On the robustness of latent class models for diagnostic testing with no gold standard.

It is difficult to estimate sensitivity and specificity of diagnostic tests when there is no gold standard. Latent class models have been proposed as a potential solution as they provide estimates without the need for a gold standard. Using a motivating example of the evaluation of point of care tests for leptospirosis in Tanzania, we show how a realistic violation of assumptions underpinning the latent class model can lead directly to substantial bias in the estimates of the parameters of interest.

Child undernutrition in households with microbiologically safer drinking water and 'improved water' in Tanna, Vanuatu.

The Sustainable Development Goal drinking water indicators include microbiological safety measures, whereas the Millennium Development Goal indicator 'improved water' may be microbiologically unsafe. In rural Vanuatu, we undertook household surveys, child anthropometry, and tested stored drinking water, to investigate relationships between water and undernutrition. Using Escherichia coli most probable number, we categorized results according to Compartment Bag Test drinking water cutoffs: <1/100 mL (safe), 1-10/100 mL (intermediate risk), >10-100/100 mL (high risk), and >100/100 mL (very high risk).

Estimating acute human leptospirosis incidence in northern Tanzania using sentinel site and community behavioural surveillance.

Many infectious diseases lack robust estimates of incidence from endemic areas, and extrapolating incidence when there are few locations with data remains a major challenge in burden of disease estimation. We sought to combine sentinel surveillance with community behavioural surveillance to estimate leptospirosis incidence. We administered a questionnaire gathering responses on established locally relevant leptospirosis risk factors and recent fever to livestock-owning community members across six districts in northern Tanzania and applied a logistic regression model predicting leptospirosis risk on the basis of behavioural factors that had been previously developed among patients with fever in Moshi Municipal and Moshi Rural Districts.

Risk factors for pulsotype NRCS-A colonisation among premature neonates in the neonatal intensive care unit of a tertiary-care hospital: a retrospective case-control study.

Background: A strain called NRCS-A ( NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide.

Aim: To identify risk factors for NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015.

Methods: Weekly axillary swabs categorised eligible neonates as a case or a control.

The New Zealand PIPER Project: colorectal cancer survival according to rurality, ethnicity and socioeconomic deprivation-results from a retrospective cohort study.

Aim: To investigate differences in survival after diagnosis with colorectal cancer (CRC) by rurality, ethnicity and deprivation.

Methods: In this retrospective cohort study, clinical records and National Collections data were merged for all patients diagnosed with CRC in New Zealand in 2007-2008. Prioritised ethnicity was classified using New Zealand Cancer Registry data; meshblock of residence at diagnosis was used to determine rurality and socioeconomic deprivation.

Outcomes for women without conventional treatment for stage 1A (microinvasive) carcinoma of the cervix.

Background: An unethical clinical study that entailed withholding treatment from women diagnosed with cervical intraepithelial neoplasia 3 (CIN3) was conducted at National Women's Hospital, Auckland, New Zealand. Women with microinvasive carcinoma of the cervix also had treatment withheld.

Aims: To describe the management and outcomes for women with microinvasive carcinoma for many of whom conventional treatment was withheld.

Risk Factors for Human Brucellosis in Northern Tanzania.

Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania.

A phase I vaccination study with dendritic cells loaded with NY-ESO-1 and α-galactosylceramide: induction of polyfunctional T cells in high-risk melanoma patients.

Vaccines that elicit targeted tumor antigen-specific T-cell responses have the potential to be used as adjuvant therapy in patients with high risk of relapse. However, the responses induced by vaccines in cancer patients have generally been disappointing. To improve vaccine function, we investigated the possibility of exploiting the immunostimulatory capacity of type 1 Natural killer T (NKT) cells, a cell type enriched in lymphoid tissues that can trigger improved antigen-presenting function in dendritic cells (DCs).

Simvastatin dose and acute kidney injury without concurrent serious muscle injury: A nationwide nested case-control study.

Background: Inconsistent findings from four observational studies suggest that the risk of acute kidney injury (AKI) may increase with increasing statin dose or potency, but none of the studies took statin-related severe muscle injury, including rhabdomyolysis, into account. We undertook a nationwide nested case-control study in New Zealand to examine the risk of AKI without concurrent serious muscle injury according to simvastatin dose in two cohorts: people without a history of renal disease and people with non-dialysis dependent chronic kidney disease.

Materials And Methods: A total of 334,710 people aged ≥ 18 years without a history of renal disease (cohort 1) and 5,437 with non-dialysis dependent chronic kidney disease (cohort 2) who initiated simvastatin therapy between 1 January 2006 and 31 December 2013 were identified using national pharmaceutical dispensing and hospital discharge data.

Demographic and regional disparities in insulin pump utilization in a setting of universal funding: a New Zealand nationwide study.

