From a36fe4c39043d71e5cf64fe03ad5918079a5e009 Mon Sep 17 00:00:00 2001
From: Kyle Belanger <kyleb44@hotmail.com>
Date: Sun, 11 Sep 2022 16:19:11 -0400
Subject: [PATCH] update chapter 2 and index

---
 chapter2.qmd                         |  61 +++++++++++++++++----------
 extras/Draft Research Questions.docx | Bin 12749 -> 0 bytes
 index.qmd                            |  26 +++---------
 references.bib                       |  14 ++++++
 4 files changed, 60 insertions(+), 41 deletions(-)
 delete mode 100644 extras/Draft Research Questions.docx

diff --git a/chapter2.qmd b/chapter2.qmd
index 49d6bcf..fdf2354 100644
--- a/chapter2.qmd
+++ b/chapter2.qmd
@@ -112,31 +112,48 @@ computed by aggregating the errors across the entire validation data set
 
 ### Machine Learning in the Clinical Laboratory
 
-<!--# Can I copy this table? -->
+<!--# Table needs to be modified -->
 
-| **Author and Year** | **Objective and Machine Learning Task**                               | **Best Model** | **Major Themes** |
-|-------------|---------------------------------|-------------|-------------|
-| Azarkhish (2012)    | Predict iron deficiency anemia and serum iron levels from CBC indices | Neural Network | Prediction       |
-
-Cao (2012) \|
-
-                    Triage manual review for urinalysis samples                                                                      |                
-                                                                                                                                                      
-                                                                                                                                      Tree-based      | Automation       |
-
-| 
-
-Yang (2013) \|
-
-                    Predict normal reference ranges of ESR for various laboratories based on geographic and other clinical features  |                
-                                                                                                                                                      
-                                                                                                                                      Neural Network  |                  
-                                                                                                                                                                         
-                                                                                                                                                       Interpretation    |
+| **Author and Year** | **Objective and Machine Learning Task**                                                                         | **Best Model** | **Major Themes** |
+|---------------|-----------------------------|---------------|---------------|
+| Azarkhish (2012)    | Predict iron deficiency anemia and serum iron levels from CBC indices                                           | Neural Network | Prediction       |
+| Cao (2012)          | Triage manual review for urinalysis samples                                                                     | Tree-based     | Automation       |
+| Yang (2013)         | Predict normal reference ranges of ESR for various laboratories based on geographic and other clinical features | Neural Network | Interpretation   |
 
 : Table 1. Summary of characteristics of machine learning algorithms
 [@rabbani2022].
 
-### 
+<!--# Need to fill in this section -->
 
-#### 
+## Reflex Testing
+
+The laboratory diagnosis of thyroid dysfunction relies on the
+measurement of circulating concentrations of thyrotropin (TSH), free
+thyroxine (fT4), and, in some cases, free triiodothyronine (fT3). TSH
+measurement is generally regarded as the most sensitive initial
+laboratory test for screening individuals for thyroid hormone
+abnormalities [@woodmansee2018]. TSH and fT4 have a complex, nonlinear
+relationship, such that small changes in fT4 result in relatively large
+changes in TSH [@plebani2020]. Many clinicians and laboratories check
+TSH alone as the initial test for thyroid problems and then only add a
+Free T4 measurement if the TSH is abnormal (outside the laboratory
+normal reference range), this is known as reflex testing
+[@woodmansee2018]. Reflex testing became possible with the advent of
+laboratory information systems (LIS) that were sufficiently flexible to
+permit modification of existing test requests at various stages of the
+analytical process [@srivastava2010]. Reflex testing is widely used, the
+major aim being to optimize the use of laboratory tests. However the
+common practice of reflex testing relies simply on hard coded rules that
+allow no flexibility. For instance in the case of TSH, free T4 will be
+added to the patient order whenever the value falls outside of the
+established laboratory reference range. This bring into the fold the
+issue that the thresholds used to trigger reflex addition of tests vary
+widely. In a study by Murphy he found the hypocalcaemic threshold to
+trigger magnesium measurement varied from 1.50 mmol/L up to 2.20 mmol/L
+[-@murphy2021]. Even allowing for differences in the nature, size and
+staffing of hospital laboratories, and populations served, the extent of
+the observed variation invites scrutiny [@murphy2021].
