In patients with chronic heart failure which polypharmacy pheno-groups are associated with adverse health outcomes? (Polypharmacy pheno-groups and heart failure outcomes).

BACKGROUND: Patients with heart failure are living longer with the inevitable morbidity of rising medication counts. It remains uncertain what fraction of this ensuing polypharmacy exactly predicts adverse clinical outcomes. METHODS: This prospective study examined records of patients admitted to a Weill Cornell-affiliated tertiary medical institution with a confirmed diagnosis of heart failure between January 2018 to January 2022. Each patient's medications for the past four months were tallied, and a definitional threshold of ≤4, ≥5, ≥10 medications was established. The primary outcome was all-cause mortality within the study period. RESULTS: Out of a total of 7354 patients included in the study, 70 % were males with a median age of 59 years IQR (48-71). The median (IQR) age-adjusted Charlson Comorbidity Index (CCI) was 21-5. A total of 1475 (20 %) participants died within the study period. Patient cohorts with excessive polypharmacy (≥9 medications) had the highest probability of survival up to 1.6 years compared to those with lower medication thresholds (≤4); the mortality rate decreased by 18 % for patients with excessive polypharmacy [HR = 0.82, 95 % CI: 0.71-0.94]). Conversely, patients with non-heart failure-related polypharmacy had increased risks of ICU admissions (aOR = 1.78, 95 % CI: 1.13-2.70). CONCLUSION: In an examination of a database of patients with chronic heart failure, major non-heart failure-related polypharmacy was associated with increased risks in intensive care admissions. Excessive polypharmacy was associated with increased rates of survival.

Machine learning and discriminant function analysis in the formulation of generic models for sex prediction using patella measurements.

Sex prediction from bone measurements that display sexual dimorphism is one of the most important aspects of forensic anthropology. Some bones like the skull and pelvis display distinct morphological traits that are based on shape. These morphological traits which are sexually dimorphic across different population groups have been shown to provide an acceptably high degree of accuracy in the prediction of sex. A sample of 100 patella of Mixed Ancestry South Africans (MASA) was collected from the Dart collection. Six parameters: maximum height (maxh), maximum breadth (maxw), maximum thickness (maxt), the height of articular facet (haf), lateral articular facet breadth (lafb), and medial articular facet breath (mafb) were used in this study. Stepwise and direct discriminant function analyses were performed for measurements that exhibited significant differences between male and female mean measurements, and the "leave-one-out" approach was used for validation. Moreover, we have used eight classical machine learning techniques along with feature ranking techniques to identify the best feature combinations for sex prediction. A stacking machine learning technique was trained and validated to classify the sex of the subject. Here, we have used the top performing three ML classifiers as base learners and the predictions of these models were used as inputs to different machine learning classifiers as meta learners to make the final decision. The measurements of the patella of South Africans are sexually dimorphic and this observation is consistent with previous studies on the patella of different countries. The range of average accuracies obtained for pooled multivariate discriminant function equations is 81.9-84.2%, while the stacking ML technique provides 90.8% accuracy which compares well with those presented for previous studies in other parts of the world. In conclusion, the models proposed in this study from measurements of the patella of different population groups in South Africa are useful resent with reasonably high average accuracies.

Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis.

Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper-Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using I 2 and τ 2 statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4-77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25-42%) (I 2 = 100%, τ2 = 0.9170, p < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27-63%) (I 2 = 100%, τ2 = 1.0886, p < 0.01) than Europe (29%, 95% CI: 20-40%) (I 2 = 100%, τ2 = 0.7944, p < 0.01). Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071. Plain Language Summary: Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors?Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America's compared with European cohorts of PLWH.Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.

Sex estimation from dimensions of the base of the skull in Black South Africans.

The pelvis and the skull are the two most utilised skeletal elements to estimate sex from skeletonised remains due to their sexually dimorphic traits. However, as increasingly more fragmented remains have been presented for analyses, other bones and their fragments have now been subjected to analyses for sex estimation. In the skull particularly, the base has shown to survive harsh conditions. In this study the foramen magnum region was explored in Black South Africans to estimate sex during forensic analyses. Seven measurements of the foramen magnum and surrounding areas were measured in 120 male and female crania and subjected to discriminant function analyses. The average accuracies for the stepwise discriminant functions ranged from 60-71% whilst the average accuracies for the direct discriminant functions ranged from 63-69%. The average accuracies obtained in this study are similar to other studies performed using the foramen magnum. However, these average accuracies are much lower than other skeletal elements that have been used for sex estimation in South Africans. Thus, the equations in this study should be used with caution and only in the absence of more accurate elements. The cranial base has always shown to have a low to moderate expression of sexual dimorphism. The cranial base of Black South Africans is no different.

