The sample size or the power of the study is directly related to the ES of the study. What is this important ES? The ES provides important information on how well the independent variable or variables predict the dependent variable. Low ES means that, independent variables don’t predict well because they are only slightly related to the dependent variable. Strong ES means that, independent variables are very good predictors of the dependent variable. Thus, ES is clinically important for evaluating how efficiently the clinicians can predict outcomes from the independent variables.
The scale of the ES values for different types of statistical tests conducted in different study types are presented in Table 3 .
t-test for means | Cohen’s d | 0.2 | 0.5 | 0.8 |
Chi-Square | Cohen’s ω | 0.1 | 0.3 | 0.5 |
r x c frequency tables | Cramer’s V or Phi | 0.1 | 0.3 | 0.5 |
Correlation studies | 0.2 | 0.5 | 0.8 | |
2 x 2 table case control | Odd Ratio (OR) | 1.5 | 2 | 3 |
2 x 2 table cohort studies | Risk Ratio (RR) | 2 | 3 | 4 |
One-way an(c)ova (regression) | Cohen’s f | 0.1 | 0.25 | 0.4 |
ANOVA (for large sample) | Eta Square ɳ | 0.01 | 0.06 | 0.14 |
ANOVA (for small size) | Omega square Ω | |||
Friedman test | Average spearman Rho | 0.1 | 0.3 | 0.5 |
Multiple regression | ɳ | 0.02 | 0.13 | 0.26 |
Coefficient of determination | r | 0.04 | 0.25 | 0.64 |
Number needed to treat | NNT | 1 / Initial risk |
In order to evaluate the effect of the study and indicate its clinical significance, it is very important to evaluate the effect size along with statistical significance. P value is important in the statistical evaluation of the research. While it provides information on presence/absence of an effect, it will not account for the size of the effect. For comprehensive presentation and interpretation of the studies, both effect size and statistical significance (P value) should be provided and considered.
It would be much easier to understand ES through an example. For example, assume that independent sample t-test is used to compare total cholesterol levels for two groups having normal distribution. Where X, SD and N stands for mean, standard deviation and sample size, respectively. Cohen’s d ES can be calculated as follows:
Group 1 6.5 0.5 30
Group 2 5.2 0.8 30
Cohen d ES results represents: 0.8 large, 0.5 medium, 0.2 small effects). The result of 1.94 indicates a very large effect. Means of the two groups are remarkably different.
In the example above, the means of the two groups are largely different in a statistically significant manner. Yet, clinical importance of the effect (whether this effect is important for the patient, clinical condition, therapy type, outcome, etc .) needs to be specifically evaluated by the experts of the topic.
Power, alpha values, sample size, and ES are closely related with each other. Let us try to explain this relationship through different situations that we created using G-Power ( 33 , 34 ).
The Figure 3 shows the change of sample size depending on the ES changes (0.2, 1 and 2.5, respectively) provided that the power remains constant at 0.8. Arguably, case 3 is particularly common in pre-clinical studies, cell culture, and animal studies (usually 5-10 samples in animal studies or 3-12 samples in cell culture studies), while case 2 is more common in clinical studies. In clinical, epidemiological or meta-analysis studies, where the sample size is very large; case 1, which emphasizes the importance of smaller effects, is more commonly observed ( 33 ).
Relationship between effect size and sample size. P – power. ES - effect size. SS - sample size. The required sample size increases as the effect size decreases. In all cases, P value is set to 0.8. The sample sizes (SS) when ES is 0.2, 1, or 2.5; are 788, 34 and 8, respectively. The graphs at the bottom represent the influence of change in the sample size on the power.
In Figure 4 , case 4 exemplifies the change in power and ES values when the sample size is kept constant ( i.e. as low as 8). As can be seen here, in studies with low ES, working with few samples will mean waste of time, redundant processing, or unnecessary use of laboratory animals.
Relationship between effect size and power. Two different cases are schematized where the sample size is kept constant either at 8 or at 30. When the sample size is kept constant, the power of the study decreases as the effect size decreases. When the effect size is 2.5, even 8 samples are sufficient to obtain power = ~0.8. When the effect size is 1, increasing sample size from 8 to 30 significantly increases the power of the study. Yet, even 30 samples are not sufficient to reach a significant power value if effect size is as low as 0.2.
Likewise, case 5 exemplifies the situation where the sample size is kept constant at 30. In this case, it is important to note that when ES is 1, the power of the study will be around 0.8. Some statisticians arbitrarily regard 30 as a critical sample size. However, case 5 clearly demonstrates that it is essential not to underestimate the importance of ES, while deciding on the sample size.
Especially in recent years, where clinical significance or effectiveness of the results has outstripped the statistical significance; understanding the effect size and power has gained tremendous importance ( 35 – 38 ).
Preliminary information about the hypothesis is eminently important to calculate the sample size at intended power. Usually, this is accomplished by determining the effect size from the results of a previous study or a preliminary study. There are software available which can calculate sample size using the effect size
We now want to focus on sample size and power analysis in some of the most common research areas.
Animal studies are the most critical studies in terms of sample size. Especially due to ethical concerns, it is vital to keep the sample size at the lowest sufficient level. It should be noted that, animal studies are radically different from human studies because many animal studies use inbred animals having extremely similar genetic background. Thus, far fewer animals are needed in the research because genetic differences that could affect the study results are kept to a minimum ( 39 , 40 ).
Consequently, alternative sample size estimation methodologies were suggested for each study type ( 41 - 44 ). If the effect size is to be determined using the results from previous or preliminary studies, sample size estimation may be performed using G-Power. In addition, Table 4 may also be used for easy estimation of the sample size ( 40 ).
| | | | |
---|---|---|---|---|
2 | 2.35 | 2.38 | 2.77 | |
1.72 | 2.03 | 2.02 | 2.35 | |
1.54 | 1.82 | 1.8 | 2.08 | |
1.41 | 1.66 | 1.63 | 1.89 | |
1.31 | 1.54 | 1.51 | 1.74 | |
1.23 | 1.44 | 1.41 | 1.63 | |
1.16 | 1.36 | 1.32 | 1.53 | |
1.05 | 1.23 | 1.2 | 1.39 | |
0.97 | 1.14 | 1.1 | 1.27 | |
0.9 | 1.06 | 1.02 | 1.18 | |
0.85 | 1 | 0.96 | 1.11 | |
0.8 | 0.94 | 0.91 | 1.05 | |
0.76 | 0.9 | 0.86 | 1 | |
0.73 | 0.86 | 0.83 | 0.96 | |
0.7 | 0.82 | 0.79 | 0.92 | |
0.67 | 0.79 | 0.76 | 0.88 | |
0.65 | 0.76 | 0.74 | 0.85 | |
0.63 | 0.74 | 0.71 | 0.82 | |
0.61 | 0.72 | 0.69 | 0.8 |
In addition to sample size estimations that may be computed according to Table 4 , formulas stated in Table 1 and the websites mentioned in Table 2 may also be utilized to estimate sample size in animal studies. Relying on previous studies pose certain limitations since it may not always be possible to acquire reliable “pooled standard deviation” and “group mean” values.