+
+<!--# insert table and study from strivastava about hypo/hyper thyroid -->
+
+<!--# data from woodmansee and plebani -->
diff --git a/extras/Draft Research Questions.docx b/extras/Draft Research Questions.docx
deleted file mode 100644
index 1febaf6d8952d45da22ad5378170b8d6b855b1d8..0000000000000000000000000000000000000000
GIT binary patch
literal 0
HcmV?d00001

literal 12749
zcmeHtg<Bj+xA&k41b252?gR@q!QI{6-62@e;7+i?-7QE6?!n#N9fE(e`|jS|&AZR{
z58T`HJl#`W^*ep4`$(NSM_vjF8Up|ecntsmNCB*|c50>&06;zr0Dum74XGt!XX|WY
z>#V2jVQ=E3!{}~fO_B=@Ns|qL1dso}<A3oRs7n~K>|#a{yA6I09B-JDY@x~T9>|S0
z!8gB$2xpfSy%q+wKDTdjv*c5-un+W-j4gSMy=Dm<Ur4itL#=nCJjCWt`WUZk!S!~2
zc8kH!7?)~2fq6w}fYaZay|oQjniGPVyuK@LL<wFl1C$Ynss0o2nJzI}mEv75F0!z1
z1n${`?&(LVQ?#ap!i7M@S4{F@!4mU_X}(+(s0cMj%@$>~l2pRXn&F}@?al{slI>D7
z;?2jM%}DMa5F?4Di{AD@xwas;q!nQr8=+2qt(xjl6QHYT)mB%;Dzrhezb~0U)ATvU
z%1!ncce9llS1tQtJLZ?r#c+f{M$3deq3I^9zku^?2%Wus`8);<t^%UU=|oh$^Xk$P
zqhpv?h;HypXz|A(qq><dC}A@I_SNTk0<CnV*eRaR0wm>$KclN}y+EqF?DqaCSNm$S
zRB_kymqKlE7)4O?-d~MB34$f-<pl~L{}1&fip6U@1^38;weJmBJ@p(-teuz`e>?x5
zTK+HA#lKCxEUpu*mI&`p1D^uN+Y}Z$aX_+6Mn4vD=3l+ml8{DUoU@#Le&U;(gVfnK
z_%Jjv8UMr6DFf)TmY{Qnm!yIi-Uc^wr`x6V(CQ9I3~tS5ai6i@KuF)YF?|{&m!KUC
zjL^UgAH#!<{TZ4v@(q2PPV{EG@Qno-?bwtNMJ*`PL1p$f#g{ERm1TOyQe4aHRSCaX
zdkA66D6TKOsbF<78$(R=_mvu*ZsmjcCe|oR+G~0|Yi1_Oj99}mc)YXL@dHm#M`2G`
zFg;ujTo}`Xx2ZOo=JRg&4z3{QDXB)C-nt!rhK|rB*h&4je$=){5W;|a8lV6G0>Ens
zH#<jTrvE63v7M2N4cL?Y=ED9|7znT*1CRdSeU!zI{AS04PJ`P6=e!trZA9Q=ooGL5
zYu!Q^dp(I<8|BGpcKC=%qJ4s$4E)SyXx1J)?Ri;_$(w!I#sOJF0TWVC<6@@?LELk*
z4wFJ{VOd-z1VQdOw{`1w$fX?jJ?8Yjvo^-C)&H}(y2D8+QvFpJ;g6u?-ggYN;<Fb*
zs#!H+?c$S^Zj%W8m8|m>SZl7=<W+_QXM*z$7WeRaHubaSdq9|5aSYB&Ql%CwiEjfE
z!dPdEuOo_Hv(sfj5?pKhVAZZ1xr8xVdy{f&IiU=tpkSDuL)s^Fm~!@=5ya<Ihrnx;
z!1c|i1-ggBod<6}WW{HsP^0)>FJ2IXzx{uUkwnkAGe1~_;@$uNsNfO5i_zZ&Xh~Jd
zZjl?M9eeKO{azhEMVxk@L~ws+gT*9(VNIrC&p}9uJPc8fg!b)8<!TO5!z4W<Z!-)t
zeJtDMdHSmlPQDIIFd83Sv`hIUqvJ#U4O`Yq20^DU-U9C;LNApumCa#1>R_>ThF{#B
zR!oCUqoB9pglUrNL$(!;+Xgn~s_`gX`r_D1zc4<rOtQ|H4B&Q`H;C~`Oyqg7sj}H4
zjXj7@hqsvf8{IzSU?w$~695WXN{g@UJ9@;CVR^z<`^-9^2Kp*2px}e^8{#~*7wD3v
zRycNEJ0M<r55U}71xcHdM~;GeORW957v$lnG~`U&Be7hwoV?<PNC}t2s$o77)H!l+
zrKb$;=H^rp38~8QRL2=kS;@Tf(Gb$U(U^xk5%Ckx$Kby#M4dE_j)V@4>Jh*o%H&~<
zO(;F?9D^T`wV#ad0#HQ*Op%ZRxp7Gh8<Q4G$I}i>G}>!gShU!mS?jD^8av^i4gh62
znyzo>+9HQ-WDs>t25Jr^Eu@kmaScx33Zk8HN!F7@osJ5mbjrFWV>r8PwU@RO;vPA?
