Exploring the association between self-efficacy and future utility beliefs in mathematics: A practical tutorial on correspondence analysis.

It has long been understood that there exists a strong association between a student's belief in the future utility of mathematics and their self-efficacy in mathematics. This study re-examines this association by studying these variables based on data collected from a sample of 21,444 ninth-grade students who participated in the 2009 High School Longitudinal Study (HSLS09). The nature of the association between future utility beliefs of students in mathematics and self-efficacy of students in mathematics is explored visually using the simple correspondence analysis technique. The main feature that will be utilised from this technique is a two-dimensional graphical display, referred to as a correspondence plot. By studying the HSLS09 data, the first two axes of such a plot summarised nearly 99% of the statistically significant association that exists between a student's beliefs in the future utility of mathematics and their mathematics self-efficacy. It is shown visually that students who strongly believe in the future importance of studying mathematics also perform strongly in the subject, while those who do not believe that there is any future utility from studying mathematics do not perform well at it. This study, therefore, suggests that mathematics ability is associated with a student's perception of its future importance.

Plasma Trimethylamine N-Oxide Levels Are Associated with Poor Kidney Function in People with Type 2 Diabetes.

Previous studies have linked elevated plasma trimethylamine N-oxide (TMAO) levels to poor renal function. The relationship between TMAO and chronic kidney disease (CKD) in type 2 diabetes (T2D) is still unclear. We investigated the association between plasma TMAO levels and CKD in patients with T2D. A cross-sectional study of 133 patients with T2D with or without CKD has been conducted. Blood biomarkers of kidney function, diabetes, and inflammation were assessed in the study participants. Plasma TMAO levels were quantified using UPLC-MS/MS. People with T2D and CKD exhibited significantly higher plasma TMAO levels [10.16 (5.86-17.45) µmol/L] than those without CKD [4.69 (2.62-7.76) µmol/L] (p = 0.002). Participants in the highest quartile of TMAO levels (>8.38 µmol/L) presented relatively elevated serum creatinine levels and a higher number of people with CKD than those in the lower quartiles. TMAO levels were significantly correlated with kidney function biomarkers, including estimated glomerular filtration rate and urinary albumin to creatinine ratio. The association between TMAO and CKD was evident (p < 0.0001) and remained significant after adjusting for risk factors of kidney disease, including age, gender, body mass index, duration of diabetes, and smoking. These findings suggest the association between plasma TMAO and CKD in patients with T2D.

Association between Plasma Trimethylamine N-Oxide Levels and Type 2 Diabetes: A Case Control Study.

Animal and human studies have reported conflicting results on the relationship between circulating trimethylamine N-oxide (TMAO) levels and risk of Type 2 diabetes (T2D). This study aimed to compare plasma TMAO levels in people with or without T2D and explore the association of TMAO and T2D. A prospective case-control study of 297 participants, 164 healthy controls and 133 patients with T2D, was conducted. TMAO levels were quantified by UPLC-MS/MS. Comorbidities, dietary patterns, physical activity, and blood biomarkers were assessed. Median (IQR) plasma TMAO levels were significantly higher in diabetes cases (4.95 (2.84−8.35) µmol/L) compared to healthy controls (3.07 (2.05−4.82) µmol/L) (p < 0.001). The association between TMAO and T2D was significant in the non-adjusted Model 1 (p < 0.001) and after adjusting for confounders of diabetes including age, BMI, and level of education in Model 2 (p = 0.04). When the association was further adjusted for physical activity and diet in Model 3, plasma TMAO levels at only the highest quartile (>6.40 µmol/L) were associated with the risk of diabetes (OR = 3.36, 95% CI [1.26, 9.04], p = 0.02). The results presented suggest an association between plasma TMAO levels and T2D. A significant correlation was found between red meat consumption and increased levels of TMAO in T2D patients. A longitudinal study is warranted to further evaluate the correlation between TMAO and T2D.

Anthropological Prosociality via Sub-Group Level Selection.

