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The Nursing Process

Biostatistics
Post Basic
Specialization in
Nursing

JEHANZEB KHAN YOUSAFZAI


R.N, M. Sc in Nursing
Post RN, B Sc N, Dip Card.
BA (Psychology/sociology), (jzk_yz@hotmail.com)
Nursing Instructor
College of Nursing, SZABMU, PIMS, Islamabad 2
Objectives

At the end of the session, the students will be able to:


• Understand about the logic of scientific reasoning
• Define Statistics and Biostatistics
• Differentiate between Population & sample and
Parameter & Statistics
• Explain the data and types of variable
• Identify the various sources of data collection
• Explore the different subtypes of Measurement scales

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LOGIC OF SCIENTIFIC REASONING

• It is the processing & organizing of ideas in order


to reach conclusions. Through reasoning, people
are able to make sense of both their thoughts and
experiences.

• Solutions to many confusing problems are


developed by logical thought processes.

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• Logical reasoning as a method of knowing
combines experience, intellectual abilities, and
formal systems of thought.

• Science of logic includes;

Inductive Reasoning

Deductive Reasoning

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Inductive reasoning

• It is the process of developing generalizations


from specific observations.

• For example, a nurse may observe the anxious


behavior of (specific) hospitalized children and
conclude that (in general) children’s separation
from their parents is stressful.

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Deductive reasoning

• It is process of developing specific predictions


from general principles.

• For example, if we assume that separation


anxiety occurs in hospitalized children (in
general), then we might predict that (specific)
children in Memorial Hospital whose parents do
not room-in will noticeable symptoms of stress.
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Statistics

The science of data/information involves its:


• Collection
• Classification
• Summarization
• Organization
• Interpretation

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• Statistics refers to numerical facts that how data
are collected, organized, summarized, presented,
analyzed, and interpreted.

• Application of this knowledge in health Sciences is


known as Biostatistics.

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Biostatistics

• Biostatistics is the application of statistical methods to the


biological and life sciences. Statistical methods include
procedures for

(1) Designing studies,

(2) Collecting data,

(3) Presenting and summarizing data, and

(4) Drawing conclusions from sample data to a population.

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Why do we need to study
Biostatistics?

• Statistics has widespread use in health sciences,


So it became necessary for health professionals
to learn it because It help research
• To learn how to deal with numbers through manual or
computerized programs

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Why do we need to study
Biostatistics?

• To assess evidence from different studies

• To understand published scientific papers

• To do research and write papers in scientific


journals.

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The task of a Bio-statistician

• Guide the investigator in the designing of an


experiment or survey prior to the data collection

• Help the investigator in analyzing data using


proper procedures and techniques.

• Help the investigator in presenting and


interpreting the result of the study

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Common statistical terms

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Populations

• A population is the group from which a sample is


drawn

• The set of all measurements of interest to the


investigator

• It varies with the problem or situation

o e.g., headache patients in an office;

o automobile crash victims in an emergency room


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Population vs. Sample

• In research, it is not practical to include all


members of a population

• Thus, a sample (a subset of a population) is


taken

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Population vs. Sample

• Sample

• Any subset of all measurements selected


from the population.

• A random sample is a good representative of


population

• A census includes all population members is


also an example of sample.
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Example of population

• Monthly income of households in Pakistan

• Households in Islamabad who have death of at


least one family member in past one year

• Number of AIDS Patients in Pakistan

• All patients came to certain clinic in the year 2015

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Examples of sample

• A survey of 1,000 households taken from all


parts of Pakistan to assess their monthly income

• A survey of 500 households conducted in


Islamabad to know whether the have death of at
least one family member in past one year

• A survey of 2500 AIDS patients conducted at


different AIDS clinics in Pakistan

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Statistical terms (cont.)

• Parameters

• Summary data from a population

• Statistics

• Summary data from a sample

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Some important Terms

 Population :  Sample :
• All subjects possessing a • A subgroup or subset of the
common characteristic that is population.
being studied.

 Example:  Example:
• Income of households living in • Income of specified area.
Islamabad. • Health status of adults who
• The health status of adults in a smoke.
community.

o Parameter : o Statistic:
o Characteristic or measure o Characteristic or measure
obtained from a population. obtained from a sample.

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Common statistical terms

• Data

• Measurements or observations of a variable

• Variable

• A characteristic that is observed or


manipulated

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Statistical terms (cont.)