zlD&JA_^fq=CGgh+w;Vmwq|HFa)wR<f>8;%#jcN20Vm}~Mvd+<DX7%A)-0tqWQ%lO(
zeuJnlqw?cgYw1O0_bIgVD*bRo<j9@!rTN+lg1oD8=?<p8u4ZcLqj`EU@Fq>Wth*@L
z+IY67DH-WAB5btwqk@uL5zK}aiIgQnA2QK-8at`f7QP9G+WU4xXyv)Jl1bx$x1&WQ
z0gOz#3f%2`Np&r#VrLV_qQ-EdoAmyPh?N7Yj8ByEtLpZFyL%<zRW`|7GaN%5oY>1j
z>rO@K7CeSJ{T2{2WtVw0n01yiR%AbdS~BZ#->SQlxJThffZ6rpD+l-ysny{9-I>j~
zAZQO%?#+l?G_92mwR<QNw>EUp2{oqnKF6najBcb9y}6e#ckH%<8|?72w;8fjlP5uV
zt8$|SB0<vEQLsjp4(j5CZQ<K0$BjezH@ZW|n(v#*%Rd@MUhFwfFi4d@jn-ItHxhg{
z($p6+8I^}^lWmNOKTq85<VPT<=LXV8uZ#c%y|BN|wjcH_8hAecyRN-zd|yHV3jjpp
z0RWhP>YB5;iH!-<?`M|Z4EB+ROawj`PCNEJaY!>S(IVTk`Uc`=^_RMN8DZD>I1nHC
z7|l#%B*ke3+{d^KPg;zL2@$BaYk5g1ME0u*;@X%W1%kP8y++a2%~CB$K@%Kh*XOO3
zL~WH<;+xH$$MiijaCr!^WmdBl+zl|bF`_gPUvJtr4f1WYA_M6mQ;e&u#z<=`kNqCU
zRjT^XQ-r1F%&d`}kAp7vb?XO(#}Vc*S%Xve@X^yC8B5qJfEXF@9kdlQgoPS15QEll
zp^ELjy!e2mb)WO4ygKX!zHR9Brdq#d;g74xG0mwO&!g&?%YaGIqz1Uzu*izaMz7;G
zG9ch!6Y4A~__?~gSh`pQ-C-@pEz3VK9AUwZ=T#h;^J(I>RP1s-<@>>W^G4?~M@$Rc
znaG0lXU1R~X-=rtt(-jcdSeZjfQ{JxQ0@yVSeJUn$9G?iCq}G%?=imo4f#_iT?nPT
z?iB)y#Wa*!*IRjAYuh!g&#P`)c)B0aB5MX<7tYh7vQv)HSgC%7pst)R8I-pBSISRM
z91I?_wcC{EuaV}6K*$fk5SU<P$*toAL1F_UffyREXk@#;rw2qbj~`8a$(clX+3r)J
z#6+!nB{cBP4t^dOzhzV%lS_NLkOg1q3U_foU3y8)G?w+~`Fyp17oUY~WVf&k(9mx1
zdgxN~<9}JYzf3+|6?j;PG&6Zj&uVwSTs(c*%CxF$_c-6#j+kBbz3Yn}L$J>ZP{8$#
zRO~O)I-6>dQe+Y80@#bLj%;v46j`sEu|VO*aKc{sQ{&yw5a{cFyUr%+dr<BVhI9A1
zktg>~_<{QYc5Q@W+W%9~8c|L!&vJrMB8Yj&@N&&rwRah2t()DoDrvjZnr?=lwHX1e
zXuLI0Y)}Y+t)F530~HG1FcC>!&oxSL0yFE*43zOTfHh<bC#r6`j<w~ZVr+7ASayFS
zR(jWiYP5d*g8<)ntf3vi+7YfAtM^d9SIE*BK~Wn>1jtMgCmOLRg2`}*-N!LBL?r7^
z8Q9_cV&!ZHpUP7BgfgZ?D8ZAK67$MGhP6hHN(geIIF@ZNj`aqe6IBXB-R(739LYUW
ztV`^x7#o>eALx2#z1GH4I9ygHlzBE#0Ru!>JMpeNLbju>&g3<Q33m8nTC3No+)8k0
z`}0Y&hLan~zUi7t_flbhQ~C_0H@>Y-6O=Id)%u|;@o){Vyfr4&mEZicUc<{}O`DD2
zscxCteHr6LkBd&TMB~bG-|J0sfxa_;S`#xv&vAM7l5kc{0Xk`P1#N`FbwhaN`P?AC
z5O>D}|6-hi0$}L;cbDNZT7wO1`4Ql14b<3#2-<dez2><y9RfhFKB6|?9Ge<-Oe?*7
z+GuW~t)%C`p_zolW;IyUg87SR*ZW)*cHQ^FBi7XP?_jZP_I=;JxvuXIpYy|t5wv!<
z9ThL*@;9KkOjyL8U-l?ygi*?JU1o0kyw#E}ZABqDBtxyB83Gr&=6U(qX;~v*8AL5o
