ath err row scla ROW sis\ The hardening of the arteries accompanied by the deposition of fat on the inner walls. Blood Clots - \blud clot\ Non-flowing blood that is coagulated. Control Group - \con • TROLL groop\ In an experiment, the group that does not receive any treatment or change. Dependent variable – \DEE• pen • dent VAIR • ee • ah • bul\ The thing that we measure and/or observe in our experiment to see if it was affected. Fair Test - \fayr test\ When all variables and conditions are held the same throughout the experiment, only changing your independent Heart Attack - \hart AH • tack\ A serious, sudden heart condition usually characterized by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. A heart attack occurs when the blood supply to a part of the heart is interrupted, causing death and scarring of the local heart tissue. Since the area affected may be large or small, the severity of heart attacks vary, but they are often a life-threatening medical emergency which demand both immediate attention and activation of the emergency medical services. Hypothesis – \hy• PAHTH • eh • sis\ An educated guess. A prediction or possible explanation based on known facts. Independent variable – \in • dee • PEN • dent VAIR • ee • ah • bul\ The thing that we change in an experiment or the thing that differs between the control and experimental group. Plaque - \plack\ A stick or pasty substance made from dead cells, fats, and calcium. Can be found on the inside of arteries and can lead to a very serious reduction or stoppage of blood flow. Stroke – \strohk\ A dangerous medical condition caused by a blockage or breakage of an artery in the brain. Trial - \TRI • all\ The process of testing something in an experiment more than once. Misconceptions: • Students may think the experiment is over when the data collection stage is finished. Have questions ready to prompt answers for conclusions and consider allowing the students to have time to finish the lab as homework. Gather class data and graph entire class results. Special Needs Considerations Heterogeneous grouping may allow sharing of ideas for completion of the procedure steps of a similar inquiry lab. Background: What is Atherosclerosis? Atherosclerosis (ath"er-o-skleh-RO'sis) comes from the Greek words athero (meaning gruel or paste) and sclerosis (hardness). It is the name of the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque. It usually affects large and medium-sized arteries. Some hardening of arteries often occurs when people grow older. Plaques can grow large enough to significantly reduce the blood's flow through an artery. However, the greatest damage occurs when arteries become fragile and rupture. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. If either happens and blocks a blood vessel that feeds the heart, it causes a heart attack. If it blocks a blood vessel that feeds the brain, it causes a stroke. And if blood supply to the arms or legs is reduced, it can cause difficulty walking and Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 eventually lead to gangrene (death and decay of body tissue, often occurring in a limb, caused by insufficient blood supply and usually following injury or disease.). How Does Atherosclerosis Start? Atherosclerosis is a slow, complex disease that typically starts in childhood and often progresses when people grow older. In some people it progresses rapidly, even in their third decade. Many scientists think it begins with damage to the innermost layer of the artery. This layer is called the endothelium (en"do-THE'le-um) (a thin layer of flat epithelial cells that lines serous cavities, lymph vessels, and blood vessels.). Causes of damage to the arterial wall include: • • • • elevated levels of cholesterol and triglyceride in the blood high blood pressure tobacco smoke diabetes Tobacco smoke greatly worsens atherosclerosis and speeds its growth in the coronary arteries, the aorta and arteries in the legs (the coronary arteries bring blood to the heart muscle; the aorta is the large vessel that the heart pumps blood through to the body). Because of the damage to the endothelium, fats, cholesterol, platelets, cellular waste products, calcium and other substances are deposited in the artery wall. These may stimulate artery wall cells to produce other substances that result in further buildup of cells. These cells and surrounding material thicken the endothelium significantly. The artery's diameter shrinks and blood flow decreases, reducing the oxygen supply. Often a blood clot forms near this plaque and blocks the artery, stopping the blood flow. What Does Research Show? Males and people with a family history of premature cardiovascular disease have an increased risk of atherosclerosis. These risk factors cannot be controlled. Research shows the benefits of reducing the controllable risk factors for atherosclerosis: • • • • • • High blood cholesterol (especially LDL or "bad" cholesterol over 100 mg/dL) Cigarette smoking and exposure to tobacco smoke High blood pressure Diabetes mellitus Obesity Physical inactivity Research also suggests that inflammation in the circulating blood may play an important role in triggering heart attacks and strokes. Inflammation is the body's response to injury, and blood clotting is often part of that response. Blood clots, as described above, can slow down or stop blood flow in the arteries. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Treatment To some extent, the body will protect itself by forming new blood vessels around the affected area. Medications may be recommended to reduce fats and cholesterol in your blood; a low-fat diet, weight loss, and exercise are usually suggested. Control of high blood pressure is also important. Aspirin, ticlopidine, and clopidogrel (inhibitors of platelet clumping) or anti-coagulants may be used to reduce the risk of clot formation. Balloon angioplasty uses a balloon-tipped catheter to flatten plaque and increase the blood flow past the deposits. The technique is used to open the arteries of the heart and other arteries in the body. Another widely used technique is stenting, which consists of implanting a small metal device inside the artery (usually following angioplasty) to keep the artery open. Surgically removing deposits may be recommended in some cases. A bypass graft is the most invasive procedure. It uses a normal artery or vein from the patient to create a bridge that bypasses the blocked section of the artery. Introduction and Warm Up: Walk the students through the warm up activity. Explain how heart attacks are caused by plaque build up in the coronary arteries and that stuffing gum into a straw has the same sort of affect that plaque builds up has on an artery. Review the Daphnia lab and ask the students if substance X affected the Daphnia by increasing the heart rate, what would happen to their hearts if the same treatment were applied to them. Activity Procedures: Divide your students into groups of two to four. Inform your students that each group will be designing an experiment and designing the methods to do the experiment; but first, all groups will participate in a brainstorming session about both the dependent variable and the possible independent variables for the experiment. Remember, in each step, it may be necessary for you to review how it relates to the steps of the scientific method and designing their experiments. Scientific Process Procedures: The structure of the question, the hypothesis, and the conclusion are sometimes difficult for students because it is quite different than everyday talk. This structure needs to be explicitly taught, so if your students have had little experience with the scientific process, allow enough time to model the unique structure of these. I. Defining Your Dependent Variable: Dependent Variable: The time it takes blood to flow through the vessel. Brainstorm with your students what can be used as a replacement for blood and how it will be measured. You may need to suggest using water with red food coloring as a substitute for “blood.” Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 In your discussion, lead students toward the idea that there will be a time factor in a clogged artery, affecting the rate at which it will flow through (time it takes for a liquid [in place of blood] to flow through a vessel). Provide a sticky note for students to write their dependent variable and place on their worksheet. II. Determining Things You Can Change (Independent Variable) That May Affect A Dependent Variable: The “percent of blockage” is the independent variable. Students are now presented with four sticky note boxes to write their top selections of independent variables to consider. Guide the students toward the full range of the percent of blockage that might impair the flow of blood through a vessel to the percent of blockage that a fluid could barely flow through. For example, 5% blockage will not impair the flow of blood like a 50% blockage. Discussion of the extremes will help students determine the percentage of blockage to use in their experiment. The students will have to determine how much blockage they have in the tube. To describe the concept of “percent blockage,” draw a pie chart on the board and shade differing amounts of area so students can relate to how much “blockage” is a certain percent. III. Experimental Design - Identifying Variables: From list of the four top independent variables, each student group will select their variables by moving the sticky notes or rewriting each selected variable. IV. Question: Students are asked to write their question in a complete sentence. Check that students’ questions contain both the independent and dependent variables. For example: Will a 2% blockage (independent variable) in an artery (or vessel) affect the time it takes a liquid to pass through the vessel (dependent variable)? V. Hypothesis: Students are asked to write a hypothesis that is based on what they think might happen to the dependent variable when they manipulate the independent variable. Guide students toward thinking of how it would compare to a healthy artery or vessel (a control artery). Hypotheses will have the following structure: If a blood vessel is clogged with a 2% blockage (independent variable),then the time it takes a liquid to flow through the vessel (dependent variable) would be about the same as a healthy artery. VI. Experimental Method Design: Students are now asked to create a model of what is happening inside a damaged artery to test their hypothesis. They are asked, “What everyday materials could you use to create a Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 model of what is happening inside a damaged artery?” Remind the students of the warm up question that considered gum in a straw. Get them to think about what everyday things are long and circular – shape of a tube. Then, get them to think about what could clog up the tube. If students have difficulty with the questions to create their method for their experiments, brainstorm ideas as a class. List of Ideas for Tubes to Use Paper towel tubes Gift wrapping paper tubes Rubber tube Portion of a hose PVC pipe Plastic tube (wide enough to observe flow) List of Ideas for the Clog Clay Putty Calking Toothpaste Oatmeal Gum Cutting the tubes in half makes it easier to observe and pour the blood through the artery as well, but it is not necessary. Help the students design their tubes by again referring to the pie chart. This will aid them into make the blockages in the tube accurate. Additionally, help guide them in coming up with a control for the experiment. Ask them, “what would constitute the control for this experiment and how would it differ from the model they create? Would it have to have similar features as their experimental model? What would be different? What would be the same?” VII. Finishing the Experimental Design: Keeping Things Fair: The students are asked to respond to what they will keep the same or fair in their experiments. Assess their responses to determine if more review is necessary. What will be the kept the same between the control and the experimental models? What will be kept the same for the experimental procedures? How many trials will they be doing? Inquiry Lab Procedures: 1. The students will gather the materials needed for their experiments. It will be necessary to review and remind them that everything must be constant between the control model and their experimental model except one thing – the size (percentage) of the clog. That means, even deciding how to pour in the liquid and when to start and stop the stopwatch as they are timing the flow. Do they pour the water in from a foot above the artery or a couple inches? When do they start the stopwatch? Do they stop the stopwatch after the last drop or do they stop when it starts to drip? Beyond the above details to keep things constant (the same or fair), if the students’ experimental designs are adequate and your students know how to do their measurements, they are ready to gather materials and begin. If not, review and model any procedures that are unclear. Then, proceed to step 2. 