• Independent variables
• Precede dependent variables in time

• Are often manipulated by the researcher

• The treatment or intervention that is used in a study

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• Dependent variables
• What is measured as an outcome in a study

• Values depend on the independent variable

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Random samples

• Subjects are selected from a population so that


each individual has an equal chance of being
selected

• Random samples are representative of the


source population

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• Non-random samples are not representative

• May be biased regarding age, severity of the


condition, socioeconomic status etc.

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Data Sources
Data
Sources

Primary Secondary

Experiment Survey Observation Published


(& On-Line)
(1) Primary Data

• The primary data are the first hand information


collected, compiled and published by organization
for some purpose. They are most original data in
character and have not undergone any sort of
statistical treatment.
(2) Secondary Data

• The secondary data are the second hand


information which are already collected by
someone (organization) for some purpose and are
available for the present study. The secondary
data are not pure in character and have
undergone some treatment at least once.
Methods of Collecting Primary Data

Primary data are collected by the following methods:

1. Personal Investigation: The researcher conducts


the survey him/herself and collects data from it. The
data collected in this way is usually accurate and
reliable. This method of collecting data is only
applicable in case of small research projects.
2. Through Investigation: Trained investigators are
employed to collect the data. These investigators
contact the individuals and fill in questionnaire after
asking the required information. Most of the organizing
implied this method.
3. Collection through Questionnaire: The
researchers get the data from local representation
or agents that are based upon their own experience.
This method is quick but gives only rough estimate.

4. Through Telephone: The researchers get


information through telephone this method is quick
and give accurate information.
Methods of Collecting
Secondary Data

1. Official: e.g. The publications of the Statistical


Division, Ministry of Finance, the Federal Bureaus
of Statistics, Ministries of Food, Agriculture,
Industry, Labor etc…

2. Semi-Official: e.g. State Bank, Railway Board,


Central Cotton Committee, Boards of Economic
Enquiry etc.…
3. Publication of Trade Associations, Chambers of
Commerce etc…

4. Technical and Trade Journals and Newspapers.

5. Research Organizations such as Universities and


other institutions.
Statistics

Descriptive Inferential
Statistics Statistics

The branch of statistics The branch of statistics that


that focuses on collecting, analyses sample data to
summarizing, and draw conclusions about a
presenting a set of data. population.

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Descriptive statistics (DSs)

• Refers to statistical techniques used to


summarize and describe a data set, and also to
the statistics (measures) used in such
summaries

• A way to summarize data from a sample or a


population
• It illustrate the shape, central tendency, and
variability of a set of data

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DSs (cont.)

• Central tendency describes the location of the


middle of the data

• Variability is the extent values are spread


above and below the middle values

• DSs are not capable of testing hypotheses

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Inferential statistics

• Use of statistics to make inferences


(assumptions) concerning some unknown
aspect of a population from a sample of that
population

• They consist of two techniques: Estimation of


parameters and Hypothesis testing

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Scope of biostatistics in
health care/ Nursing
• In recent years biostatistics has become one of
the most stimulating areas of applied statistics.
The field includes the methodology and theory of
statistics as applied to problems in the life and
health sciences.

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• It is said that biostatistics is the tool of all health
sciences and is called as the “language of
research” because the findings in research are
based on bio-statistical techniques.

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• By the knowledge of biostatistics nurses/ health
care worker may trained in the skilled application
of statistical methods to the solution of problems
encountered in public health and medicine.

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• In nursing/ health care biostatistics is an essential
tool to determine the effectiveness of treatment
based on the collection of records of clinical trials
devised in such a scale and such form that valid
conclusions can be drawn

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• Nurses/ health worker have a better
understanding of nursing/ health care and
medical research journals, respectively, if they
have knowledge on bio-statistical methods and
techniques

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• They collaborate with scientists in nearly every
area related to health and have made major
contributions to our understanding of AIDS,
cancer, and immunology, as well as other areas.

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• Further, they spend a considerable amount of
time developing and evaluating the statistical
methodology used in those projects.

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• Biostatistics may prepare health worker/ nursing
graduates for work in a wide variety of challenging
positions in government, N.G.O’s, international
organizations (WHO/UNICEF) and education.