zEdiSLC2me4t0_R_p0t`No^wK!Yl7>nvx@F1m&ceaKI_Y~g(NW3;oXXO|AKFls@VJB
zPst<gvVAFs`f2Jr4W?CF25d%o)ARuYPakrEcHi9@Sz-I2M93x!!d+65iptftY-C$9
z^bmY1+{6b7XUnLw$Q2kedEHVfC>+w><nc%p28I(AjM**AYRr1Q5mhaWH48{AYDtY@
zrzSe4{e+#Il!`IQN+v3{aFaMjp95WM3SP<F=50W1VS$F=$||XzVf}<plnUeWq2?@Y
zo$Vs6!yQzPs0~L7P==LLUaS6K%GI5e2C-2)ZE-YICkytlRFw#&r%iF1Q&%o#T%`Kq
zVWZ_;R|aj#nKU0cbPw`SGg{G%u+C@`2dKzO(2;Ky@jzGJVPPeEgHyY3;^q<9bK45E
zS)0!At$bF84yLvk8R{bn-^JzAYxPk$#<$a-*hurCq_9XV^0HUKE#+dazrW#P#zKqr
zm?}f&jgqa@*k^w<=sCV!NR<6?q;fx!JxzQARk@5S&`^#J<N5?#<9u~2S&IdY*|;x$
ze=M87J#*N;c(DjI>(?4upW<<@6Qp*&@PhwuOSrLOkewnl0D%4XC7hFqv$KV*nbU7B
zrA~Fxagh_n=T!PdsB3qS%tWD@Czh>6y}@uuLZ<o4O%GIDOb|RaEI@4F%d;0Y3F)9i
z`nwTPCdk{POda~$?~SLfkqr&%bYwrjy^-~<4ECU7{jLUeYQSQX<-w4TI);KtfZWQj
zy7D!G*w0-H2ycaGSptKhEk;l1ZdHC+G^wzU$Cf86`kBXHiWGO^j7E(xWUHWmu~?sH
zf`T+*&!_P4!KbnS6{<3ZuY`6XGEb4Fda9QKZHQ9B;c1tC%j!{;3OyDJ!O4c-m7)M8
zaLrQ2aeHp=#RSU!SiC{6r8`NXP!0C^ZG{$mDj~ftdL~PMzIe6bSpbd;1lkJsNgK(#
zp8^o8*O&~LDX-f32|p0|5(?eI2<fd?f?ivNe_mi~brKD4r=rAkmO=|NR<U;xP{$il
z)fP{XfBouWBA~S1+Ia;=`7R!%Oa;i3MB8d<j=FmL4%Qz!!lW#=7f?!|Wa&kfj{{+Y
zTTWppe=KWg!`dneGyNu^TXQSBP7LKK-Bu>GB387xmvvMD-rA_M9%E|XWJ7k3#rbm(
zwwBhMfTgU%bi95iYTyIkVQq7NRajZf)^!*c?2H!*(bvbNSbtnHi4bh6=;{?EzTh>Z
zi=a<@UV1b#{^PETT%u?B0A{XC!Efn$M^1b_;@B|-r(47AVYHNY8RE2Ck!JGvt0TA?
zjMdPupe=2Xwng%2Y%(iZ2KAl&K&zt;xF%#zFcQ-Q$Oe1@x+<75x6y4U<d6LycUuZg
zyAIrVTE{yI(xbxtRz__5?oPs-PizB9pB|NXVB8t7YJ(NZcsB$ypkGcz#-n%Bm)mk{
zpO&{8PrM!PoVjo_KaVn1y27-Czx3Nlb{BqK^$6WucV-|C$ru5qB!n2r>pks#uY#`a
zTGxGjto`tuciVe<T^fV9K+^SGELi?<%QG?OjI>10YPA7!rk<o=P}PV;m7)+TZ`Pn7
z1jY7`gxY_i#(~8X0B(>u=zrCL2q%>+WELaP7co)*DhqT<c@;QOs3F>wlfEdxqaQwf
z9Fl%dUzta90nb1=Si0dxCse7Xg;rq)=j5nDQC+*i91xuyU`E_9u~RG|higG&$SZ0a
zYXe&v;qgFPksdrahw&~G#8-JwsR08O9XGAHSTlZ>(0Lo;Bd)rPcc@vWWpD$Lzhj!M
zLyV^}JMj5R_RCRS>~%)jY`-w|8+?t`fqP&>hy<m9jdixm@_2u8fTF_2QA?*@XbD9T
z$KZM10-d~WF4~k8u)YCxrE~N<?)VvQa(raY7Yzd)t)zNRF)xKZvldvk!8@lA1dFYZ
zUN$4GjjSHS1|7+4f=zy@G)h-R7}>A@q2#Xi$?tU?J-#*SKiFh=0%Ze~+DOKL@e+R8
zojJ?#o)BW~A8&o5lgab!RgFg3%cNfjV4lsr1rQh4&Dm{ldv}wM4Y*z}niZOD`u@ne
