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Statistics for Biomedical Engineers and Scientists Statistics for Biomedical Engineers and Scientists How to Visualize and Analyze Data Andrew P. King Robert J. Eckersley AcademicPressisanimprintofElsevier 125LondonWall,LondonEC2Y5AS,UnitedKingdom 525BStreet,Suite1650,SanDiego,CA92101,UnitedStates 50HampshireStreet,5thFloor,Cambridge,MA02139,UnitedStates TheBoulevard,LangfordLane,Kidlington,OxfordOX51GB,UnitedKingdom Copyright©2019ElsevierLtd.Allrightsreserved. Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronic ormechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem, withoutpermissioninwritingfromthepublisher.Detailsonhowtoseekpermission,further informationaboutthePublisher’spermissionspoliciesandourarrangementswithorganizationssuch astheCopyrightClearanceCenterandtheCopyrightLicensingAgency,canbefoundatourwebsite: www.elsevier.com/permissions. Thisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythe Publisher(otherthanasmaybenotedherein). Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment maybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingand usinganyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuch informationormethodstheyshouldbemindfuloftheirownsafetyandthesafetyofothers,including partiesforwhomtheyhaveaprofessionalresponsibility. Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assume anyliabilityforanyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability, negligenceorotherwise,orfromanyuseoroperationofanymethods,products,instructions,orideas containedinthematerialherein. LibraryofCongressCataloging-in-PublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress BritishLibraryCataloguing-in-PublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary ISBN:978-0-08-102939-8 ForinformationonallAcademicPresspublications visitourwebsiteathttps://www.elsevier.com/books-and-journals Publisher:MaraConner AcquisitionEditor:TimPitts EditorialProjectManager:JoshuaMearns ProductionProjectManager:KameshRamajogi Designer:MarkRogers TypesetbyVTeX Dedication A.P.K.–Formyparents,BernardandMaureen. R.J.E.–InmemoryofProf.DavidCosgrove. v “Thequietstatisticianshavechangedtheworld,notbydiscoveringnewfacts ortechnicaldevelopmentsbutbychangingthewayswereason,experiment, andformouropinionsaboutit.” IanHacking About the Authors Andrew King has over 15 years of experience of teaching courses at university level. He is currently a Reader in Medical Image Analysis in the School of Biomedical Engineering and Imaging Sciences at King’sCollegeLondon. In 2001–2005, Andrew worked as an Assistant Professor in the Computer Science department at Mekelle University in Ethiopia and was responsible forcurriculumdevelopment,design,anddeliveryof modules. Andrew’s research interests focus on the use of machine learning and medi- calimagingtolearnclinicallyusefulinformation,withaspecialemphasison movingorgans(http://kclmmag.org). Robert Eckersley has been a Senior Lecturer in the School of Biomedical Engineering and Imaging Sci- ences at King’s College London since 2012. He has been teaching at undergraduate and postgraduate levelssince2006.Priorto2012,Robertwasalecturer in the Department of Imaging Sciences at Imperial CollegeLondon. Robert’sresearchiscenteredaroundtheuseofultra- sound in medical imaging. He has a long standing interestintheuseofmicrobubblesascontrastagents forultrasoundimaging. Together Andrew and Robert run the Computational Statistics module for BiomedicalEngineeringstudentsuponwhichthisbookwasbased. xv Preface AIMS ANDMOTIVATION Recentyearshaveseenarapidincreaseintheuseoftechnologyinhealthcare, and the field of statistics provides essential tools for understanding and test- ing the impact of new biomedical technologies and techniques. The authors (cid:2) have been teaching an undergraduate module on statistics using MATLAB forBiomedicalEngineeringstudentsatKing’sCollegeLondonforanumberof