ORCID Profile
0000-0002-9640-1647
Current Organisation
University of Newcastle Australia
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Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JCLINEPI.2018.11.016
Abstract: We tested the hypothesis that participants who know the behavioral focus of a study and are thus aware that a particular behavior is being studied will modify that behavior, independently of any possible effect of assessment, thereby dismantling a Hawthorne effect into two putative components. We undertook a three-arm in idually randomized trial online among students: group A (control) were told they were completing a lifestyle survey group B were told the focus of the survey was alcohol consumption and group C additionally answered 20 questions on their alcohol use and its consequences before answering the same lifestyle questions as Groups A and B. Nondrinkers were excluded, and all groups were aware they would be followed up after 1 month. Outcome data were obtained for 4,583 of 5,478 trial participants (84% follow-up rate). There were no differences between the three groups on primary (overall volume consumed) or secondary outcome measures (drinking frequency and amount per typical occasion) in the intervening 4 weeks. There is no evidence that any form of Hawthorne effect exists in relation to self-reported alcohol consumption online among university students in usual research practice. Attention to study contexts is warranted for investigating research participation effects.
Publisher: Elsevier BV
Date: 11-2019
Publisher: Elsevier BV
Date: 09-2023
Publisher: Oxford University Press (OUP)
Date: 05-03-2015
DOI: 10.1093/NTR/NTV039
Abstract: People with severe mental disorders typically experience a range of health problems consequently, interventions addressing multiple health behaviors may provide an efficient way to tackle this major public health issue. This two-arm randomized controlled trial among people with psychotic disorders examined the efficacy of nicotine replacement therapy (NRT) plus either a face-to-face or predominantly telephone delivered intervention for smoking cessation and cardiovascular disease (CVD) risk reduction. Following baseline assessment and completion of a common, in idually delivered 90-minute face-to-face intervention, participants (n = 235) were randomized to receive NRT plus: (1) a "Healthy Lifestyles" intervention for smoking cessation and CVD risk behaviors or (2) a predominantly telephone-based intervention (designed to control for NRT provision, session frequency, and other monitoring activities). Research assistants blind to treatment allocation performed assessments at 15 weeks (mid-intervention) and 12 months after baseline. There were no significant differences between intervention conditions in CVD risk or smoking outcomes at 15 weeks or 12 months, with improvements in both conditions (eg, 12 months: 6.4% confirmed point prevalence abstinence rate 17% experiencing a 50% or greater smoking reduction mean reduction of 8.6 cigarettes per day mean improvement in functioning of 9.8 points). The health disparity experienced by people with psychotic disorders is high. Face-to-face Healthy Lifestyle interventions appear to be feasible and somewhat effective. However, given the accessibility of telephone delivered interventions, potentially combined with lower cost, further studies are needed to evaluate telephone delivered smoking cessation and lifestyle interventions for people with psychotic disorders.
Publisher: Springer Science and Business Media LLC
Date: 30-04-2021
DOI: 10.1007/S00068-021-01678-0
Abstract: Packed red blood cell (PRBC) transfusion remains an integral part of trauma resuscitation and an independent predictor of unfavourable outcomes. It is often administered urgently based on clinical judgement. These facts put trauma patients at high risk of potentially dangerous overtransfusion. We hypothesised that trauma patients are frequently overtransfused and overtransfusion is associated with worse outcomes. Trauma patients who received PRBCs within 24 h of admission were identified from the trauma registry during the period January 1 2011–December 31 2018. Overtransfusion was defined as haemoglobin concentration of greater than or equal to 110 g/L at 24 h post ED arrival (± 12 h). Demographics, injury severity, injury pattern, shock severity, blood gas values and outcomes were compared between overtransfused and non-overtransfused patients. From the 211 patients (mean age 45 years, 71% male, ISS 27, mortality 12%) who met inclusion criteria 27% (56/211) were overtransfused. Patients with a higher pre-hospital systolic blood pressure (112 vs 99 mmHg p 0.01) and a higher initial haemoglobin concentration (132 vs 124 p = 0.02) were more likely to be overtransfused. Overtransfused patients received smaller volumes of packed red blood cells (5 vs 7 units p = 0.049), fresh frozen plasma (4 vs 6 units p 0.01) and cryoprecipitate (6 vs 9 units p = 0.01) than non-overtransfused patients. More than a quarter of patients in our cohort were potentially given more blood products than required without obvious clinical consequences. There were no clinically relevant associations with overtransfusion.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-021125