A perennial challenge of evolutionary psychology is explaining prosocial traits such as a preference for fairness rather than inequality, compassion towards suffering, and an instinctive ability to coordinate within small teams. Considering recent fossil evidence and a novel logical test, we deem present explanations insufficiently explanatory of the divergence of hominins. In answering this question, we focus on the divergence of hominins from the last common ancestor (LCA) shared with Pan. We consider recent fossil discoveries that indicate the LCA was bipedal, which reduces the cogency of this explanation for hominin development. We also review evolutionary theory that claims to explain how hominins developed into modern humans, however it is found that no mechanism differentiates hominins from other primates. Either the mechanism was available to the last common ancestor (LCA) (with P. troglodytes as its proxy), or because early hominins had insufficient cognition to utilise the mechanism. A novel mechanism, sub-group level selection (sGLS) is hypothesised by triangulating two pieces of data rarely considered by evolutionary biologists. These are behavioural dimorphism of Pan (chimpanzees and bonobos) that remain identifiable in modern humans, and the social behaviour of primate troops in a savannah ecology. We then contend that sGLS supplied an exponential effect which was available to LCA who left the forest, but was not sufficiently available to any other primates. In conclusion, while only indirectly supported by various evidence, sGLS is found to be singularly and persuasively explanatory of human's unique evolutionary story.

Bayesian analysis of meta-analytic models incorporating dependency: new approaches for the hierarchical Bayesian delta-splitting model.

Dependence between studies in meta-analysis is an assumption which is imposed on the structure of hierarchical Bayesian meta-analytic models. Dependence in meta-analysis can occur as a result of study reports using the same data or from the same authors. In this paper, the hierarchical Bayesian delta-splitting (HBDS) model (Steven and Taylor, 2009), which allows for dependence between studies and sub-studies by introducing dependency at the sampling and hierarchical levels, is developed using Bayesian approaches. Parameter estimation obtained from the joint posterior distributions of all parameters for the HBDS model was conducted using the Metropolis within Gibbs algorithm. The estimation of parameters for simulation studies using R code confirmed the consistency of the model parameters. These parameters were then tested successfully on studies to assess the effects of native-language vocabulary aids on second language reading as a case study.

Modeling the dynamics of the COVID-19 population in Australia: A probabilistic analysis.

The novel coronavirus COVID-19 arrived on Australian shores around 25 January 2020. This paper presents a novel method of dynamically modeling and forecasting the COVID-19 pandemic in Australia with a high degree of accuracy and in a timely manner using limited data; a valuable resource that can be used to guide government decision-making on societal restrictions on a daily and/or weekly basis. The "partially-observable stochastic process" used in this study predicts not only the future actual values with extremely low error, but also the percentage of unobserved COVID-19 cases in the population. The model can further assist policy makers to assess the effectiveness of several possible alternative scenarios in their decision-making processes.

High molecular weight oat ß-glucan enhances lipid-lowering effects of phytosterols. A randomised controlled trial.

BACKGROUND & AIMS: Oat ß-glucan (OBG) and phytosterols (PS) are known to lower blood cholesterol levels via different mechanisms. Combination of high molecular weight (MW) OBG and PS in a single functional food could have complementary and/or synergistic effects for optimising heart health. The aim of this study was to investigate the effects of dietary supplementation with high-MW OBG with or without PS on plasma lipids in hypercholesterolaemic individuals. METHODS: In a double-blinded, placebo-controlled, 2 × 2 factorial trial, participants were randomised to receive biscuits fortified with either no PS or OBG (PL, n = 18) or 2 g PS (PS, n = 18), 3 g OBG (OBG, n = 18), or combination of 2 g PS and 3 g OBG (PS-OBG, n = 18) per day for 6 weeks. Primary outcome was fasting plasma total cholesterol (TC) and secondary outcomes were LDL-cholesterol, LDL-C; HDL-cholesterol, HDL-C; triglycerides, TG and TC to HDL-cholesterol (TC:HDL) ratio. RESULTS: TC and LDL-C were significantly lowered following PS (-4.6% and -7.6% respectively; p < 0.05), OBG (-5.7% and -8.6%; p < 0.01) and PS-OBG (-11.5% and -13.9%; p < 0.0001) administration. The reduction in TC in the PS-OBG group was significantly greater compared to PL (p < 0.001) and PS (p < 0.05). PS-OBG group had a significantly greater reduction in LDL-C compared to PL (p < 0.01) but not in comparison to PS or OBG groups. TC:HDL ratio was significantly reduced following PS-OBG (-8.9%; p < 0.01) only, and there was no significant difference found between groups. Plasma TG reduced by 8.4% following PS-OBG, however, this was statistically non-significant. Plasma HDL-C remained unchanged across all groups. CONCLUSIONS: Dietary supplementation with high-MW OBG and PS in a single functional food enhances their lipid-lowering potential. Blood cholesterol lowering by PS and OBG is additive. Delivery of these two bioactive nutrients in a single food allows optimisation of their lipid-lowering effects and may provide added heart health benefits with enhanced compliance. The trial was registered with the Australian New Zealand Clinical Trials Registry at http://www.anzctr.org.au/(ACTRN12618001455257).

