Research Methods lecture 2

We will continue last lectures topic which is basic principles, this lecture starts from the slide entitled Variables: Variables are things that vary and can be measured. So anything that changes (vary) and also can be measured is considered in research as a variable. There are two types of variables: dependant or independent. The other words or terms that can be used for independent variables: explanatory, controlled, manipulated, predictor, exposure or input variables. Dependent variables are also called: response, measured, observed, explained, outcome or output variables (please correct them in the slides). Example: smoking is a factor that causes lung cancer, so we see that there are two variables: smoking and the incidence of lung cancer. Now let us apply what we learned so far on this example>> smoking is an independent variable because smoking causes lung cancer, in other words lung cancer depends on smoking, and thats why the incidence of lung cancer is a dependant variable. From our example we can see why dependant variables are called response, because it is the outcome of smoking. It is called the observed because as we saw in our example we will observe the lung cancer not smoking. Also called the explained because it is explained that it is due to smoking, also called the measured variable because we measure lung cancer as the output variable The same thing can be said about the independent variable, as it is called the explanatory as it will explain the occurrence of lung cancer, also called controlled because we can control it (we can control smoking but we cant control lung
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cancer), also called the predictor variable because it predicts lung cancer, also called exposure variable because people who are exposed to smoking may develop lung cancer, also it is the input variable that causes the second variable. Note: Be sure to understand the variables as in the exam the questions will be in the form of examples. Like if the doctor gives this question>>Q: The age of children affects the time of eruption, so according to that what is the dependant and what is the independent variable? A: age will be the independent variable and eruption is the dependant variable. Another example: Sugar causes caries, so sugar is the independent variable and caries is the dependant variable. Independent variables can be: Entirely manipulated: sometimes we might be able to manipulate the factor entirely like for example a dose of pesticide. Sometimes it can be unethical to modify the variables like for example smoking because it is not ethical to ask people to start smoking for me to study lung cancer. On the other hand dependant variables cant be modified but we only observe them. We cannot modify the timing of tooth eruption but we can observe it. Health outcomes: events that can be directly be studied in intact humans only. Includes five Ds: disease, discomfort, dissatisfaction, disability, death. Now if we want to do a research we have to deal with numbers and probability and thats why mathematics is important in research (not all but at least the part that deals with probability). Clinical science depends on quantitative measures, usually we depend on quantity. Sometimes we might depend on impressions, instincts and beliefs and they are important when added to a solid ground of numerical information. Examples: What is the impression of old people wearing dentures? What is the impression of students on a doctors way of teaching?

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So those were impressions and they can be measured by good, average or poor. But it is important to add numbers to these beliefs or impressions. So it is better to asses a teacher by saying he was as good as 90%, so when adding numbers to impressions it adds solid grounds to the research, better conformation and estimation of error because we need numbers to estimate any error, and thats why when you do a research try to add numbers. Prediction of treatment outcomes or disease sequences: it is better expressed as a percentage. Example: what is the prognosis of people recently had breast cancer? We could say that the prognosis is good, average or poor but this is not good enough. If I say that people who had lung cancer have a mortality rate of 90% after 5 years. So by adding numbers this adds a solid ground to the research, and it is better to be expressed as a percentage rather than just words. Probability needs to be expressed quantitatively this estimated by referring to past experiences with groups of similar patients. Example: if you are a physician and you have a patient who has breast cancer you have to provide that patient with information because the patient will be asking you like: what about my future? How long will I live? So to answer that patient you have to refer to a previous research that has been done, and that research involves for example 100 patients and studied them for about five years and concluded that 80% out of those who had breast cancer cured from the disease, and so with this previous research you can provide your patient with information. Population and samples: Population is defined as all people with defined setting with certain defined characteristics. Example is the population of Jordan, those people have common thing: they are Jordanian citizens

