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Soumaya Allouch,1 Raja Mahamade Ali,2 Mohammed Seed Ahmed,1 Saghir Akhtar,1 Ahmed Awaisu,2 Mubarak Bidmos1 1Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar; 2College of Pharmacy, QU Health, Qatar University, Doha, QatarCorrespondence: Mubarak Bidmos, Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar, Tel +974 7054 3213, Email mbidmos@qu.edu.qaPurpose: This study aimed to determine the perceptions of senior medical students and recent graduates from College of Medicine (CMED) at Qatar University regarding their undergraduate education and training related to prescribing, their confidence in achieving the learning outcomes specified in the curriculum and their preparedness to prescribe in practice.Patients and Methods: This was a cross-sectional web-based survey with qualitative elements, utilizing a 22-item pre-validated questionnaire developed through a multi-phase iterative process. The survey was administered to all senior medical students (year 4– 6) and recent graduates of CMED at Qatar University.Results: One hundred sixty-seven medical students and graduates responded to the survey (response rate ~45%). Overall, the participants expressed positive attitude towards curricular content related to prescribing that aimed to prepare them for practice, including pharmacology and therapeutics, history-taking, physical examination, diagnostic investigations, application of evidence-based medicine, and other skills. Over 60% of the participants believed that the prescribing components of the undergraduate curriculum made them competent in providing safe and effective prescriptions in practice. Notably, there was an association between seniority and perceived curricular effectiveness, highlighting the impact of clinical experience on participants’ views. Recommendations for curriculum enhancement focused on practical integration, contextualized education, and a holistic approach to both theoretical and clinical learning.Conclusion: The study revealed positive opinions regarding curricular content related to prescribing and identified areas for improvement in medical curriculum. Continuous monitoring, evaluation and refinement based on participants’ feedback are crucial for ensuring the preparedness of medical graduates for safe and effective prescribing in real-world clinical practice.Keywords: medical education, curriculum evaluation, contextualized education, curriculum enhancement

Salah Eldin Kassab,1 Mubarak Bidmos,1 Michail Nomikos,1 Suhad Daher-Nashif,2 Tanya Kane,2 Srikant Sarangi,3 Marwan Abu-Hijleh1 1Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar; 2Department of Population Medicine, College of Medicine, Qatar University, QU Health, Doha, Qatar; 3Danish Institute of Humanities and Medicine (DIHM), Aalborg University, Aalborg, DenmarkCorrespondence: Salah Eldin KassabPhysiology & Medical Education, College of Medicine, QU Health, Qatar University, PO Box 2713, Doha, QatarTel +974 – 4403 7843Email skassab@qu.edu.qaPurpose: 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.Keywords: G-theory, validity, reflective writing, portfolio, reliability, student assessment

Salah Eldin Kassab,1 Mubarak Bidmos,1 Michail Nomikos,1 Suhad Daher-Nashif,2 Tanya Kane,2 Srikant Sarangi,3 Marwan Abu-Hijleh1 1Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar; 2Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; 3Danish Institute of Humanities and Medicine (DIHM), Aalborg University, Aalborg, DenmarkCorrespondence: Salah Eldin KassabPhysiology and Medical Education, College of Medicine, QU Health, Qatar University, PO Box 2713, Doha, QatarTel +974 4403 7843Email skassab@qu.edu.qa We thank Forenc et al1 for their interest in our study titled Construct Validity of an Instrument for Assessment of Reflective Writing-Based Portfolios of Medical Students.2 In their Letter to Editor, their main critique concerned the extent to which the nonanonymity of reflective portfolios and the lack of reflection prompts to students may have affected the G-theory analysis. In their view, these two aspects will have reduced the percentage variance of the object of measurement (students) and thus influenced the variance attributed to the study facets. In addition, they draw attention that the study instrument might not be replicable for clinical students, due to increased complexity of the learning environment. We address their concerns in turn. View the original paper by Kassab and colleagues This is in response to the Letter to the Editor

The anatomical method is considered the most accurate stature estimation method, however, research has concluded that the soft-tissue correction factors associated with this method may be sex- and population-specific. Therefore, this study aimed to evaluate the applicability of these soft-tissue correction factors for the estimation of stature in White South African males. Magnetic resonance imaging scans of 30 White South African male volunteers, between 21 and 59 years of age, were used to collect skeletal measurements of bones that contribute to total skeletal height. The soft-tissue correction factors within the literature were subsequently applied to estimate the living stature of each individual. Paired t-tests were used to compare the accuracies of these estimates of living stature to the measured heights of the participants. Living stature was significantly underestimated using the soft-tissue correction factors of Fully (1956; 6.14 cm), Raxter and colleagues (2006; 4.80 cm), and Brits and colleagues (2017; 0.96 cm), and significantly overestimated by Bidmos and Manger (2012; 9.65 cm). Cloete's (2017) equation overestimated stature by 0.65 cm, however, this was not significant. These results suggest population-specific soft-tissue correction factors associated with stature estimation and, therefore, the newly derived stature estimation equations should be used to estimate stature of White South African males. [ABSTRACT FROM AUTHOR]

