Ms Le Hoang Le

A fascination with evidence (or lack thereof) kick-started Dr Lesley MacDonald-Wicks' journey into higher education.

“I actually started out wanting to study a double major in Biology and Chemistry – I was interested in complementary medicine.

“People have been using these remedies for thousands of years, but back then not many academics were doing any research to see whether there was any real evidence to say that it was working.

“But then when I sat down to look at the UON course guide, and I came across Nutrition and Dietetics and thought, ‘Actually, maybe that’s what I want to be studying’.”

After graduating from her undergraduate degree and working for a few years in clinical practise, Lesley came back to UON to undertake her PhD with Professor Manohar Garg.

“I have a long history of really enjoying studying.”

“My starting point was around dietary fat intake, and that's one of the cornerstones of my research - I've weaved in and out of that area throughout my career.

“But what my PhD really gave me was an interest in what has been successful in treating Chronic Disease.”

While exercise, nutrition and psychology are all vital areas to consider, we want the advice given to people to be based on rigorous scientific analysis and discussion rather than anecdotes.

“When it comes to the challenge of obesity and diabetes, we’re not really winning yet.”

This search for evidence for real, practical and effective advice is what motivates Lesley’s research, especially for mothers and their babies.

Gestational diabetes is the condition that occurs when a woman experiences high blood sugar levels throughout their pregnancy. While it’s not entirely driven by lifestyle factors, overweight and obese patients are more vulnerable.

The condition puts babies at a higher risk for a number of well described complications, but the effects on the mother, especially long term, can be side lined.

“What often happens is these women see their obstetrician six weeks after the birth and then no one mentions their condition again.

However, the reality is that the condition puts patients at an increased risk of going on to develop type 2 diabetes.

Lesley is looking for ways to help patients mitigate this risk. This involves extending patient care beyond the pregnancy, as well as ensuring pre-natal care is meeting individual patients’ needs.

The most important meal of the day?

Although eating breakfast is often encouraged as a means to boost metabolism and maintain weight loss, the systematic evidence is lacking.

“This is some of the major anecdotal based advice that many clinicians use, but the actual evidence isn’t there.

“It's plausible that eating breakfast will kick start your metabolism and reduce your need to eat at morning tea. And there’s evidence from longitudinal studies that people who eat less maintain their weight loss outcome for longer than others -  but why?

“These people who eat breakfast are probably more likely to eat a wide range of balanced foods. They’re likely to be in employment because they can afford to eat breakfast. They’re likely to have good organisational skills because they shop regularly.

“Are we just observing a clustering of these health-related behaviours?

“When we conduct randomised control trials, what we can do is pinpoint one thing and test against a controlled environment.”

There is good evidence for the Mediterranean way of eating

An extension of Lesley’s research interests is chronic disease prevention and treatment using diets such as the Mediterranean Diet.  “I’m interested in this dietary pattern as it has such good evidence that it works so well in the prevention and management of chronic disease, but why does it work?  I think it might be the type of dietary fat and antioxidants in this dietary pattern and the effect on oxidative stress.”

“What we eat can really nourish us and might stop the course of a disease path, managing or preventing the complications of chronic disease” and I am wondering if this is also true in mental health, especially in the area of cognitive decline in the elderly.

Starting on the right path

What underpins each of Lesley’s research interests is the search for practical and effective advice that can help people along their personal journey of chronic disease management.

“For many years, dietitians have educated people on what they needed to do - but that's not sufficient.

“We have to immerse ourselves in these people's lives and find the habits – eating and exercise- that are mitigatable and help them make those changes.

“That's hard! That's really hard work. For the patient and for the clinician.”

Dietitian Dr Leanne Brown is working towards improving the health of rural Australians, as well as the sustainability of the clinical workforce who look after them.

Leanne is a Senior Lecturer and Academic Lead, Teaching and Learning at the University of Newcastle, Department of Rural Health (UONDRH).