Modulation of Circulating Trimethylamine N-Oxide Concentrations by Dietary Supplements and Pharmacological Agents: A Systematic Review.

Discovery of the association of plasma/serum trimethylamine N-oxide (TMAO) concentrations with atherosclerosis has sparked immense interest in exploring TMAO as a predictor of cardiovascular disease risk. A spectrum of antibiotics and other therapeutic strategies have been employed to test their potential to modulate TMAO concentrations, assuming the gut microbiome to be the key source of TMAO. The aim of this systematic review was to determine whether dietary supplements or pharmacological agents affect TMAO concentrations in adults. Six databases were searched (Medline, EMBASE, CINAHL, Scopus, ProQuest, and PubMed) for randomized and nonrandomized controlled trials. Searches were limited to the English language and to studies in adults. Thirteen eligible trials were identified, including 6 studies on dietary supplements and 7 on pharmacological agents. Whereas intervention studies involving dietary supplements were mostly randomized controlled trials, those involving pharmacological agents appeared opportunistic and varied greatly in study design and duration. Different interventional products were tested, and the studies lacked the consistency to reliably synthesize any evidence for the modifiability of TMAO concentrations by dietary supplements or pharmacological agents. Choline and l-carnitine are conditionally essential nutrients, and carefully designed placebo-controlled randomized trials specifically aimed at reducing the synthesis of microflora-dependent TMAO production from choline-containing precursors by pro- and/or prebiotics, antibiotics, or other pharmaceutical agents may be the way forward for future research.

Bread enriched with phytosterols with or without curcumin modulates lipoprotein profiles in hypercholesterolaemic individuals. A randomised controlled trial.

We previously demonstrated that the combination of phytosterols (PS) and curcumin administered as dietary supplements significantly lowers LDL-cholesterol (LDL-C) more than either treatment alone. The aim of this study was to investigate the effects of this combination in a novel food (bread) on plasma lipid profiles in hypercholesterolaemic individuals. In a double-blinded, placebo-controlled, 2 × 2 factorial trial, participants were randomised to receive bread fortified with placebo (PL), 2.3 g PS (PS), 228 mg curcumin (CC) or a combination of 2.3 g PS and 228 mg CC (PS-CC) daily for four weeks. Primary outcomes were fasting plasma lipids [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)] and secondary outcomes were plasma LDL-particle (LDL-P) profile: LDL-P number and LDL-P size. Cardiovascular disease (CVD) risk (Framingham Risk Algorithm) was also explored. There was no significant difference between PL and CC or PS and PS-CC on blood lipids or CVD risk; therefore, groups were pooled for final analysis: the PL and CC group (PL-C, n = 36) and the PS and PS-CC group (PS-C, n = 39). PS-C significantly lowered TC (-0.52 mmol L-1, p < 0.0001), LDL-C (-0.49 mmol L-1, p < 0.0001) and CVD risk (-1.1 absolute %, p = 0.0005) compared to the PL-C group. Reductions from baseline in the PS-C group compared to that in the PL-C group were 7.6% and 10.6% for TC and LDL-C, respectively, and statistically significant (p < 0.0001). CVD-risk in the PS-C group reduced significantly (-12.7%) compared to that in the PL-C group (p = 0.0005). HDL-C and TG remained unchanged. The LDL-P number significantly decreased in the PS-C group by 124.33 nmol L-1 compared to that in the PL-C group (p = 0.005) and both groups showed a significant decrease in LDL-P size (p < 0.01); however, the absolute nm change in LDL-P size did not differ between groups and the percent change in LDL-P size in the PS-C group was borderline significant (-0.89%, p = 0.05) compared to that in the PL-C group. Regular consumption of PS-enriched bread with or without curcumin lowers blood cholesterol; however, curcumin alone did not influence blood lipids. Bread may be a convenient means of delivering PS with greater compliance for reducing the blood cholesterol concentration.

