Mehrdimensionale Nicht-Parametrische Normbereiche: Methodologische Und Medizinische Aspekte
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"Normalcy is a vestigial concept left in medicine from its unscien- tific era. " Dieser Satz des bekannten Medizintheoretikers E. A. Murphy aus dem Jahre 1966 gibt fur eine Normbereichstheorie wenig AnlaB zur Hoffnung, trotzdem spielen in der wissenschaftlichen wie in der prak- tischen Medizin bis zum heutigen Tag Vorstellungen uber "Normalitat" eine herausragende Rolle. Die Versuche, "Normalitat" durch "Norm"- Bereiche zu definieren, sind inzwischen glucklicherweise eher zu Ra- ritaten geworden, andererseits hat sich auch eine nicht nur inter-, sondern auch intra-individuelle Betrachtungsweise durchgesetzt, denn, wie es Immanuel Kant formuliert, "ein jeder hat eine andere Art, ge- sund zu sein". Aus diesen unterschiedlichen Gesichtspunkten liiBt sich auch bereits der Stellenwert der statistischen Normbereiche in der Medizin charakterisieren: Diese sollten dem diagnostizierenden Arzt Orientierungs- und Entscheidungshilfe bieten, keinesfalls aber als ein autonomes Beurteilungskriterium aufgefaBt werden. Die Mathematische Statistik wurde durch eine Arbeit von W. A. Shew- hart aus dem Jahre 1931 zu einer Untersuchung des Normalitatsbegrif- fes angeregt und beschaftigt sich seit der grundlegenden Arbeit von S. S. Wilks, die 1941 in den Annals of Mathematical Statistics publi- ziert wurde, eingehender mit dieser Thematik. Die Diskussion der Norm- oder Toleranzbereiche wurde seit diesen frUhen Arbeiten von der in der Statistik bekannten Unterscheidung in parametrische und nicht - parametrische ("verteilungsfreie") Methoden gepragt. In der Medizin und Biologie scheint eine nicht - parametrische Betrachtungs- weise, die auf Voraussetzungen spezieller Verteilungsformen verzich- tet, eher angemessen zu sein als eine parametrische Behandlung, so daB die erst ere Gegenstand der vorliegenden Abhandlung sein solI.
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