Accuracies of discriminant function equations for sex estimation using long bones of upper extremities.

One of the scopes of practice of forensic anthropologists is the estimation of sex from skeletal remains. As a result, population-specific discriminant function equations have been developed from measurements of various bones of the human skeletons. Steyn, Patriquin (Forensic Sci Int 191 (1-3):113, 2009) noted that the lack of skeletal collections and data from most parts of the world has made this process impractical. Previous attempts to develop global discriminant function equations from measurements of the pelvis showed that population-specific equations are not necessary as equations derived from other populations yielded high sex estimation scores when applied to a different population. However, information on the suitability and applicability of generalised equations in sex estimation using long bones is still scarce. It is, therefore, the aim of this study to assess the accuracies of population-specific discriminant function equations derived from measurements of long bones of the upper limb of South African population groups. Data analysed in the current study were obtained from Mokoena, Billings, Bidmos, Mazengenya (Forensic Sci Int 278:404, 2017) and Mokoena, Billings, Gibbon, Bidmos, Mazengenya (Science & Justice 6(59):660-666, 2019) in which a total sample of 988 bones (humeri, radii, and ulnae) of South Africans of African descent (SAAD), South Africans of European descent (SAED) and Mixed Ancestry South Africans (MASA) were measured. Stepwise and direct discriminant function analyses were performed on the pooled data. Each function was used to estimate the sex of cases in each population group separately and average accuracies calculated. Thereafter, population-specific discriminant function equations were formulated for each population group and then applied to other population groups. The average accuracies of functions for pooled data ranged between 80.7 and 86.5%. The cross-validation average accuracies remained unchanged for most functions, confirming the validity of derived functions. A drop in average accuracies (0.8-5.3%) was observed when the functions were tested on a sample of SAAD while increased average accuracy was observed for the SAED and MASA (0.5-6.9%). When population-specific functions for a particular population group were applied to other groups, a wide range of a drop in average accuracies was observed (1.3 to 22.4%). This thereby confirms that population-specific equations should not be applied to other population groups. However, discriminant function equations from the pooled data of South Africans are accurate in the estimation of sex and efforts should be made towards the development and validation of such equations from as many bones of the human skeleton.

Avoidability of drug-induced liver injury (DILI) in an elderly hospital cohort with cases assessed for causality by the updated RUCAM score.

BACKGROUND: Drug-induced liver injury (DILI) represents an increasing morbidity in the general population, but more so in the elderly cohort of patients. Despite this, the concept of its prevention through prospective analysis has largely remained unexamined. We evaluated the utility of recently validated adverse drug reactions (ADR) avoidability tool in a cohort of elderly patients with DILI. METHODS: We examined 38 DILI-drug pairs from n=38 patients in a prospective cohort of patients presenting with adverse drug reactions to a Weill Cornell-affiliated tertiary hospital between February 2019 and January 2020. DILI outcomes were adjudicated by the updated Roussel Uclaf Causality Assessment Method (RUCAM). Two clinical pharmacologists and two general physicians utilized the Liverpool adverse drug reactions avoidability tool (LAAT) and the modified Hallas tools to rate the preventability of DILI-drug pairs. Inter-rater, exact agreement proportions, as well as intraclass correlation coefficients were generated and expressed as ordinal outcomes. RESULTS: The cases examined for the determination of DILI avoidability had probability likelihood of "probable" or "highly probable" by the updated RUCAM scale. Examination of the 38 DILI-drug pairs (n= 38 patients) resulted in a total of 152 ordinal outcome decisions. We found about 32.3% (50/152) and 34.2% (52/152) of DILI-drug pairs were rated as "avoidable" ("probable" or "definite") by the LAAT and the modified Hallas tools respectively. The overall median Krippendorf's kappa with the LAAT was 0.61 (SE 0.12, CI 0.36, 0.85) and for modified Hallas tool was 0.53 (SE 0.18; CI 0.16, 0.89). The inter-rater correlation coefficient (ICC) for the LAAT and modified Hallas were 0.50 [0.32, 0.65] and 0.63 [0.48, 0.76] respectively. Exact pairwise agreement was present in 30/38 (IQR 29.5, 34.5), and 28/38 (IQR 27.5-35.5) of DILI-ADR pairs using the LAAT and modified Hallas tools respectively. CONCLUSION: We found a significant proportion of drug-induced liver injury adjudicated by the updated RUCAM scale in elderly hospitalized cohort of patients were avoidable with significant implication for therapeutic commissioning as well as cost effectiveness interventions in this cohort of patients.