An Advanced Accredited Practising Dietitian with more than 20 years experience in the dietetics profession, Leanne spent ten years in metropolitan hospitals before joining the UONDRH in Tamworth in 2003.

With support from the Commonwealth Government, the UONDRH works toward a sustainable rural health workforce through facilitating student placements and learning, enhancing the health of local communities through community projects and conducting research into rural health issues.

Leanne completed her PhD (Nutrition and Dietetics) at the University of Newcastle 2009, with her doctoral research investigating the barriers to the provision of a best practice dietetics service in rural areas.

Her ongoing research interests include dietetic workforce issues, rural dietetic services, sports nutrition, and best practice dietetic services for rural areas.

Nutrition and diet

Leanne’s work is readily translational to public health programs that can change health outcomes, especially in a rural context.

And it seems those programs are more necessary now than ever.

Leanne admits to being concerned when recent data from the Australian Health Policy Collaboration found the local area to have some of the highest rates of overweight and obesity in Australia.

“We have a focus at the moment on a research project looking at cardiovascular disease rurally, and trying to look at different ways of engaging with people,” Leanne says.

“Obviously the further you go out from major cities, the more difficult and expensive access to fresh food becomes.”

“If you don’t have a lot of income or accessible transport, and you live in a part of town that is only serviced by corner shops and takeaways, your food choices are very limited.”

One area of possible change that Leanne is a strong advocate for is implementing lifestyle change instead to combat health risks related to ill-health such as cardiovascular disease, obesity, and diabetes.

“We are trying to intervene earlier and support people to try some dietary changes, and use phone and text to follow people up as opposed to having to wait for appointments.”

Rural focus on learning

As Academic Lead, Teaching and Learning at UONDRH, Leanne supports students on placements navigate practice based education, learning and assessment.

An area of current focus at the UONDRH is inter-professional education, with the aim of improving relationships in healthcare practice.

“We have year-long student placements in medicine and some allied health disciplines,” Leanne explains.

“So we are getting those students together on a monthly basis and engaging them in an inter-professional activity with them that is focused on a health topic or communication skill that is relevant across disciplines.”

“Our role is also to provide continuing professional development locally, so we organise speakers and information days on relevant topics for students and clinicians.”

“We have also just started a local graduate network that offers new practitioners professional and social support to work rurally.”

Body Composition

Leanne has accreditation as a Level 3 Anthropometrist with the International Society for Advancement of Kinanthropometry. She explains:

“We can measure height and weight and calculate BMI but we know that BMI is not the best indicator of whether you are overweight or not,” she says.

To get a more accurate measure of body composition Leanne uses bioelectrical impedance analysis, which differentiates between muscle and fat.

“So not only is this differentiation important when predicting health outcomes, but it is a way to evaluate the success of exercise and diet interventions despite overall weight not changing significantly.”

Sports nutrition is another area of expertise for Leanne.

Whereas in the general population, the public health focus is most often on limiting energy intake to maintain or lose weight, the opposite can be true for elite athletes who need adequate energy to fuel significant exercise.

This area of specialisation also extends to knowledge of which sportspeople may benefit from which supplements that have an ergogenic effect, improving performance.

Future direction

Looking to the future, Leanne will continue several ongoing collaborations and her own research.

Leanne works with Associate Professor Kym Rae on the Gomeroi gaaynggal program, targeting the health of local rural Aboriginal mothers and their babies.

Another collaboration is with Dr Lesley MacDonald-Wicks and Dr Amanda Patterson, who are finalising for publication work on changing body composition and circumference measures of average urban and rural Australian women.

Leanne is also working in concert with Professor Clare Collins to replicate urban nutrition studies in the rural landscape.

Leading on from Professor Collins’ work using a spectrophotometer, Leanne is looking at comparing self-reported diet to actual diet reflected by the effects of carotenoid intakes from vegetables and fruit on skin colour.

Leanne is also looking to further develop a strong dietetics and nutrition focus at the UONDRH with fellow dietitian, Dr Tracy Schumacher.