zVjAn}IG}RTtHbsKM~eR)L$*RfQ6hmi7udjCbr^rHYu!u?mHuXf62?0%Az4sh*SvC0
zQ5<K>6!Ym%;PYSeH~RSFm~o^G1f|YR3;1-+G+;1!rZcBT-=+3kgbMipA`0jB2AU?|
zb3swji@=VKa$vNkM1zA7l$iMyoG8=c!&foA+bZASj3GG%u`orD)fMBeGCsNOD{~WR
zI7189ZgVG(i<#{0C(<YagPQqDpR+sT0u_!~vye)KqQlleGsjm!DW5#LP{PF(Tm=TA
zXY@eV-Ra$1@AI}g&yI7h&y!R6wBPR$#>*%7Q4V{6KGJQ*TNW`tLewt$@53--H$|m<
zfg`650;%pDB->Cl9LndRNhFp}0S+575)^Ot1P#O<yQkh%Szzz17B4dWYYc7}!V~BX
zHs0b6008oz@6XBE!`kF`^WFLdY`(eCLQWekS3l;L&PRwQMTc2s&=POdTWxlu^Q2pa
z2GN%Z2@i=_A5Ss?;?TCKXgKFK-)iOFLxmFip^pS!JrFZhBlw=Pqto%=%dDJ6L1qTg
zp$%-#@AY+Ee?<n73~8XT6r=faYMxtP^%Zu!9N+Fv((6fN!r;Xi7dp6eYHr<KIP;Bu
zhl$p>(Pi++<r-DNtJUt1ChlXA$_n59D&HfO6p<Q3rWbX4d-M4NCe^Ws!e#U8yF~bi
z6zb+E;zDi9T*;bXbyJSxX5?dy{Bc$l(lOSy$!dBJ7W4r;HXi6~^`PRxDL%hSw}OLM
zvHi1w%qONK{BNj8Rmgxo+&<FJblu!qJ&z_B-Rt|uM!AZd@o9N(v_IP5>D{j+N^y(N
z!pAg7FNa&DPbUvdt_Po+Rl(ek71F;6cK^}#qe$KSV8kOXEOzC)MpBkpK)tPYil1g<
zkj9GpgRrO}J12wb%Ot)ZiwEbzYUOG(JO7-gT+LRsZ#4C(uXH-UMJvbTQZ1^~s?3<o
zTGK-Hg`JUGa;4sUNHRS}10m;Fb7oQeCO=f-_n(F@dqz(iUIxGv%;pljYX6H<JYHDx
zirvc0k;w^V&$n5A3hU_61<fn=oHaK4Tz*R{g~Is@+-9KY2AQXwguV@+D5@MDu{0Lh
zh9EZIUF^B}<#X1o>xG(KP>J}}%PVSh-Z#crKE7~w6Y3InGAZL*rEoDjlfiTBwp}k;
zT~vu^Hs^0fr3K)qDp4CAXu8|O`tiILN9lEszdm7<<ODWa?wyt6z4I&$`Mg?^6Ax~7
zX>k~{_?d{1h5eMW5S>HFKH1=23f<uz4%y*u4cg%@3)tb#@ZaI4dY87D(r5nJD2<G}
z8D6Khie(;|ptddj>jTbu-?ESR+2)A=<WC1TYHz`llgE?3<u9X8O<!vpiQU|4dYy*y
zRqab{lC}bMIMwLnlt%+IIuHu0MQg2N#k$yD@n^;zQ9u+7TTg#<XJ#<Ixjw-)lsWL@
z8<XL|F7jZ;jutDiy38Tm9bjT~NhGMEncx%FAG{=Ui3}afkiE+&<b&hc?k)&SlVlbT
zcLy?aB_G8`_QZ#}|Fk5NP*j&Q*AZljlz{Hc`>c^tvaX{PNiXP)I)7Hp8nc!g6Ng^i
zJ|WFAgr|$IK72Ou%`ij_7K^Qw+1wn+A&MDgo=1l_?yth0>+p7$db;ViKc(iPo2ug>
z(Tjoo`7-AtDt&n`&0nR8hb_)KpHjm6g7#s)ops5$jIuYG(RxYGJEEr4P8`qe2pBCk
z%a7B!XLA>nODG?D@`^ED>qg|^2xM!q(>axUh~8*kh9WfVAU4i@(WOd<SwNKGXJat+
zD79cHPPQnN#@Y^WZCX?p@D8y-uxFTv9ELqs55Rq#rZ<bqz(}>599kz_tO{8?a8V^Y
z)(xiE%U51Um%(e-VDKmzswwQuv!cxR+(9LDNGmMKu#y=%)spbkcy?;lu9BY9w0JZA
zBCn?>k9;!cc!snrMTLg9EYJbgXozL_jh*!qsk7{)f?;+j5vW#qj|xLpQx~eU#w_m}
z<TRwrLo#j+)Z=5G@qN-aUooIxrN-rvk;UnnhKt4!h%lV$d2=YyN12=7(lVVI4Dg^j
z3~rb-?~$A(jYf>UdqF7+p+8-v$J}W}Nh~H3*N>VE(O`K%M*dXTQb|X`!**5Pe|-1h