2. There are blanks in the data tables that need to be filled out. Instruct each group to fill in those blanks and check student work. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 3. Emphasize that students must follow their experimental design as they record their data. 4. Conclusions – have the students write their answers to the conclusion questions. Wrap Up: Discuss the experiment with students. Did their models work? What could they have done differently? What did they learn from this experiment? Will this knowledge change how they maintain their own health? Assessment: Questions: 1. At what percentage of blockage do we first see an increase in the time it takes for the blood to flow through the tube? 2. What happens to the areas on the other side of the blockage? Think about flow and oxygen. 3. What is a heart attack? 4. How are strokes and heart attacks related? Extensions and Optional Substitutions: • Blow up a balloon until it breaks to simulate what can happen to a clogged blood vessel as pressure builds up behind the clot. • Looking at the figure of the heart and point out the arteries and blood vessels. Resources: This URL provides a description of heart attacks and factors causing them; including a short video clip about coronary arteries. http://www.pbs.org/healaheart/thequietenemy/coronary.html From this page, if you click on “Heart Stopper” you will find an activity similar to this one but slightly more advanced. http://www.ncabr.org/educators/lessons.html American Heart Association has a variety of pages on heart structure, heart attacks, strokes, genetic and environmental contributors to CVD, and suggested healthy habits. http://www.americanheart.org National Institutes of Health also has a page summarizing CVD, complete with diagrams, and discusses both genetic and environmental contributors to CVD. http://www.nhlbi.nih.gov/resources/docs/cvdrpt.htm Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 7 CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 4: “Lethal Dose” [adapted from a similar activity developed in the Entomology Department at Purdue University] Grade Level: 6-9 National Science Content Standards: A, F Purpose: The purpose of this activity is to have students conduct an experiment that illustrates the affects of nicotine on Drosophila hearts. Objectives: After completing this exercise students will be able to: • Describe how tobacco is toxic to animals, including insects. • Explain that nicotine is the component of tobacco that is toxic and that causes tobacco to be addictive. • Form hypotheses, identify variables, and draw conclusions. Suggested Time Period: One or two 45 minute periods Prerequisite Skills: Collecting data Materials: (per student group) • 20 wingless flies (Carolina Biological cat# ER-14-4455, $4.90 per culture, 1-800334-5551) • 4 plastic Petri dishes or other small containers with lids for holding flies • 1 artist paintbrush per group to take fruit flies out of container and place into Petri dishes • 1 canister of fine cut chewing tobacco – the kind that comes in the small, round cans. • Measuring spoons (1/8 tsp, 1/4 tsp, 1/2 tsp) to pre-measured amounts of tobacco. • Clock with a second hand or stopwatch. • Toxicology props would be useful – measure out 50 mg of sand or some kind of substance and place it in a jar. Be dramatic with illustrations: 50 mg = 2.5 packs of cigarettes. Note: Care should be taken to prevent students from removing tobacco from the lab for personal use. Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Anxiety - \ang • ZY • et • ee\ Refers to a complex combination of negative emotions that includes fear, apprehension and worry, and is often accompanied by physical sensations such as palpitations, nausea, chest pain and/or shortness of breath. Dependent variable – \DEE• pen • dent VAIR • ee • ah • bul\ The thing that we measure and/or observe in our experiment to see if it was affected. Depression - \dee • PRESS • shun\ A medical condition identified by clusters of symptoms such as markedly-decreased mood, motivation, interest, energy levels, etc. Dose - \dos\ A specified amount that is contained in a drug or medicine. Drosophila - \dro • SOPH • ill • uh\ A genus of small flies that feed on unripe or ripe fruit. Endorphins - \en • DOR • fins\ Natural pain killers released by the pituitary gland. Hypothesis – \hy• PAHTH • eh • sis\ An educated guess. A prediction or possible explanation based on known facts. Independent variable – \in • dee • PEN • dent VAIR • ee • ah • bul\ The thing that we change in an experiment or the thing that differs between the control and experimental group. Irritability - \ear • it • ah • BILL • it • ee\ An excessive response to stimuli. Knock Down - \knok douwn\ The twitching and passing out of fruit flies. Lethal - \LEE •thal\ Capable of causing death. Mutation - \meu • TA • shun\ Changes to the genetic material, usually DNA or RNA. Mutations can be induced by chemicals or radiation, or can occur naturally. Neuron - \NEW • ron\ Specialized cells of the nervous system which transmit signals through a synapse. Nicotine - \NIK • oh • teen\ A highly addictive chemical found in tobacco plants. Reward Center - \re • WARD SEN • ter\ The place in the brain that releases the neurotransmitter called dopamine that allows you to feel pleasure. Misconceptions: • In this experiment, students often believe the Drosophila are dead--they are not, although they may be very incapacitated. • Students may think the activity is over once all data is collected. Have questions ready to prompt answers for conclusions and consider allowing the students to have time to finish the lab as homework Special Needs Considerations Heterogeneous grouping may allow sharing of ideas for completion of the procedure steps of a similar inquiry lab. Background: Drosophila melanogaster is a fruit fly, a little insect about 3mm long, that often accumulates around spoiled fruit. It is also one of the most valuable of organisms in biological research, particularly in genetics and developmental biology. Drosophila have been used as a model organism for research for almost a century. Drosophila remain a popular research organism. Its relevance to human research was recognized by the award Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 of the Nobel Prize in medicine/physiology to Ed Lewis, Christiane Nusslein-Volhard and Eric Wieschaus in 1995. Why Work with Drosophila? Drosophilia are popular research subjects because so much is already known about them. In addition, they are small, have a short life cycle of just two weeks, are inexpensive, easy to work with and easy to keep in large numbers. Tobacco refers to broad-leafed plants of the nightshade family indigenous to North and South America which are dried and cured for smoking material: cigar, cigarette, smoking pipe, or water pipe or a hookah. Tobacco is also chewed, "dipped" (placed between the cheek and gum), and sniffed into the nose as finely powdered snuff. Tobacco contains the alkaloid nicotine, a powerful neurotoxin that is particularly harmful to insects. All means of consuming tobacco result in the absorption of nicotine in varying amounts into the user's bloodstream, and over time the development of tolerance and dependence. Absorption quantity, frequency and speed seem to have a direct relationship with how strong a dependence and tolerance, if any, might be created. A lethal dose of nicotine is contained in as little as one half of a cigar or three cigarettes; however, only a fraction of the nicotine contained in these products is actually released into the smoke, and most clinically significant cases of nicotine poisoning are the result of concentrated forms of the compound used as insecticides. Tobacco smoking carries significant risks including the potential to develop various cancers as well as strokes, and severe cardiovascular and respiratory diseases. Significantly shorter life expectancies have been associated with tobacco smoking. Many jurisdictions have enacted smoking bans in an effort to minimize possible damage to public health caused by tobacco smoking. Introduction and Warm Up: Read the Background on Nicotine with your class. Inquire about students’ background knowledge about the words in the title by asking: What does lethal mean? What does dose mean? Be dramatic about presenting the lethal dose of nicotine – use props as described in the materials section. Compare your 50 mg of sand to the amount of tobacco a person might use in one pinch of chew. Discuss how this amount is only 2.5 packs of cigarettes. After reading the Introduction, demonstrate what “knock-down” is – that it does not mean dead, so that the students have a better understanding about the observations they will make in the activity. Twitching and acting like you are about to pass out gets the concept across. Describe the procedures of the activity to help them begin to visualize the procedures to help them form a hypothesis before doing the experiment. Activity Procedures: Lab Preparation Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Label the Petri dishes with the amount of tobacco (i.e., 1/8, 1/4, 1/2 tsp). Add the amount of tobacco into each Petri dish accordingly. Shake the dish until the entire dish is coated with the juice from the tobacco. Pour out the residual tobacco. Each student group will be given Petri dishes with each amount of tobacco. The residual nicotine lasts for five class periods, but the “time to knock-down” takes longer each period. Students should note that no knock-down occurs with the 0 tsp tobacco Petri dish of fruit flies. Scientific Question The question is provided for the students. Hypothesis Students are asked to form a hypothesis about how the amount of nicotine will affect the time to knock-down. It is recommended that you describe the procedures of the activity to help them form their educated guess with more background information about what they are doing (what they will be measuring) by walking the students through the idea that the amount of tobacco in the dish will affect how long it will take for the Drosophila to become knocked down. Guide students into thinking about greater and lesser amounts of tobacco. They do not need to form a hypothesis for each amount of tobacco that will be used in the experiment. Variables The amount of tobacco is the independent variable and time is the dependent variable. Help your students come up with these responses. Lab Procedures: 1. Instruct students to use the paintbrush to remove 5 fruit flies from their container and transfer them to the Petri dish labeled “0 tsp.” Students will be timing the control group of fruit flies for the entire class period. Have them note the time they placed the flies into the container and have them observe the flies, periodically, throughout the period to see if they go to knock-down – they will not go to knock-down. 2. Instruct students to use the paintbrush to remove 5 fruit flies from their container and transfer them to another Petri dish. It does not matter which container the students begin with, but it does matter that they place their data in the correct column on the data table. 