Her wish list also includes more PhD students in dietetics choosing to study in Tamworth.

“Given the nutrition-related health issues in rural areas, we will be looking to implement and evaluate community based interventions so there are opportunities for students to be involved in positive change in rural communities.”

Leah Armstrong brings over twenty years experience, in establishing and leading Indigenous social and commercial enterprises, to the role of Director of the Wollotuka Institute.

A change management professional skilled in identifying tangible steps to facilitate growth whilst maintaining excellence, Leah is relishing her new position at Wollotuka, which is recognised as a leader in Indigenous education.

“Any eminent organisation needs to move, and change, to keep growing and earning prominence, and facilitating that is my role,” Leah says.

A Torres Strait Islander, and former Chief Executive Officer of Reconciliation Australia, Leah brings with her much expertise on a local to national level, in both a paid and voluntary capacity.

Leah’s extensive work has not gone unnoticed.

In 2009, The Australian Financial Review Boss Magazine recognised her as a “True Leader” and in 2012 Leah was recognised in the inaugural 2012 Australian Financial Review/Westpac 100 Influential Women Awards.

A straight talking realist, Leah excels in collaborating with people to transform noble but vague goals and concepts into practical actions.

Renewing passions

The Wollotuka Institute is the body of the University of Newcastle that serves the University’s commitment to collaboration with Indigenous communities.

The Wollotuka Institute serves four main functions that cover the areas of academia, research, Indigenous student support and development as well as Indigenous staff support and development.

Leah identifies Wollotuka’s strong identity, record of achieving outcomes, and recognised expertise in specific research areas as great strengths.

“But Wollotuka’s biggest asset is its people, who are all here because they are passionate about Indigenous higher education,” says Leah.

“The first step in reinvigorating the institute is having a clarity of purpose, with people galvanised together behind that purpose.”

“We will then be putting in place structures and processes and systems that at the end of day, manage themselves, allowing staff to just get on and do great stuff.”

A renewed focus on research excellence, staff development, and equitable practice, are all steps toward fulfilling the most important function of Wollotuka.

“The end goal of course is to create, through student-focused learning, graduates who are highly employable and can make a difference.”

Although being a standalone institute within the University allows for an essential level of autonomy, Leah points out that ensuring Wollotuka influences back into the university is essential.

“We need Aboriginal and Torres Strait Islander staff in all faculties across the University, not only to achieve the indigenous employment outcomes but to truly challenge perceptions and attitudes.”

Business in her blood

Leah’s family heritage is connected to Boigu Island in the Torres Strait, although she has called Newcastle home for the past 30 odd years.

Her childhood was spent in Mackay, where her grandmother remarried.

Known to Leah simply as ‘Pop’, Ram Chandra OAM, an famous Indian snake charmer, was a tireless community advocate who helped develop the antivenin for the Australasian Taipan.

“Pop was a real entrepreneur, and a bit of a showman. My stepfather and the majority of my uncles all had their own businesses and were very hard workers too.”

“There was a very strong work ethic in my family, and a focus on building business.”

Community played an equally important role in her upbringing.

“My family were also involved with local Torres Strait Islander and Aboriginal or Murri advancement groups like the Health Centres, Legal Aid, and Housing.”

“We were always a part of helping with organisation and governance, plus raising money and helping out where we could.”

Addressing the gap

Arriving in Newcastle in the late 80s, Leah began work with the Awabakal Co-Operative under then CEO, Jim Wright.

“As successful as the co-op was at providing essential safety nets and supports for local Aboriginal people, sustainability of employment and businesses was where I saw a gap.”

In collaboration with Wright, Leah set up Yarnteen Aboriginal and Torres Strait Islander Corporation, focused on employment, training, economic development, and business development.

So successful was this enterprise that within ten years, Yarnteen was able to reinvest back into cultural and educational ventures, bulk warehousing, a car wash, plus building company and property portfolios.

After nineteen years at the helm of Yarnteen, Leah moved to the position of CEO of Reconciliation Australia.