Identifying Differences Between Cut Marks Made on Bone by a Machete and Katana: A Pilot Study.

The aim of this research was to identify characteristics specific to a machete and katana on three different bone types. One machete and two katanas were used to produce cut marks on Sus scrofa rib, flat and long bones. Fifty-nine cuts were produced by the katanas and 38 by the machete. The presence of flaking, feathering, peeling, micropeeling, chattering, microcurvature, scoop defect, and exit notch was noted, and bivariate associations between each characteristic and weapon type were assessed using Pearson's chi-square tests for independence and logistic regression models developed. Significant predictors for machete cut marks are scoop defect for rib bones (correct classification 93%), micropeeling in flat bones, chattering on flat and long bones (all p < 001) and for the katana, microcurvature (p < 004) and exit notch on flat and long bones (p < 001; correct classification 96% and 100%, respectively). The identified bivariate associations and final logistic regression models may be utilized in forensic investigations when identifying hacking trauma.

Curcumin potentiates cholesterol-lowering effects of phytosterols in hypercholesterolaemic individuals. A randomised controlled trial.

BACKGROUND: Dietary phytosterols (PS) are well-known hypocholesterolaemic agents. Curcumin elicits hypolipidaemic and anti-inflammatory effects in preclinical studies, however, consistent findings in humans are lacking. OBJECTIVE: Concurrent PS and curcumin supplementation may exhibit enhanced hypocholesterolaemic and anti-inflammatory effects to optimise cardio-protection. The objective of this trial was to investigate the effects of dietary intervention with PS with or without curcumin on blood lipids (primary outcome) in hypercholesterolaemic individuals. METHODS: A double-blinded, randomised, placebo-controlled, 2 × 2 factorial trial was conducted in hypercholesterolaemic individuals. Participants received either placebo (PL, no phytosterols or curcumin), phytosterols (PS, 2 g/d), curcumin (CC, 200 mg/d) or a combination of PS and curcumin (PS-CC, 2 g/d-200 mg/d respectively) for four weeks. Primary outcomes included fasting total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, triglycerides (TG), TC-to-HDL-C ratio (TC:HDL-C). Secondary outcomes included anthropometrics and fasting blood glucose concentrations. RESULTS: Seventy participants with a mean (±SEM) fasting TC concentration of 6.57 ± 0.13 mmol/L completed the study (PL, n = 18; PS, n = 17; CC, n = 18; PS-CC, n = 17). PS and PS-CC supplementation significantly lowered TC, LDL-cholesterol and TC:HDL-C post-intervention (p < 0.05). Reductions from baseline in the PS group were 4.8% and 8.1% for TC and LDL-cholesterol respectively (p < 0.05). CC exhibited non-significant reduction (2.3% and 2.6%) in TC and LDL-C respectively, however, the PS-CC resulted in a greater reduction in TC (11.0%) and LDL-cholesterol (14.4%) than either of the treatments alone (p < 0.0001). The reduction in the PS-CC treatment was significantly greater compared to those for CC (p < 0.05) or PL (p < 0.01) alone. Plasma HDL-cholesterol and TG concentrations remained unchanged across all groups. No adverse side effects were reported. CONCLUSIONS: The addition of curcumin to phytosterol therapy provides a complementary cholesterol-lowering effect that is larger than phytosterol therapy alone. Implications of these findings include the development of a single functional food containing both the active ingredients for enhanced lipid-lowering and compliance in hypercholesterolaemic individuals. ANZCTR identifier: 1261500095650.

Fat type in phytosterol products influence their cholesterol-lowering potential: A systematic review and meta-analysis of RCTs.