3. As soon as all fruit flies are in the container, a student should start the stopwatch or watch the time on a clock with a second hand. 4. As soon as all 5 flies are experiencing knock-down, the stopwatch or timing should be stopped and the amount of time to knock-down should be recorded in the correct slot on the data table. 5. Repeat steps 2-4 for the other amounts of tobacco. Wrap Up: The students have conclusion questions to respond to, but the data from the entire class becomes more meaningful if all student data is collected, graphed and discussed. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 Assessment: At the end of the student worksheets, there is a short unit assessment that encompasses Activities 1-4. Use this as a guide for how students are progressing with their learning gains. Answer Key for the Assessment 1. True 2. False 3. False 4. True 5. True 6. True 7. True 8. True 9. The hardening of the arteries accompanied by the deposition of fat on the inner walls. 10. The type of damage that leads to plaque buildup is a small, minor injury to the artery wall. Some of the things that cause these small injuries include: eating fatty foods, smoking cigarettes, being overweight, high cholesterol, high blood pressure, and diabetes. 11. Alcohol, tobacco, sleeping aids, etc. 12. Stop or never begin smoking, watch what I eat, and exercise. Resources: How Stuff Works - Nicotine http://health.howstuffworks.com/nicotine.htm Neuroscience For Kids - Nicotine http://faculty.washington.edu/chudler/nic.html Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 5: “Heart Bypass Surgery” Grade Level: 6-9 National Science Content Standards: C, F Purpose: The purpose of this activity is to familiarize students with the parts of the heart, the physical conditions of a heart attack, and heart bypass surgery. Objectives: After completing this exercise students will be able to: • Identify the chambers, major blood vessels and valves of the heart. • Accurately describe the flow of blood through the heart. • Describe the events that lead to a heart attack. Suggested Time Period: Two 45-minute periods Materials: • Sheep or Pig Hearts – these can often be obtained from local slaughterhouses with advanced notice. Alternatively, preserved hearts may be ordered in advance from Carolina Biological Supply Company. o Pig Heart cat# ER-22-8560 $5.00 ea/ $4.25 ea for ten or more o Sheep Heart cat # ER-22-8770 $3.25 ea/ $2.40 ea for ten or more • Mark the coronary artery on each of the hearts with permanent marker (to represent the blockage for the bypass activity) • Dissecting pans • Scissors or scalpels • Gloves and lab coats (optional) • Transparency – Dissection – Pages 1-4 Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Aorta - \aye • OR • tah\ The large blood vessel connected to the left ventricle of the heart. This artery supplies oxygenated blood to the rest of the body. Aortic Valve – \ay• OR• tik valv\ The “one way door” that controls the flow of blood between the left ventricle and the aorta. Apex - \APE • echs\ The pointed bottom part of the heart that is away from all the blood vessels entering the upper portion of the heart. Blockage - \BLOK • ayge\ An obstruction preventing flow of materials through the designated pathway. Bypass Surgery - \BY • pass SURGE • er • ee\ An operation of the heart that bypasses blockage in an artery by rerouting blood through a newly inserted vessel. Cardiologist - \card • ee • OL • oh • gist\ A medical professional that is trained to diagnose and treat heart problems. Left Atrium – \left AY • tree • um\ One of the four chambers of the heart. Blood enters the left atrium from the pulmonary vein and exits the left atrium into the left ventricle. Left Ventricle – \left VEN • tri • cul\ One of the four chambers of the heart. Blood enters the left ventricle from the left atrium and exits the left ventricle into the aorta. Mitral Valve – \MY• trul valv\ The “one way door” that controls the flow of blood between the left atrium and the left ventricle of the heart. Probe - \proube\ A sharp needle-like object used in dissections to point out or move structures. Plaque - \plack\ A stick or pasty substance made from dead cells, fats, and calcium. Can be found on the inside of arteries and can lead to a very serious reduction or stoppage of blood flow. Pulmonary – \PUL • muh • nair • ee\ Having to do with the lungs. Pulmonary Artery – \PUL • muh • nair • ee AR • ter • ee\ The blood vessel that takes blood from the right ventricle to the lungs. Pulmonary Valve – \PUL • muh • nair • ee valv\ The “one way door” that controls the flow of blood from the right ventricle to the pulmonary artery. Pulmonary Vein – \PUL • muh • nair • ee vayn\ The blood vessel that takes blood from the lungs to the left atrium. Right Atrium – \ryt AY • tree • um\ One of the four chambers of the heart. Blood enters the right atrium from the vena cava and exits the right atrium into the right ventricle. Right Ventricle – \ryt VEN • tri • kul\ One of the four chambers of the heart. Blood enters the right ventricle from the right atrium and exits the right ventricle into the pulmonary artery. Tendons - \TEN • dons\ The connective tissue that connects muscle to bones, in the case of the heart the tendons open and close the valves within the heart. Tricuspid Valve – \TRY • kus • pid valv\ The “one way door” that controls the flow of blood from the right atrium to the right ventricle. Vena Cava – \VEE • nuh KAY • vuh\ One of the blood vessels that takes blood from the body to the right atrium of the heart. Misconceptions: • Students may have the misconception that regular doctors perform cardiac surgery. • Students may not realize blockages in the coronary arteries can be very dangerous. • Students may not know that, in some cases, the heart must be stopped for the bypass procedure to be carried out. Special Needs Considerations: Heterogeneous grouping may help students requiring more assistance. Background: Review material for heart structures located in CardioHEADS Level I, Activity 2. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 What is coronary artery bypass surgery? This is a type of heart surgery. It's sometimes called CABG ("cabbage"). The surgery reroutes or "bypasses" blood around clogged arteries to improve blood flow and oxygen to the heart. Why is this surgery performed? The arteries that bring blood to the heart muscle (coronary arteries) can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack. How is coronary bypass done? Surgeons take a segment of a healthy blood vessel from another part of the body (usually the leg) and make a detour around the blocked part of the coronary artery. • • • An artery may be detached from the chest wall and the open end attached to the coronary artery below the blocked area. A piece of a long vein in your leg may be taken. One end is sewn onto the large artery leaving your heart -- the aorta. The other end of the vein is attached or "grafted" to the coronary artery below the blocked area. Either way, blood can use this new path to flow freely to the heart muscle. A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are blocked. What happens after bypass surgery? Patients usually stay in the hospital at least three to five days while they are assessed and monitored. Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs must wait longer. Introduction and Warm Up: Guide the students to answer the warm up questions. 1. What is the cause of heart attacks? Blockage of the coronary arteries, that causes irregular rhythms of the heart. 2. If arteries leading to the heart are blocked, what happens to the part of the heart that is starved of oxygen? The area of the heart downstream from the blockage becomes starved for oxygen and nutrients, eventually the tissue will die and is replaced be scar tissue. 3. What might a doctor do to repair arteries that are blocked and leading to the heart itself? Heart bypass surgery. When students have completed the warm up, discuss their answers as a class. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Health Career Cardiologist career information is provided for students. This information sheet could be read as homework or in class. Allow students some time to discuss whether or not they would be interested in a career as a cardiologist. Additional cardiologist information is provided in the box below: Cardiologist Cardiologists are medical doctors who specialize in the diagnosis and treatment of diseases or conditions of the heart and blood vessels, such as chest pain (angina), irregular heart rhythms, high blood pressure, heart failure, or heart attacks. Cardiologists administer tests that indicate how well a person's heart is working, such as a treadmill test (exercise electrocardiogram), and perform procedures such as cardiac catheterization and angioplasty. They can further specialize in interventional cardiology (the use of mechanical treatment methods, such as angioplasty) or electrophysiology (treatments involving the heart's electrical system) and may also specialize in treating specific age groups, such as a pediatric cardiologist, who only treats children. Activity Procedures: Dissection Review the included photos on the Transparencies (under resources of this document). These photos provide a visual guide for the dissection procedures and the identification of some of the heart structures. Heart Bypass Surgery NOTE: Be sure to mark the hearts where the blockages occur in the coronary arteries. Consider marking more than one artery to make the procedure a double or triple bypass. Guide the students through the bypass procedures: 1.) Find the blocked artery or arteries on the sheep heart. 2.) Find the aorta. 3.) Take a piece of tubing or drinking straw. 4.) Cut a hole just big enough for the tube to fit into in the aorta. 5.) Decide where you want to connect the other end of the tube. Remember that you are trying to create a detour or bypass around the blockage by delivering blood through the tube to the areas that are not getting blood because of the blockage. 6.) Cut a hole just big enough for the tube to fit into in the blocked artery. 7.) Insert the tube into both holes. You may need to cut the tube so that it is shorter. If this were a real surgery, the doctor would sew the ends of the tube to the aorta and artery, and a blood vessel from another part of the body would be used instead of a tube. Wrap Up: Discuss the dissection and bypass with the students. What did they find interesting? Surprising? Gross? Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 Discuss the students’ conclusions for both the dissection and the bypass. Dissection Conclusion Responses: 1. Aorta and to the rest of the body. 2. Into the pulmonary artery and to the lungs. 3. Oxygenated blood enters the heart via the left ventricle. Heart Bypass Conclusion Responses: 1. Heart bypass surgery is performed on a heart that has blocked coronary arteries. The bypass is performed to allow blood to the part of the heart deprived of oxygenated blood due to the blockage. 