“Coming from a local body to a National focused one was a huge step.”

“And when your organisation is about reconciling national prejudices and attitudes, it's no small task,” Leah notes with a smile.

Community supporter

As if running a national campaign to address racism wasn’t a big enough job, Leah has been the Chair of the NSW Aboriginal Housing Office for the past two years, is on the board of The Smith Family, and part of the CSIRO’s Indigenous Advisory Group.

She became a member of Tony Abbott’s Indigenous Advisory Council in 2013.

“I have taken on committee work as well where I can make particular contribution and have some impact if I can,” Leah explains.

She recently walked the Kokoda track as a mentor for Jobs Australia Foundation with ten young Indigenous people.

Leah is also Chair of Supply Nation, an organisation with the aim of integrating Indigenous businesses into the mainstream corporate and government procurement and supply chains.

“Fortunately enough in this new role at Wollotuka, I have been permitted to keep a position on a number of the boards that I am on,” Leah says.

“I see them as all having really important connections for the University and they fit in in terms of the entrepreneurial spirit that the university wants our graduates to have,” Leah says.

“That in turn ties into the university’s new plan, NeW Futures. I believe there is so much that Wollotuka can add to that.”

Controversially putting Corporate Australia under a microscope, Sharlene Leroy-Dyer is looking to magnify racial discrimination and other incidents of employer misconduct in the workplace.

Labelling the latest Closing the Gap Report as a “huge fail,” Sharlene Leroy-Dyer concedes there is still a lot that needs to be done if our country is to successfully and permanently narrow the divide between Indigenous and non-Indigenous peoples. In fact, the early career researcher insists the inequalities are actually worsening, particularly in health, literacy, education and employment. It’s the latter, however, that she believes is most concerning.

“Existing employment strategies are, at best, short-term fixes,” Sharlene elaborates.

“They are entrenched in ‘whiteness’ and do not contribute to self-determination or adequately address Aboriginal and Torres Strait Islander social and economic issues.”

"If the Commonwealth Government really wants to reduce labour market disadvantage, it needs comprehensive programs that act as early interventions at the primary and/or high school level"

“The appropriate individuals must also be held to account if targets are not met.”

Focusing her studies on the private sector, Sharlene is seeking to more clearly define the professional needs and desires of Aboriginal and Torres Strait Islander peoples, developing a “best practice toolkit” that organisations can use to guide the creation of “culturally sensitive” workplace polices and procedures.

“My research is largely motivated by personal experience,” she shares.

“I previously worked at a company here in the Hunter, where I was racially discriminated against and publicly humiliated.”

“The manager had no idea how to treat Aboriginal employees.”

“The case was brought to the Human Rights Commission and later settled out of court.”

Turning the bad into good

Sharlene’s research career began in 2007, when she commenced a PhD at the University of Newcastle. Honing in on Aboriginal and Torres Strait Islander unemployment and underemployment, the case study cuts across a wide cross section of Australian society.

“It involved 220 Aboriginal and Torres Strait Islander employees from six private sector organisations,” she comments.

“A total of eight mentors, five of whom are Aboriginal and Torres Strait Islander, and 59 managers who were directly involved in Indigenous employment also partook in this project.”

“Only six of them, however, are Aboriginal.”

Opting for a qualitative approach, Sharlene acquired information from these participants using both yarning and Indigenous knowledges.

“The former is a process of making meaning through informal and ‘culturally friendly’ conversations,” she explains.

Indigenous knowledges, on the other hand, refers to the social, physical and spiritual understandings of Aboriginal and Torres Strait Islander peoples that are passed down through the generations and deeply connected to their unique ties with country and kinship.

“I asked employers about the policies and procedures that they had in place for recruiting and retaining Indigenous workers, and I asked employees about their experiences in the workplace and whether the policies and procedures were adequate and appropriate – or even implemented in some cases.”