Arifin et al. proposed simpler formulas ( Table 5 ) to calculate sample size in animal studies ( 45 ). In group comparison studies, it is possible to calculate the sample size as follows: N = (DF/k)+1 (Eq. 4).
Group comparison (ANOVA) | = (10 / k) + 1 | = (20 / k) + 1 |
One group, repeated measures (one within factor, repeated measures ANOVA) | = 10 (r - 1) + 1 | = 20 (r - 1) + 1 |
Group comparison, repeated measures (one-between, one within factor, repeated measures ANOVA) | = (10 / kr) + 1 | = (20 / kr) + 1 |
k - number of groups. N - number of subjects group. r - number of repeated measurements. a = N, because only one group is involved, b - must be multiplied by r whenever the experiment involves sacrificing the animals at each measurement. |
Based on acceptable range of the degrees of freedom (DF), the DF in formulas are replaced with the minimum ( 10 ) and maximum ( 20 ). For example, in an experimental animal study where the use of 3 investigational drugs are tested minimum number of animals that will be required: N = (10/3)+1 = 4.3; rounded up to 5 animals / group, total sample size = 5 x 3 = 15 animals. Maximum number of animals that will be required: N = (20/3)+1 = 7.7; rounded down to 7 animals / group, total sample size = 7 x 3 = 21 animals.
In conclusion, for the recommended study, 5 to 7 animals per group will be required. In other words, a total of 15 to 21 animals will be required to keep the DF within the range of 10 to 20.
In a compilation where Ricci et al. reviewed 15 studies involving animal models, it was noted that the sample size used was 10 in average (between 6 and 18), however, no formal power analysis was reported by any of the groups. It was striking that, all studies included in the review have used parametric analysis without prior normality testing ( i.e. Shapiro-Wilk) to justify their statistical methodology ( 46 ).
It is noteworthy that, unnecessary animal use could be prevented by keeping the power at 0.8 and selecting one-tailed analysis over two-tailed analysis with an accepted 5% risk of making type I error as performed in some pharmacological studies, reducing the number of required animals by 14% ( 47 ).
Neumann et al. proposed a group-sequential design to minimize animal use without a decrease in statistical power. In this strategy, researchers started the experiments with only 30% of the animals that were initially planned to be included in the study. After an interim analysis of the results obtained with 30% of the animals, if sufficient power is not reached, another 30% is included in the study. If results from this initial 60% of the animals provide sufficient statistical power, then the rest of the animals are excused from the study. If not, the remaining animals are also included in the study. This approach was reported to save 20% of the animals in average, without leading to a decrease in statistical power ( 48 ).
Alternative sample size estimation strategies are implemented for animal testing in different countries. As an example, a local authority in southwestern Germany recommended that, in the absence of a formal sample size estimation, less than 7 animals per experimental group should be included in pilot studies and the total number of experimental animals should not exceed 100 ( 48 ).
On the other hand, it should be noted that, for a sample size of 8 to 10 animals per group, statistical significance will not be accomplished unless a large or very large ES (> 2) is expected ( 45 , 46 ). This problem remains as an important limitation for animal studies. Software like G-Power can be used for sample size estimation. In this case, results obtained from a previous or a preliminary study will be required to be used in the calculations. However, even when a previous study is available in literature, using its data for a sample size estimation will still pose an uncertainty risk unless a clearly detailed study design and data is provided in the publication. Although researchers suggested that reliability analyses could be performed by methods such as Markov Chain Monte Carlo, further research is needed in this regard ( 49 ).
The output of the joint workshop held by The National Institutes of Health (NIH), Nature Publishing Group and Science; “Principles and Guidelines for Reporting Preclinical Research” that was published in 2014, has since been acknowledged by many organizations and journals. This guide has shed significant light on studies using biological materials, involving animal studies, and handling image-based data ( 50 ).
Another important point regarding animal studies is the use of technical repetition (pseudo replication) instead of biological repetition. Technical repetition is a specific type of repetition where the same sample is measured multiple times, aiming to probe the noise associated with the measurement method or the device. Here, no matter how many times the same sample is measured, the actual sample size will remain the same. Let us assume a research group is investigating the effect of a therapeutic drug on blood glucose level. If the researchers measure the blood glucose level of 3 mice receiving the actual treatment and 3 mice receiving placebo, this would be a biological repetition. On the other hand, if the blood glucose level of a single mouse receiving the actual treatment and the blood glucose level of a single mouse receiving placebo are each measured 3 times, this would be technical repetition. Both designs will provide 6 data points to calculate P value, yet the P value obtained from the second design would be meaningless since each treatment group will only have one member ( Figure 5 ). Multiple measurements on single mice are pseudo replication; therefore do not contribute to N. No matter how ingenious, no statistical analysis method can fix incorrectly selected replicates at the post-experimental stage; replicate types should be selected accurately at the design stage. This problem is a critical limitation, especially in pre-clinical studies that conduct cell culture experiments. It is very important for critical assessment and evaluation of the published research results ( 51 ). This issue is mostly underestimated, concealed or ignored. It is striking that in some publications, the actual sample size is found to be as low as one. Experiments comparing drug treatments in a patient-derived stem cell line are specific examples for this situation. Although there may be many technical replications for such experiments and the experiment can be repeated several times, the original patient is a single biological entity. Similarly, when six metatarsals are harvested from the front paws of a single mouse and cultured as six individual cultures, another pseudo replication is practiced where the sample size is actually 1, instead of 6 ( 52 ). Lazic et al . suggested that almost half of the studies (46%) had mistaken pseudo replication (technical repeat) for genuine replication, while 32% did not provide sufficient information to enable evaluation of appropriateness of the sample size ( 53 , 54 ).