Construct Validity of an Instrument for Assessment of Reflective Writing-Based Portfolios of Medical Students.

PURPOSE: Assessment of reflective writing for medical students is challenging, and there is lack of an available instrument with good psychometric properties. The authors developed a new instrument for assessment of reflective writing-based portfolios and examined the construct validity of this instrument. METHODS: After an extensive literature review and pilot testing of the instrument, two raters assessed the reflective writing-based portfolios from years 2 and 3 medical students (n=135) on three occasions. The instrument consists of three criteria: organization, description of an experience and reflection on the experience. We calculated the reliability of scores using generalizability theory with a fully crossed design and two facets (raters and occasions). In addition, we measured criterion validity by testing correlations with students' scores using other assessment methods. RESULTS: The dependability (Φ) coefficient of the portfolio scores was 0.75 using two raters on three occasions. Students' portfolio scores represented 46.6% of the total variance across all score comparisons. The variance due to occasions was negligible, while the student-occasion interaction was small. The variance due to student-rater interaction represented 17.7%, and the remaining 27.7% of the variance was due to unexplained sources of error. The decision (D) study suggested that an acceptable dependability (Φ = 0.70 and 0.72) can be achieved by using two raters for one and two occasions, respectively. Finally, we found moderate to large effect-size correlations between students' scores in reflective writing-based portfolios and communication skills (r = 0.47) and PBL tutorials (r = 0.50). CONCLUSION: We demonstrated the presence of different sources of evidence that support construct validity of the study instrument. Further studies are warranted before utilizing this instrument for summative assessment of students' reflective writing-based portfolios in other medical schools.

Comparative effectiveness and safety of direct-acting oral anticoagulants (DOACS) for the reduction of recurrent venous thromboembolism in cancer patients: A protocol for systematic review and network meta-analysis using a generalized pairwise modeling methodology.

BACKGROUND: There has been a significant improvement in both our understanding and therapeutic choices available to clinicians for the management of cancer associated thrombosis (CAT). Even with the recent publication of a systematic review and landmark trials demonstrating the non-inferiority of DOACS-based anticoagulation strategy compared to the standard of care in patients with CAT, there is unresolved uncertainty regarding the exact hierarchy of risks and effectiveness of various DOAC analogues in these cohorts of patients. METHOD: We will carry out a network meta-analyses, utilizing a novel generalized pairwise methodology to generate direct and indirect comparisons between the various DOAC analogues. We will search the following databases for studies that satisfies pre-specified inclusions criteria; these include PubMed, EMBASE, Cochrane library, Clinicaltrials.gov, conference abstracts among other sources. The primary efficacy and safety outcomes are recurrent VTE and major hemorrhagic events, respectively. Two reviewers will Search the databases independently with the view to identify studies that meet eligibility criteria. The methodological quality of the included studies will be determined using a recently validated risk of bias assessment tool. RESULTS: We expect that the result of this review will ascertain the hierarchy of risks and effectiveness of various DOAC analogues in patients with CAT. CONCLUSION: Results of this review will assist in informed decisions making regarding therapeutic guidelines of DOAC in CAT.

Forensic utility of cranial measurements in stature reconstruction in South Africans of European descent.

The height of an individual (stature) is one of the biological profiles that is estimated as part of human identification process from various components of the human skeleton. The anatomical method is often used for this purpose when a complete and intact skeleton is available for forensic analysis because it is accurate. Since complete skeletons are seldom present in most forensic cases, the mathematical method, which shows linear relationship between stature and bone measurements, becomes the method of choice. Population and sex-specific regression equations for stature estimation have been formulated using intact and fragmentary long bones amongst South African whites and blacks. Individual and combinations of measurements of other skeletal elements including bones of the feet have also been used in the formulation of regression equations. However, few studies have utilized measurements of the skull for stature reconstruction. Skeletal height, calculated from a suite of measurements, was regressed on six cranial measurements. Basibregmatic height and basion-nasion length presented with the highest correlation coefficient for an individual variable in males (0.50) and females (0.48), respectively. The range of correlation coefficient from multivariate analyses in males (0.58-0.63) is similar to that obtained in females (0.55-0.62). The standard error of estimates of the equations, a measure of the accuracy of the equations, for male sample (6.74-7.09) was slightly higher than that for females (5.47-5.89). Regression equations presented in this study should be used with caution in forensic cases when only the skull is available for human identification. Significance of main findings: 1. Skull measurements show low to moderate correlation with stature. 2. Use of skull dimensions is advised only in the absence of intact long bones and other skeletal elements in South Africa.