Divide and not conquer

Now at the pointy end of her candidature, Sharlene has come to the disappointing conclusion that we will “never close the gap” on Indigenous disadvantage in employment. Powerfully suggesting it to be “beyond the capacity” of the Commonwealth Government, she affirms a substantial narrowing will only happen when Aboriginal and Torres Strait Islander development policymakers balance socioeconomic equality and the recognition of choice and self-determination for the traditional custodians of our land.

“Australians are not all alike,” she asserts.

“We share a history but our roles in that shared history are very different, based on race, ethnicity, religion, sexual orientation and nationality.”

“This fixation on being a homogeneous group generally results in those who are non-white being pressured into assimilating as fully as possible, giving up our cultural identities and accepting the culture of the majority.”

Related links

• Centre for Interdisciplinary Built Environment Research website
• Interested in a PhD in Architecture?

Professor Tracy Levett-Jones is working towards evidence-based curricula redesign to ensure future health professionals are equipped to provide safe, effective and person-centred care.

When compared to international healthcare systems, Australia has one of the safest.  Yet Levett-Jones' research, along with multiple patient safety reports, indicates it is safer to go hang-gliding or to work in the nuclear power industry than it is to be a patient in an Australian hospital.

'The statistics are quite staggering,' she concedes.

As a clinician and more recently as an educator and researcher, Levett-Jones' primary emphasis has been on patient safety and preventing adverse patient outcomes. Combined with her commitment to improving the learning experiences of healthcare students, the internationally published author is working with an interdisciplinary team to design and undertake research that addresses patient safety concerns.

'I lead a large, extremely dedicated team who collaborates with academics from other countries, universities and clinical contexts,' she states.

'This ensures the international relevance of our research and optimises its translation to practice.'

Multipronged and multipurpose

Levett-Jones' team has expertise in a wide range of research methodologies, including quasi-experimental designs, case studies, cross-sectional surveys, Delphi technique, systematic reviews and narrative inquiry, as well as many other qualitative and quantitative approaches.

The University of Newcastle's world-renowned and award winning simulation program is excellent for teaching and research into patient safety. Sessions are conducted using high fidelity manikins, actors, masked educators, 3D cultural simulations, disaster simulations and inter-professional simulations. Each scenario is linked to a specific learning outcome and integrated into the curriculum.

'These simulation strategies create authentic learning situations that expose students to real practice but in a safe environment,' Levett-Jones explains.

'While some research can be undertaken in healthcare settings, it's not always ethical or safe for patients, so we prefer to recreate authentic simulated environments and scenarios instead.'

Seeking to put evidence into practice, the multiple-award winner is working collaboratively with researchers and educators across Australia and internationally to implement and evaluate patient safety simulations.

'In healthcare, when we teach and research, we are focused on both the here and now,' she reveals.

'But we're also looking beyond the horizon to ensure our work influences the recipients of our care, such as residents in aged-care facilities, the community, and many other health services. Without this focus the work we do has little meaning or relevance.  We are committed to truly making a difference.'

Moral courage and patient safety

Levett-Jones first began examining the relationship between education and patient safety during her PhD candidateship nearly ten years ago. While exploring the clinical learning experiences of nursing students in Australia and the United Kingdom, it became apparent that students who didn't experience a strong sense of belonging were constantly preoccupied with trying to fit in.

'While they identified practices that were unsafe, they were too afraid of 'rocking the boat' to speak up,' she disclosed.

'Essentially, students chose to conform and comply, rather than risk exclusion from the team.'

By contrast, students who experienced a strong sense of belonging were much more likely to demonstrate moral courage and address issues that may have threatened patient safety.

'So it became apparent that one of the most effective ways to improve patient safety is to empower students to become agents of change.'

Thinking about thinking

Post PhD, Levett-Jones has continued to work with her team to identify and address patient safety issues that could be improved through meaningful educational initiatives.

'We've identified that nearly 60% of adverse patient incidents in healthcare are related to the way health professionals think, or fail to think, about the complex data they are presented with during emergent clinical situations,' Levett-Jones asserts.