Technical vs biological repeat.
In studies providing qualitative data (such as electrophoresis, histology, chromatography, electron microscopy), the number of replications (“number of repeats” or “sample size”) should explicitly be stated.
Especially in pre-clinical studies, standard error of the mean (SEM) is frequently used instead of SD in some situations and by certain journals. The SEM is calculated by dividing the SD by the square root of the sample size (N). The SEM will indicate how variable the mean will be if the whole study is repeated many times. Whereas the SD is a measure of how scattered the scores within a set of data are. Since SD is usually higher than SEM, researchers tend to use SEM. While SEM is not a distribution criterion; there is a relation between SEM and 95% confidence interval (CI). For example, when N = 3, 95% CI is almost equal to mean ± 4 SEM, but when N ≥ 10; 95% CI equals to mean ± 2 SEM. Standard deviation and 95% CI can be used to report the statistical analysis results such as variation and precision on the same plot to demonstrate the differences between test groups ( 52 , 55 ).
Given the attrition and unexpected death risk of the laboratory animals during the study, the researchers are generally recommended to increase the sample size by 10% ( 56 ).
Sample size is important for genetic studies as well. In genetic studies, calculation of allele frequencies, calculation of homozygous and heterozygous frequencies based on Hardy-Weinberg principle, natural selection, mutation, genetic drift, association, linkage, segregation, haplotype analysis are carried out by means of probability and statistical models ( 57 - 62 ). While G-Power is useful for basic statistics, substantial amount of analyses can be conducted using genetic power calculator ( http://zzz.bwh.harvard.edu/gpc/ ) ( 61 , 62 ). This calculator, which provides automated power analysis for variance components (VC) quantitative trait locus (QTL) linkage and association tests in sibships, and other common tests, is significantly effective especially for genetics studies analysing complex diseases.
Case-control association studies for single nucleotide polymorphisms (SNPs) may be facilitated using OSSE web site ( http://osse.bii.a-star.edu.sg/ ). As an example, let us assume the minor allele frequencies of an SNP in cases and controls are approximately 15% and 7% respectively. To have a power of 0.8 with 0.05 significance, the study is required to include 239 samples both for cases and controls, adding up to 578 samples in total ( Figure 6 ).
Interface of Online Sample Size Estimator (OSSE) Tool. (Available at: http://osse.bii.a-star.edu.sg/ ).
Hong and Park have proposed tables and graphics in their article for facilitating sample size estimation ( 57 ). With the assumption of 5% disease prevalence, 5% minor allele frequency and complete linkage disequilibrium (D’ = 1), the sample size in a case-control study with a single SNP marker, 1:1 case-to-control ratio, 0.8 statistical power, and 5% type I error rate can be calculated according to the genetic models of inheritance (allelic, additive, dominant, recessive, and co-dominant models) and the odd ratios of heterozygotes/rare homozygotes ( Table 6 ). As demonstrated by Hong and Park among all other types of inheritance, dominant inheritance requires the lowest sample size to achieve 0.8 statistical power. Whereas, testing a single SNP in a recessive inheritance model requires a very large sample size even with a high homozygote ratio, that is practically challenging with a limited budget ( 57 ). The Table 6 illustrates the difficulty in detecting a disease allele following a recessive mode of inheritance with moderate sample size.
/OR ratio | ||||
---|---|---|---|---|
Allelic | 1974 | 789 | 248 | 134 |
Dominant | 606 | 258 | 90 | 53 |
Co-Dominant | 2418 | 964 | 301 | 161 |
Recessive | 20,294 | 8390 | 2776 | 1536 |
Effective sample sizes are calculated according to the following assumptions: minor allele frequency is 5%, disease prevalence is 5%, there is complete linkage disequilibrium (D’ = 1), case-to-control ratio is 1:1, and the type I error rate is 5% for single marker analysis (57). |
In clinical research, sample size is calculated in line with the hypothesis and study design. The cross-over study design and parallel study design apply different approaches for sample size estimation. Unlike pre-clinical studies, a significant number of clinical journals necessitate sample size estimation for clinical studies.
The basic rules for sample size estimation in clinical trials are as follows ( 63 , 64 ):
The relationship among clinical significance, statistical significance, power and effect size. In the example above, in order to provide a clinically significant effect, a treatment is required to trigger at least 0.5 mmol/L decreases in cholesterol levels. Four different scenarios are given for a candidate treatment, each having different mean total cholesterol change and 95% confidence interval. ES - effect size. N – number of participant. Adapted from reference 65 .
Sample size estimation can be performed manually using the formulas in Table 1 as well as software and websites in Table 2 (especially by G-Power). However, all of these calculations require preliminary results or previous study outputs regarding the hypothesis of interest. Sample size estimations are difficult in complex or mixed study designs. In addition: a) unplanned interim analysis, b) planned interim analysis and
In addition, post-hoc power analysis (possible with G-Power, PASS) following the study significantly facilitates the evaluation of the results in clinical studies.
A number of high-quality journals emphasize that the statistical significance is not sufficient on its own. In fact, they would require evaluation of the results in terms of effect size and clinical effect as well as statistical significance.
In order to fully comprehend the effect size, it would be useful to know the study design in detail and evaluate the effect size with respect to the type of the statistical tests conducted as provided in Table 3 .
Hence, the sample size is one of the critical steps in planning clinical trials, and any negligence or shortcomings in its estimate may lead to rejection of an effective drug, process, or marker. Since statistical concepts have crucial roles in calculating the sample size, sufficient statistical expertise is of paramount importance for these vital studies.
In clinical laboratories, software such as G-Power, Medcalc, Minitab, and Stata can be used for group comparisons (such as t-tests, Mann Whitney U, Wilcoxon, ANOVA, Friedman, Chi-square, etc. ), correlation analyses (Pearson, Spearman, etc .) and regression analyses.
Effect size that can be calculated according to the methods mentioned in Table 3 is important in clinical laboratories as well. However, there are additional important criteria that must be considered while investigating differences or relationships. Especially the guidelines (such as CLSI, RiliBÄK, CLIA, ISO documents) that were established according to many years of experience, and results obtained from biological variation studies provide us with essential information and critical values primarily on effect size and sometimes on sample size.