A comparison of the direct and indirect methods of estimating skeletal height from tibial fragments in black South Africans.

The estimation of maximum bone length from its fragments is important in forensic anthropology as these length estimates can be used to estimate the total skeletal height (TSH), and thereby stature, of unknown skeletal remains. This is known as the indirect method of stature estimation. Alternatively, TSH can be estimated directly from bone fragments without first estimating maximum bone length. While regression equations for estimating maximum bone length from its fragments exist for long bones of the upper and lower limbs, these equations are population- and sex-specific and their use on populations other than the one they were derived from is not recommended. The aim of this study was therefore to develop formulae for estimating maximum tibial length from its fragments in black South Africans, which previously did not exist, and to compare the accuracies of the direct and indirect methods of estimating TSH from tibial fragments. Several measurements representing fragments were measured on the tibiae of 99 male and 99 female black South Africans, and equations estimating tibial length from these measurements were derived. Correlation coefficients of each equation were significant, and all equations estimated tibial length with moderate to high accuracy. A comparison of the standard errors of estimate (SEEs) between the direct and indirect methods of stature estimation indicate that the direct method is more accurate and should be used to estimate stature from tibial fragments when such equations exist.

Efficacy of sodium-glucose co-transporter 2 inhibitors in patients with type II diabetes: A protocol for systematic review of randomised controlled clinical trials utilising a generalised pairwise modelling methodology.

BACKGROUND: Recent systematic reviews have evaluated the efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2) inhibitors (SGLT2I) in improving glycaemic control and mortality in patients with type II diabetes mellitus. None have incorporated the most recent study or utilized the generalized pairwise modeling methodology network meta-analysis (NMA), as well as a novel bias risk assessment approach. METHODS: We propose to conduct literature search of all randomized controlled clinical trials published in English language evaluating the efficacy of (SGLT2I) versus placebo or usual standard of care from the inception of following databases to September 30, 2019: Controlled Clinical Trials Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), EMBASE, Database of Abstracts of Reviews of Effectiveness (DARE), PubMed. Two reviewers will independently search these databases to identify studies that satisfy pre-specified eligibility criteria. Study bias risk assessment amongst other methodology quality evaluation of the studies will be carried out using a novel risk bias assessment tool. RESULTS: We anticipate that the result of this review will provide additional insight into the ranking of the efficacy of various (SGLT2I) in type II diabetic patients especially as it relates to mortality, glycemic control, and body weight reduction. CONCLUSION: The result of this review will be useful informing therapeutic decisions by policy makers with regards to commissioning of diabetic care.Prospero registration number: CRD42019139708.

Development of discriminant functions to estimate sex in upper limb bones for mixed ancestry South Africans.

South Africa has one of the highest murder rates in the world, which is associated with an increasing number of unidentified individuals. Forensic anthropologists can assist in these cases to reduce the number of potential victims the remains may belong to. Sex estimation potentially decreases the number of possible victims by half. The mixed ancestry population in South Africa is the second largest group of people; however, there remains a paucity of data and population-specific methods for sex estimation in this group. The aim of this study was to assess the potential for metrices obtained around the nutrient foramen and the maximum length of upper limb long bones to estimate sex in mixed ancestry South Africans using discriminant function analysis. A total of 328 humeri, radii and ulnae from individuals of mixed ancestry were analysed. Sex was correctly classified with an average classification accuracy of 84.3% in the humeri, 88.3% for radii and 83.5% for the ulnae. Total length was the single best predictor of sex; the combination of total length with dimensions related to the nutrient foramen produced high classification accuracies in the current study. Overall, sexual dimorphism was observed in mixed ancestry South Africans upper limb long bones. The findings of this study further emphasise the need for population-specific standards of sexing in an attempt to improve current methods of forensic identification of descendants.

Using tibial fragments to reconstruct the total skeletal height of black South Africans.