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• Health worker/ nursing graduates have found
careers involving teaching, research, and
consulting in such fields as medicine, public
health, life sciences, and survey research.

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• There has always been a strong demand for well-
trained biostatistician nurse; graduates have had
little difficulty finding employment well suited to
their particular interests.

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Importance of Statistics in
Nursing
• Statistics have a set of applications in every fields
of study as it is the science of data collection,
analysis and presentation. It has key importance
in nursing like:

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• Biostatistics permits the most exact kind of
description

• It forces the researcher to definite and exact in his


procedures and techniques

• It enables the researcher to summarize results in


meaningful and convenient form

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• It enables the researcher to draw general
conclusions: the process of extracting
conclusions is carried out according to accepted
rules.

• It enables the researcher to predict “how much”


of a thing will happen under conditions he knows
and has measured.
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Biostatistics
Post Basic Specialization in Nursing
Data Presentation
JEHANZEB KHAN YOUSAFZAI
R.N, M. Sc in Nursing
Post RN, B Sc N, Dip Card.
BA (Psychology/sociology), (jzk_yz@hotmail.com)
Nursing Instructor
College of Nursing, SZABMU, PIMS, Islamabad 54
Data

• Data

• Measurements or observations of a variable

• Variable

• A characteristic that is observed or manipulated

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Categories / Types of data

There are two main categories of data i.e

• Quantitative (Numerical)
like No. of Children 5, height 5.6 feet

• Qualitative (categorical)
like male , married tall, obese , yellow
Quantitative (Numerical) data

It is based on numbers and classified as follow

a. Discrete data

• It is always counted like

5 pencils, 3 children, Pulse rate 74 b/minutes

• It can be with units e.g Pulse rate 74 b/minutes

• or may be with out units e.g 5 pencils, 3 children


Continue…..

b. Continuous data (infinite Number)


• It is always measured

• It can be in fraction like height of a person 5.6 feet

• It can be in whole No like weight of a person 60 kg

• It is always with units like height in feet, weight in


kg or temperature in centigrade etc
Qualitative (categorical) data

• There are 4 levels of categorical data


Nominal, ordinal, interval, and ratio
1. Nominal
• Data are coded by a number, name, or letter
that is assigned to a category or group
• Examples
• Gender (e.g., male, female)
• Treatment preference (e.g., manipulation,
mobilization, massage)

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Continue….

2. Ordinal
• Is similar to nominal because the
measurements involve categories
• However, the categories are ordered by rank
• Examples
• Pain level (e.g., mild, moderate, severe)
• Military rank (e.g., lieutenant, captain,
major, colonel, general)

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Continue…..

• Ordinal values only describe order, not quantity


• Thus, severe pain is not the same as 2 times
mild pain
• The only mathematical operations allowed for
nominal and ordinal data are counting of
categories
• e.g., 25 males and 30 females

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Continue…..

3. Interval
• Measurements are ordered (like ordinal data)
• Have equal intervals
• Does not have a true zero
• Examples
• The Fahrenheit scale, where 0° does not
correspond to an absence of heat (no true
zero)
• PH is also an interval scale

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Continue…..

4. Ratio
• Measurements have equal intervals

• There is a true zero

• Ratio is the most advanced level of


measurement, which can handle most types
of mathematical operations

• examples blood pressure, age, body weight

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Continue…..

• Ratio examples
• Range of motion

• No movement corresponds to zero degrees

• The interval between 10 and 20 degrees is the


same as between 40 and 50 degrees

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Continue…..

• NOIR is a mnemonic to help remember the names


and order of the levels of measurement

• Nominal

• Ordinal

• Interval

• Ratio

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Continue…..
Permissible
Best measure of
Measurement scale mathematic
central tendency
operations

Nominal Counting Mode


Greater or less than
Ordinal Median
operations

Symmetrical – Mean
Interval Addition and subtraction
Skewed – Median

Addition, subtraction,
Symmetrical – Mean
Ratio multiplication and
Skewed – Median
division
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PROCESSING OF DATA

The first step in processing of data is classification and


tabulation.

• Classification is the process of arranging data on the


basis of some common characteristics possessed by
them.