Furthermore, in addition to the statistical significance (P value interpretation), different evaluation criteria are also important for the assessment of the effect size. These include precision, accuracy, coefficient of variation (CV), standard deviation, total allowable error, bias, biological variation, and standard deviation index, etc . as recommended and elaborated by various guidelines and reference literature ( 66 - 70 ).
In this section, we will assess sample size, effect size, and power for some analysis types used in clinical laboratories.
Sample size is a critical determinant for Linear, Passing Bablok, and Deming regression studies that are predominantly being used in method comparison studies. Sample size estimations for the Passing-Bablok and Deming method comparison studies are exemplified in Table 7 and Table 8 respectively. As seen in these tables, sample size estimations are based on slope, analytical precision (% CV), and range ratio (c) value ( 66 , 67 ). These tables might seem quite complicated for some researchers that are not familiar with statistics. Therefore, in order to further simplify sample size estimation; reference documents and guidelines have been prepared and published. As stated in CLSI EP09-A3 guideline, the general recommendation for the minimum sample size for validation studies to be conducted by the manufacturer is 100; while the minimum sample size for user-conducted verification is 40 ( 68 ). In addition, these documents clearly explain the requirements that should be considered while collecting the samples for method/device comparison studies. For instance, samples should be homogeneously dispersed covering the whole detection range. Hence, it should be kept in mind that randomly selected 40-100 sample will not be sufficient for impeccable method comparison ( 68 ).
2 | > 90 | 30 | < 30 | < 30 | < 30 | < 30 | < 30 | < 30 | |||||||
5 | > 90 | > 90 | 80 | 45 | 35 | < 30 | < 30 | < 30 | |||||||
7 | > 90 | > 90 | > 90 | 90 | 60 | 45 | 30 | < 30 | |||||||
10 | > 90 | > 90 | > 90 | > 90 | > 90 | 80 | 55 | 35 | |||||||
13 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | 80 | 50 | |||||||
2 | > 90 | 90 | 40 | < 30 | < 30 | < 30 | < 30 | < 30 | |||||||
5 | > 90 | > 90 | > 90 | > 90 | 85 | 65 | 40 | < 30 | |||||||
7 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | 80 | 45 | |||||||
10 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | 80 | |||||||
2 | > 90 | > 90 | > 90 | 75 | 50 | 35 | < 30 | < 30 | |||||||
5 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | > 90 | 80 | |||||||
Slope - the steepness of a line and the intercept indicates the location where it intersects an axis. The greater the magnitude of the slope, the steeper the line and the greater the rate of change. The formula for the regression line in method comparison study is y = ax + b, where a is the slope of the line and b is the y-intercept. The range ratio (concentration of the upper limit / concentration of the lower limit). % CV - coefficient of variation (analytical precision). *Sample size values are proposed for respective slope ranges. i.e. for range ratio: 4, CV: 2%, slope range: 1.00–1.02 or 1.00–0.98 requires > 90 samples; whereas slope range: 1.04-1.06 or 0.96-0.94 requires 40 samples. Note: In this example, similar % CV values are assumed for the two methods compared. For methods having dissimilar % CV values, the researcher should refer to the reference 66. |
5104 | 1575 | 567 | 343 | 256 | 182 | 150 | 116 | 108 | |||
1276 | 410 | 152 | 90 | 69 | 48 | 39 | 32 | 27 | |||
585 | 185 | 70 | 42 | 32 | 25 | 20 | 16 | 15 | |||
325 | 104 | 41 | 27 | 20 | 15 | 13 | 11 | ≤ 10 | |||
544 | 320 | 226 | 150 | 114 | 75 | 64 | 45 | 37 | |||
144 | 82 | 61 | 40 | 33 | 23 | 20 | 18 | 15 | |||
66 | 42 | 29 | 22 | 17 | ≤ 10 | ≤ 10 | ≤ 10 | ≤ 10 | |||
39 | 26 | 19 | 15 | 12 | ≤ 10 | ≤ 10 | ≤ 10 | ≤ 10 | |||
Type I error = 0.05. Power = 0.9. Standardized Δ value for slope Slope . CV – coefficient of variation. The range ratio - concentration of the upper limit / concentration of the lower limit. CV refers to the CV at the middle of the given interval (SD / mean of the interval for the analytes), while the required sample size is 343 for a “standardized Δ value for slope” of 1 for a range ratio of 2.5 in Deming regression, it is 320 in weighted Deming regression (Simplified from reference ). |
Additionally, comparison studies might be carried out in clinical laboratories for other purposes; such as inter-device, where usage of relatively few samples is suggested to be sufficient. For method comparison studies to be conducted using patient samples; sample size estimation, and power analysis methodologies, in addition to the required number of replicates are defined in CLSI document EP31-A-IR. The critical point here is to know the values of constant difference, within-run standard deviation, and total sample standard deviation ( 69 ). While studies that compare devices having high analytical performance would suffice lower sample size; studies comparing devices with lower analytical performance would require higher sample size.
Lu et al. used maximum allowed differences for calculating sample sizes that would be required in Bland Altman comparison studies. This type of sample size estimation, which is critically important in laboratory medicine, can easily be performed using Medcalc software ( 70 ).
It is acknowledged that lot-to-lot variation may influence the test results. In line with this, method comparison is also recommended to monitor the performance of the kit in use, between lot changes. To aid in the sample size estimation of these studies; CLSI has prepared the EP26-A guideline “User evaluation of between-reagent lot variation; approved guideline”, which provides a methodology like EP31-A-IR ( 71 , 72 ).
