The Discriminant Formula for the Determination of Sex of Adults in A Nigerian Population (Using Pelvic Radiographs)

Identification of sex in human skeletal remains is an important component and frequently the starting point of many forensic anthropological investigations. This study was carried out to document the determination of sex by discriminant formula using the pelvic radiographs of Nigerian adults. Measurements were carried out on the pelvis. Pelvic radiographs of 500 adult Nigerians of known sex, age range 18-75 years (comprising 250 males and 250 females) were measured in the antero-posterior position using a digital vernier calliper. The data was analysed using z-test. The results showed that the mean values for the Ischial length and Pubic length in males were 86.82±8.25mm and 76.41±8.91mm respectively while in females the Ischial length and Pubic length were 80.62±7.66mm and 84.58±8.80mm respectively. 4% males and 19% females were identified for ischial length and 15% males and 42% females were identified for pubic length. The mean value for pelvic height in males and females were 236.70±12.51mm and 223.02±12.18mm respectively, the demarking points identified 29% males and 32% females, while the mean value for midpubic width in males and females were 25.94± 4.54mm and 30.09± 3.67mm respectively, the demarking points identified 40% and 65% females. The mean values for ischiopubic and pelvic height/midpubic width were statistically significant (P<0.05). The mean values of the pelvic height/midpubic index were 9.35 ± 1.38 in males and 7.49 ± 0.82 in females. The demarking points identified 72% males and 75% females. While the mean values of the ischiopubic index in males and females were 88.46±9.26 in males and 114.67±99.28 in females, the demarking points identified 56% males and 84% females. It was observed that the males had higher pelvic height and ischial length than females, while the females had longer pubic length and mid pubic width which contributed to the females having wider pelvis. The accurate determination of sex and race are important tools to forensic Scientists and physical anthropologists. Keywords: Pelvis, Radiographs, Sex determination, Nigerian population

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways