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Biomedical subjects

E H Kaplan

Publications and source records attributed to E H Kaplan.

At least 19 recordsLinked to original sources
PubMed1998

HIV incidence in Ethiopian immigrants to Israel.

The HIV incidence in recent adult Ethiopian immigrants to Israel is estimated through the use of snapshot estimators based on percentage of CD4 progression with time since infection, whereas the preimmigration incidence experienced by this population is estimated using an epidemic model applied to HIV prevalence data obtained from immigrants on arrival in Israel. The snapshot estimators place incidence in adult Ethiopian immigrants in Israel between 3 and 11 infections/1000 uninfected persons/year around May 1995. In contrast, the epidemic model suggests that the incidence experienced by this population before immigration was between 12 and 22 infections/1000 uninfected persons/year. Although the drop in incidence postimmigration is good news, in the aggregate, we estimate that between 50 and 190 new infections have occurred annually in adult Ethiopians who have immigrated to Israel.

Adolescent↗
PubMed1998

Accidental, intravenous infusion of a peanut oil-based medication.

OBJECTIVES: To describe a case of fat embolus syndrome with lipoid pneumonia resulting from intravenous infusion of lipid and to illustrate the potential for accidental intravenous administration of vegetable oil-based progesterone preparations in the treatment of oncology patients. CASE REPORT: A patient with recurrent ovarian carcinoma accidentally received approximately 20 mL (0.29 mL/kg) of a peanut oil-based methylprogesterone product intravenously via infusion pump over 24 hours. The patient developed a lipoid pneumonia with dyspnea, cough, hypoxia, radiographic infiltrates, and a pleural effusion. She was hospitalized for 4 days, and signs and symptoms resolved over 2 weeks following steroids and supportive care. DISCUSSION: Experience with accidental or intentional intravenous lipid overdose in humans is limited. Typical findings of fat embolus syndrome are similar to lipid aspiration, with respiratory distress, hypoxia, and pulmonary infiltrates. In contrast to aspiration, however, fat embolus syndrome results in lipogranulomas surrounding blood vessels, rather than air passages, and potentially produces cerebrovascular, accident-like symptoms. Management of fat embolus syndrome is similar to that for lipid aspiration. However, as seen in this case, fat embolus syndrome typically resolves over several weeks as opposed to the 3-month to 1-year period seen with aspiration lipoid pneumonias. CONCLUSIONS: Accidental intravenous infusion of vegetable oil-based products is a potential complication of the increased use of intravenous progesterones.

Antineoplastic Agents, Phytogenic↗
PubMed1997

Telepsychotherapy. Psychotherapy by telephone, videotelephone, and computer videoconferencing.

Telepsychotherapy is defined as psychotherapy conducted by a therapist at a location different from the patient's through bidirectional communication technology supporting real-time interactivity in the audio, audiovisual, or text modalities. Various types of telecommunication equipment are considered. Vignettes of 2 cases treated by means of the AT&T Videophone 2500 are presented. Medicolegal aspects and clinical issues, including ethics, confidentiality, patient selection, and therapy technique, are addressed.

Computer Systems↗
PubMed1997

Aging and retirement: a difficult issue for individual psychoanalysts and organized psychoanalysis.

Organized psychoanalysis has a long history of discussing and formulating policies on retirement, but follow-through has been lax and few analysts retire unless forced by illness. Institutes tend to avoid and deny the problem of the impaired analyst. Procedural guidelines are needed for assessing competency and imposing involuntary retirement. The authors recommend that all institute appointments be time-limited and that medical clearance specifically addressing conditions potentially impairing professional functioning be required for appointment and renewal.

Aged↗
PubMed1996

Initial results of a phase II trial of high dose radiation therapy, 5-fluorouracil, and cisplatin for patients with anal cancer (E4292): an Eastern Cooperative Oncology Group study.