The Table 9 presents sample size and power values of a lot-to-lot variation study comparing glucose measurements at 3 different concentrations. In this example, if the difference in the glucose values measured by different lots is > 0.2 mmol/L, > 0.58 mmol/L and > 1.16 mmol/L at analyte concentrations of 2.77 mmol/L, 8.32 mmol/L and 16.65 mmol/L respectively, lots would be confirmed to be different. In a scenario where one sample is used for each concentration; if the lot-to-lot variation results obtained from each of the three different concentrations are lower than the rejection limits (meaning that the precision values for the tested lots are within the acceptance limits), then the lot variation is accepted to lie within the acceptance range. While the example for glucose measurements presented in the guideline suggests that “1 sample” would be sufficient at each analyte concentration, it should be noted that sample size might vary according to the number to devices to be tested, analytical performance results of the devices ( i.e. precision), total allowable error, etc. For different analytes and scenarios ( i.e. for occasions where one sample/concentration is not sufficient), researchers need to refer CLSI EP26-A ( 71 ).
| /S | | |||||||
---|---|---|---|---|---|---|---|---|---|
Glucose | 2.77 | 0.33 | 0.055 | 0.033 | 6.0 | 0.6 | 0.6 x Cd (0.2) | 1 | 0.955 |
8.32 | 0.83 | 0.11 | 0.08 | 7.5 | 0.75 | 0.7 x Cd (0.58) | 1 | > 0.916 | |
16.65 | 1.66 | 0.25 | 0.19 | 6.7 | 0.78 | 0.7 x Cd (1.16) | 1 | > 0.916 | |
Cd - critical difference is the total allowable error (TAE) according to the CLIA criteria. S - repeatability (within-run imprecision). S - within-reagent lot imprecision. Note: S and S values should be obtained from the manufacturer. Power is calculated according to critical difference, imprecision values and sample size as explained in detail in CLSI EP 26-A. If the lot-to-lot variation results obtained from three different concentrations are lower than the rejection limits when one sample is used for each concentration (meaning method precision of the tested lots are within the acceptance limits), then the lot variation is said to remain within the acceptance range. (The actual table provided in the guideline (CSLI EP26A) is of 3 pages. Since the primary aim of this paper is to familiarize the reader with sample size estimation methodologies in different study types; for simplification, only a glucose example is included in this table. For different analytes and scenarios ( for occasions where one sample/concentration is not sufficient), researchers need to refer CLSI EP26-A.) (71). |
Some researchers find CLSI EP26-A and CLSI EP31 rather complicated for estimating the sample size in lot-to-lot variation and method comparison studies (which are similar to a certain extent). They instead prefer to use the sample size (number of replicates) suggested by Mayo Laboratories. Mayo Laboratories decided that lot-to-lot variation studies may be conducted using 20 human samples where the data are analysed by Passing-Bablok regression and accepted according to the following criteria: a) slope of the regression line will lie between 0.9 and 1.1; b) R2 coefficient of determination will be > 0.95; c) the Y-intercept of the regression line will be < 50% of the lowest reportable concentration, d) difference of the means between reagent lots will be < 10% ( 73 ).
Acceptance limits should be defined before the verification and validation studies. These could be determined according to clinical cut-off values, biological variation, CLIA criteria, RiliBÄK criteria, criteria defined by the manufacturer, or state of the art criteria. In verification studies, the “sample size” and the “minimum proportion of the observed samples required to lie within the CI limits” are proportional. For instance, for a 50-sample study, 90% of the samples are required to lie within the CI limits for approval of the verification; while for a 200-sample study, 93% is required ( Table 10 ). In an example study whose total allowable error (TAE) is specified as 15%; 50 samples were measured. Results of the 46 samples (92% of all samples) lied within the TAE limit of 15%. Since the proportion of the samples having results within the 15% TAE limit (92% of the samples) exceeds the minimum proportion required to lie within the TAE limits (90% of the samples), the method is verified ( 74 ).
20 | 85 |
30 | 87 |
40 | 90 |
50 | 90 |
100 | 91 |
200 | 93 |
500 | 93 |
1000 | 94 |
N – sample size. CI – confidence interval. for a verification study of 20 samples, 85% of the samples (17 samples) are required to lie within the CI limits, whereas for a verification study of 100 samples, 91% of the samples (91 samples) are required to lie within the CI limits (74). |
Especially in recent years, researchers tend to use CLSI EP15-A3 or alternative strategies relying on EP15-A3, for verification analyses. While the alternative strategies diverge from each other in many ways, most of them necessitate a sample size of at least 20 ( 75 - 78 ). Yet, for bias studies, especially for the ones involving External Quality Control materials, even lower sample sizes ( i.e. 10) may be observed ( 79 ). Verification still remains to be one of the critical problems for clinical laboratories. It is not possible to find a single criteria and a single verification method that fits all test methods ( i.e. immunological, chemical, chromatographical, etc. ).
While sample size for qualitative laboratory tests may vary according to the reference literature and the experimental context, CLSI EP12 recommends at least 50 positive and 50 negative samples, where 20% of the samples from each group are required to fall within cut-off value +/- 20% ( 80 , 81 ). According to the clinical microbiology validation/verification guideline Cumitech 31A, the minimum number of the samples in positive and negative groups is 100/each group for validation studies, and 10/each group for verification studies ( 82 ).
ROC analysis is the most important statistical analysis in diagnostic and prognostic studies. Although sample size estimation for ROC analyses might be slightly complicated; Medcalc, PASS, and Stata may be used to facilitate the estimation process. Before the actual size estimations, it is a prerequisite for the researcher to calculate potential area under the curve (AUC) using data from previous or preliminary studies. In addition, size estimation may also be calculated manually according to Table 1 , or using sensitivity (or TPF) and 1-specificity (FPF) values according to Table 11 which is adapted from CLSI EP24-A2 ( 83 , 84 ).
0.80 | 0.05 | 246 |
0.85 | 0.05 | 196 |
0.90 | 0.05 | 139 |
0.95 | 0.05 | 73 |
0.70 | 0.10 | 81 |
0.75 | 0.10 | 73 |
0.80 | 0.10 | 62 |
0.85 | 0.10 | 49 |
L - desired width of one half of the confidence interval (CI), or maximum allowable error of the estimate. (95% CI for 0.05 and 90% CI for 0.10). TPF - true positive fraction. FPF - false positive fraction. Adapted from CLSI EP24-A2, reference . |
As is known, X-axis of the ROC curve is FPF, and Y-axis is TPF. While TPF represents sensitivity, FPF represents 1-specificity. Utilizing Table 11 , for a 0.85 sensitivity, 0.90 specificity and a maximum allowable error of 5% (L = 0.05), 196 positive and 139 negative samples are required. For the scenarios not included in this table, reader should refer to the formulas given under “diagnostic prognostic studies” subsection of Table 1 .