z>s0-?bJO}z5W~_LWq^tjG12fN<=i~D^=0|H!tqhQu?AH}vV5C|@>i|PqFXojbG7pX
z<^9$eXDD^30bmtu9AZwKScY+em$gR_ueHb2gA}(3ee_yF#`Y5%CTc1U7BD|3SYbfl
zKp9URrx?(6`orQ|$ZEl)KVpYkVGt?<1RisV2hj5;b<5zSzrqOH8&H}V7La3%KGHIi
zP#eZuU^YU(MMN4(f@2p?yah@o?$W(jF{vUnCX3R~7@AsKYQd*uXJ;KYF@ehgon(Z^
zQle>&(LtH)Ws9w*0vF4q<Mn7LD{Ug#yT%5dwYmOduUXgNd1@Y5w{_i`7^Z|s_k%fV
zx3Y@l!fhkm%CB}`#}DgvvCo_O1NRMm8al#wRu*wJu#dD1zT#WsUvA!eBsEm=5`~df
z@WK-pa0~1aTbo^}o~@s(jYt~4y(luHu)cJ6+cHgT#q^k9Lu<IpG0VH&S2a#1u28?9
zdWS08vNP7w>m=PCU!hTlWNXu4MOIF}Sg<BBOTSPfX-^cgV+o;Lm}Rzf{xrP#xv!~T
zrgLsUX8-stSMHGh>K&88=cAN7i$$$feu#^99nsst3_q+AKD!Q=&f*slokq{~1Y<t)
zZGx)~`}#zarOi3s<tEg&%g^}Zyb#T(ZLG0u1c`A=2`kM5QF~wVmR>tI1bl$jZU{JU
zvWD68slm+qX<Q0X3gF7Ub^I3f9v_qJ2avEz(Vko$2(zvW492KaAceG14h8oxezOM#
zpL2u0yAy+i!=n{QVg7R;j0k@HpJ8M5ZEQ<JMKJ-KbfVc&@TlgXh3gFf7?Gi1&<aNM
z^!>e07<!=y<>PNdBjLZdMZ(jXgZ{W>c~_Lvp<uu_TEx5phHMxqiwphE+Mf^ljUTfA
zVsToRo<Lt2Cz_2e@|J}z?<WqX;$OV|4*9K_pdi$g{1^8vJ7z9n6E5jb(0((M9(}$q
zQfexN?Oep$wz)|6pab1zji)TJCiw$ebDy)bZ!`E$B!*PMHHAfl$<yiDUQ*Bp-*+2_
zPN==pu0HCuDD%HDs7!_YX|O78FS}i3HONIS6zev}F_|8#KkYG>=#w71#_T?q=v>Zp
zn67xW{u<gXKNWb^jk=Opj=ydn`qj~y9ObjUnyD@HcZie0zNl}YZxp+;;~)6@_T7E_
zXi1!9`e4_)W%kmN<V)WXiWpsCj>znlW~Tp819Cy+7orDZ&qN8oJp$fIAlif^F02;W
zLaJJdpT*(nKjw$f*cFow%2}r1R4a;rZ@+9EQMpSXGCwPdBs5N;Y*TaaB^cy~K$lI$
z_$PX<LClApC*$R|f^mYy>l;XKIVkl1)4N8=@$IJ+qQVLom^GCx36w&FQ!gfk0FU?^
zy=lsN{)ie%4#{;Ow=L?->u$mr{EtmrORukrlJLeerxgR&G#G@+Ek_)t6_wbzaw<J-
zh4pZkp%XG?5p>nL;LEG<!7Np1TE_n|4ek1^1Uxkc7s;s7q<8tfDpIz^U}*YOlV!2Y
zACvjB=ZoTI31#DddbI1OsD3B&=al{+u>>BI&-phJ|6lrlP;va9hksGzEy+K>oIz&B
zZFurwds_Fd-`e4A!bct!-FAyn#fCV3We2)OrcBkJjL*K8C^@iMTt5gfn9oHFk_mpZ
ztg7zg6$dIl(2}2xKA$^%@3UOBS*mFBfm1}@uLW;nB>%^SlU6c6@57gL($l@##5|`+
z$!TrEM|GJl9sa4O)Pai+U#|okCGsG~rjb<>`J;5z!zLD)niJg09_ut)1nKVhm>Oko
zjzlgi8^#7t{hWFWITg4eHjhUWm`aI}oFd)sqRyr<t#=dHZOw6Qy?A?m#Jb+v3^5+A
zq;PV{WwxCpTpyb{@svn6UX8fptHZfIWVgI)V@V~tk;ZvCzG-VK?TT-EN3GUzNOknc
ze3154yaWR??bE&9MZmzp-G-ytp`K%@Ys)j!!<FB^F4QZKbsB@ffet=63_=CxT)}xV
zc}F{YCnh61N0UDahW;<n3VwBwaSBr4M63TQ%!|lCt<D6JsHB<!l8`eQw}N-XfK5b!