'For many years university nursing and other health programs failed to teach and research these cognitive processes effectively.'

'But over the last five or six years, we have turned our attention to the relationship between clinical reasoning and patient safety, and this has had a significant impact not only on our own curriculum, but also on health professional curricula in Australia and internationally.'

Describing the term 'clinical reasoning' as one that necessitates an awareness of the assumptions, biases and preconceptions health professionals often hold, Levett-Jones is a firm believer in the importance of teaching students to think 'differently and deeply' to improve patient safety.

'Through our research, simulations, classroom and online teaching, we have given considerable attention to enhancing graduates' clinical reasoning skills, and this has resulted in measurable improvements,' she conveys.

Adding to this body of work, the Director of the University's Research Centre for Health Professional Education is currently working with researchers and clinicians to improve medication safety in Australia.  Together with a team from the University of Western Sydney, Levett-Jones is designing simulations to help registered nurses and students confidently prevent and manage interruptions.

'There is growing evidence that they lead to significant numbers of medication errors each day,' she explains.

This research is part of a broader agenda to improve the inter-professional and therapeutic communication skills of health professional students.

'Lack of communication is implicated in 70 to 80% of all sentinel events,' she admits.

'Again, there hasn't been enough research on the most effective way to teach students and health professionals how to communicate in a manner that prevents errors from occurring.'

Cultural competence

Culturally and linguistically diverse patients experience twice as many adverse outcomes in Australian hospitals as English-speaking patients.  This is another area that needs much more attention in the education of health professionals, and in the research sphere.  While most educators focus on cultural competence, Levett-Jones' team is looking at cultural empathy as an antecedent to cultural competence.

'We have found that cultural empathy may be the key to changing attitudes and the way health professionals care for patients from culturally and linguistically diverse backgrounds,' she advises.

To this end, Levett-Jones' team has undertaken a number of research projects specifically designed to enhance students' cultural empathy and competence, with very encouraging results. Levett-Jones is also collaborating with Flinders University to create a set of interactive resources that focus on the mental illness experiences of people from different cultural backgrounds.

The interactive resources include a young Aboriginal man with depression, an older Chinese immigrant with dementia, and a woman from Middle Eastern background with postnatal depression.  The modules also address issues associated with stigma and social justice, and take learners on a journey that helps them to reflect on their own biases and preconceptions.

What matters most

When asked about her future research directions, Levett-Jones is quick to answer.

'There is a real need for evidence-based education,' she enthuses.

'We need to work collaboratively to invest in the education of future health professionals so that they make a tangible difference to the way graduates' practice, and ultimately, to patient safety.' 

'Our education and research agenda must lead to knowledgeable, effective, safe, compassionate and person-centred health professionals.'

A University of Newcastle sociologist is behind a film documenting a permaculture project in Zimbabwe that has changed lives and boosted food security.

Dr Terry Leahy, and his documentary-making sister, Associate Professor Gillian Leahy of the University of Technology Sydney, travelled to Zimbabwe in 2010 and saw how the use of permaculture changed the degraded landscape into a lush paradise that produces food.

"Where once the 7,000 people of the Chikukwa villages suffered hunger, malnutrition and high rates of disease, this community has turned its fortunes around using permaculture farming techniques," Dr Leahy said.

The Chikukwa Project was started over 20 years ago and through the use of permaculture practices has consistently produced food during that time.

"Now they have a surplus of food and the people in these villages are healthy and proud of their achievements."

"Complementing these strategies for food security, they have built their community strength through locally controlled and initiated programs for permaculture training, conflict resolution, women's empowerment, primary education and HIV management," Dr Leahy said.

Funding for the film was provided by the University of Newcastle, the University of Technology Sydney and the Pozible crowd funding website.

View the 20-minute trailer for the "The Chikukwa Project".

Dr Leahy has undertaken research and consultancy work on environmental attitudes, landcare and sustainability in the Hunter Valley, Australia, as well as in Indonesia and Southern Africa. He says his present research covers three broad topics.