Standards for reporting of diagnostic accuracy studies (STARD) checklist may be followed for diagnostic studies. It is a powerful checklist whose application is explained in detail by Cohen et al. and Flaubaut et al. ( 85 , 86 ). This document suggests that, readers demand to understand the anticipated precision and power of the study and whether authors were successful in recruiting the sufficient number of participants; therefore it is critical for the authors to explain the intended sample size of their study and how it was determined. For this reason, in diagnostic and prognostic studies, sample size and power should clearly be stated.
As can be seen here, the critical parameters for sample size estimation are AUC, specificity and sensitivity, and their 95% CI values. The table 12 demonstrates the relationship of sample size with sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV); the lower the sample size, the higher is the 95% CI values, leading to increase in type II errors ( 87 ). As can be seen here, confidence interval is narrowed as the sample size increases, leading to a decrease in type II errors.
FPR = 0.05, FNR = 0.05, .) | sensitivity = 0.80, specificity = 0.80, PPV = 0.80, NPV = 0.80, .) | |
---|---|---|
20 | 0.00-0.25 | 0.56-0.94 |
60 | 0.01-0.14 | 0.68-0.90 |
100 | 0.02-0.11 | 0.71-0.87 |
500 | 0.03-0.07 | 0.76-0.83 |
1000 | 0.04-0.07 | 0.77-0.82 |
95% CI of the test characteristic ratios of 0.05 and 0.8 are selected for illustration. Test characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, false-positives and false-negatives are denoted either as percentages or ratios. To use a terminology similar to the original table, the term “ratio” is preferred here. The 95% CI is inversely proportional with the sample size; 95% CI is narrower with increased sample size. In the example here, a diagnostic study having a sensitivity of 0.8 is provided. The 95% CI is broader (0.56–0.94) if the study is conducted with 20 samples, and narrower (0.71–0.87) is the study is conducted with 100 samples. Thus, at small sample sizes, only rather uncertain estimates of specificity, sensitivity, FPR, FNR, are obtained (87). |
Like all sample size calculations, preliminary information is required for sample size estimations in diagnostic and prognostic studies. Yet, variation occurs among sample size estimates that are calculated according to different reference literature or guidelines. This variation is especially prominent depending on the specific requirements of different countries and local authorities.
While sample size calculations for ROC analyses may easily be performed via Medcalc, the method explained by Hanley et al. and Delong et al. may be utilized to calculate sample size in studies comparing different ROC curves ( 88 , 89 ).
Both IFCC working groups and the CLSI guideline C28-A3c offer suggestions regarding sample size estimations in reference interval studies ( 90 - 93 ). These references mainly suggest at least 120 samples should be included for each study sub-group ( i.e., age-group, gender, race, etc. ). In addition, the guideline also states that, at least 20 samples should be studied for verification of the determined reference intervals.
Since extremes of the observed values may under/over-represent the actual percentile values of a population in nonparametric studies, care should be taken not to rely solely on the extreme values while determining the nonparametric 95% reference interval. Reed et al. suggested a minimum sample size of 120 to be used for 90% CI, 146 for 95% CI, and 210 for 99% CI (93). Linnet proposed that up to 700 samples should be obtained for results having highly skewed distributions ( 94 ). The IFCC Committee on Reference Intervals and Decision Limits working group recommends a minimum of 120 reference subjects for nonparametric methods, to obtain results within 90% CI limits ( 90 ).
Due to the inconvenience of the direct method, in addition to the challenges encountered using paediatric and geriatric samples as well as the samples obtained from complex biological fluids ( i.e. cerebrospinal fluid); indirect sample size estimations using patient results has gained significant importance in recent years. Hoffmann method, Bhattacharya method or their modified versions may be used for indirect determination of the reference intervals ( 95 - 101 ). While a specific sample size is not established, sample size between 1000 and 10.000 is recommended for each sub-group. For samples that cannot be easily acquired ( i.e. paediatric and geriatric samples, and complex biological fluids), sample sizes as low as 400 may be used for each sub-group ( 92 , 100 ).
The formulations given on Table 1 and the websites mentioned on Table 2 will be particularly useful for sample size estimations in survey studies which are dependent primarily on the population size ( 101 ).
Three critical aspects should be determined for sample size determination in survey studies:
| ||||||||
---|---|---|---|---|---|---|---|---|
100 | 50 | 80 | 99 | 74 | 80 | 88 | ||
500 | 81 | 218 | 476 | 176 | 218 | 286 | ||
1000 | 88 | 278 | 906 | 215 | 278 | 400 | ||
10,000 | 96 | 370 | 4900 | 264 | 370 | 623 | ||
100,000 | 96 | 383 | 8763 | 270 | 383 | 660 | ||
1.000,000 | 97 | 384 | 9513 | 271 | 384 | 664 | ||
Sample size estimation may be performed according to the actual population size, margin of error and confidence interval. Here most commonly used ME (5%) and CI (95%) levels are exemplified. A variation in ME causes a more drastic change in sample size than a variation in CI. As an example, for a population of 10,000 people, a survey with a 95% CI and 5% ME would require at least 370 samples. When CI is changed from 95% to 90% or 99%, the sample size which was 370 initially would change into 264 or 623 respectively. Whereas, when ME is changed from 5% to 10% or 1%; the sample size which was initially 370 would change into 96 or 4900 respectively. For other ME and CI levels, the researcher should refer to the equations and software provided on Table 1 and Table 2 (102). |
For a given CI, sample size and ME is inversely proportional; sample size should be increased in order to obtain a narrower ME. On the contrary, for a fixed ME, CI and sample size is directly proportional; in order to obtain a higher CI, the sample size should be increased. In addition, sample size is directly proportional to the population size; higher sample size should be used for a larger population. A variation in ME causes a more drastic change in sample size than a variation in CI. As exemplified in Table 13 , for a population of 10,000 people, a survey with a 95% CI and 5% ME would require at least 370 samples. When CI is changed from 95% to 90% or 99%, the sample size which was 370 initially would change into 264 or 623 respectively. Whereas, when ME is changed from 5% to 10% or 1%; the sample size which was initially 370 would change into 96 or 4900 respectively. For other ME and CI levels, the researcher should refer to the equations and software provided on Table 1 and Table 2 .