2. A place to start to prevent blockages is to eat healthy foods and exercise. Remember from Activity 3, plaque build up starts at an early age, so it is important to develop a healthy lifestyle early in life. Assessments: Check student responses to the dissection and heart bypass questions. Assess the students as they perform the dissection and bypass surgery. Extensions and Optional Substitutions: • Instead of dissection, have students construct model hearts out of clay. • If the school has a heart model available, have students compare the pig or sheep heart to the human heart model. • Have students take digital photos of their hearts at various stages of dissection and create a web page or CD photo album of their dissection. Resources: Online sheep heart anatomy. http://www.gwc.maricopa.edu/class/bio202/heart/anthrt.htm Step by step pig heart dissection with color photos. http://www.heartlab.robarts.ca/dissect/dissection.html Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 Transparency – Dissection – Page 1 Figure 1. View of the heart with apex pointing down. The heart is positioned as it would be if you looking at the animal lying on its back. Apex Transparency – Dissection – Page 2 Figure 2. Probe is positioned in right atrium. Figure 3. Probe is positioned in right ventricle. Transparency – Dissection – Page 3 Figure 4. Probe is positioned in left atrium. Figure 5. Probe is positioned in left ventricle. Transparency – Dissection – Page 4 Figure 6. Bicuspid valve. Note string-like tendons. Figure 7: Probe extending from pulmonary vein into left atrium. CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 6: “The Rhythm of the Beat” Grade Level: 6-9 National Science Content Standards: C, E Purpose: The purpose of this activity is to introduce students to the electrical impulses created by the heart, the methods of monitoring these impulses through the use of the EKG machine, and the way heart function is represented in an EKG waveform. Objectives: After completing this activity, students will be able to: • Explain that an EKG records the electrical activity generated by contraction of heart muscle. • Understand that the heart’s nodes of electrical conductivity are responsible for maintaining a regular heart rate. • Evaluate EKG patterns from various patients. Suggested Time Period: Two 45-minute periods Prerequisite Skills: • Heart anatomy (refer to CardioHEADS Level I Activity 2) • Electrical charge • Starting up the computer, opening applications, and using the mouse Materials: Transparency - Normal Components of the EKG Waveform Transparency - Additional Examples of EKG Patterns If Pasco EKG Sensors are available: Computers USB Links EKG Sensors EKG Electrodes (additional electrodes can be purchased from Pasco 1-800-772-8700, pack of 100 electrodes, cat# CI-6620, $15) Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Atrial Fibrillation - \ATE • real fib • rill • AYE • shun\ An abnormal heart rhythm which involves the two small, upper heart chambers. Impulses of the sinoatrial node are replaced by disorganized, rapid electrical impulses which result in irregular heart beats. AV node – \ay • vee nohd\ A cluster of cells that generates regular electrical charges and transfers an electrical signal from the atria to the ventricles. Defibrillator – \dee • FIB • rih • lay • ter\ A device used to restore a regular rhythm to someone’s heart using an electrical charge. Electrocardiogram (EKG) – \ee • LEK • troh • KAR • dee • oh • gram\ A record of the electrical activity of the heart. Doctors use EKGs to detect and diagnose heart problems. Heart Attack - \hart AH • tack\ A serious, sudden heart condition usually characterized by varying degrees of chest pain or discomfort, weakness, sweating, nausea, vomiting, and arrhythmias, sometimes causing loss of consciousness. A heart attack occurs when the blood supply to a part of the heart is interrupted, causing death and scarring of the local heart tissue. Since the area affected may be large or small, the severity of heart attacks vary, but they are often a life-threatening medical emergency which demand both immediate attention and activation of the emergency medical services. Left Atrium – \left AY • tree • um\ One of the four chambers of the heart. Blood enters the left atrium from the pulmonary vein and exits the left atrium into the left ventricle. Left Ventricle – \left VEN • tri • cul\ One of the four chambers of the heart. Blood enters the left ventricle from the left atrium and exits the left ventricle into the aorta. Right Atrium – \ryt AY • tree • um\ One of the four chambers of the heart. Blood enters the right atrium from the vena cava and exits the right atrium into the right ventricle. Right Ventricle – \ryt VEN • tri • kul\ One of the four chambers of the heart. Blood enters the right ventricle from the right atrium and exits the right ventricle into the pulmonary artery. Sinus Tachycardia - \SIGH • nus tack • ee • CARD • ee • ah\ A rhythm with elevated rate of impulses originating from the SA node, defined as a rate greater than 100 beats/min in an average adult. Stroke – \strohk\ A dangerous medical condition caused by a blockage or breakage of an artery in the brain. P Wave – \pee wayv\ Part of an EKG pattern that shows the electrical stimulation from the SA node that causes the atria to contract. P-R Interval – \pee ar IN • ter vul\ The time that it takes for electrical impulse to travel through the AV node. QRS Complex – \kyoo ar es CAHM • pleks\ Part of an EKG pattern that shows the electrical stimulation from the AV node that causes the ventricles to contract. Q-T Interval – \kyoo tee IN • ter vul\ The time that it takes for electrical impulse to cause ventricles to contract and then return to beginning state. SA Node – \es ay nohd\ A cluster of cells that generates regular electrical charges, which sends the electrical signal that causes the atria to contract in a regular rate and pattern of beats. T Wave – \tee wayv\ Part of an EKG pattern that shows the return of the heart to its electrical state before the next time the atria contract. Ventricular Fibrillation - \ven • TRICK • you • lar fib • rill • AYE • shun\ A cardiac condition that consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 Misconceptions: • In this activity, students have expressed the belief that one EKG pattern defines the patients’ condition. • Students often believe that patients are easily revived with the defibrillator. Special Needs Considerations: Heterogenous grouping may help students requiring more assistance. Background: An electrocardiogram, or EKG, is a graphical recording of the electrical events occurring within the heart. Because an EKG is a recording of the heart’s electrical events, it is valuable in diagnosing diseases or ailments that damage the conductive abilities of the heart muscle. When cardiac muscle cells are damaged or destroyed, they are no longer able to conduct the electrical impulses that flow through them. This causes the electrical signal to terminate at the damaged tissue or be directed away from the flow of the signal. The termination or redirection of the electrical signal will alter the manner in which the heart contracts. A cardiologist can look at a patient’s electrocardiogram and determine the presence of damaged cardiac muscle based on the time interval between electrical events. A technician will begin the EKG by placing 10 to 12 electrodes at various points on your body. The electrodes are attached to wires, called leads, which are attached to the EKG machine. Various EKG patterns are exhibited from the leads attached to different locations of the body. The diagnosis of the normal EKG is made by excluding any recognized abnormalities. Analysis is, therefore, quite comprehensive. Introduction: To introduce this activity, guide students through the various components of the EKG. A transparency “Normal Components of the EKG Waveform” is provided at the end of this document. Health Career Electrocardiogram Technician career information is provided for students. This information sheet could be read as homework or in class. Allow students some time to discuss whether or not they would be interested in a career as an Electrocardiogram Technician. Activity Procedures: In Activity 5, students reviewed the parts of the heart including the four chambers. In the student Background Information, students are introduced to the two regions of the heart that contain cells that generate regular electrical signals. Use the student text and the “Normal Components of the EKG Waveform” transparency to continue the discussion about the components of the EKG and the function of the nodes that trigger the electrical functions of the heart. Point out the examples of the normal and abnormal components of the EKG. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Additional Examples of EKG Patterns Show the students the additional examples of the EKG patterns by using the transparency “Additional Examples of EKG Patterns” and have the students follow along by circling the differences they see in the patterns. These are the exact same patterns that will be used in Activity 8 for some of the patient scenarios. Situation in the Emergency Room This section uses what students may have observed on television to show how a patient’s EKG is monitored and how it can change through time. This also prepares students for their observation of EKG patterns in Activity 8. Measuring Your Own EKG 1. If you have the Pasco Scientific EKG sensors, divide the class into groups of two to three. For EKG sensor methods, see the supplemental document: Pasco Equip Teach Guidelines.doc. 2. Have student complete the data table for their EKGs. Guide them to use the Complete Waveform pattern to help them find their waveforms on the computer. Wrap Up: To wrap up this activity ask students to explain the following: • The process involved in contracting the heart. • The process of diagnosing heart trouble. • The relationship between the different components of the EKG and the heart function. Assessments: The following questions serve as good assessments for this activity: 1.) What causes your heart contract? 2.) What components of the heart cause it to contract? 3.) Name a few conditions doctors may find by looking at an EKG strip. 4.) Draw and label a normal EKG pattern. Extensions and Optional Substitutions: • Have students act out a role play involving the emergency room scenario with the EKG traces. • Invite a paramedic or EMT unit to bring in their defibrillator to show the students. • Using the additional information below, have students identify the P-wave, QRScomplex, and T-wave from their own EKG traces. Resources: Online course for nurses on reading basic EKG’s. http://www.rnceus.com/ekg/ekgframe.html EKG Library with 12-lead EKG’s of different heart conditions. http://www.ecglibrary.com/ecghome.html Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 Transparency - Normal Components of the EKG Waveform P Wave – The P wave shows the electrical stimulation from the SA node that causes the atria to contract. QRS Complex – The QRS complex shows the electrical stimulation from the AV node that causes the ventricles to contract. T Wave – The T wave shows the return of the heart to its electrical state before the next time the atria contract. QRS complex P wave T wave P-R interval Q-T interval Complete Waveform (P-P) There are also intervals or distances between waves in the EKG. These represent intervals of time. The complete waveform is the time from the beginning of the P-wave to the next P-wave. P-R Interval – time that it takes for electrical impulse to travel through the AV node. Q-T Interval – time that it takes for electrical impulse to cause ventricles to contract and then return to beginning state. Transparency - Additional Examples of EKG Patterns This is another example of what a normal EKG looks like. You will use this as a guide to see how the following EKGs are different and what problems they help diagnose. It might be very helpful to circle the differences, in each example below, of abnormal EKG strips compared to the normal strip. This will help you with activities later. In this EKG pattern, notice the irregular pattern of the heart. There is not a consistent rhythm. Next, notice the many smaller waves before and after the large peak. This indicates that the atria are contracting many more times than they should. This condition is called atrial fibrillation. Atrial fibrillation is consistent with stroke victims. One issue with this condition is that because the atria do not have time to fill due to the constant contractions, the blood flow is severely impaired. The heart may return to a normal pattern on its’ own, but immediate attention is required. This EKG pattern shows irregular ventricular contractions. Notice that the ventricular contractions are happening too soon and do not allow for the heart to have a consistent time to relax in between contractions. This condition is called sinus tachycardia. The patient is