The most common form of phytosterol (PS) fortified foods are fat spreads and dairy products. The predominant fats used are soybean/sunflower (SS) or rapeseed/canola (RC) oils and animal fat (D) in dairy products. This review aimed to investigate whether the carrier fat is a determinant of the hypocholesterolaemic effects of PS fortified foods. Databases were searched using relevant keywords and published RCTs from 1990 investigating the effects of dietary PS intervention (≥1.5g per day) on total cholesterol and LDL-C were included. After methodological quality assessment and data extraction, a total of 32 RCTs (RC, n=15; SS, n=9; D, n=8) were included. As expected, all fat groups significantly reduced TC and LDL-C (p<0.01). When compared across different carrier fats, RC as the main carrier fat, reduced LDL-C significantly more than the SS spreads (p=0.01). Therefore, a combination of monounsaturated fatty acid rich spread with adequate amounts of omega-3 fatty acids (as evident in RC spreads) may be the superior carrier fat for the delivery of PS for optimal blood cholesterol-lowering. The findings of this research provide useful evidence for optimising the hypocholesterolaemic effects of PS and support further investigation into the possible mechanisms behind these findings.

Diet quality score is a predictor of type 2 diabetes risk in women: the Australian Longitudinal Study on Women's Health.

The present study aimed to determine the ability of two diet quality scores to predict the incidence of type 2 diabetes in women. The study population comprised a nationally representative sample of 8370 Australian middle-aged (45-50 years) women participating in the ALSWH (Australian Longitudinal Study on Women's Health), who were free of diabetes and completed FFQ at baseline. The associations between the Australian Recommended Food Score (ARFS) and Dietary Guideline Index (DGI) with type 2 diabetes risk were assessed using multiple logistic regression models, adjusting for sociodemographic characteristics, lifestyle factors and energy intake. During 6 years of follow-up, 311 incident cases of type 2 diabetes were reported. The DGI score was inversely associated with type 2 diabetes risk (OR comparing the highest with the lowest quintile of DGI was 0·51; 95% CI 0·35, 0·76; P for trend = 0·01). There was no statistically significant association between the ARFS and type 2 diabetes risk (OR comparing the highest with the lowest quintile of ARFS was 0·99; 95% CI 0·68, 1·43; P for trend = 0·42). The results of the present prospective study indicate that the DGI score, which assesses compliance with established dietary guidelines, is predictive of type 2 diabetes risk in Australian women. The risk of type 2 diabetes among women in the highest quintile of DGI was approximately 50% lower than that in women in the lowest quintile. The ARFS was not significantly predictive of type 2 diabetes.

Fasting whole blood fatty acid profile and risk of type 2 diabetes in adults: a nested case control study.

OBJECTIVE: to determine the association of fasting whole blood fatty acid concentrations with incidence of type 2 diabetes in adults. METHODS: A nested case-control study of 187 subjects from a cohort of men and women aged 55-85 years from the Hunter Region, New South Wales, Australia. Fasting whole blood fatty acids were measured using gas chromatography and incidence of type 2 diabetes was ascertained by self-reported questionnaire at the study follow-up. RESULTS: After adjustment for potential confounding variables, positive associations with type 2 diabetes were seen for dihomo-gamma-linolenic acid (DGLA) (OR = 1.04, 95% CI:1.01-1.07, P = 0.01); arachidonic acid (ARA) (OR = 1.01, 95% CI:1.00-1.01, P = 0.002); alpha-linolenic acid (ALA) (OR = 1.10, 95% CI: 1.03-1.18, P = 0.01); eicosapentaenoic acid (EPA) (OR = 1.05, 95% CI:1.02-1.08, P = 0.001); and docosahexaenoic acid (DHA) (OR = 1.03, 95% CI:1.02-1.05, P<0.0001). Lignoceric acid is significantly associated with lower type 2 diabetes risk (OR = 0.95, 95% CI: 0.92-0.99, P = 0.01). CONCLUSION: These data suggest that higher fasting whole blood concentrations of omega-6 polyunsaturated fatty acids (n-6PUFA) (ARA and DGLA) as well as omega-3 polyunsaturated fatty acid (n-3PUFA) (ALA, EPA, and DHA) are associated with an increased risk of diabetes, whereas increased fasting whole blood concentrations of lignoceric acid is inversely associated with diabetes risk.

Macronutrient intake and type 2 diabetes risk in middle-aged Australian women. Results from the Australian Longitudinal Study on Women's Health.

