title: Neural multi-class classification approach to blood glucose level forecasting with prediction uncertainty visualisation

authors: Mayo, Michael

subjects: computer science

abstract: A machine learning-based method for blood glucose level prediction thirty and sixty minutes in advance based on highly multiclass classification (as opposed to the more traditional regression approach) is proposed. An advantage of this approach is the possibility of modelling and visualising the uncertainty of a prediction across the entire range of blood glucose levels without parametric assumptions such as normality. To demonstrate the approach, a long-short term memory-based neural network classifier is used in conjunction with a blood glucose-specific data preprocessing technique (risk domain transform) to train a set of models and generate predictions for the 2018 and 2020 Blood Glucose Level Prediction Competition datasets. Numeric accuracy results are reported along with examples of the uncertainty visualisation possible using this technique.

text: Neural multi-class classification approach to blood glucose level forecasting with prediction uncertainty visualisation A machine learning-based method for blood glucose level prediction thirty and sixty minutes in advance based on highly multiclass classification (as opposed to the more traditional regression approach) is proposed. An advantage of this approach is the possibility of modelling and visualising the uncertainty of a prediction across the entire range of blood glucose levels without parametric assumptions such as normality. To demonstrate the approach, a long-short term memory-based neural network classifier is used in conjunction with a blood glucose-specific data preprocessing technique (risk domain transform) to train a set of models and generate predictions for the 2018 and 2020 Blood Glucose Level Prediction Competition datasets. Numeric accuracy results are reported along with examples of the uncertainty visualisation possible using this technique.

year: 2020

title: Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand

authors: Campbell, Ian

subjects: Science & Technology

abstract: Background
The aim of this study was to understand the factors influencing the use of surgical options by New Zealand women with newly diagnosed breast cancer.

Methods
Using data from the Auckland and Waikato breast cancer registers, we included 11 798 women diagnosed with stage I–III breast cancer from June 2000 to May 2013. The characteristics of women receiving different surgical treatments and having immediate breast reconstruction following mastectomy were examined. A logistic regression was used to estimate the odds ratio of having breast‐conserving surgery (BCS) versus mastectomy and immediate post‐mastectomy reconstruction. Bilateral breast cancer cases and women with unilateral breast cancer, but who had bilateral surgery, were also identified.

Results
Fifty‐two percent of women received BCS and 44% had mastectomy over the study period. Key influences associated with BCS were age, mode of diagnosis, socio‐economic status and public or private treatment. Just under half of the women who underwent bilateral surgery did not have bilateral cancer. Nineteen percent of women undergoing mastectomy underwent immediate reconstruction. Implant use increased slightly over the study period but there was a decrease in the use of autologous flap procedures.

Conclusion
Surgical management of women with localized breast cancer was generally in line with guidelines, but with potential to further increase the use of breast conservation and immediate reconstruction in suitable cases.

text: Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand Background
The aim of this study was to understand the factors influencing the use of surgical options by New Zealand women with newly diagnosed breast cancer.

Methods
Using data from the Auckland and Waikato breast cancer registers, we included 11 798 women diagnosed with stage I–III breast cancer from June 2000 to May 2013. The characteristics of women receiving different surgical treatments and having immediate breast reconstruction following mastectomy were examined. A logistic regression was used to estimate the odds ratio of having breast‐conserving surgery (BCS) versus mastectomy and immediate post‐mastectomy reconstruction. Bilateral breast cancer cases and women with unilateral breast cancer, but who had bilateral surgery, were also identified.

Results
Fifty‐two percent of women received BCS and 44% had mastectomy over the study period. Key influences associated with BCS were age, mode of diagnosis, socio‐economic status and public or private treatment. Just under half of the women who underwent bilateral surgery did not have bilateral cancer. Nineteen percent of women undergoing mastectomy underwent immediate reconstruction. Implant use increased slightly over the study period but there was a decrease in the use of autologous flap procedures.

Conclusion
Surgical management of women with localized breast cancer was generally in line with guidelines, but with potential to further increase the use of breast conservation and immediate reconstruction in suitable cases.

year: 2018

title: Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand

authors: Chepulis, Lynne Merran

subjects: GLP1RA

abstract: Background: Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. 

Methods: Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. 

Results: Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access.

Conclusion: Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.

text: Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand Background: Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. 

Methods: Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. 

Results: Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access.

Conclusion: Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.

year: 2025