Abstract: Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients. Double-blind, cluster randomised controlled trial. General practices in Australia between 2007 and 2010. General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention 55 waitlist). A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines (3) addressing GPs’ barriers to dementia diagnosis and (4) a business case outlining a cost-effective dementia assessment approach. Primary outcome measures were patient quality of life and depression secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia (2) referral to medical specialists and/or support services (3) patient satisfaction with care and (4) carer quality of life, depression and satisfaction with care. The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002 OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024 mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007 mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185 mean difference 24.77, 95% CI 4.15 to 45.40). Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication. ACTRN12607000117415 Pre-results.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2021
Publisher: American Medical Association (AMA)
Date: 06-07-2021
Publisher: Oxford University Press (OUP)
Date: 13-05-2015
Publisher: SAGE Publications
Date: 02-06-2017
Publisher: Cambridge University Press (CUP)
Date: 26-06-2013
DOI: 10.1017/S1041610213000884
Abstract: Dementia is a complex and variable condition which makes recognition of it particularly difficult in a low prevalence primary care setting. This study examined the factors associated with agreement between an objective measure of cognitive function (the revised Cambridge Cognitive Assessment, CAMCOG-R) and general practitioner (GP) clinical judgment of dementia. This was a cross-sectional study involving 165 GPs and 2,024 community-dwelling patients aged 75 years or older. GPs provided their clinical judgment in relation to each of their patient's dementia status. Each patient's cognitive function and depression status was measured by a research nurse using the CAMCOG-R and the 15-item Geriatric Depression Scale (GDS), respectively. GPs correctly identified 44.5% of patients with CAMCOG-R dementia and 90% of patients without CAMCOG-R dementia. In those patients with CAMCOG-R dementia, two patient-dependent factors were most important for predicting agreement between the CAMCOG-R and GP judgment: the CAMCOG-R score (p = 0.006) and patient's mention of subjective memory complaints (SMC) to the GP (p = 0.040). A higher CAMCOG-R (p 0.001) score, female gender (p = 0.005), and larger practice size (p 0.001) were positively associated with GP agreement that the patient did not have dementia. Subjective memory complaints (p 0.001) were more likely to result in a false-positive diagnosis of dementia. Timely recognition of dementia is advocated for optimal dementia management, but early recognition of a possible dementia syndrome needs to be balanced with awareness of the likelihood of false positives in detection. Although GPs correctly agree with dimensions measured by the CAMCOG-R, improvements in sensitivity are required for earlier detection of dementia.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2022
DOI: 10.1007/S13384-020-00428-2
Abstract: For more than three decades, Australian higher education policy has been guided by a national equity framework focussed on six underrepresented target groups: Indigenous Australians, people from low socioeconomic status backgrounds, people from regional and remote areas, people with disabilities, people from non-English speaking backgrounds, and women in non-traditional areas of study. Despite bringing equitable access to the forefront of university agendas, this policy framework has fostered a somewhat narrow conceptualisation of how educational disadvantage should be addressed. Responding to calls for reform, this paper draws on survey data from 6492 students in NSW government schools to examine the extent to which a new category warrants inclusion in the national framework: first-generation status. We illustrate how being the first in a family to attend university brings distinct equity status and argue for a revision of the national equity framework to recognise and support students who are ‘first’.
Publisher: BMJ
Date: 21-12-2021
DOI: 10.1136/BJSPORTS-2020-103277
Abstract: Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents’ CRF. Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering. We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol. Implementing HIIT during curricular time improved adolescents’ CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day. Australian New Zealand Clinical Trials Registry (ACTRN12618000293268).