OBJECTIVE: To investigate the association between macronutrient intake and type 2 diabetes risk in middle-aged Australian women. DESIGN: A prospective cohort study, with 6 years (2002-2007) of follow up. Dietary intake was assessed with a validated FFQ. Relative risks with 95 % confidence intervals were used to examine risk associations. SETTING: Australian Longitudinal Study on Women's Health, Australia. SUBJECTS: Australian women (n 8370) from the Australian Longitudinal Study on Women's Health aged 45-50 years and free of type 2 diabetes at baseline. RESULTS: After 6 years of follow-up, 311 women developed type 2 diabetes. After adjusting for sociodemographic, lifestyle and other dietary risk factors, MUFA, total n-3 PUFA, α-linolenic acid and total n-6 PUFA intakes were positively associated with the incidence of type 2 diabetes. The relative risks for type 2 diabetes for the highest compared with the lowest quintiles were 1·64 (95 % CI 1·06, 2·54), P = 0·04 for MUFA; 1·55 (95 % CI 1·03, 2·32), P = 0·01 for n-3 PUFA; 1·84 (95 % CI 1·25, 2·71), P < 0·01 for α-linolenic acid; and 1·60 (95 % CI 1·03, 2·48), P = 0·04 for n-6 PUFA. Other dietary macronutrients were not significantly associated with diabetes risk. CONCLUSIONS: The data indicate that consumption of MUFA, n-3 PUFA and n-6 PUFA may influence the risk of developing type 2 diabetes in women.

The next generation of the supportive care needs survey: a brief screening tool for administration in the clinical oncology setting.

OBJECTIVE: The short form of the Supportive Care Needs Survey (SCNS-SF34) is a 34-item instrument for assessing the perceived needs of people diagnosed with cancer. This research is aimed at developing a brief screening tool for administration to patients in the clinical setting, by identifying the minimum number and optimal combination of item(s) to measure each of the SCNS-SF34 domains with high sensitivity and specificity. METHODS: Secondary analyses were undertaken on data from 1458 patients at 12 major public cancer treatment centres in Australia; with a random sample of 67% (n = 977) of the patient records selected as the developmental sample for developing the screening tool, while the remaining 33% (n = 481) constituted the validation sample on which analyses were repeated. Five criteria were applied to identify the optimum subset of items for the screening tool. Where statistical results were very similar across candidate item/s, items deemed more clinically important were chosen. RESULTS: Nine items were identified, which can be efficiently and reliably used as a brief screening tool (SCNS-ST9). An overall comparison of the results on the SCNS-ST9 with the original SCNS-SF34 indicates that only 11% of people reporting at least one moderate/high need on any SCNS-SF34 domain were missed as having a moderate/high need on the SCNS-ST9. CONCLUSIONS: Our very brief screening tool can be implemented in a clinical setting to reliably screen for unmet needs among cancer patients, with considerable savings in time and expense, increasing its potential for wide-scale adoption in clinical settings.

Macronutrient intakes and development of type 2 diabetes: a systematic review and meta-analysis of cohort studies.

OBJECTIVE: To synthesize the best available evidence on the association between macronutrient intake and type 2 diabetes risk. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Cochrane Library, ProQuest, Mednar, and the JBI Library of Systematic Reviews were searched up to July 2012 to identify published and unpublished studies. The review was restricted to human participants only but was not restricted by date or by language. STUDY ELIGIBILITY: Studies were included in the review if they were a cohort study examining the relationship between dietary macronutrient intake and type 2 diabetes risk, included healthy participants with no history of type 2 diabetes at the baseline assessment, and reported risk estimates (odds ratios, hazards ratios, or relative risks [RRs]) and corresponding 95% confidence intervals for type 2 diabetes risk by comparison of the highest with the lowest level of macronutrient consumption. METHODS: Data extraction and risk of bias assessments were performed in duplicate by 2 reviewers. Random-effects meta-analyses were performed to pool RR estimates from individual studies to assess the relationship between dietary macronutrient (carbohydrate, fat, protein, and macronutrient subtypes) intake and type 2 diabetes risk. Statistical heterogeneity was assessed using the I(2) statistic. Sensitivity analyses were performed to assess robustness of results, and publication bias was evaluated by the visual inspection of funnel plots and was formally assessed using Egger's test. RESULTS: Twenty-two relevant cohort studies were eligible for inclusion in this review. High intake of total dietary carbohydrate was associated with an increased type 2 diabetes risk (relative risk [RR] = 1.11, 95% confidence interval [CI]: 1.01 to 1.22, p = 0.035); however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake was associated with a reduced type 2 diabetes risk in females (RR = 0.76, 95% CI: 0.68 to 0.85, p < 0.001). Other macronutrients were not significantly associated with type 2 diabetes risk. CONCLUSIONS AND IMPLICATIONS: The results of this systematic review and meta-analysis indicate that total carbohydrate is associated with an increased risk of type 2 diabetes; however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake may decrease type 2 diabetes risk in females. There is a need for further well-designed prospective cohort studies to examine the potential association between macronutrient intake and type 2 diabetes risk.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students.