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Lets take another population like the males in Jordan. We didnt take all people but only males. A population can be the students of this course. As we said it is group of people but they have to be defined according to the research that we are going to do. Another example is Dr. Ashrafs research about timing of tooth eruption, and the population in this research was Jordanian children. So we conclude that population is any group of people who have defined settings and certain characteristics, and we dont mean by population the geographical population which is related to certain nation. A sample is a subset of people in the defined population. Like if we have the population of Jordanian children so we have like one to two million children and it is impossible to study them all thats why we take a sample. The best is to take the whole population but when it is impossible we take the sample. The sample should always be representative; in the research of the timing of tooth eruption the sample that was taken were 3000 child out of maybe 2000000 children and it represents 0.1% of the whole population so it has to be representative. How we make the sample representative? We dont take the people in Irbid and say that those represent the whole population of Jordan. So in order for the sample to be representative it has to have certain characteristics it has to include a sample of every city or class like poor or rich, living in the city or rural area. A sample makes inference about the population. Two important points in sampling: -Are the conclusions of research correct for the people in the sample?
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-Are the conclusions correct a different sample of people belonging to the same to the same population? Now the sample you took should be also similar to another sample that may have been taken, for example: you took a sample, it is 0.1% of the whole population, if you took another sample, and it is 0.1% of the population, the conclusions should be the same, because it is representative for the whole population. A 100% representative sample is similar to any other sample within the population. Does the sample fairly represent the population of interest? It is another important question A sample is representative depends on how the sample was selected, i.e. it should be structured, you have to think about the factors and different categories in your sample. For example: I want to make a research on Jordanian children, I took samples from Amman, Irbid and Aqaba. I cant say it is representative, because I neglected people of villages, and so on. Sometimes a sample should not be totally random; I cant take 3000 child randomly, maybe for coincidence because I live in a certain town, the entire 3000 child are from this town and surroundings, the far towns are not included in the sample, it is not fair. But sometimes, depending on your research, a sample can be totally random. For example: I want to make a research about the prevalence of caries among JUST students, as long as he is a student there, he belongs to your sample, but If I want to make the research among dental students in just, I shouldnt go and select haphazardly. So it depends on the research you are going to do, and the population of your research, that you are going to define. A sample can be purely random.
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For example: I want your opinion about Harley Davidson type of motorcycle, I can stand in malls, streets, etc. and start collecting information. This is a random sample. But If I want to see the opinion about Harley Davidson among bikers, I cant go to grocery stores. A sample can be clustered Categorized. You have to define the population; we have children belonging to different states, urban and rural people, governmental and private schools students, all of these are important factors that are why they should be categorized and clustered. A sample should be stratified For example: I took a big sample, under this big sample we have jordanian children, then we stratify it to: jordanian children in the state of Amman, Irbid and Aqaba, then I take Irbid and divide it to: rural, urban and their govermental and private schools. Jordanian sample Jordanina children 1. In Aqaba 2. In Amman 3. In Irbed Urban Govermental schools Private schools Rural Govermental schools Private schools So it is stratified, one big pyramide and its braches.