South Africa has one of the highest crime rates in the world and the discovery of dismembered bodies for human identification process poses a greater challenge. The South African Africans (also known as South African blacks) population group is often the victims of crimes as they are the largest group. While measurements of several bones of the human skeleton have been used for sex estimation, the potential of metatarsals have not been explored in this population group. Metatarsal bones are usually well-preserved since they are recovered in shoes protected from scavengers and they are able to withstand environmental degradation and taphonomy. This study investigated the potential of measurements of metatarsals in sex estimate amongst South African Africans using logistic and discriminant function analysis. Six measurements of metatarsals from 100 individuals of known sex and population affinity from the Raymond Dart Collection of Human skeletons were analysed. Various combinations of measurements of metatarsal bones yielded suitably high average accuracies (79% to 84%) for sex estimation and are comparable to functions derived from other skeletal elements of South African Africans. Metatarsals of South African Africans are therefore useful as alternatives to highly sexual dimorphic bones in the forensic estimation of sex. [ABSTRACT FROM AUTHOR]

Accurate estimates of stature play an important role in the personal identification of unknown decedents, however a drawback in the application of many stature estimation equations is the need for known sex and population, the assignment of which can be challenging. Researchers have formulated equations for stature estimation that are neither population- nor sex-specific and thereof the aim of this study was to assess the applicability of these stature estimation equations proposed by Albanese et al.. (2016) (Albanese J, Tuck A, Gomes J, Cardoso HFV (2016) An alternative approach for estimating stature for long bones that is not population- or group-specific. Forensic Sci Int 259:59-68). The physiological length of the femur, condylar malleolar length of the tibia and a combination of these measurements, collected from Magnetic Resonance Imaging Scanograms of adult (20-60 years) White South African males (n = 30) and females (n = 44) were used to assess the accuracy of the Albanese et al. (Albanese J, Tuck A, Gomes J, Cardoso HFV (2016) An alternative approach for estimating stature for long bones that is not population- or group-specific. Forensic Sci Int 259:59-68). sex-specific and generic stature estimation equations. The stature estimates were compared with measured living stature (LSM), using paired t-tests. Results indicated that the Albanese et al. (Albanese J, Tuck A, Gomes J, Cardoso HFV (2016) An alternative approach for estimating stature for long bones that is not population- or group-specific. Forensic Sci Int 259:59-68). equations underestimated living stature by between 1.1 and 5.0 cm. These underestimations were significantly different between the LSM and the sex-specific estimates for females and the LSM and the generic estimates for males and the tibia for sex-specific equation. All stature estimates however fell in between two standard error of estimates for the sex-specific equations for males and the generic equations for the females. Although, the equations by Albanese et al. (Albanese J, Tuck A, Gomes J, Cardoso HFV (2016) An alternative approach for estimating stature for long bones that is not population- or group-specific. Forensic Sci Int 259:59-68). can be used to estimate stature in White South Africans in certain cases, the use of sex/population-specific equations remains the method of choice., Competing Interests: Declarations. Ethical approval: Ethical approval with number M2111174 was obtained from the Human Research Ethics Committee – Medical of the University of the Witwatersrand, Johannesburg, South Africa. Informed consent: Each participant signed an informed consent document prior to their participation in the study. Research involving human participants and/or animals: This study was conducted following strict adherence to ethical principles and guidelines that govern human research in accordance with Singapore Statement on Research Integrity. The study received approval from the Human Research Ethics Committee (HREC) – Medical at University of the Witwatersrand, Johannesburg. All collected data were treated with strict confidentiality and any information that could potentially identify them were anonymized. All authors also declare that there is no conflict of interest that could influence the objectivity of this study. Competing interests: No competing interests., (© 2024. The Author(s).)

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 2 1-5 . 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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

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.