years,andthisbookhasgrownoutofthisexperience.Wehaveseenthewide range of challenges, difficulties, and misconceptions faced by students when trying to learn about statistical techniques and their practical application in biomedicine,andwehavedevelopedavarietyofwaysofaddressingthem.We have tried to incorporate these into this book, and we hope that the result is a clear and logically structured introduction to the fundamental concepts of statistics,featuringintuitiveexplanationsmotivatedbyrealisticexamples. The module that we have been teaching is aimed at Biomedical Engineering students, and so most of the examples and exercises reflect this fact. How- ever,webelievethatthecontentofthebookanditspresentationwillbemore widely applicable. Therefore the intended audience of this book is any un- dergraduate or postgraduate student who wants to learn the fundamentals of visualizingandanalyzingdatausingstatisticaltechniques.Wealsobelievethat researchersworkinginthebiomedicalsciencesandrelatedareaswhoarelook- ingtoincludestatisticalanalysisintheirworkmaybenefitfromthebook. We believe that it is important not just to learn how to apply statistical meth- ods,butalsotoappreciatesomeoftheirunderlyingconceptsandtheory.The content of this book reflects this belief. However, we stop short of including lengthy mathematical proofs and derivations of the techniques we present, butratherwetrytogetacrossan“intuitive”feelfortheunderlyingtheory.To makethingseasierforthereader,weoftenseparatetheseexplanationsofwhy techniquesworkfromthedescriptionsofhowtheycanbeapplied.Thisallows the readers to havemoreflexibilityinhowthey usethe book.Ifyou areonly interestedinquicklygettingstartedonusingstatisticstoanalyzeandvisualize yourdata,thenyoucanskipthesesections(whichareboxedoffwiththehead- ingTheIntuition).If,however,youwanttocometoadeeperunderstandingof xvii xviii Preface the methods that you are using (which we hope you do), then you can read andunderstandtheseextrasections. Atthebeginningofeachchapter,clearlearningobjectivesareprovided.Inthe chapterbodiesarangeofpracticalbiomedicalexamplesareusedtoillustrate theconceptsbeingpresented.WealsoincludeActivitiesinthechapterbodies, whichenablethereadertotesthowwelltheyhavemeteachofthelearningob- jectives.Solutionstoallactivitiesareavailablefromthebook’swebsite.Weuse MATLAB to illustrate the practical application of the statistical techniques we describe.1However,theMATLABcontentisincludedattheendofeachchapter inaseparatesection,whichcanthenbeusedbythereadertosolvethepracti- calExercisesthatfollow(whicharealsolinkedtothelearningobjectivesatthe beginningofthechapter).Thereforeitispossibletoreadthisbookpurelyasa bookaboutstatisticsandnotengagewiththeMATLABcontentatall.Having saidthis,usinganautomatedtoolsuchasMATLABmakesvisualizingandan- alyzingdataaloteasier,sowestronglyrecommendusingone,evenifitisnot MATLAB.Wehavedoneourbesttoensuretherealismofthedatathatweuse inourexamples,activities,andexercises,andwhicharefreelyaccessibletothe readeronthebook’swebsite.However,alldataarecompletelysynthetic,and wetakefullresponsibilityforanylackofrealism. At the end of each chapter, we include a brief pen portrait of a famous figure fromthehistoryofthefieldofstatistics.Statisticsissometimesviewedasadry andlifelesssubject.Wehopethatbybringingtolifesomeofthesesignificant figuresandlinkingtheirworktotheconceptsthatwepresent,wecanhelpto overcomethismyth. LearningObjectives Oncompletionofthebookthereadershouldbeableto: ■ Demonstrateanunderstandingofthefundamentalconceptsofdescrip- tiveandinferentialstatistics. ■ Analyze data and choose an appropriate hypothesis test to answer a givenquestion. ■ Compute numerical statistical measures and perform hypothesis tests “byhand”. ■ VisualizedataandperformstatisticalanalysisusingMATLAB. ■ Analyzeaproblemanddesignanexperimenttogathertherequireddata toanswerquestionsaboutit. 1AllMATLABcodesarecompatiblewithversion2018a.

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