having a heart attack and needs to receive medical attention. This EKG strip shows a very irregular heart beat. This condition is called ventricular fibrillation. This is a very serious condition. The heart will not come out of this condition without help from either drugs to restore the normal rhythm or a strong electric jolt from a machine called a defibrillator. Serious attention is required because soon the heart will stop and the breathing will cease as well. CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 7: “EMT Training Day” Grade Level: 6-9 National Science Content Standards: C, F Note: This is a very challenging activity. Plan on spending extra time with students on each aspect of the first responder procedures: the ABC’s +D. SAMPLE, and checking vital signs. Purpose: The purpose of this activity is to teach students the rudiments of the procedures used by EMT’s: the ABC’s +D. SAMPLE, and checking vital signs. Objectives: After completing this exercise students should be able to: • Identify common medical problems in people through patient assessment. • Take and record a complete set of vitals. Suggested Time Period: Three or four 45-minute class periods Materials: Clock w/ second hand Blood pressure monitor (optional—if you do not have them instruct students to follow the manual procedures) Transparency – Vital Signs Transparency – Common Medical Conditions Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Cardiovascular Disease - \CARD • eeo • vas •cue • lar DIZ • eaz\ Refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system, it is usually used to refer to those related to atherosclerosis (arterial disease). Cardiopulmonary Resuscitation (CPR) -- An emergency procedure, often employed after cardiac arrest, in which cardiac massage, artificial respiration, and drugs are used to maintain the circulation of oxygenated blood to the brain. Defibrillate - \dee • FIB • rill • ate\ Medical technique used to counter the onset of ventricular fibrillation. Diastolic Blood Pressure – \dy• uh • STAHL • ik blud PRESH • ur\ The pressure in the arteries when the heart relaxes between beats. It is the lower number in the measurement of a person's blood pressure. For example, in the measurement 120/75, 75 is the diastolic blood pressure. Electrocardiogram (EKG) – \ee • LEK • troh • KAR • dee • oh • gram\ A record of the electrical activity of the heart. Doctors use EKGs to detect and diagnose heart problems. Emergency Medical Technician (EMT) - \ee • merj • en • see med • ick • all teck • ni • shun\ An emergency responder trained to provide emergency medical services to the critically ill and injured. First Aid -- Emergency treatment administered to an injured or sick person before professional medical care is available. Paramedic - \para • MED • ik\ A trained medical professional who responds to medical and trauma emergencies in the pre-hospital setting ("in-field") for the purpose of stabilizing a patient's condition before and during transportation to an appropriate medical facility, usually by ambulance. Ratio -- \ray • SHE • o \ The relationship in quantity, amount, or size between two or more things. Rescue Breaths – Breathing for a person who is not breathing. Shock - \shok\ A serious medical condition where blood flow is not sufficient enough to meet the required supply. /has many causes, symptoms and treatments. Systolic blood pressure – \sis • STAHL • ik blud PRESH • ur\ Describes the surge of pressure in the arteries as the heart pumps blood out of the left ventricle. It is the upper number in the measurement of a person's blood pressure. For example, in the measurement 120/75, 120 is the systolic blood pressure. Thready - \THRED • ee\ A weak, barely perceptible pulse. Misconceptions: • From television programs and other media, students may have the perception that, in emergency situations, all people get saved. • The scene is safe for emergency medical personnel to go in and help people right away. Special Needs Considerations: Heterogenous grouping may help students requiring more assistance. Background Information on First Responders and Assessing a Medical Situation EMT vs. Paramedic Training There are many federal and state standards for each level of EMT (from basic to advanced). A paramedic is the most advanced of EMTs and has the greatest training. He/she can administer many prescribed medicines and do other procedures at an emergency site. Further information regarding the different levels of training is available at the websites provided in the resources section. Scene Size-up The first thing that an EMT does when they arrive on the scene is to take a look around for clues – to make sure the scene is safe for both the rescuers and the patients, determine the number of emergency personnel needed for the number of patients, and make an assessment of what happened. Initial Assessment The first examination of a patient includes assessment of airway, breathing, circulation (ABCs + D), and anything that may be creating a disability (i.e., excessive bleeding, body part crushed by an object, etc.). The ABC’s determine whether or not the patient is receiving oxygen to parts of their body. If any of the ABC’s is missing, the patient will soon loose consciousness since the patient is either not getting oxygen into their lungs or it is not being circulated. In many situations, an EMT will put an oxygen mask on a patient, which assists breathing and often calms a patient Funded by a Science Education Partnership Award from the National Center for Research Resources of the 2 National Institutes of Health down. In this initial assessment, a “conscious” patient is awake or can respond to verbal cues. If they are conscious and they can speak, it is likely they have an airway and are breathing. Such patients may be able to describe what happened and assist in assessing their own circulation and disability. If they indicate or sound like they cannot speak, breathe, or are coughing, the EMT must go through step-by-step procedures to help the patient gain an airway and be able to breath. When breathing stops or the heart stops, the body does not get oxygen. If the brain is deprived of oxygen for even a few minutes, brain damage or death will occur. Unconscious patient If a patient is “unconscious,” they are unresponsive or they only respond to pain. Again, the airway and their ability to breath must be checked first. If a patient is not breathing, due to having an obstructed airway, that airway needs to be cleared. Circulation must be checked next - does the patient have a pulse? The patient has an obvious disability of being unconscious, but if the patient does not have a pulse, it is also life threatening and other procedures must be performed that may include cardiopulmonary resuscitation (CPR) or defibrillation. Physical Exam, Patient History (SAMPLE), and Vital Signs The Initial Assessment is about evaluating and treating the most life threatening conditions first. The next step for an EMT is performing a physical exam, gathering the patient’s history and checking vital signs. • • • Physical Exam – Examining patient’s general conditions. Is their current medical condition from trauma or some other medical problem? What is their chief complaint and symptoms? This includes head to toe inspection and general observations. Patient History (SAMPLE) – The “S” stands for symptoms, the “A” stands for allergies, The “M” stands for medications, the “P” stands for pertinent history (medical, family, medical tags, etc.), the “L” stands for last foods and fluids, and the “E” stands for events – what happened to cause the emergency. Vital Signs – Are important to monitor and measure continuously. The vital signs include respiration rate to make sure the airway and breathing are maintained at a healthy rate; pulse + pulse quality– to make sure circulation continues and is of good quality; blood pressure; and skin color. Introduction and Warm Up: Students begin this activity describing an emergency medical situation they witnessed in person or on television. Give students an opportunity to answer the questions in the warm up and then give them an opportunity to share their experiences with the class. General Activity Information This activity is designed to help students understand the process by which medical professionals assess patient health. Students will gain knowledge on how to analyze their own bodies to make health decisions. Activity Procedures: Health Career Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 EMT career information is provided for students. This information sheet could be read as homework or in class. Allow students some time to discuss whether or not they would be interested in a career as an EMT. EMT Training Divide your students into pairs. Inform your students that they will be following the procedures step by step just as an EMT would. Explain to students that EMTs never skip any of these steps because doing so could cause them to miss a potential clue as to the patient’s condition. In addition, this step-by-step process helps to keep EMTs focused in the event of a traumatic or multi-victim accident. EMTs record vital signs neatly and accurately so that when they hand the patients over to doctors at the hospital, they can relay the vitals and other info. Step IStudents should be in pairs. Ask one student to pretend to have been injured (and provide them with the symptoms for the injury) and ask the other student to go through the process of assessing the “injured” student’s ABC’s + D and record information on their sheet. Ideally, have students switch roles and repeat the experiment. Step IIPut the “Vital Signs” transparency up on the overhead. Have the students take their own vitals first and then practice on their partner. Inform students that people rarely breathe normally when they know someone is taking their respiratory rate (RR). To get a true RR, EMTs often take it as they are taking the pulse without telling the patient. Pulse Demonstrate to students the process of taking a pulse. Students can use the pulse in their carotid artery in their neck to take their own heart rate, but should use the radial pulse (wrist) to take their teammates’ heart rates. Inform students that the pulse cannot be taken with the thumb because it has a pulse of its own. Heart Rate Guide students through taking their heart rate. Inform them that if a heartbeat is not steady and rhythmic it is described as irregular. Blood Pressure Guide students through the systolic and dystolic blood pressure and the procedures for taking the blood pressure. If a blood pressure monitor is not available, you can take the pulse in different places in the body and estimate the minimum systolic blood pressure, follow the manual blood pressure procedures: Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 BP Procedures (if you do not have blood pressure monitors): If you do not have blood pressure monitors, you can find your minimum pressure by using the following: • If you can find a pulse in your carotid artery (in the neck) your BP is at least 60 mmHg • If you can find a pulse in your radial artery (in the wrist) your BP is at least 70 mmHg • If you can find a pulse just below the bone on the inside of your ankle, your BP is at least 90 mmHg. Skin Color An indicator of general health is the skin and mucous membranes. EMTs describe normal skin as pink, warm, and dry. The color does not refer to the person’s skin color. Pink refers to the color of the gums, fingernail beds, and eyelids, which change rapidly when a patient’s condition is declining. Step IIIAt this point, it might be useful to select a patient profile from Level III Activity 8 to demonstrate to students how to go through this process. S - The sample history is a set of background clues that supplement the vital signs. Put the “Common Medical Conditions” transparency on the overhead and have the students refer to it to find some symptoms for each of the ailments listed. A - Students may want to share their ideas or experiences with allergies. Students should make the connection that a doctor could make a bad situation worse if she or he prescribes a medication that an individual is allergic to. M - Medications as well as past history are often an easy way for medical professionals to surmise a patient’s medical problem and often lead to an easy diagnosis and treatment since a patient may have been dealing with a problem for a while and may have medical records on the condition. P – Past history often provides clues as to what led to the current problem. L - Food intake is important for many reasons. Something to keep in mind is that loss of appetite can be an indicator for poor health. Other considerations are food poison or poor diet leading to major health problems. E - The events leading up to a person’s problem can have a major impact on the diagnosis and treatment of a patient. The treatment for a person who is unconscious because of a trauma can be very different then someone who passes out in the middle of a meeting. Wrap Up and Assessment: To wrap up and assess this activity have students recount the steps taken by EMTs in a medical emergency OR use Level III Activity 8 to assess students learning of this material. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 Resources: EMT and Paramedic Training Sites: http://www.mass.gov/dph/oems/emt/emttrain.htm http://www.rfaas.org/emtbvsemti.html Basic First Aid www.healthy.net/clinic/firstaid/ http://www.redcross.org/services/hss/courses/index.html?WT.srch=1 Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 Transparency – Vital Signs Vital Sign Respiratory Rate (RR) Heart Rate/ Pulse Rate (HR) Heart Rate Quality Blood Pressure (BP) Skin Color, Temperature, moisture (SCTM) Normal Range (for adults) 12 to 20 Breaths per minute (might be a little higher in middle school students) 60 to 100 beats per minute Regular and strong 90 to 140 mmHg (systolic) 60 to 90 mmHg (diastolic) Normal color, 98.6 degrees, moist Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 7 Transparency – Common Medical Conditions Medical Vital Signs Condition RR HR s Diabetic Normal High Shock Symptoms Pulse Quality regular and ‘thready’ (very weak, almost undetectable pulse) Heart Attack Rapid Rapid irregular Stroke Normal Rapid Normal BP SCT M Norm Pale, *Increased thirst al moist *Increased cool urination *Weight loss in spite of increased appetite *Fatigue *Nausea *Vomiting Norm *Squeezing or al, pressure in chest high, *Indigestion or low *Shortness of breath *Lightheadedness dizziness *Fainting *Nausea or vomiting *Sweating *Anxiety High Pink *Weakness or and paralysis of an arm, moist leg, side of the face *Numbness *Slurred speech, *inability to speak *Loss of memory *Loss of balance *Mood changes *Drowsiness *Uncontrollable eye movements Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 8 CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 8: “EMT for a Day” Grade Level: 6-9 National Science Content Standards: A, C, F Purpose: The purpose of this activity is to provide students an engaging way for them to synthesize all their learning from the unit. Students engage in role-playing as an EMT health care professional and as patients with many risk factors for cardiovascular disease (CVD). Objectives: After completing this exercise, students should be able to: • Identify common medical problems through patient assessment. • Take and record a complete set of vitals. • Perform a systematic problem-solving process. • Perform many symptoms that are risk factors or definite indications for CVD. Suggested Time Period: Two or three 45-minute class periods Materials: • Transparency – Diabetic Patient Scenario • Transparency – Patient EKG Patterns • Clock w/ second hand • Blood pressure monitor (optional—if you do not have them instruct students to follow the manual procedures) • Transparency – Vital Signs (from Activity 7) • Transparency – Common Medical Conditions (from Activity 7) • Optional Velcro bands with vital signs [If this activity becomes part of your curriculum, you may want to create arm bands that report vitals so that the patient does not need to verbalize all of their symptoms]. Vocabulary: List vocabulary on word walls for students. You may also consider having students record the vocabulary in a “CardioHEADS” unit journal. Airway - \AYR • way\ The airway begins at the mouth or nose, and accesses the trachea via the pharynx. Atrial Fibrillation - \ATE • real fib • rill • AYE • shun\ An abnormal heart rhythm which involves the two small, upper heart chambers. Impulses of the sinoatrial node are replaced by disorganized, rapid electrical impulses which result in irregular heart beats. Blood Pressure - \blud PRES • shure\ Pressure exerted by the blood on the walls of the blood vessels. Cardiopulmonary Resuscitation (CPR) - \card • eo • PULL • mon • airy re • sus • it • TAY • shun\ An emergency procedure, often employed after cardiac arrest, in which cardiac massage, artificial respiration, and drugs are used to maintain the circulation of oxygenated blood to the brain. Defibrillate - \dee • FIB • rill • ate\ Medical technique used to counter the onset of ventricular fibrillation. Diabetes - \di • uh • BEE • tees\ A disease in which the body does not produce enough insulin or is unable to respond to insulin. Electrocardiogram (EKG) – \ee • LEK • troh • KAR • dee • oh • gram\ A record of the electrical activity of the heart. Doctors use EKGs to detect and diagnose heart problems. Emergency Medical Technician (EMT) - \ee • merj • en • see med • ick • all teck • ni • shun\ An emergency responder trained to provide emergency medical services to the critically ill and injured. Emphysema - \em • fiz • EE • ma\ A chronic lung disease. It is often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke. Emphysema is characterized by loss of elasticity of the lung tissue; destruction of structures supporting the alveoli; and destruction of capillaries feeding the alveoli. Heartburn - \HART • burn\ A painful or burning sensation in the esophagus, just below the breastbone caused by regurgitation of gastric acid Sinus Tachycardia - \SIGH • nus tack • ee • CARD • ee • ah\ A rhythm with elevated rate of impulses originating from the SA node, defined as a rate greater than 100 beats/min in an average adult. Stroke – \strohk\ A dangerous medical condition caused by a blockage or breakage of an artery in the brain. Ventricular Fibrillation - \ven • TRICK • you • lar fib • rill • AYE • shun\ A cardiac condition that consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. Vital signs - \VIE • tal sihns\ Taken by health professionals in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. Misconceptions: From television programs and other media, students may have the perception that, in emergency situations, all people get saved. Special Needs Considerations: Heterogenous grouping may help students requiring more assistance. See Activity Procedures – Alternative Station Lab Method as a method for students who may need greater guidance. Background Information on First Responders and Assessing a Medical Situation Background information for this activity is provided in Activity 7. The basic procedures for Scene Size-up, Initial Assessment, and the Physical Exam, Patient History (SAMPLE), and Vital Signs are reinforced in this activity by a step-by-step process that the students perform through role-playing as an EMT. Students synthesize concepts they have been learning throughout the unit by role-playing patients who have risk factors for or direct indicators of CVD. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 Introduction: As you introduce this activity, it is important to remind the students that role-playing is an important part of the training process for medical professionals and first responders. Trainees are assessed on their ability to go through a systematic process to respond to an emergency medical situation and patients act out the signs and symptoms of the medical condition they have been assigned. EMTs approach each medical condition in a systematic way in order to gain clues about the condition of each patient. When it is your turn to play the role of the patient, it is your job to play your role correctly to challenge the EMTs and force them to do their job correctly. Inform your students that everyone will have the opportunity to role -play both roles. Gender Considerations It is unlikely that all female students will be able to role play a female patient and so on, but if you communicate that it is an opportunity to be challenged by and be even more creative with their acting skills, it will help them better perceive opposite gender roles. There is one patient who should be played by a male, especially, if the students are motivated to find and use props that mimic a defibrillator. The patient is the heart attack victim at Station 6. Students may use erasers or other objects that look like the paddles that are applied to someone’s chest to give them a shock from the “crash cart” (Activity 6) machine or defibrillator. Station Lab Set Up This activity is designed to have 6 complete stations with the following materials at each: One or two “patient scenario” sheets at each station, depending on your class size. One patient EKG sheet at each station. Four to six copies of the patient assessment form for each group. Optional One blood pressure monitor at each station (if you do not have six, place them in an accessible area of the classroom, so students can use them for their acting out measuring the patient’s blood pressure). Optional Other props help make the scenarios realistic, fun and allow for greater drama in the students’ role-playing (for example, washable fake blood could enhance the believability of Station Lab #4 –heart attack victim who has fallen off his bike due to heart attack). Erasers or wooden blocks easily serve as defibrillators. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Activity Procedures: 1. Divide your students into groups of three. Instruct the students that they will rotate through the stations with one person in their group taking on the role of the patient and two people in their group playing the role of the EMTs. As students rotate through the stations, they will take turns playing the role of patient and EMT. 2. Use patient #1 (Juana Perez) to model what students are expected to do at each station. Place the transparency Diabetic Patient Scenario on an overhead projector. Model this scenario by role-playing the part of the patient—do not forget to display patient #1’s EKG as well! Have a few student volunteers play the role of the EMTs to systematically determine your condition (guiding them as they play along). 