The derivation of discriminant function equations for skeletal elements of South African populations continues to be an area of interest to both forensic anthropologists and skeletal biologists alike. The skull of black South Africans has previously been subjected to discriminant function analysis, using four measurements and two indices; however, no equations were derived to address the issue of sex determination. Recently Franklin, Freedman and Milne [2005. Sexual dimorphism and discriminant function sexing in indigenous South African crania. HOMO J. Comp. Hum. Biol. 55, 213-228] used the crania of black South Africans, in a three-dimensional approach, with eight linear measurements to investigate sex determination. This study, although valuable, requires the use of highly technical and expensive morphometric equipment that renders it less feasible in South Africa. In response to this, our study uses traditional anthropometric measurements and equipment to address the question of sex determination from the crania and mandible of blacks. One hundred and twenty non-pathological skulls were randomly selected from the Raymond Dart Collection of Human Skeletons, equally distributed by sex and belonging to individuals whose age at death ranges between 25 and 70 years. Fourteen cranial and six mandibular measurements were subjected to discriminant function analyses and discriminant function equations were derived for sex determination. Average accuracies ranged between 80% and 85% and were on par with that obtained in previous studies. Our study shows that traditional methods provide average accuracies that are comparable to those obtained using more complex techniques.

Intact long limb bones have been used in the derivation of regression equations for stature assessment in different population groups. Since intact long bones are not always present for analyses in forensic cases, it has become necessary to derive regression equations for the estimation of stature from the fragments of these bones which are obtained in forensic and archaeological cases. Regression equations have been derived for stature estimation from fragments of the tibia. Since these equations are population specific, it was the aim of this study to derive similar equations for estimation of stature and maximum tibia length from measurements of different fragments of tibia of South Africans of European descent. Analyses were based on a sample of 50 male and 50 female complete skeletons of adult South Africans of European descent. Total skeletal height for the individual skeletons was measured using the Fully's (anatomical) method. Six variables were measured on the tibia which included the medial tibial condyle lengths and breadths, lateral tibial condyle lengths and breadths, proximal breadth and distal breadth. Univariate and multivariate regression equations were formulated for estimation of total skeletal height (and subsequent estimation of living stature) and maximum tibial length from measurements of the tibia. The standard errors of estimate for the equations were higher than those obtained for intact long bones which when present in forensic cases should be used for stature estimation. In the absence of intact long bones, the equations derived from the present study can provide a reliable estimate of skeletal height and living stature.

Stature reconstruction is important as it provides a forensic anthropological estimate of the height of a person in the living state; playing a vital role in the identification of individuals from their skeletal remains. Regression formulae for stature estimation have been generated for indigenous South Africans based on measurements of long bones of upper and lower extremities and the calcaneus. Since these bones are not always available for forensic analysis, it became necessary to use other bones such as the skull for stature estimation. The aim of the present study was to investigate the usefulness of certain measurements of the skull of indigenous South Africans in the estimation of adult stature. Ninety-nine complete skeletons obtained from the Raymond A. Dart Collection, School of Anatomical Sciences of the University of the Witwatersrand, were used. Total skeletal height (TSH) was calculated for each skeleton using the Fully's (anatomical) method. Furthermore, six variables were measured on each skull. TSH was regressed onto these cranial measurements in order to obtain regression formulae. The correlation coefficients obtained ranged between 0.40 and 0.54. The range of the standard errors of estimate from the current study (4.37 and 6.24) is high in comparison to that obtained for stature estimation based on intact long bones and the calcaneus. Therefore, the equations presented in this study should be used with caution in forensic cases when only the skull is available for human identification.

The reconstruction of adult stature from length of limb bones is not a new concept. Population specific regression equations for stature estimation have been derived from these bones in most part of the world. Due to increased violence in major cities of the world resulting in dismemberment of the human body and skeleton, there was a need for derivation of regression equations from fragments of long bones of limbs and segments of the vertebral column. This was achieved with lower accuracies compared to intact limb bones. The calcaneus, the largest of the foot bones, has been used for sex determination in Americans, Europeans and South Africans. Its usefulness in the estimation of stature is not well documented. In this study, Fully's anatomical method was utilized in the estimation of stature of 85 complete skeletons of South Africans of European descent of known sex and age, obtained from the Raymond A Dart Collection of Human skeletons. Univariate and multivariate regression equations were derived from nine measurements of the calcaneus. Most measurements presented with significantly positive correlation with stature. The resulting standard error of estimate, which is a measure of the accuracy of the equations, compared well with the values that have been recorded for fragments of long bones; thereby making the calcaneus a reliable skeletal element in the estimation of adult stature of South Africans of European descent.