• Two approaches in analyzing data are:

• Descriptive statistics

• Inferential statistics
“Descriptive statistics are concerned
with describing the characteristics of frequency
distributions.”
The common methods in descriptive analyses are:
• Measures of central tendency
• Measures of dispersion
And the data is presented through
• Tabulation
• Line diagram, bar diagram, pie diagram.
• Histogram, frequency polygon, frequency curve
• “The inferential statistics helps to decide
whether the outcome of the study is a result of
factors planned within design of the study or
determined by chance.”
• Common inferential statistical tests are:
• T-tests (Z test)
• Chi-squire test
• Pearson correlation
PRESENTATION OF DATA

• Tabular presentation

• Diagrammatic Presentation

• Graphical Presentation
Frequency Distribution

• Simple representation of all the data


• Frequency distribution is a statistical table
containing “groups of values according to the
number of times a value occurs.”
• The data collected by an investigator is called raw
data.
• Raw data is ungrouped data.
• Raw data is arranged in order called array.
• The data arranged in ascending order or
descending order
A. Tabular Presentation of Data

• Arranging values in columns is called tabulation.


• E.g. The amount of oxygen content in water
samples

Water samples Amount of O2 in mL


1 4.5
2 6.9
3 6.2
4 5.3
Frequency tabulation
B. Diagrammatic Presentation of data

• It is a visual form of presentation of statistical data


in which data are presented in the form of
diagrams such as

• Common Types

• Line Diagram

• Pie diagram

• Bar diagram
Line diagram

• E.g. A traffic survey shows the following vehicles


passing a particular bus stop during an hour

Vehicles Frequency
Cars 45
Lorries 22
Motor Cycles 6
Buses 3

Total 76
Pie Diagram

Example: blood group of 50


students
Group Students
Pie Diagram

A 5
B 20
AB 10
O 15
Bar Diagram

Example: Age
of active
Minnesota RNs,
2007
C. Graphical Presentation of data

• Presenting data in the form of graphs prepared on


a graph.
• The graph has two axes: X & Y
• Usually, Independent variable is marked on the X-
axis and dependent variable on the Y-axis.
• Common Types:
• Histogram
• Frequency Polygon
• Frequency curve
Histogram

• Histogram is a graph containing frequencies in the


form of vertical rectangles.
• It is the graphical presentation of frequency
distribution.
• X-axis is marked with class intervals
• Y-axis is marked with frequencies
• Histogram differs from bar diagram. The bar
diagram is one dimensional,
• whereas histogram is two-dimensional.
Uses of histogram

• It facilitates comparison of two or more frequency


distributions on the same graph
Frequency polygon
• A frequency polygon is obtained by plotting the frequency of
the class against its class marks, and joining the parts with
line segments.
Frequency Curve

• When the consecutive points on the graph join with


a specific pattern smoothly shown in the below
example. Frequency curve can also be drawn with
the help of histogram by joining their mid points of
rectangle.
• Frequency polygon and frequency curves are
same except frequency curve is drawn using free
hand and frequency polygon is drawn using scale.
(Each point is joint using scale)
Biostatistics
Post Basic Specialization in Nursing
Descriptive Statistics
JEHANZEB KHAN YOUSAFZAI
R.N, M.Sc in Nursing
Post RN, B Sc N, Dip Card.
BA (Psychology/sociology), (jzk_yz@hotmail.com)
Nursing Instructor
College of Nursing, SZABMU, PIMS, Islamabad 85
DESCRIPTIVE STATISTICS

• Measures of central tendency

• Measures of dispersion/variability
MEASURES OF CENTRAL TENDANCY

• A measure of central tendency is a single number


used to represent the Centre of a grouped data.

• The basic measures are;

• Mean, Median and Mode

• For any symmetrical distribution, the mean, median,


and mode will be identical.
• Each measure is designed to represent a typical
score.

• The choice of which measure to use depends on:

• the shape of the distribution (whether normal or


skewed), and

• the variable’s “level of measurement” (data are


nominal, ordinal or interval).
Measures of central
tendency
• Mean

• The most commonly used DS

• To calculate the mean

• Add all values of a series of numbers and then


divided by the total number of elements

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Notation

x is pronounced ‘x-bar’ and denotes the mean


of a set of sample values

x
x =
n
Notation

 denotes the addition of a set of values

x is the variable usually used to represent the


individual data values

n represents the number of data values in a


sample

N represents the number of data values in a


population
Notation
x is pronounced ‘x-bar’ and denotes the mean of a set
of sample values
x
x =
n
µ is pronounced ‘mu’ and denotes the mean of all
values in a population

x
µ =
N
Example:

3,4,5,6,7

3+4+5+6+7= 25

25 divided by 5 = 5

The mean is 5
Find the mean of given data
Study Participant Age
1 25
2 22
3 38
4 45
5 25
6 28
7 28
8 38
9 48
10 32
11 35
12 72
13 58
14 55
15 65
Definitions

 Median
• The value which divides the values into two equal
halves, one half of the values being lower than the
median and half higher than the median.