"The first is food security in the context of rural development. The second is the global environmental crisis and the response of the public to environmental politics. The third is social theory, the philosophy of the social sciences and the place of a humanist realist perspective in sociological analysis," Dr Leahy said.

Out of his research in South Africa came a monograph "Permaculture Strategy for the South African Villages" which was published in 2009.

"The book explains a set of tactical approaches to environmental sustainability in regard to land care, local agriculture and food security in the South African villages. People and their meaningful interaction with land is the starting point for strategies and planning principles that address sustainable food and fuel production in villages, to enhance the quality of life for the rural poor," Dr Leahy said.

Dr Leahy will continue his research into food security when he travels to Zambia, South Africa, Uganda and Zimbabwe in 2014. He will visit villages where successful project designs for food security are operating.

"A lot of money has been spent on projects in Africa which have had no lasting impact and the intention of my research is to find out what actually does work and to promote it. The film on the Chikukwa project is a key part of that work as that project has been remarkably successful over a 20 year period," Dr Leahy said.

Internationally renowned stroke clinical researcher, Conjoint Professor Chris Levi is on a medical mission: "Cure more, improve more, harm less".

Working on more than eight ground-breaking research projects improving stroke treatment options for patients, Professor Levi is on target to meet his goal, launching what he has described as "the most important acute stroke trial globally".

A clot-busting drug, Tenecteplase (TNK) will be trialled at 50 major hospitals around the world. Its potential to cure stroke in some patients has earned TNK the nickname 'The New Kid' on the stroke block.

Professor Levi and fellow University of Newcastle researcher Professor Mark Parsons, are the principal investigators on this global acute stroke trial.

"TNK is a clot-dissolving drug developed by industry and derived from a naturally occurring protein from the blood vessel wall. The trial will test TNK against the current standard clot-busting drug Alteplase," he said.

"Alteplase is good if it works. However, we need better, more effective and safer treatments.  Alteplase carries a small, but significant, risk of bleeding and only dissolves the clot in 30-40% of cases. TNK in Phase 2 Trial looks considerably better. We saw patients affected by stroke making almost miraculous recoveries on TNK."

Published in the prestigious New England Journal of Medicine, findings from Phase 2 Trial showed that two-thirds of patients treated with TNK displayed major improvement within 24 hours, and 72 per cent showed excellent recovery within three months after their stroke.

The TNK Phase 3 Trial begins in Australia and New Zealand in February 2014 and in Europe and Asia in mid-2014.

Australia's No 1 cause of disability

Following his arrival at the University of Newcastle in 1999 to establish the Hunter Medical Research Institute (HMRI) Stroke Research Group, Professor Levi led the group to its current position, recognised globally as one of the leading teams for stroke research in imaging, clinical trials, health systems research and stroke genetics.

"Ten thousand people die from stroke each year in Australia. A quarter of those people are aged under 55," Professor Levi said.

"Death is one thing, disability is another. With 20,000 people left disabled by stroke in Australia, it's a major problem and the number one cause of disability. It is truly sad to see the impact of stroke on the patients and their families and communities.

"Frustration has been my driver. As a clinician, not being able to do enough for my patients or knowing that our health systems could be better is what drives me in research. The problem stares me in the face every day. "

Stroke of genes

Part of a team of researchers from the University of Newcastle credited with making a major genetic discovery in stroke, Professor Levi said the future is in tailored medical care.

"We're using genetics to unravel the complex biology of the brain and to see if it can give us a clue to pre-determining factors of stroke," Professor Levi said.

Published in Nature Genetics in 2012, the discovery of the signal located within a regulatory DNA on Chromosome 6 (6p21.1) is strongly associated with large artery atherosclerotic stroke, which represent one quarter of acute strokes.

"We don't know very much about the genetics of stroke as yet. It's a very complex disease genetically, influenced by many genes and environmental factors. Most of these genetic factors are unknown but once we learn enough about them we'll be able to better profile people and advise if they are at risk of stroke."