To date, there are no metric standards for differentiating between population groups from measurements of the calcaneus in South Africa. Previously, some of the measurements of the calcaneus have been used for sex determination in Americans, Europeans, Italians and South Africans. However, the variations in the number of articular facet present on the superior surface of the calcaneus have been observed in different population groups. This study aims at investigating the potentials of measurements of the calcaneus in diagnosing population affinity and observes population variations of the number of articular facet present on its superior surface in indigenous South Africans and those of European descent. Nine measurements were taken from 180 non-pathological left calcanei in a sample of known sex and population affinity obtained from the Raymond A. Dart Collection of Human Skeletons. Three articular facet types were observed. A significantly higher incidence of type A was observed in South Africans of European descent (SAED) population group while type B predominated in the indigenous South African (ISA) population group. Type C even though rare was found only in ISA group. The metrical data were subjected to discriminant function analyses. The average accuracy in correct classification (81-89%) obtained for the discriminant function equations derived in this study may assist in the determination of population affinity when the calcaneus is present for analysis in forensic cases.

Stature (height) is an important factor in establishing the identity of a person in the living as well as in the skeletonized state. When stature is estimated from the bones of the limbs, regression equations, which estimate the ratios of the lengths of bones to the height of the individual, are generated. The majority of bones that were used previously were the long bones. The calcaneus was used for estimating stature only in American whites and blacks (Holland [1995] Am. J. Phys. Anthropol. 96:315-320). The regression equations that he generated were found to be useful for stature estimation in these population groups. Since the calcaneus has not been used for the same purpose in South Africa, the aim of this study was to derive regression equations that will allow this bone to be used for stature estimation in South African blacks. In total, 116 complete skeletons (60 males and 56 females) were selected from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, University of the Witwatersrand (Johannesburg, South Africa). The skeletal heights of these sets of skeletons were calculated using the anatomical method of Fully ([1956] Ann. Med. Leg. 35:266-273). Nine parameters of the calcaneus were measured and matched against skeletal heights, using univariate and multivariate regression methods. Regression equations were obtained for estimation of the stature of the South African black population from the calcaneus. The standard error of estimate that was obtained with univariate regression analysis was higher than the corresponding values using multivariate regression analysis. In both cases, the standard errors of estimate compared well with the values obtained for fragmentary long bones by previous authors., ((c) 2004 Wiley-Liss, Inc.)

This study uses metrical characteristics of the patella to derive population specific equations for sex determination in South Africa. Six measurements were taken from 120 normal and undamaged left patellae in a sample of known race, equally distributed by sex, obtained from the Raymond A Dart collection of human skeletons. These data were subjected to discriminant analysis. Maximum height and maximum breadth were selected in the stepwise analysis with an average accuracy of 83% in correct sex classification. Four functions were derived from the direct analysis with a range of average accuracy between 77% and 85%. While most individual variables showed high misclassification rates and may not be useful on their own, maximum height and maximum breadth have an average accuracy of 85 and 79%, respectively.

When fragmentary and incomplete bones are all that are available to the forensic anthropologist for use in sex determination, non-metric and metric sex discriminating parameters that have been derived from complete bones may be of little use. In such circumstances, sex discriminating metric methods that are of specific application to fragmentary bones will be more useful. Since such studies have not been systematically carried out in bones of South African blacks, the aim of this study was to begin to provide such data. Two hundred and twenty left femurs of black South Africans were obtained from the Raymond A. Dart Collection of African Skeleton, School of Anatomical Sciences, University of the Witwatersrand, South Africa. Five variables from the upper end of the femur and three variables from the lower end of the femur were measured and subjected to univariate and multivariate discriminant function analyses. The vertical head diameter and the medial condylar length were most successful in sex identification from the upper and lower ends of the femur respectively. The combined variables were more useful than the use of variables individually. Discriminant function score equations were derived for individual and combined variables from the upper and lower ends of the femur of the South African blacks.

Patent left and right supernumerary inferior polar renal arteries were found in a dissection room cadaver. Both arteries originated from the left common iliac artery. This is an unusual form of origin of these arteries in the presence of an apparently normal ascent and position of the two kidneys.

The testis is an important organ upon which the survival of the human species depends. The testicular arteries and veins play major roles in the thermo-regulation that is essential for the efficient functioning of this organ. However, very little is found in the literature about the veins and their anatomical variations. Therefore the testicular veins and arteries in 150 dissection room cadavers at the University of the Witwatersrand, Johannesburg and University of Zimbabwe, Harare were examined for anatomical variations from the usual descriptions in textbooks of Anatomy. Variations were found more frequently in the testicular veins than in the accompanying arteries. The variations, which were more common on the left side, were seen in 32 (21.3%) of the cadavers. In 6 (18.8%) of these cases, the variations were present bilaterally. The veins were either completely or partially duplicated, with or without beading. The duplicated veins terminated in the corresponding renal veins either separately or after combining into one vein. In two cases, the right testicular vein terminated in the right renal vein, rather than in the inferior vena cava. Anatomical variations of the testicular artery were present in 4.7% of cases and were associated with their origin, which were either from unusually high levels of the abdominal aorta or from the renal artery.