• Note: For an even number of observations the


median is defined as the average of the middle two
values.
Median is appropriate for Ordinal Data, Not
influenced by Extreme Scores (Outliers)

~
often denoted by x (pronounced ‘x-tilde’)

is not affected by an extreme value


Calculating the Median

For Even Numbers


Find the median
(45, 55, 56, 45, 47, 52, 42, 54, 55, 60)
Arrange data in ascending order
(42, 45, 45, 47, 52, 54, 55, 55, 56, 60)
Then we count number of observations (n), so we
know that data is odd or even,
Serial 1 2 3 4 5 6 7 8 9 10
No
Data 42 45 45 47 52 54 55 55 56 60
values

As data is in even numbers (n=10), so we apply


following formula, in which two middle value will be
M1 (52) and M2 (54)

Median = 52+54/ 2
Median = 53
For Odd Numbers

• If we erase last value of above example then our data will


become odd and will be as follow

45, 55, 56, 45, 47, 52, 42, 54, 55

• To calculate median of odd numbers we follow these steps

• arrange data in ascending order;

42, 45, 45,47, 52, 54, 55, 55, 56 .


Then we count number of observations (n), so we know •
that data is odd or even,
1 2 3 4 5 6 7 8 9
42 45 45 47 52 54 55 55 56
•As data is odd number (n=9), so we follow following formula, which
gives location of median

Median = 5th value which is 52


Median= 52
Find the median of given data
Study Participant Age
1 25
2 22
3 38
4 45
5 25
6 28
7 28
8 38
9 48
10 32
11 35
12 72
13 58
14 55
15 65
Definitions
 Mode
the score that occurs most frequently
Bimodal
Multimodal
No Mode
denoted by M
the only measure of central tendency that can be
used with nominal data
Examples
a. 5 5 5 3 1 5 1 4 3 5 Mode is 5
b. 1 2 2 2 3 4 5 6 6 6 7 9 Bimodal - 2 and 6

c. 1 2 3 6 7 8 9 10 No Mode
Find the mod of given data
Study Participant Age
1 25
2 22
3 38
4 45
5 25
6 28
7 28
8 38
9 48
10 32
11 35
12 72
13 58
14 55
15 65
MEASURES OF DISPERSION/
SPREAD/ VARIABILITY

• Measures of dispersion are descriptive statistics


that describe how similar a set of scores are to
each other. In other words, it measures how
closely the data cluster around the measure of
central tendency.
• Some of the most commonly used measures of
spread are:

• Range,

• Variance (Mean deviation)

• Standard Deviation,
RANGE

• It is the difference between the largest


observation and the smallest.

• Number that reports the distance between the


highest and lowest scores in a distribution;

• Describes how widely data are spread out across


a distribution;

• Sensitive to extreme scores;


Calculating Range

• Age of children living in joint family is

• 2, 3, 5, 7, 5, 2, and 8. Find range of this Data

Steps;

• Arrange data values in ascending order;

2, 2, 3, 5, 5, 7, 8

• Find the lowest and highest values in the data.

2, 2, 3, 5, 5, 7, 8
• Find range by subtracting the lowest value from
the highest value. Range = Xmax - Xmin

• Range = 8 – 2 = 6.

So the range is 6
VARIANCE

• Mean of all squared deviations from the mean is called as


variance

• Sample variance=S2

• Population variance= σ2 [sigma squared (standard deviation


squared)].