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

A comparison of cervical spine mobilization forces applied by experienced and novice physiotherapists.

STUDY DESIGN: Clinical measurement, cross-sectional. OBJECTIVES: To compare cervical mobilization forces applied by physiotherapists and students, and the factors associated with forces for each group. BACKGROUND: Cervical spine joint mobilization is a common manual technique for treating patients with mechanical neck pain. But little is known about the forces applied during this technique. Potential variability between therapists may result from clinical experience or may be due to factors present in individuals prior to clinical practice exposure. METHODS: One hundred sixteen practicing physiotherapists and 120 physiotherapy students without clinical experience applied grades I through IV posteroanterior mobilization to the premarked C2 and C7 spinous and articular processes of 1 of 67 asymptomatic subjects. An instrumented table recorded applied forces (N), force amplitudes (N), and oscillation frequencies (Hz), and a custom device measured subjects' spinal stiffness (N/mm). Independent t tests were used to compare the forces applied by therapists and students, intraclass correlation coefficients were used to determine variability, and linear regression was used to establish factors associated with applied forces. RESULTS: Students' forces were generally lower (mean difference, 15.7 N for grades III and IV; P<.001) and applied with slower oscillation frequencies (0.12 Hz; P<.001) than therapists' forces. Similar factors were associated with applied forces for both groups: male gender and greater subject body weight were associated with higher applied forces, and greater C2 stiffness with lower forces. Having thumb pain was associated with lower applied forces for therapists but higher ones for students. CONCLUSIONS: Students apply lower forces than therapists. Similar factors appear to affect applied forces regardless of clinical experience.

Cervical spine mobilisation forces applied by physiotherapy students.

OBJECTIVES: Postero-anterior (PA) mobilisation is commonly used in cervical spine treatment and included in physiotherapy curricula. The manual forces that students apply while learning cervical mobilisation are not known. Quantifying these forces informs the development of strategies for learning to apply cervical mobilisation effectively and safely. This study describes the mechanical properties of cervical PA mobilisation techniques applied by students, and investigates factors associated with force application. PARTICIPANTS: Physiotherapy students (n=120) mobilised one of 32 asymptomatic subjects. METHODS: Students applied Grades I to IV central and unilateral PA mobilisation to C2 and C7 of one asymptomatic subject. Manual forces were measured in three directions using an instrumented treatment table. Spinal stiffness of mobilised subjects was measured at C2 and C7 using a device that applied a standard oscillating force while measuring this force and its concurrent displacement. Analysis of variance was used to determine differences between techniques and grades, intraclass correlation coefficients (ICC) were used to calculate the inter- and intrastudent repeatability of forces, and linear regression was used to determine the associations between applied forces and characteristics of students and mobilised subjects. RESULTS: Mobilisation forces increased from Grades I to IV (highest mean peak force, Grade IV C7 central PA technique: 63.7N). Interstudent reliability was poor [ICC(2,1)=0.23, 95% confidence interval (CI) 0.14 to 0.43], but intrastudent repeatability of forces was somewhat better (0.83, 95% CI 0.81 to 0.86). Higher applied force was associated with greater C7 stiffness, increased frequency of thumb pain, male gender of the student or mobilised subject, and a student being earlier in their learning process. Lower forces were associated with greater C2 stiffness. CONCLUSION: This study describes the cervical mobilisation forces applied by students, and the characteristics of the student and mobilised subject associated with these forces. These results form a basis for the development of strategies to provide objective feedback to students learning to apply cervical mobilisation.