zggC1e>eF$-@r=e&pk4Edn_h+6z?h&UZd;&>a4DQ55LzrdWk<N2YR|v{H!G*#ql7zA
zvlDuH?T3ehcLG~Hi_Q9|CDhCtdj)3NWEM6dt5cbfY9lL}Vtg3k;4Q_)xO<cZOwNS1
zam=-Z7$xn1!VJ%Fd;@Dw@&!7c!$eaflecRKfk9{qZrr$(?qi-+`Ml~sOnqbX&+0!0
z?lI0!63brctEhl1mvVDnpan<lP8Ri|f-OyZ0GK>xso1*0v71jU8B06cm?@_Mw?f=(
zZ>FrYq=gjgA-&LaX3=uT=8u=3ZWA{G=q&3nPD&Y;*GI@!vMcJg8O2{IeB<Ue4L&z$
zTTTo_{+Kj%=P`Gy2*{dwX?e0!A+I@OOjA>)U>N^&=Sr#5_YK56Scd<|c*)(K!oa8y
z8^<0sppg+H#yT3uPQKM_;VIvNowNx1Y$HAJqY2&F3147$<JG^#=#Ml(jc4Had>jz~
zK>IVsv~{sDG;suP6aFT<t*Xbi3(Oc#f)=MJVhdv%6ci}A6D7-oQ^n~8<z9ez9K&h7
z8X5n_tS?OP`6`fTe$36peY;z_db{_oB4J7-#mr_(v&8Ndf$D>7!%0fFtCvS~u7vrd
zLnP}6GRq8#C&weZa<hj)<$DAY=zBN_1#$J_g|-#-;sAMz&os(V;YtITdV4~Hv}+MC
zvZ(4#sUN>xwq0b!@QF#{W>m&t$~SXpx9o=`Ni=Z|U@=2mAmszo2}4%#DIn2Nh#|)t
zCz{?5b7N~O7L9<kA>p@&B(-t1AviLP0<LG?dxBs?<dzeSB@n^px0+T$EMGSbVcukw
zZW~`t4TDAJ<TV9Z2$UIJU#?H#l`{M0Fn-JiIVudL%#!BMbq~bz@{&QMsy9z92?@%>
zg21abB+P0Q8z46PgBPbXO}BO9xkTm8^w2fP7to3CA1nMsl8Xmf#IQ^lRj;0@wtX5`
z*^Pvl_35TxSCgK%%2R)O`JyFo+QayHM?M84J-OvD&=llkh?Ba&Ti`9L0nwL<cH0}N
z#I2_JUHL^*!R&OOCB4OzK0QH{j4dLcLpA=^HYc_<`E~moO2l`JQE5+zfhoe(Wx3o>
zpHknHeX0oUl`DF`<?&V?J>G5?%}lU7T3rvbw3vipuuF#^3Y2{j^Zi|w2AyIUR`)QF
z>53|IcSI72vX5%H@?zM81ys%=LR(O^GOW)Jk~w_XK-PSSuB%3?`;n;enB>|yd{Ad9
z!a`HL6~i#(WyO7AO<xo!6z0;uB4~UnCmE6IVQP=n4|G-%`H43`ohQTa`7ONX+l#I<
zXo*gIiQ8TA`z~7JK1{@D+Bo;r4kp^O4-avVO@Vpqu|&Kw6QB68Zz|+b`lyv@TD2#|
z+9+{hsKvt>XPiOLGT2DSK#{@%e4T>*-nO?G9)*#?=i6zFCrlRJ%vkRv!kK2A<DX@?
z;E{n{yfUwDD(=$Kl%5xOI~1#KNq-!zeq%{jEuVhXIr8tOogxOfR}VJreBf%(|IrUq
za7C!HfuZ&9wtXpf%yy9(q4yN(1}Weq%4Al87bN@91(8{Q&R~z|y@GLi$}>(b8ke1*
zrfZFeYIgGx^BdTr=q<Ua!cTo_R&zqHpieC`nV`)UXgi>0XC8Nlc6Kt^A}5aX&ShsG
zi(&;U1by9cN_xMBM&1*us!q2?R9Ds@s1%lW2cOo1j5h-lV;gct$`Cqko}w-ql2IG<
zNr-BNLou^h*7-43*|V>(D{oZ4rrg(NBcir-A$jtRhur>vC3f{WlO&(`Ql9Fr8o+CG
zaRF&81QXpJ_NHZ+PeEA0i&4>dg!tRVyY~(d>N)L5)fuR`MCHEQ!zBk+hu$$-A`~rX
zpkj5%%j?G!>!OUh1Yd~KSf5#_hxKyj;_T#6&}i`viOh(YkQJqEk7B|VHbx>J{u>o)
zr~_0^%y0?YJQydwVp0dC+)qU<@xCz-y{Ls4!ct-Uwqhe$!6-eKrd`yOm3Qd0Znr~Y
zwTh8u`KOa*OPQD~baW0AoLSs-4x=2-rkp$u>;3WURfuOH=;>SEnj|lBng-zr0O#+h
z2RnEa65L)U;BF8X7~A*z_P+Za^bxGxbN#FTCM|}hj{<+>EwCX(`Mdu%u($s|_YHn!