• A high variance means most scores are far away from the
mean,

• A low variance indicates most scores cluster tightly about the


mean.
Heart rate of certain patient is
80, 84, 80, 72, 76, 88, 84, 80, 78, & 78.
Calculate variance for this data.
Solution: This formula is used to calculate variance
Step 1:
Find mean of this data
= 800/10 Mean = 80
Step 2:
Draw two Columns respectively ‘X’ and
deviation about mean (X- ). In column ‘X’
put all values of X and in (X- ) subtract
each ‘X’ value with . see table
X X
X Deviation about mean
80 80 - 80 = 0
84 84 - 80 = 4
80 80 - 80 = 0
72 72 - 80 = -8
76 76 - 80 = -4
88 88 - 80 = 8
84 84 - 80 = 4
80 80 - 80 = 0
78 78 - 80 = -2
78 78 - 80 = -2
∑X = 800 ∑ X X = 0
Step 3:
Draw another Column of
(X- )2, in which put
square of deviation
about mean

X (X- ) (X- )2
Deviation about mean Square of Deviation about mean
80 80 - 80 = 0 0x0 = 00
84 84 - 80 = 4 4x4 = 16
80 80 - 80 = 0 0x0 = 00
72 72 - 80 = -8 -8 x -8 = 64
76 76 - 80 = -4 -4 x -4 = 16
88 88 - 80 = 8 8x8 = 64
84 84 - 80 = 4 4x4 = 16
80 80 - 80 = 0 0x0 = 00
78 78 - 80 = -2 -2 x -2 = 04
78 78 - 80 = -2 -2 x -2 = 04

∑(X- )=0 ∑(X- )2 = 184


∑X = 800 Summation of Deviation about Summation of Square of
mean is always zero Deviation about mean
= 80
Step 4
Apply formula and put
following values
∑(X- )2 = 184
n = 10
Variance = 184/ 10-1 = 184/9
Variance = 20.44
Worked example Find the variance of

6, 7, 10, 11, 11, 13, 16, 18, 25


• Firstly we find the mean,

¯x = ∑ x/n =

¯x = 117/9 = 13

• ∑(x − x¯) 2 = 280

• S2 = ∑ (x − x¯)2 /n-1

• = 280/9-1 = 35
STANDARD DEVIATION

• The square root of the variance.

• It measures the spread of data around the


mean. One standard deviation includes 68% of
the values in a sample population and two
standard deviations include 95% of the values.
Calculating Standard Deviation
[same Example]

• Heart rate of certain patient is

80, 84, 80, 72, 76, 88, 84, 80, 78, & 78.

Calculate standard deviation for this data.

Formula for standard deviation


Step 1:
Find mean of this data
= 800/10 Mean = 80
Step 2:
Draw two Columns respectively ‘X’ and
deviation about mean (X- ). In column ‘X’
put all values of X and in (X- ) subtract
each ‘X’ value with . see table
X X
X Deviation about mean
80 80 - 80 = 0
84 84 - 80 = 4
80 80 - 80 = 0
72 72 - 80 = -8
76 76 - 80 = -4
88 88 - 80 = 8
84 84 - 80 = 4
80 80 - 80 = 0
78 78 - 80 = -2
78 78 - 80 = -2
∑X = 800 ∑ X X = 0
Step 3:
Draw another Column of
(X- )2, in which put
square of deviation
about mean

X (X- ) (X- )2
Deviation about mean Square of Deviation about mean
80 80 - 80 = 0 0x0 = 00
84 84 - 80 = 4 4x4 = 16
80 80 - 80 = 0 0x0 = 00
72 72 - 80 = -8 -8 x -8 = 64
76 76 - 80 = -4 -4 x -4 = 16
88 88 - 80 = 8 8x8 = 64
84 84 - 80 = 4 4x4 = 16
80 80 - 80 = 0 0x0 = 00
78 78 - 80 = -2 -2 x -2 = 04
78 78 - 80 = -2 -2 x -2 = 04

∑(X- )=0 ∑(X- )2 = 184


∑X = 800 Summation of Deviation about Summation of Square of
mean is always zero Deviation about mean
= 80
Step 4
Apply formula and
put following
values
∑(X- )2 = 184
n = 10
Worked example Find the Standard Deviation of the following
data

6, 7, 10, 11, 11, 13, 16, 18, 25


Exercises Find the variance and standard deviation
of the following correct to 2 decimal places:
a) 10, 16, 12, 15, 9, 16, 10, 17, 12, 15

b) 74, 72, 83, 96, 64, 79, 88, 69

c) £326, £438, £375, £366, £419, £424


Answers
a) 7.76, 2.79

b) 97.36, 9.87

c) £21 531.22, £39.13

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