Stature is an important component of the biological profile of unknown skeletal remains and regression equations for estimating stature have been derived for a number of bones. However, bones are rarely recovered intact in both forensic and archaeological cases, and regression formulae for fragmentary remains have therefore been developed. These equations are, however, both sex- and population-specific, and while formulae exist for many populations, those using fragmentary tibiae do not exist for black South Africans. The aim of this study was therefore to establish regression equations for estimating total skeletal height (TSH), and thereby stature, from tibial fragments in a black South African population. A sample of 99 male and 99 female black South African skeletons were obtained from the Raymond A. Dart Collection of Human Skeletons and the TSH of each skeleton was calculated using the anatomical method. Eleven additional measurements representing tibial fragments were taken on each tibia, and both uni- and multivariate equations were established for estimating TSH from these fragments. All tibial variables were significantly, positively correlated with TSH, and equation correlations ranged between 0.41 and 0.91. The range of standard errors of estimate for the derived sex-specific (3.43-5.06 cm) and sex-pooled (3.44-5.94 cm) multivariate equations were slightly larger than those reported for intact tibiae in black (2.78-3.06 cm) and white (2.59-3.16 cm) South Africans. All uni- and multivariate-equations estimated TSH with moderate to high accuracy, which indicates that in the absence of intact tibiae, the equations presented in this study can be used to give accurate estimates of TSH, and thereby stature, for black South Africans.

Dimensions around the nutrient foramina of the tibia and fibula in the estimation of sex.

Sex estimation from skeletal remains is one of the key components in establishing a biological profile and consequent identification of an individual in a forensic and medico-legal practice. The use of dimensions around the nutrient foramen in instances where long bones may be fragmented and damaged is of benefit due to the fact that the nutrient foramen is easily identifiable and may be preserved on the shaft of long bones. This study is an investigation of the usefulness of various measurements around the nutrient foramen of the tibia and fibula of South Africans in an attempt to develop osteometric standards for sex estimation. The sample included 206 tibiae and 204 fibulae of South African Africans (SAA) and South African whites (SAW) procured from the Raymond A. Dart Collection of Human Skeletons based at the University of the Witwatersrand. Sex was correctly classified for the tibia with an accuracy ranging between 79-82% in SAA and 84-88% in SAW, with the circumference at the level of the nutrient foramen as the single best predictor of sex in both populations. An accuracy ranging from 69 to 74% in SAA and 70-77% in SAW was observed for the combined measurements on the fibula. The current study confirms the usefulness of measurements around the nutrient foramen of the tibia in the assignment of sex. However functions of the fibula generally performed poorly and should be used with caution.

Measurements of the talus in the assessment of population affinity.

As part of their routine work, forensic anthropologists are expected to report population affinity as part of the biological profile of an individual. The skull is the most widely used bone for the estimation of population affinity but it is not always present in a forensic case. Thus, other bones that preserve well have been shown to give a good indication of either the sex or population affinity of an individual. In this study, the potential of measurements of the talus was investigated for the purpose of estimating population affinity in South Africans. Nine measurements from two hundred and twenty tali of South African Africans (SAA) and South African Whites (SAW) from the Raymond A. Dart Collection of Human Skeletons were used. Direct and step-wise discriminant function and logistic regression analyses were carried out using SPSS and SAS. Talar length was the best single variable for discriminating between these two groups for males while in females the head height was the best single predictor. Average accuracies for correct population affinity classification using logistic regression analysis were higher than those obtained from discriminant function analysis. This study was the first of its type to employ discriminant function analyses and logistic regression analyses to estimate the population affinity of an individual from the talus. Thus these equations can now be used by South African anthropologists when estimating the population affinity of dismembered or damaged or incomplete skeletal remains of SAA and SAW.

Assessing the use of the anatomical method for the estimation of sub-adult stature in Black South Africans.

Stature estimation is rarely attempted in sub-adults due to the general lack of available standards as a result of the dearth of sufficiently large sub-adult skeletal collections with known demographic information. To overcome this problem sub-adult research mainly relies on modern imaging modalities. In the current study Magnetic Resonance Imaging (MRI) scans were used to assess the use of the anatomical method for stature estimation in sub-adults. A total of 53 Black South African sub-adult males (n=24) and females (n=29) aged between 10 and 17 years participated in the study by voluntarily completing a full-body MRI scan. A stadiometer was used to measure living stature prior to all MRI scans. Skeletal elements that contribute directly to stature were measured from the MRI scans using OsiriX and summed to compute the total skeletal height. Total skeletal height was calculated using the diaphyseal, maximum and physiological long bone lengths and correlated to living stature using Pearson's correlations. Subsequently least squares regression equations were generated for the estimation of sub-adult stature. Results indicated strong, statistically significant positive correlations between living stature and total skeletal heights in sub-adult males, females and a combined sex sample. The regression equations were characterized by small standard error of estimates which are comparable to that reported for Black South African adults. Based on these results the anatomical method can be used to accurately describe living stature in Black South African sub-adults. This method is therefore encouraged as it will add valuable information when dealing with unknown sub-adult skeletal remains.