Part of an International Stroke Genetics Consortium, Meta-Stroke, Professor Levi and his team are also collecting samples from patients with acute stroke, investigating genetic factors that could influence responsiveness to clot-busting treatment.

"It's not just about whether you will have a stroke, we're also looking at how well you might do after a stroke and what treatment plan might work best for you."

"The body's enzyme systems are all under genetic control. Our genes basically set the plan for all of our body function and drugs. Pharmacological agents are influenced in both their efficacy and their safety by our enzyme systems in our body, which are influenced by our genes."

Setting the standard for stroke care

Professor Levi's drive and stellar reputation led him to being selected by the Australian Government to help set the upcoming national standards for treatment for stroke patients, as part of the Australian Commission for Quality and Safety in Health Care Clinical Standards and Indicators Group.

"We're moving into an era in stroke medicine where it will be treatment tailored to the patient. Why? It's because every stroke is a bit different, every cause is a little different and it's not a one-size-fits-all-situation," Professor Levi said.

"Alteplase has been guideline approved for years, it's been out there on the market, but the proportion of stroke patients that get access to it across the country is only about five per cent. It should be in the order of 20 to 25 per cent.

"The Newcastle health system has been re-engineered over the past seven years so that 20 to 30 per cent are receiving clot-busting drugs within the 4.5 hour treatment window. We have achieved this through a number of initiatives."

Working with Stroke Awareness, Professor Levi's team has been promoting the FAST: Face, Arms, Speech and Time to call 000 message to raise community awareness of the signs of stroke and the importance of acting quickly to get treatment.

At the next stage, a Pre-hospital Acute Stroke Triage (PAST) program was introduced to both metropolitan and rural regions establishing systems to improve pre-hospital care and enhance access to clot-busting drugs. Techniques included bypass of smaller hospitals, helicopter transfer where needed, ambulance guidelines and cutting red tape. The system was introduced in the Hunter Region in 2007 and in 2013 was adopted across the state of New South Wales.

In the stroke of time

Professor Levi is also involved in two health systems studies, one aiming to improve diagnosis and treatment of transient ischaemic attack and minor stroke patients in general practices and hospitals, the other aiming to better implement clot-busting treatment.

INSIST, a National Health and Medical Research Council funded comparison study of Trans Ischemic Attacks (TIA) and minor strokes compares treatment of TIA patients from 20 different general practices in the Hunter Region to data collected by Oxford and Auckland Universities. The study assesses how GPs determine if someone is having a stroke, what happens to the patient, how they are looked after and what the long-term outcomes are.

The Thrombolysis ImPlementation in Stroke (TIPS) trial is a cluster-randomised trial that is testing strategies to boost the implementation of clot-busting drug treatment. It is testing various strategies including advanced training, education, behaviour change, executive support and more. The TIPS trial is running across 20 hospitals in QLD, NSW and Victoria.

Imaging in one stroke

The stroke research team have world leading expertise in the application of advanced CT imaging technology to acute stroke diagnosis and treatment.

Under the leadership of colleague Prof Mark Parsons, and working as a Toshiba International Luminary Site, the group have pioneered how brain perfusion imaging can better select individual patients for clot-busting treatment by identifying how much brain tissue remains viable at different time points after the onset of stroke.

The imaging analysis techniques and their applications are a world-first. Professor Levi is also investigating how combining CT imaging and ultrasound (fusion ultrasound) can be used to determine precisely when a clot has been dissolved and a blocked artery opens.

Professor Levi credits the integrated health care system in operation between the local community, John Hunter and Mater Hospitals, HMRI and the University as key to his group's success across many areas of stroke research. The various national, international and local research networks they have built is another reason for their achievements.

"Across the University and medical sector, we have people working with the Stroke Research Group in cognitive issues and depression post-stroke, imaging, nutrition, physical activity and more."

"By working together in an integrated system, we are making huge advances. The army of people we have pooled together is helping to win the battle against this crippling condition."