PURPOSE: A prospective clinical trial was performed to assess the response and toxicity associated with the use of high dose radiation therapy, 5-fluorouracil, and cisplatin in patients with anal cancer. METHODS AND MATERIALS: Patients with anal cancer without distant metastasis were eligible for this study. Radiation therapy consisted of 59.4 Gy in 33 fractions; a 2 week break in treatment was taken after 36 Gy had been given. A treatment of 5-fluorouracil, 1,000 mg/m2 per day intravenously, was given for the first 4 days of radiation therapy, and cisplatin, 75 mg/m2 intravenously, was given on day 1 of radiation therapy. A second course of 5-fluorouracil and cisplatin was given after 36 Gy of radiation, when the radiation therapy was resumed. RESULTS: Nineteen patients entered this study and received treatment. Thirteen (68%) had a complete response, 5 (26%) had a partial response, and 1 (5%) had stable disease. The patient with stable disease and one of the patients with a partial response had complete disappearance of tumor more than 8 weeks after completion of radiation therapy. Fifteen patients had toxicity of Grade 3 or higher: the worst toxicity was Grade 3 in eight patients, Grade 4 in six patients, and Grade 5 in one patient. The most common form of toxicity of Grade 3 or higher was hematologic. The one lethal toxicity was due to pseudomembranous colitis, which was a complication of antibiotic therapy for a urinary tract infection. CONCLUSION: Radiation therapy, cisplatin, and 5-fluorouracil resulted in an overall response rate of 95%. Significant toxicity occurred, an indication that this regimen is near the maximal tolerated dose. A Phase III clinical trial is planned in which radiation therapy, cisplatin, and 5-fluorouracil will be used as an experimental arm.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data.

This article provides updated estimates of the rate of new HIV infections among participants in New Haven's legal needle exchange program from syringe tracking and testing data. We previously reported that based on data collected from November 1990 through May 1992, the maximum likelihood incidence rate was zero with a 95% confidence interval of 0-10.2 new infections per 100 drug injectors per year. Expanding this data set through August 1993, the same statistical methods yield a maximum likelihood estimate of 1.63 new infections per 100 drug injectors per year with a 95% confidence interval of 0-7.2. Given these data, the null hypothesis of no new infections cannot be rejected, providing further support for the efficacy of New Haven's needle exchange program.

Confidence Intervals↗
PubMed1995

An analysis of the process of human immunodeficiency virus sexual risk behavior change.

Few studies have tried to identify the process of risk behavior change. In this paper, we present a method for the analysis of the process of risk behavior change; the methodology involves using time series data to form transition probability matrices. We apply the method to human immunodeficiency virus (HIV) sexual risk behavioral data from a cohort of gay men in Amsterdam. We determine the process of risk behavior change in this cohort, and we demonstrate that it is not possible to deduce the process simply from an examination of the static pattern. Our results imply that the risk behavior change that is observed in this cohort may be viewed as a homogeneous one-step Markovian process. This process of risk behavior change has implications for the long-term prediction of HIV seroconversion rates and for the design and evaluation of HIV behavioral intervention studies and vaccine trials. Our results also have implications for the interpretation of relapse behavior.

Cognition↗
PubMed1995

How many HIV infections are there in Israel? Reconstructing HIV incidence from AIDS case reporting.

BACKGROUND: The reporting of AIDS cases to Israel's Ministry of Health is believed to be accurate, but the completeness of HIV surveillance is unknown. We implement a model that reconstructs HIV incidence in Israel from AIDS case reports excluding Ethiopian immigrants. METHODS: We apply the well-known method of backcalculation to AIDS cases reported to the Ministry of Health. The data are adjusted statistically to account for reporting delays and the elimination of AIDS Related Complex reporting. The analysis also accounts for the impact of differential administration of antiretroviral therapy to HIV-infected persons over time. RESULTS: Excluding Ethiopian immigrants, we find that the cumulative number of HIV infections reported to the Ministry of Health through December 1993 (1,011) is not statistically different from the model's estimate of 922 (z = 1.04; p = 0.30), though the reported number of new infections in recent years exceeds the modeleted rate. CONCLUSIONS: The low HIV incidence estimated among non-Ethiopian Israelis is consistent with other studies of sexually transmitted diseases and HIV-related risky behavior in Israel. This result counters the hypothesis that an explosive HIV epidemic will occur. That the number of recently reported new infections exceeds the estimate from the model could indicate that the reporting system is catching up with the extant spread of disease, or that the model is missing some aspect of the dynamics of HIV in Israel. We suggest that comparing future annual HIV incidence rates to the model's upper bound of 80 infections per year will enable resolution of this issue over time.