Publisher: Springer Science and Business Media LLC
Date: 22-04-2022
DOI: 10.1007/S00592-022-01888-X
Abstract: The burden and health costs of Type 2 Diabetes Mellitus continue to increase globally and prevention strategies in at-risk people need to be explored. Previous work, in both animal models and humans, supports the role of zinc in improving glucose homeostasis. We, therefore, aimed to test the effectiveness of zinc supplementation on glycaemic control in pre-diabetic adults. We conducted a randomized, double-blind, placebo-controlled trial across 10 General Practitioner (GP) practices in NSW, Australia. The trial is known as Zinc in Preventing the Progression of pre-Diabetes (ZIPPeD)Study. Pre-diabetic (haemoglobin A1c [HbA1c] 5.7–6.4%, 39–46 mmol/mol) men and women ( N = 98) were all assigned to a free state government telephone health coaching service (New South Wales Get Healthy Information and Coaching Service) and then randomised to either daily 30 mg zinc gluconate or placebo. Blood tests were collected at baseline, 1, 6 and 12 months for the primary outcomes (HbA1c, fasting blood glucose (FBG)) secondary outcomes included Homeostasis Model Assessment 2 (HOMA 2) parameters, lipids, body weight, height, waist circumference, blood pressure and pulse. The baseline-adjusted mean group difference at 6 months, expressed as treatment–placebo, (95% CI) was −0.02 (−0.14, 0.11, p = 0.78) for HbA1c and 0.17 (−0.07, 0.42 p = 0.17) for FBG, neither of which were statistically significant. There were also no significant differences between groups in any of the secondary outcomes. Zinc was well tolerated, and compliance was high (88%). We believe our results are consistent with other Western clinical trial studies and do not support the use of supplemental zinc in populations with a Western diet. There may still be a role for supplemental zinc in the developing world where diets may be zinc deficient. Australian and New Zealand Clinical Trials Registry, ACTRN12618001120268. Registered on 6 July 2018.
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2023-072668
Abstract: Retaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses’ levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting. A two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair s le, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers. Ethics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.
Publisher: MDPI AG
Date: 09-11-2020
DOI: 10.3390/JCM9113609
Abstract: The aim of our study was to investigate the cumulative effective dose of radiation resulting from medical imaging in orthopaedic patients with isolated extremity trauma. Deidentified radiology records of consecutive patients without age restriction with isolated extremity trauma requiring operative treatment at a regional hospital were reviewed retrospectively over a 1-year period, and the effective dose per patient for each study type of plain film X-ray, computed tomography, and operative fluoroscopy was used to calculate cumulative effective dose. Values were summarised as mean, ± standard deviation, maximum, and proportion with overdose ( mSv). The study cohort included 428 patients (193 male and 235 female) with an average age of 44 years (±28). There were 447 procedures performed, i.e., all involved operative fluoroscopy, 116 involved computed tomography, and 397 involved X-ray. The mean cumulative effective dose per patient was 1.96 mSv (±4.98, 45.12). The mean cumulative effective dose for operative fluoroscopy was 0.32 mSv (±0.73, 5.91), for X-ray was 1.12 mSv (±3.6, 39.23) and for computed tomography was 2.22 mSv (±4.13, 20.14). The mean cumulative effective dose of 1.96 mSv falls below the recommended maximum annual exposure of 20 mSv. This study can serve as a guide for informing clinicians and patients of the acceptable radiation risk in the context of isolated extremity trauma.
Publisher: MDPI AG
Date: 17-11-2020
DOI: 10.3390/NU12113532
Abstract: The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women’s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2–64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery women in obese class II (35.0–39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39 p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54 p = 0.05). There was no evidence of an association between ARFS and mode of delivery or “midwifery-in-the-home-visits”.
Publisher: Informa UK Limited
Date: 16-05-2017
Publisher: SAGE Publications
Date: 06-08-2021
Abstract: Examine patterns of medication use, changes in medication patterns over time, and investigate factors associated with medication patterns among older Australian women with Atrial Fibrillation (AF). It is a retrospective analysis of the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), diagnosed with AF between 2000-2015 (N = 1206). Survey data of these women was linked with national registries for medications and death. Latent Transition Analysis (LTA) identified distinct patterns of medication use and transitions among these patterns for 3 consecutive years following AF diagnosis. LTA with co-variates determined the factors associated with latent status membership. One-tenth (9.6%, 11.7%, 11.4%) of the study population did not receive any medication for AF in all 3 years following AF diagnosis and about 60% did not receive any medication for the prevention of thromboembolism. Among those who received medications, almost three-quarters (76.6%, 68.4%, 68.5%) received some kind of combination of medications. LTA indicated at least 6 different patterns of AF medications. These patterns had transition probabilities % for most of the latent statuses. All factors but diabetes mellitus among the CHA 2 DS 2 -VA scoring scheme were independently associated with latent status membership at the time of AF diagnosis. Evaluation of pharmacological treatment indicates that prevention of thromboembolism is inadequate among women with AF. There exists wide variations in medication patterns. However, once in a particular pattern, women are likely to continue the same medications long-term. This underscores the importance of initial assessment of patient profile and stroke risk score in determining the treatment for AF. Failure to assess risk makes women susceptible to devastating AF complications.