ze;gT#GIn55Z$qB*L-E$7r^XMc&{syF4JWE8H($D;7q4TG){B|Sy}Jb+PF+?lI+GC(
z6!uYfPM6jm!6<Qdo|d>QD<ibQFZ}dX<FDf?jR@Z+YfIvEUs9nSo=*Jv6XHZMG$p)q
zIQ09j4o3nS6VI6Cduk^c6S+i23hFoc#k)C&k>3xqGYRj%bIH_h|J3|pHC4)uu8O|7
zEp?}-NH|r*B-l_W?hUEwJU$q((Z_9JMHmhx0QwO^W@AMV{w81-`ouU|qwJ#`1YdAo
z?av877TFv!tAtAb`|3OCGqO*1ESex=QmY;}kYaz%+oRodUCvP`y#~Osz36p@G!I;^
zW`RAkFB&Th1^s})0C&dp2rfZlT~pz)7_|*>%?~j53OipgEIn;G&Q8{|<DIxGasP_k
zk-W1Eeuh`?Tfgm3b0LT0xoq>RYlctMN+CuG;oUY3ddWa~I(rHX4jayhbcm+>MoHJL
zLXB0B@9AA5v*rW0k7o7C4B{6qrd1Y4<7b(TzeE@Uk^#K0{_l0`e}1w*um4iTE-&>@
z0{^V6{S)}xH4D71{ac;wufTtn9R3~H0j_HK{}mwqO6k|Cv%hG;!u?AP+OP0m3u*p>
zJ0ko6|Fx{<R}#M_P5&Y>05<=>&*kqa)L-Ghrab<FOJe^4|0MzPD}`S-{r{p6j`Jr2
z|C0jv75vXY<S!^V2SWh>{8w1=EBx2R;9mqzsQ!5NKbD5S;(v9Pf8mkn{=omkb^eO~
kryc$a4FFue{Tus#SY>%B7_fK&00`h81Xw~F7=LU1Kf5Nkb^rhX

diff --git a/index.qmd b/index.qmd
index 09afa5c..d64b002 100644
--- a/index.qmd
+++ b/index.qmd
@@ -20,16 +20,11 @@ existing test requests at various stages of the analytical process
 testing, those tests added automatically by a set of rules established
 in each laboratory. In most current clinical laboratories, reflex
 testing is performed with a 'hard' cutoff, using a specifically
-established range with no means of flexibility [@murphy2021].
-
-<!--# Rewrite this section -->
-
-This study will examine the use of Machine learning to develop
-algorithms to allow flexibility for automatic reflex testing in clinical
-chemistry. The goal is to fill the gap between hard coded reflex testing
-and fully manual reflective testing using machine learning algorithms.
-
-<!--#  -->
+established range with no means of flexibility [@murphy2021]. This study
+will examine the use of Machine learning to develop algorithms to allow
+flexibility for automatic reflex testing in clinical chemistry. The goal
+is to fill the gap between hard coded reflex testing and fully manual
+reflective testing using machine learning algorithms.
 
 ## Statement of Problem
 
@@ -77,15 +72,8 @@ widened to decrease the number of unnecessary Free T4 measurements
 performed. This reduction would reduce overall costs to the medical
 system without likely causing negative consequences of missing the
 detection of people with thyroid hormone abnormalities
-[@whitneyw.woodmansee2018].
-
-<!--# This paragraph should be written and most removed-->
-
-The reduction in testing aside, the hard-coded rule still exists.
-Additionally, machine learning may predict missing values in a patient's
-record or even suggest further testing on a particular patient. In a
-study at Massachusetts General hospital, researchers predicted ferritin
-results based on already run laboratory testing [@charnaalbert2020].
+[@woodmansee2018]. Even with the potential reduction in testing the
+hard-coded reflex rule still exists.
 
 ## Purposed Study Set Up
 
diff --git a/references.bib b/references.bib
index 5535ea2..08815d3 100644
--- a/references.bib
+++ b/references.bib
@@ -214,3 +214,17 @@ PMID: 33045173}
 	doi = {10.1214/ss/1009213726},
 	url = {http://dx.doi.org/10.1214/ss/1009213726}
 }
+
+@article{woodmansee2018,
+	title = {Determination of optimal TSH ranges for reflex Free T4 testing},
+	author = {Woodmansee, Whitney W.},
+	year = {2018},
+	month = {02},
+	date = {2018-02},
+	journal = {Clinical Thyroidology for the Public},
+	pages = {3--4},
+	volume = {11},
+	number = {2},
+	url = {https://www.thyroid.org/patient-thyroid-information/ct-for-patients/february-2018/vol-11-issue-2-p-3-4/},
+	langid = {canadian}
+}