The situation is slightly different for the survey studies to be conducted for problem detection. It would be most appropriate to perform a preliminary survey with a small sample size, followed by a power analysis, and completion of the study using the appropriate number of samples estimated based on the power analysis. While 30 is suggested as a minimum sample size for the preliminary studies, the optimal sample size can be determined using the formula suggested in Table 14 which is based on the prevalence value ( 103 ). It is unlikely to reach a sufficient power for revealing of uncommon problems (prevalence 0.02) at small sample sizes. As can be seen on the table, in the case of 0.02 prevalence, a sample size of 30 would yield a power of 0.45. In contrast, frequent problems ( i.e. prevalence 0.30) were discovered with higher power (0.83) even when the sample size was as low as 5. For situations where power and prevalence are known, effective sample size can easily be estimated using the formula in Table 1 .
0.01 | 0.05 | 0.07 | 0.1 | 0.14 | 0.18 | 0.26 | 0.39 |
0.02 | 0.1 | 0.13 | 0.18 | 0.26 | 0.33 | 0.45 | 0.64 |
0.03 | 0.14 | 0.19 | 0.26 | 0.37 | 0.46 | 0.6 | 0.78 |
0.04 | 0.18 | 0.25 | 0.34 | 0.46 | 0.56 | 0.71 | 0.87 |
0.05 | 0.23 | 0.3 | 0.4 | 0.54 | 0.64 | 0.79 | 0.92 |
0.10 | 0.41 | 0.52 | 0.65 | 0.79 | 0.88 | 0.96 | > 0.99 |
0.15 | 0.56 | 0.68 | 0.8 | 0.91 | 0.96 | > 0.99 | > 0.99 |
0.20 | 0.67 | 0.79 | 0.89 | 0.96 | 0.99 | > 0.99 | > 0.99 |
0.25 | 0.76 | 0.87 | 0.94 | 0.99 | > 0.99 | > 0.99 | > 0.99 |
0.30 | 0.83 | 0.92 | 0.97 | > 0.99 | > 0.99 | > 0.99 | > 0.99 |
When prevalence is low, higher sample size is required to reach sufficient power. I.e. for a prevalence of 0.2, even 10 interviews (N = 10) is sufficient to reach a power value of 0.89. However, for a prevalence of 0.05, with 10 interviews (N = 10) the power will remain at 0.4, leading to a type II error. According to reference . |
While larger sample size may provide researchers with great opportunities, it may create problems in interpretation of statistical significance and clinical impact. Especially in studies with big sample sizes, it is critically important for the researchers not to rely only on the magnitude of the regression (or correlation) coefficient, and the P value. The study results should be evaluated together with the effect size, study efficiencies ( i.e. basic research, clinical laboratory, and clinical studies) and confidence interval levels. Monte Carlo simulations could be utilized for statistical evaluations of the big data results ( 18 , 104 ).
As a result, sample size estimation is a critical step for scientific studies and may show significant differences according to research types. It is important that sample size estimation is planned ahead of the study, and may be performed through various routes:
Sample size estimations may be rather complex, requiring advanced knowledge and experience. In order to properly appreciate the concept and perform precise size estimation, one should comprehend properties of different study techniques and relevant statistics to certain extend. To assist researchers in different fields, we aimed to compile useful guidelines, references and practical software for calculating sample size and effect size in various study types. Sample size estimation and the relationship between P value and effect size are key points for comprehension and evaluation of biological studies. Evaluation of statistical significance together with the effect size is critical for both basic science, and clinical and laboratory studies. Therefore, effect size and confidence intervals should definitely be provided and its impact on the laboratory/clinical results should be discussed thoroughly.
Potential conflict of interest
None declared.
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Methodology
Published on May 14, 2020 by Pritha Bhandari . Revised on June 21, 2023.
A population is the entire group that you want to draw conclusions about.
A sample is the specific group that you will collect data from. The size of the sample is always less than the total size of the population.
In research, a population doesn’t always refer to people. It can mean a group containing elements of anything you want to study, such as objects, events, organizations, countries, species, organisms, etc.
Population | Sample |
---|---|
Advertisements for IT jobs in the Netherlands | The top 50 search results for advertisements for IT jobs in the Netherlands on May 1, 2020 |
Songs from the Eurovision Song Contest | Winning songs from the Eurovision Song Contest that were performed in English |
Undergraduate students in the Netherlands | 300 undergraduate students from three Dutch universities who volunteer for your psychology research study |
All countries of the world | Countries with published data available on birth rates and GDP since 2000 |
Collecting data from a population, collecting data from a sample, population parameter vs. sample statistic, practice questions : populations vs. samples, other interesting articles, frequently asked questions about samples and populations.
Populations are used when your research question requires, or when you have access to, data from every member of the population.
Usually, it is only straightforward to collect data from a whole population when it is small, accessible and cooperative.
For larger and more dispersed populations, it is often difficult or impossible to collect data from every individual. For example, every 10 years, the federal US government aims to count every person living in the country using the US Census. This data is used to distribute funding across the nation.
However, historically, marginalized and low-income groups have been difficult to contact, locate and encourage participation from. Because of non-responses, the population count is incomplete and biased towards some groups, which results in disproportionate funding across the country.
In cases like this, sampling can be used to make more precise inferences about the population.
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When your population is large in size, geographically dispersed, or difficult to contact, it’s necessary to use a sample. With statistical analysis , you can use sample data to make estimates or test hypotheses about population data.
Ideally, a sample should be randomly selected and representative of the population. Using probability sampling methods (such as simple random sampling or stratified sampling ) reduces the risk of sampling bias and enhances both internal and external validity .
For practical reasons, researchers often use non-probability sampling methods. Non-probability samples are chosen for specific criteria; they may be more convenient or cheaper to access. Because of non-random selection methods, any statistical inferences about the broader population will be weaker than with a probability sample.
When you collect data from a population or a sample, there are various measurements and numbers you can calculate from the data. A parameter is a measure that describes the whole population. A statistic is a measure that describes the sample.
You can use estimation or hypothesis testing to estimate how likely it is that a sample statistic differs from the population parameter.
A sampling error is the difference between a population parameter and a sample statistic. In your study, the sampling error is the difference between the mean political attitude rating of your sample and the true mean political attitude rating of all undergraduate students in the Netherlands.
Sampling errors happen even when you use a randomly selected sample. This is because random samples are not identical to the population in terms of numerical measures like means and standard deviations .
Because the aim of scientific research is to generalize findings from the sample to the population, you want the sampling error to be low. You can reduce sampling error by increasing the sample size.
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If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.