3. Once students understand the process, have them begin the activity. Students need about 10 minutes at each of the remaining 5 stations. Instructions for playing the role of Patient and EMT Instruct the entire class about how to play both the roles of the EMT and the patient. Remind them that, as a patient, it is important to not give away the symptoms too quickly; rather, let the EMTs perform their step-by-step process to determine their condition. All patients will have an airyway, so the EMTs can make that determination quickly. Give the students a few minutes to read both instruction sections. Before beginning the station lab, explain that it is IMPORTANT for the patients to keep the patient scenario sheet out of view of the EMTs. Instruct the students who are playing the next patient to go to the station first, quickly read the sheet to get the main ideas of what they are supposed to act out for the patient condition, and then keep the sheet turned over – hidden from the EMTs. As the EMTs are going through the step-by-step process, they will be able to look at the sheet, by keeping it hidden, to respond to a specific vital sign or any detail of the scenario. Remind the EMTs to complete the last questions in the “Patient Assessment” section on their own. After they report their results, the patient may report the “Treatment” listed at the bottom of their scenario sheet. Alternative Method for Station Lab Procedures In many first responder training courses, the general approach to role playing the various scenarios takes place in the following format: the instructors pull those who are roleplaying the first responders aside and give them a very general patient scenario. Then, the instructors pull aside those who are going to act the role of the patients. The patients are given information about their condition – including the events, symptoms, vitals, etc. This teacher-directed strategy could be implemented to help guide and model the scenarios to your students - one station lab at a time. This method may help your Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 students may feel more comfortable and do a better job role-playing because all small groups will be acting out the same roles. Procedures for keeping the patient scenario sheet and general role-playing procedures will be the same as described above and in the student activity EXCEPT you will need to have at least 6 copies of the “patient scenario” sheets, if implementing this modification. Patient Assessment/Treatment – Conclusions of the EMT At the end of the EMT worksheet, there is a “Patient Assessment” list of questions. Students are asked to describe the patient’s medical condition, what they think the patient needs to do and continue to do to “feel better,” and finally, what they would recommend to prevent the condition from happening again. Each patient scenario is, generally, the answer key to all of these questions; including the “Treatment” listed at the end. Assess student responses as they rotate through the stations. Offer guidance to help the role-playing process. Wrap Up: Wrap up the activity by having the groups report their experiences. You may lead them into reporting which clues helped them figure out a patient’s condition. For fun, you may ask who gets the best actress or actor award and why. Which patient was the most difficult to figure out? Which one was the easiest? Evaluate EMT worksheets to assess student-learning gains. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 Transparency – Diabetic Patient Scenario Station Lab 1: Patient = Type I Diabetic You are a patient with Type I diabetes. Your EKG is normal, but your heart rate is fast (showing a quicker rhythm of an EKG pattern). General Patient Information Vital Signs Name: Juana Perez Respiration Rate: 12 breaths per minute Age: 53 Pulse/Heart Rate: 110 beats per minute Gender: Female Pulse Quality: Regular and “thready” Height: 5’3” Blood Pressure: 96/60 mmHg Weight: 175 lbs. Skin: pale, moist, and cool despite hot day Symptoms 1. 2. 3. 4. 5. Allergies Medications + Smoking/ Alcohol Use Pertinent Medical History Last Food /Fluids -Last Ins and Outs Events 6. 7. Patient SAMPLE Information You are almost completely unconscious. You can be roused by shaking, but quickly fall back out of consciousness. Lack of proper food intake and overexertion triggered symptoms. Scale of severity of symptoms: 10 About 20 minutes before the EMTs arrived. Your neighbor called the EMTs. Just before you started to lose consciousness, you realized that you were feeling lightheaded, hungry, and fatigued. You knew you needed to go inside and get something to eat, and then your vision started to go blurry. None Prescription: Insulin therapy Non-smoker & non-drinker – due to diabetes. 8. You are wearing a necklace that states you are a Type I diabetic. 9. Type I diabetes by age 13 sister is a diabetic – age 55, father has heart disease – age 77, and mother is a diabetic – age 75 10. High total cholesterol and LDL levels and high normal blood pressure. 11. Last ate at breakfast that was 6 hours ago; went in once to relieve yourself about 2 hours prior to the loss of consciousness. 12. Normal peeing and pooping. 13. You just spent several hours cleaning out the garage on a hot day. You haven’t eaten since breakfast (about 6 hours ago) because you wanted to get a lot accomplished and it also seemed too hot to eat – you just didn’t feel hungry. Your neighbor was over visiting when you started to feel the symptoms. Treatment You need sugar. At the station, there is a prop or an actual jar of honey. When the EMTs figure out that you’re a diabetic, they can role-play giving you honey. They must make sure you are alert enough to swallow and not choke. When they try and rouse you, become conscious enough to sit up and swallow the honey. As soon as the EMTs give you the honey, you will start to become more alert. The EMTs should direct you taking care of yourself and getting additional medical attention. Transparency – Patient EKG Patterns Station Lab 1: Patient EKG - Juana Perez Station Lab 2: Patient EKG – Roxanne Greer Station Lab 3: Patient EKG - Roy Frazier Station Lab 4: Patient EKG – Gilberto Gutierrez Station Lab 5: Patient EKG - Angelica Montoya Station Lab 6: Patient EKG – Garret Stokes Cardiopulmonary Resuscitation (CPR) - \card • eo • PULL • mon • airy re • sus • it • TAY • shun\ An emergency procedure, often employed after cardiac arrest, in which cardiac massage, artificial respiration, and drugs are used to maintain the circulation of oxygenated blood to the brain. Defibrillate - \dee • FIB • rill • ate\ Medical technique used to counter the onset of ventricular fibrillation. Diabetes - \di • uh • BEE • tees\ A disease in which the body does not produce enough insulin or is unable to respond to insulin. Electrocardiogram (EKG) – \ee • LEK • troh • KAR • dee • oh • gram\ A record of the electrical activity of the heart. Doctors use EKGs to detect and diagnose heart problems. Emergency Medical Technician (EMT) - \ee • merj • en • see med • ick • all teck • ni • shun\ An emergency responder trained to provide emergency medical services to the critically ill and injured. Emphysema - \em • fiz • EE • ma\ A chronic lung disease. It is often caused by exposure to toxic chemicals or long-term exposure to tobacco smoke. Emphysema is characterized by loss of elasticity of the lung tissue; destruction of structures supporting the alveoli; and destruction of capillaries feeding the alveoli. Heartburn - \HART • burn\ A painful or burning sensation in the esophagus, just below the breastbone caused by regurgitation of gastric acid Sinus Tachycardia - \SIGH • nus tack • ee • CARD • ee • ah\ A rhythm with elevated rate of impulses originating from the SA node, defined as a rate greater than 100 beats/min in an average adult. Stroke – \strohk\ A dangerous medical condition caused by a blockage or breakage of an artery in the brain. Ventricular Fibrillation - \ven • TRICK • you • lar fib • rill • AYE • shun\ A cardiac condition that consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. Vital signs - \VIE • tal sihns\ Taken by health professionals in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. Misconceptions: From television programs and other media, students may have the perception that, in emergency situations, all people get saved. Special Needs Considerations: Heterogenous grouping may help students requiring more assistance. See Activity Procedures – Alternative Station Lab Method as a method for students who may need greater guidance. Background Information on First Responders and Assessing a Medical Situation Background information for this activity is provided in Activity 7. The basic procedures for Scene Size-up, Initial Assessment, and the Physical Exam, Patient History (SAMPLE), and Vital Signs are reinforced in this activity by a step-by-step process that the students perform through role-playing as an EMT. Students synthesize concepts they Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 have been learning throughout the unit by role-playing patients who have risk factors for or direct indicators of CVD. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 Introduction: As you introduce this activity, it is important to remind the students that role-playing is an important part of the training process for medical professionals and first responders. Trainees are assessed on their ability to go through a systematic process to respond to an emergency medical situation and patients act out the signs and symptoms of the medical condition they have been assigned. EMTs approach each medical condition in a systematic way in order to gain clues about the condition of each patient. When it is your turn to play the role of the patient, it is your job to play your role correctly to challenge the EMTs and force them to do their job correctly. Inform your students that everyone will have the opportunity to role -play both roles. Gender Considerations It is unlikely that all female students will be able to role play a female patient and so on, but if you communicate that it is an opportunity to be challenged by and be even more creative with their acting skills, it will help them better perceive opposite gender roles. There is one patient who should be played by a male, especially, if the students are motivated to find and use props that mimic a defibrillator. The patient is the heart attack victim at Station 6. Students may use erasers or other objects that look like the paddles that are applied to someone’s chest to give them a shock from the “crash cart” (Activity 6) machine or defibrillator. Station Lab Set Up This activity is designed to have 6 complete stations with the following materials at each: One or two “patient scenario” sheets at each station, depending on your class size. One patient EKG sheet at each station. Four to six copies of the patient assessment form for each group. Optional One blood pressure monitor at each station (if you do not have six, place them in an accessible area of the classroom, so students can use them for their acting out measuring the patient’s blood pressure). Optional Other props help make the scenarios realistic, fun and allow for greater drama in the students’ role-playing (for example, washable fake blood could enhance the believability of Station Lab #4 –heart attack victim who has fallen off his bike due to heart attack). Erasers or wooden blocks easily serve as defibrillators. Activity Procedures: 1. Divide your students into groups of three. Instruct the students that they will rotate through the stations with one person in their group taking on the role of the patient and two people in their group playing the role of the EMTs. As students Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 4 rotate through the stations, they will take turns playing the role of patient and EMT. 2. Use patient #1 (Juana Perez) to model what students are expected to do at each station. Place the transparency Diabetic Patient Scenario on an overhead projector. Model this scenario by role-playing the part of the patient—do not forget to display patient #1’s EKG as well! Have a few student volunteers play the role of the EMTs to systematically determine your condition (guiding them as they play along). 3. Once students understand the process, have them begin the activity. Students need about 10 minutes at each of the remaining 5 stations. Instructions for playing the role of Patient and EMT Instruct the entire class about how to play both the roles of the EMT and the patient. Remind them that, as a patient, it is important to not give away the symptoms too quickly; rather, let the EMTs perform their step-by-step process to determine their condition. All patients will have an airyway, so the EMTs can make that determination quickly. Give the students a few minutes to read both instruction sections. Before beginning the station lab, explain that it is IMPORTANT for the patients to keep the patient scenario sheet out of view of the EMTs. Instruct the students who are playing the next patient to go to the station first, quickly read the sheet to get the main ideas of what they are supposed to act out for the patient condition, and then keep the sheet turned over – hidden from the EMTs. As the EMTs are going through the step-by-step process, they will be able to look at the sheet, by keeping it hidden, to respond to a specific vital sign or any detail of the scenario. Remind the EMTs to complete the last questions in the “Patient Assessment” section on their own. After they report their results, the patient may report the “Treatment” listed at the bottom of their scenario sheet. Alternative Method for Station Lab Procedures In many first responder training courses, the general approach to role playing the various scenarios takes place in the following format: the instructors pull those who are roleplaying the first responders aside and give them a very general patient scenario. Then, the instructors pull aside those who are going to act the role of the patients. The patients are given information about their condition – including the events, symptoms, vitals, etc. This teacher-directed strategy could be implemented to help guide and model the scenarios to your students - one station lab at a time. This method may help your students may feel more comfortable and do a better job role-playing because all small groups will be acting out the same roles. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 5 Procedures for keeping the patient scenario sheet and general role-playing procedures will be the same as described above and in the student activity EXCEPT you will need to have at least 6 copies of the “patient scenario” sheets, if implementing this modification. Patient Assessment/Treatment – Conclusions of the EMT At the end of the EMT worksheet, there is a “Patient Assessment” list of questions. Students are asked to describe the patient’s medical condition, what they think the patient needs to do and continue to do to “feel better,” and finally, what they would recommend to prevent the condition from happening again. Each patient scenario is, generally, the answer key to all of these questions; including the “Treatment” listed at the end. Assess student responses as they rotate through the stations. Offer guidance to help the role-playing process. Wrap Up: Wrap up the activity by having the groups report their experiences. You may lead them into reporting which clues helped them figure out a patient’s condition. For fun, you may ask who gets the best actress or actor award and why. Which patient was the most difficult to figure out? Which one was the easiest? Evaluate EMT worksheets to assess student-learning gains. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 6 Transparency – Diabetic Patient Scenario Station Lab 1: Patient = Type I Diabetic You are a patient with Type I diabetes. Your EKG is normal, but your heart rate is fast (showing a quicker rhythm of an EKG pattern). General Patient Information Vital Signs Name: Juana Perez Respiration Rate: 12 breaths per minute Age: 53 Pulse/Heart Rate: 110 beats per minute Gender: Female Pulse Quality: Regular and “thready” Height: 5’3” Blood Pressure: 96/60 mmHg Weight: 175 lbs. Skin: pale, moist, and cool despite hot day Symptoms 1. 2. 3. 4. 5. Allergies Medications + Smoking/ Alcohol Use Pertinent Medical History Last Food /Fluids -Last Ins and Outs Events 6. 7. Patient SAMPLE Information You are almost completely unconscious. You can be roused by shaking, but quickly fall back out of consciousness. Lack of proper food intake and overexertion triggered symptoms. Scale of severity of symptoms: 10 About 20 minutes before the EMTs arrived. Your neighbor called the EMTs. Just before you started to lose consciousness, you realized that you were feeling lightheaded, hungry, and fatigued. You knew you needed to go inside and get something to eat, and then your vision started to go blurry. None Prescription: Insulin therapy Non-smoker & non-drinker – due to diabetes. 8. You are wearing a necklace that states you are a Type I diabetic. 9. Type I diabetes by age 13 sister is a diabetic – age 55, father has heart disease – age 77, and mother is a diabetic – age 75 10. High total cholesterol and LDL levels and high normal blood pressure. 11. Last ate at breakfast that was 6 hours ago; went in once to relieve yourself about 2 hours prior to the loss of consciousness. 12. Normal peeing and pooping. 13. You just spent several hours cleaning out the garage on a hot day. You haven’t eaten since breakfast (about 6 hours ago) because you wanted to get a lot accomplished and it also seemed too hot to eat – you just didn’t feel hungry. Your neighbor was over visiting when you started to feel the symptoms. Treatment You need sugar. At the station, there is a prop or an actual jar of honey. When the EMTs figure out that you’re a diabetic, they can role-play giving you honey. They must make sure you are alert enough to swallow and not choke. When they try and rouse you, become conscious enough to sit up and swallow the honey. As soon as the EMTs give you the honey, you will start to become more alert. The EMTs should direct you taking care of yourself and getting additional medical attention. Transparency – Patient EKG Patterns Station Lab 1: Patient EKG - Juana Perez Station Lab 2: Patient EKG – Roxanne Greer Station Lab 3: Patient EKG - Roy Frazier Station Lab 4: Patient EKG – Gilberto Gutierrez Station Lab 5: Patient EKG - Angelica Montoya Station Lab 6: Patient EKG – Garret Stokes CardioHEADS Level III: Cardiovascular Health and Disease Teacher Information - Activity 9: “Community Connection” Grade Level: 6-9 National Science Content Standards: F Purpose: To have students apply their learning about CVD to an authentic task and real life issue. Objectives: After completing this exercise, students will be able to synthesize and apply their knowledge of blood to create a persuasive poster for controlling risk factors for CVD or make personal connections to the information through interviewing a friend or family member. Suggested Time: Provide this assignment in advance so that students have an opportunity to select which assignment they will complete. One or two 45-minute periods or one 90-minute block. Materials: Supplies for making posters Computer (Technology Lab, home, etc.) for students to research additional information. Magazines for pictures (optional) Introduction and Warm Up: Explain to students the two options they have for this assignment. For the students who selected the poster assignment, have them discuss the effectiveness of facts to persuade people versus opinion. For students who have selected the interview, have them think about whom they might interview and how they might explain this assignment to the person they are interviewing. Poster: Several sections give students questions to think about what kind of information they might want on the poster. Give them the rubric to see how they will gain the most points for their posters. Students may work individually or in small groups to gather the facts and data they will use on the poster. Use of the Internet and magazines should provide students with a source of pictures. As you assess student progress, remind them to include a persuasive appeal in their poster design. Interview: Have the students who have selected the interview add one or two more questions to their interview protocol. Have them practice their interviewing technique with other students who have selected this assignment. After students have conducted their interviews ask them to share what they have learned in a short oral presentation to the class. Wrap Up: This activity constitutes the culmination of the unit. A good wrap up of the activity and the unit would be a parent night where student posters and other work from the unit could be displayed. Assessments: - See rubric for detailed evaluation of posters. - The interview report should have full sentences and suggest student knowledge of the topic. - Content knowledge assessment questions for the unit are provided below: Content Knowledge Assessment Questions LEVEL III 1. The main purpose of the heart is to pump blood throughout the body. True False 2. Blood is only pumped to a few major parts of the body. True False 3. The way you treat your body does not have an affect on how your heart works. True False 4. If your family has a history of heart disease, you may also be at a higher risk for developing heart disease. True False 5. Smoking cigarettes may cause injury to parts of your body besides your lungs. True False 6. If you have a family history of diabetes or if you have diabetes, it increases your risk of developing heart disease. True False 7. If you have high total cholesterol levels, it increases your risk of for developing heart disease. True False 8. If you smoke, it increases your risk of developing heart disease. True False Resources: American Red Cross blood donation site http://www.redcross.org/donate/give/ America’s Blood Centers, a network of non-profit community blood centers http://www.americasblood.org Armed services blood donation program designed for service members to give blood but includes some stories on military personnel who have been saved due to donated blood. http://www.militaryblood.dod.mil Optional Extensions and Substitutions: • Invite a guest speaker—either a health care professional or a victim of CVD. • Display the posters during an event where parents and community members are invited. Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 2 Poster Assessment Rubric Poster Scoring Advanced Work Guide 3 points Heading or title Design clearly communicates of poster on blood donation idea, colorful, fully developed and detailed, grabs attention with pictures or drawings Six or more facts are Facts used from on blood CardioHeads donation activities or research that persuade people who read the poster Original student ideas Original Ideas show accurate and on blood specific summary donation learning Proficient Work 2 points Heading or title is appropriate, adequate details, colorful, drawings or pictures are used 8 – 9 points: Four to five facts are used from CardioHeads or research that persuade people who read the poster Original student ideas show generalized and adequate summary learning Advanced Work 5 – 7 points: Proficient Work 3 – 4 points: Work in Progress Work in Progress 1 point Lacking or incomplete title, non specific details, lacks color or neatness Score Less than four facts are used to persuade people who read the poster Original student ideas are lacking or show little learning TOTAL Funded by a Science Education Partnership Award from the National Center for Research Resources of the National Institutes of Health 3 CardioHEADS Level III: Cardiovascular Health and Disease Student Assessment Rubric Points category Item 1 4 3 2 1 Question that includes the dependent and independent variables Question that includes one variable Question about cholesterol Other question. Three ideas from the list of items below Two ideas from One idea from the list of items the list of items below below Item 2 Item 2 scoring list Keeping the characteristics constant (the same or fair) in both groups is important to see if the new dietary program (independent variable or change) has an affect on the experimental group (Group One) in comparison to the control group (Group Two). *mention of the importance of keeping things constant (the same or fair) *mention of changing only one thing (dietary program) – independent variable * mention of control group versus the experimental group. Item 3 The question is thoroughly answered using the information from the table in the explanation. Item 3 Sample Answer Sample answer: Yes. The table shows that the average total cholesterol decreased in Group One in comparison to the average total cholesterol for Group Two (both groups had about the same average cholesterol level before the experiment). Item 4 One of the two Two of the items is correct items are correct Item #1: The independent variable is the new dietary program. Item #2: The dependent variable is cholesterol. Item 4 Correct Responses Item 5 Four items from the list below Item 5 Sample answer Two items Three items from the list from the list below below *Data is graphed correctly *Graph has a title *Axes are labeled *Appropriate units are indicated for each axis Student can accurately extrapolate data to make a prediction Item 6 Total TOTAL One item from the list below Advanced Work Proficient Work Work in Progress 12 – 15 points 8 – 11 points 5 – 7 points Score