Publisher: Cambridge University Press (CUP)
Date: 23-08-2010
DOI: 10.1017/S0004972709001269
Abstract: Higher-rank graphs were introduced by Kumjian and Pask to provide models for higher-rank Cuntz–Krieger algebras. In a previous paper, we constructed 2-graphs whose path spaces are rank-two subshifts of finite type, and showed that this construction yields aperiodic 2-graphs whose C * -algebras are simple and are not ordinary graph algebras. Here we show that the construction also gives a family of periodic 2-graphs which we call domino graphs . We investigate the combinatorial structure of domino graphs, finding interesting points of contact with the existing combinatorial literature, and prove a structure theorem for the C * -algebras of domino graphs.
Publisher: Cambridge University Press (CUP)
Date: 12-03-2009
DOI: 10.1017/S0143385708000795
Abstract: Higher-rank graphs (or k -graphs) were introduced by Kumjian and Pask to provide combinatorial models for the higher-rank Cuntz–Krieger C * -algebras of Robertson and Steger. Here we consider a family of finite 2-graphs whose path spaces are dynamical systems of algebraic origin, as studied by Schmidt and others. We analyse the C * -algebras of these 2-graphs, find criteria under which they are simple and purely infinite, and compute their K -theory. We find ex les whose C * -algebras satisfy the hypotheses of the classification theorem of Kirchberg and Phillips, but are not isomorphic to the C * -algebras of ordinary directed graphs.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 17-01-2023
DOI: 10.1007/S00268-023-06897-7
Abstract: Pelvic fracture-associated bleeding can be difficult to control with historically high mortality rates. The impact of resuscitation advancements for trauma patients with unstable pelvic ring injuries is unknown. We hypothesized that the time elapsed since introduction of our protocol would be associated with decreased blood transfusion requirements. A level 1 trauma center’s prospective pelvic fracture database was reviewed from 01/01/2009–31/12/2018. All patients with unstable pelvic ring injuries initially presenting to our institution were included. Adjusted regression analysis was performed on the overall cohort and separately for patients in traumatic shock (TS). The primary outcome was 24 h packed red blood cell (PRBC) requirements. Secondary outcomes were 24 h plasma, cryoprecipitate, platelet and intravenous fluid (IVF) requirements, length of stay and mortality. Patients with mechanically unstable pelvic ring injuries ( n = 144, median [Q 1 –Q 3 ] age 44 [28–55] years, 74% male) received a median (Q 1 –Q 3 ) of 0 (0–4) units PRBC within 24 h, with TS patients ( n = 47, 42 [28–60] years, 74% male) receiving 6 (4–9) units PRBC. There was no decrease in 24 h PRBC requirements for the overall cohort (years IRR = 0.91, 95% CI 0.83–1.01 p = 0.07). TS patients had decreases in 24 h PRBC (years IRR = 0.90, 95%CI 0.84–0.96 p = 0.002), plasma (IRR = 0.92, 95%CI 0.85–0.99 p = 0.019), cryoprecipitate (IRR = 0.88, 95%CI 0.81–0.95 p = 0.001) and IVF (IRR = 0.94, 95%CI 0.90–0.98 p = 0.004). There were 5 deaths (5/144, 3.5%) with no deaths due to acute hemorrhage. Over this 10-year period, there was no hemorrhage-related mortality among patients presenting with pelvic fractures. Crystalloid and transfusion requirements decreased for patients presenting with traumatic shock.
Publisher: Cambridge University Press (CUP)
Date: 28-09-2020
DOI: 10.1017/S104161022000174X
Abstract: Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people. This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined. Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86 95% confidence interval 1.48–5.51). Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.
No related grants have been discovered for Natasha Weaver.