Research bias
Samples are used to make inferences about populations . Samples are easier to collect data from because they are practical, cost-effective, convenient, and manageable.
Populations are used when a research question requires data from every member of the population. This is usually only feasible when the population is small and easily accessible.
A statistic refers to measures about the sample , while a parameter refers to measures about the population .
A sampling error is the difference between a population parameter and a sample statistic .
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Bhandari, P. (2023, June 21). Population vs. Sample | Definitions, Differences & Examples. Scribbr. Retrieved August 21, 2024, from https://www.scribbr.com/methodology/population-vs-sample/
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The purpose of a research paper is to present the results of a study or investigation in a clear, concise, and structured manner. Research papers are written to communicate new knowledge, ideas, or findings to a specific audience, such as researchers, scholars, practitioners, or policymakers. The primary purposes of a research paper are:
Delimitations refer to the specific boundaries or limitations that are set in a research study in order to narrow its scope and focus. Delimitations may be related to a variety of factors, including the population being studied, the geographical location, the time period, the research design, and the methods or tools being used to collect data.
Your study's scope and delimitations are the sections where you define the broader parameters and boundaries of your research. The scope details what your study will explore, such as the target population, extent, or study duration. Delimitations are factors and variables not included in the study. Scope and delimitations are not methodological ...
What is scope and delimitation in research. The scope of a research paper explains the context and framework for the study, outlines the extent, variables, or dimensions that will be investigated, and provides details of the parameters within which the study is conducted.Delimitations in research, on the other hand, refer to the limitations imposed on the study.
Why - the general aims and objectives (purpose) of the research.; What - the subject to be investigated, and the included variables.; Where - the location or setting of the study, i.e. where the data will be gathered and to which entity the data will belong.; When - the timeframe within which the data is to be collected.; Who - the subject matter of the study and the population from ...
The thesis is generally the narrowest part and last sentence of the introduction, and conveys your position, the essence of your argument or idea. See our handout on Writing a Thesis Statement for more. The roadmap Not all academic papers include a roadmap, but many do. Usually following the thesis, a roadmap is a
A research paper provides an excellent opportunity to contribute to your area of study or profession by exploring a topic in depth.. With proper planning, knowledge, and framework, completing a research paper can be a fulfilling and exciting experience. Though it might initially sound slightly intimidating, this guide will help you embrace the challenge.
Formal Research Structure. These are the primary purposes for formal research: enter the discourse, or conversation, of other writers and scholars in your field. learn how others in your field use primary and secondary resources. find and understand raw data and information. For the formal academic research assignment, consider an ...
This portion tells two things: 1. The study's "Scope" - concepts and variables you have explored in your research and; The study's "Delimitation" - the "boundaries" of your study's scope. It sets apart the things included in your analysis from those excluded. For example, your scope might be the effectiveness of plant ...
In order to write the scope of the study that you plan to perform, you must be clear on the research parameters that you will and won't consider. These parameters usually consist of the sample size, the duration, inclusion and exclusion criteria, the methodology and any geographical or monetary constraints. Each of these parameters will have ...
The introduction leads the reader from a general subject area to a particular topic of inquiry. It establishes the scope, context, and significance of the research being conducted by summarizing current understanding and background information about the topic, stating the purpose of the work in the form of the research problem supported by a hypothesis or a set of questions, explaining briefly ...
The reader is oriented to the significance of the study. Anchors the research questions, hypotheses, or assumptions to follow. It offers a concise statement about the purpose of your paper. Place the topic into a particular context that defines the parameters of what is to be investigated.
Citations are part of what sets research papers apart from more casual nonfiction like personal essays. Citing your sources both validates your data and also links your research paper to the greater scientific community. Because of their importance, citations must follow precise formatting rules . . . problem is, there's more than one set of ...
A research design is a strategy for answering your research question using empirical data. Creating a research design means making decisions about: Your overall research objectives and approach. Whether you'll rely on primary research or secondary research. Your sampling methods or criteria for selecting subjects. Your data collection methods.
A confidence level tells you the probability (in percentage) of the interval containing the parameter estimate if you repeat the study again. A 95% confidence interval means that if you repeat your study with a new sample in exactly the same way 100 times, you can expect your estimate to lie within the specified range of values 95 times.
Study with Quizlet and memorize flashcards containing terms like The part of your study that sets boundaries and parameters of the problem inquiry and narrows down the scope of the inquiry., It will provide information to the reader on how the study will contribute., The portion of your study that will provide evidence of academic standards and procedure and more.
A questionnaire is an important instrument in a research study to help the researcher collect relevant data regarding the research topic. It is significant to ensure that the design of the ...
production of a multi-authored research paper. The Study This manuscript reports on part of a bigger enquiry on the writing and publishing processes of a research paper by multiple authors. All nine drafts of a research article, written by a team of researchers during five months in a leading university in Malaysia, were collected and analyzed
Statistical analysis is a crucial part of a research. A scientific study must include statistical tools in the study, beginning from the planning stage. ... α is often set at 0.10 or 0.20. In studies where it is especially important to avoid concluding a treatment is effective when it actually is not, the alpha may be set at a much lower value ...
Example: Experimental research design. You design a within-subjects experiment to study whether a 5-minute meditation exercise can improve math test scores. Your study takes repeated measures from one group of participants. First, you'll take baseline test scores from participants. Then, your participants will undergo a 5-minute meditation ...
Research Questions and Types of Statistical Studies. In a statistical study, a population is a set of all people or objects that share certain characteristics.A sample is a subset of the population used in the study.Subjects are the individuals or objects in the sample.Subjects are often people, but could be animals, plants, or things. Variables are the characteristics of the subjects we study.
The sampling frame intersects the target population. The sam-ple and sampling frame described extends outside of the target population and population of interest as occa-sionally the sampling frame may include individuals not qualified for the study. Figure 1. The relationship between populations within research.
In research, there are 2 kinds of populations: the target population and the accessible population. The accessible population is exactly what it sounds like, the subset of the target population that we can easily get our hands on to conduct our research. While our target population may be Caucasian females with a GFR of 20 or less who are ...
A population is the entire group that you want to draw conclusions about.. A sample is the specific group that you will collect data from. The size of the sample is always less than the total size of the population. In research, a population doesn't always refer to people. It can mean a group containing elements of anything you want to study, such as objects, events, organizations, countries ...