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Equal chance for all members is imortant in random sampling, i.e. if I want to do a sample, there should be an equal chance for any potential member in the population to be selected, it is very important for the sample to be random. For exapmle: if I want to study students of JUST, everyone should have an equal chance to be selected, I cant say that Medical and Dental students are dissmissed, other wise it is not a random sample and it is misrepresented. Now, we have computerized programmes for selection of samples, so it become easy to provide random sampling and it is the best way. The only difference between sample and population is: The Role Effect of Chance. Now your random sample should be representative to the population and in order for that to happen you should consider the role of chance, it is impossible for your sample to be 100% similar to the population, because of it, thats why you have to guarantee that it doesnt exceed 5%, other wise your sample is not representative. For example: you want to study who is taller, males or females? We take a sample. In jordanian population, adult males percentage is: 49%, and adult females percentage is: 51%, I cant guarantee that I have in my sample 49% males and 51% females, but the difference between your sample and the population shouldnt exceed 5%. Probability sapmle: it is random sample, but sometimes it is diffecult to take a purely random sample, so we take probability sample, each member has a known probability of being selected. For example: I took 3000 children from jordanian population, the percentage of children in Irbid to Jordan equals 20%, so I must have 20% of my sample from Irbid, children who lives in Irbid has a known probability of being selected which equals 20%. The advantage of that, you oversample low frequency of groups.
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Now lets assume that from my 3000 children, no one from valleys or from Bedouins, because they have low percentage. So we do oversampling the percentage of Bedouins and people of valleys should minimally exceed their real percentage to make sure we have enough numbers. Including subjects from minorities when the study cant include enough of them because of random sampling. For example: old people cant always participate in our research because of long trip or any reason, so we go to their gatherings, and oversample. Non-random sampling presents generalizing problems and bias, so you cant generalize the outcomes because it isnt representative. It is very common to see generalizability problems in literature, not every research that you read is 100% pure, a lot of them have problems. An example on non-random sampling: Convenient sample, i.e. the sample is choosen because it is more convenient, I want to make a study, who is taller? Males or Females? But it is difficult for me to go and choose randomly, and I have a group of people who are next to me, so it is called a convenient sample nonrandom because these people dont represent the population. Another example: the prevalence of caries among university students, instead of taking samples of university students from different faculties, I took only from this theatre, the theatre where I give lectures, it is more convenient for me to take that sample. But the question is: are these students representing university students? Maybe no, but it is convenient. Grap samples, subjects are grapped wherever they could be found. For example: the doctor made a research on people who have a bony swilling on their hard palate torus palatinus, everytime he has a patient with torus palatinus, he grap him and include him in his research.
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Another example: I want to make a research on those who have oral cancers, it is difficult to reach large groups who have oral cancers, so while practicing my work as a dentist, everytime I see a patient with oral cancer I include him in my research grapping. Bias :defined as a process at any stage of inference tend to produce results that depart systematically from the true value. For example: the average hight of Jordanian males is 1.70 cm, and when I made my research, I made it on basketball players, and the average popped to 1.90 cm, this is bias and systematic error, because the value departed systematically from the true values. It is also defined as any trend in the collection, analysis, interputation, publication or review of the data that can lead to conclusions that are systematically different from the truth. Bias can be in any part of the research: collection of data, analysis of data and interputation of data. Bias can be subdivided to three types: Selection bias: Bias resulting because of mis-select my sample, and it occurs when comparesions are made between group of patients that differ in ways other than the main factor under study Example: examine dental caries among different age groups, keep in mind that the prevalence of caries among children is higher than old age people, so you studied caries but you didnt define age group, this is called selection bias. Example: examine periodontal conditions without adjustment for smoking, such as studying periodontitis without considering the factor of smoking, so it well lead to selection bias Measurment bias

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 Occurs when the methods of measurement are not similar among different groups of patients Example: examine dental caries visually and radiographically, you have to choose one way, you cant include both of them, because if we dis so, we will have measurment bias. (in radiographs, caries will be more appearent than visually, class II caries wont appear clinically, but with radiographs they will) Example: examine the working lenghts of Roots using different techniques, in indodontics, theres is something called: determining the length of the root you want to work in working length of the tooth, so you have to study it in one technique, you cant apply radiographic technique on one group, and apex locater on another group, all participants should have the same way of measurments, or Ill have measurment bias. Confounding bias occurs when two factors or processes are associated or "travel together" and the effect of one is confused with or distorted by the effect of the other Example: tri-glyceride and cholesterol levels are associated with risk for coronary heart disease, you cant take tri-glyceride alone and see its effect on coronary heart diease, because we have another factor which is cholesterol levels, it is associated with triglyceride. Example: you want to study the incedence of lung cancer among people that work in mines, you didnt control for another important factor which is smoking, half of workers there, might be smokers, you only considered working in mines, and you didnt look for the other factor, I might get as a result: 5% of workers in mines well have lung cancer, but maybe these 5% are heavy smokers, and thats confounding bias.

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DONE BY: ABDULLAH WADDAH KHALID MORTAJA

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