Sex estimation using dimensions around the nutrient foramen of the long bones of the arm and forearm in South Africans.

South Africa has had an increase in rates of crime, interpersonal violence and homicide since the introduction of democracy in 1994. Forensic osteological standards was lacking for South Africans of different population groups necessitating the generation of new standards for forensic identification of individuals from skeletal remains. For these reasons, there is a concerted demand for methods of identifying skeletal remains with sex being amongst the most important of the biological characteristics required. The nutrient foramen has been used to estimate sex in lower limb long bones with much accuracy but this has not been demonstrated in the upper limb long bones. The aim of this study was to develop osteometric standards for sex estimation from measurements around the nutrient foramen of the arm and forearm bones of South Africans of different population affinities. A total of 660 bones consisting of humeri, radii and ulnae of black South Africans and white South Africans were assessed for sex estimation using dimensions related to the nutrient foramen. Sex was correctly classified with a range of 84-85% for the humerus and 83-88% for the arm bones. The study showed that length measurements were more sexually dimorphic than width dimensions in South Africans, as length was consistently selected as the best predictor of sex in all bones. However, the average accuracy increased when length was used in combination with measurements related to the nutrient foramen. In conclusion, the dimensions of upper limb long bones that are directly related to the nutrient foramen are sexually dimorphic and are useful in the estimation of sex in South Africans, with the highest accuracy shown in the white South African population group.

The accuracy of the anatomical method for stature estimation in Black South African females.

The anatomical method is considered the most accurate stature estimation method, but investigation has shown that it continuously underestimates stature. This underestimation is believed to be related to the use of universal soft tissue correction factors. Therefore, the aim of this study was to assess the accuracy of the soft tissue correction factors in a living population of Black South African females and to subsequently calculate a new soft tissue correction factor, specific for stature estimation in this population group. Thirty Black South African adult females voluntarily participated in this study and underwent a full body Magnetic Resonance Imaging (MRI) scan. Living stature was measured with a stadiometer and total skeletal height (TSH) was calculated from the MRI measurements. Stature was estimated from the TSH of each participant using Fully's (1956) [17], Raxter et al.'s (2006) [38] and Bidmos and Manger's (2012) [5] methods. Results indicated strong, statistically significant positive correlations between living and estimated statures, however, paired t-tests revealed that living stature was significantly underestimated using Fully's and Raxter et al.'s methods, while the method by Bidmos and Manger significantly overestimated stature. A lack of statistically significant correlations between soft tissue correction factors and the total skeletal height was found. Likewise, an absence of statistically significant correlations between age and the estimation error, with and without age adjustments were also observed. A new soft tissue correction factor, specific for stature estimation in Black South African females was calculated. The newly proposed regression equation presented improved stature estimation accuracies for this population group.

Stature estimation from the femur and tibia in Black South African sub-adults.

Stature estimation can play a role in the positive identification of unknown individuals and as such it is routinely assessed during the examination of adult remains. Unfortunately, this is not a standard procedure when dealing with sub-adult remains due to the general lack of standard procedures for the estimation of sub-adult stature. The aim of this study was therefore to derive regression equations for the estimation of stature in black South African sub-adults. Fifty nine black South African sub-adult males and females, aged 10-17 years, voluntarily participated in the study by undergoing a full body Magnetic Resonance Imaging (MRI) scan. Living stature was measured with a stadiometer and the maximum and diaphyseal lengths of the femur and tibia were measured from the MRI scans using the image processing software OsiriX. Pearson's correlation coefficients and linear least square regression analyses were used to assess the correlations between living stature and the measurements and to generate sub-adult stature estimation equations for males, females and a combined sex sample. Measurements of the femur, tibia and the combined measures thereof showed strong statistically significant positive correlations with living stature, while the obtained regression equations were characterized by low standard error of estimates. The strong correlations and low standard error of estimates are comparable to stature estimation models reported for Black South African adults and therefore these variables can be considered good estimators of sub-adult stature which will contribute valuable information to the biological profile of unidentified sub-adult skeletal remains.