Aims: Insulin pumps have been publically funded in New Zealand since 2012 for patients who meet certain clinical criteria; however, the patterns of utilization have not been described. We undertook a nationwide study to estimate the annual proportions of patients with type 1 diabetes mellitus who used a pump between 2012 and 2014, overall, and according to sex, age, ethnicity, socioeconomic position, and region.

Methods: We used data from the New Zealand Virtual Diabetes Register and routinely collected national demographic, health, and pharmaceutical dispensing data from the Ministry of Health to identify patients with type 1 diabetes and to calculate the overall, and subgroup, proportions using pumps.

Methods of a national colorectal cancer cohort study: the PIPER Project.

Aim: Colorectal cancer is one of the most common cancers, and second-leading cause of cancer-related death, in New Zealand. The PIPER (Presentations, Investigations, Pathways, Evaluation, Rx [treatment]) project was undertaken to compare presentation, investigations, management and outcomes by rurality, ethnicity and deprivation. This paper reports the methods of the project, a comparison of PIPER patient diagnoses to the New Zealand Cancer Registry (NZCR) data, and the characteristics of the PIPER cohort.

Community prevalence of fever and relationship with malaria among infants and children in low-resource areas.

We used Demographic and Health Survey data to describe the 2-week period prevalence of fever, cough, and diarrhea among children aged < 5 years in low-resources areas. We then explored the relationship between prevalence of isolated fever and national malaria risk. Fever and isolated fever occurred in 26.

Dendritic cell vaccination combined with temozolomide retreatment: results of a phase I trial in patients with recurrent glioblastoma multiforme.

There is no standard treatment for recurrent glioblastoma multiforme (GBM). Retreatment with temozolomide (TMZ) is one treatment option. We reasoned this could be more effective if combined with a vaccine that preferentially targeted TMZ-resistant cells.

Pseudomonas aeruginosa uses multiple pathways to acquire iron during chronic infection in cystic fibrosis lungs.

Pseudomonas aeruginosa chronically infects the lungs of more than 80% of adult patients with cystic fibrosis (CF) and is a major contributor to the progression of disease pathology. P. aeruginosa requires iron for growth and has multiple iron uptake systems that have been studied in bacteria grown in laboratory culture.

Capture-recapture using multiple data sources: estimating the prevalence of diabetes.

Objective: To examine the potential for using multiple list sources and capture-recapture methods for estimating the prevalence of diagnosed diabetes.

Method: A model-averaging procedure using an adjusted Akaike's Information Criterion (QAICc) was used to combine capture-recapture estimates from log-linear models obtained from simultaneously analysing four sources of data. The method was illustrated using four separate lists of patients with diabetes, resident in Otago, New Zealand.

Pseudomonas siderophores in the sputum of patients with cystic fibrosis.

The lungs of patients with cystic fibrosis become chronically infected with the bacterium Pseudomonas aeruginosa, which heralds progressive lung damage and a decline in health. Iron is a crucial micronutrient for bacteria and its acquisition is a key factor in infection. P.

Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3.

Background: A retrospective cohort study was performed in 1063 women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (previously termed carcinoma in situ- CIS) in the National Women's Hospital, Auckland, New Zealand. The study describes the clinical management and outcomes for women with CIN3 diagnosed in the decade of 1965-1974, when treatment with curative intent was withheld in an unethical clinical study of the natural history of CIS. A comparison is made with women who were diagnosed earlier (1955-1964) and later (1975-1976).

Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study.

Background: The invasive potential of cervical intraepithelial neoplasia 3 (CIN3; also termed stage 0 carcinoma) has been poorly defined. At the National Women's Hospital, Auckland, New Zealand, treatment of CIN3 was withheld from a substantial number of women between 1965 and 1974 as part of an unethical clinical study. The resulting variation in management allows comparison of the long-term risk of invasive cancer of the cervix in women whose lesion was minimally disturbed with those who had adequate initial treatment followed by conventional management.

Differences in cardiovascular mortality between Australia and New Zealand according to socioeconomic status: findings from the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study.

Background: Cardiovascular mortality is higher in New Zealand compared to Australia, but reasons for this difference are uncertain. This study describes differences in cardiovascular risk factors and cardiovascular mortality in Australians and New Zealanders with stable coronary artery disease stratified by socioeconomic status.

Methods: Socioeconomic status was estimated from the residential area of 5949 Australians and 2784 New Zealanders with a history of myocardial infarction or unstable angina who participated in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study.

Review of cytologic slides from the national women's hospital, New Zealand, cohort of women with cervical intraepithelial neoplasia 3 diagnosed in 1955-1976.

Objective: To review cytologic slides, mostly at least 25 years old, from women attending National Women's Hospital, Auckland, who had been diagnosed histologically with cervical carcinoma in situ in 1955-1976.

Study Design: Smears comprised all those from the 2 years following diagnosis as well as all subsequent smears for women who developed "microinvasive" or invasive lower genital tract cancer. The Victorian Cytology Service performed the review using the Australian Modified Bethesda System.