Acquired Immunodeficiency Syndrome↗
PubMed1994

A decline in HIV-infected needles returned to New Haven's needle exchange program: client shift or needle exchange?

The New Haven needle exchange program experienced a significant decline in the fraction of returned needles containing human immunodeficiency virus 1 (HIV-1) proviral DNA. Is this decline due to the operations of the needle exchange or to a shift in clients? Analysis of demographic and behavioral data revealed that only one variable, the race of participating clients, changed significantly over time. However, HIV-1 prevalences in needles given to Whites and to non-Whites were not statistically different. Thus, client shift cannot be responsible for the decline in the observed HIV prevalence in needles. Instead, needle circulation times were a significant predictor of HIV prevalence.

Connecticut↗
PubMed1994

HIV incidence among needle exchange participants: estimates from syringe tracking and testing data.

This paper develops a statistical procedure for estimating the HIV infection rate among needle exchange clients without using any self-reported information. Instead, data are accumulated by following the distribution and return of sequentially labeled syringes and by testing a sample of returns for the presence of HIV-1 proviral DNA using polymerase chain reaction. For each drug injector in the sample, a maximum likelihood change point model is constructed to determine if a statistically significant upward shift in the fraction of needles testing HIV positive is evident, as would occur if the drug injector in question became infected. A second maximum likelihood model is formulated to estimate the HIV incidence rate among needle exchange participants by aggregating the individual change point results. When these methods are applied to the syringe tracking and testing data collected to evaluate the legal needle exchange program in New Haven, Connecticut, the maximum likelihood incidence estimate equals zero, with a 95% confidence interval of 0-10.2 new infections per 100 drug injectors per year. Given these data, we cannot reject the null hypothesis that no new infections have occurred among needle exchange participants between November 1990 and May 1992.

Connecticut↗
PubMed1993

Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut.

PURPOSE: To report on the deployment of the syringe tracking and testing system in the New Haven needle exchange program, which is the first federally funded evaluation of a needle exchange program conducted in the United States. PATIENTS AND METHODS: A legal needle exchange for intravenous drug users began in New Haven, Connecticut, in November 1990. All syringes distributed by the program received unique tracking codes. Syringes were tracked and HIV-1 proviral DNA prevalence in returned syringes was assessed using polymerase chain reaction and Southern blotting. RESULTS: At the outset of the program, the prevalence of HIV-1 proviral DNA in syringes exceeded two thirds. Prevalence decreased rapidly to less than 45% during the first 3 months of the program and remained at this level for the following 10 months. During the periods of decreasing prevalence and subsequent steady state, no changes in the demographics of program participants or in the drug use habits of newly enrolling clients that could account for the decrease in HIV-1 prevalence in needles were detected. In addition, the program referred almost 20% of its clients to drug treatment programs. CONCLUSION: The needle exchange program in New Haven has decreased the percentage of syringes testing positive for HIV-1 proviral DNA among needle exchange clients while simultaneously serving as an entry point for drug treatment.

Analysis of Variance↗
PubMed1993

Cutaneous T-cell lymphomas.

Cutaneous T-cell lymphoma, which usually presents as mycosis fungoides or Sézary syndrome, remains a mostly incurable, yet highly treatable group of diseases. The myriad of active therapies continues to grow, and new insights into the mechanism of systemic and topical therapies are being elucidated. Multimodality treatment initiated for early-stage disease may help improve long-term survival. The need for randomized prospective trials is obvious and should become a priority. Further development of molecular genetic techniques and cell-surface phenotyping has enhanced our understanding of these diseases and will hopefully allow for the development of more effective and specific treatments.

Humans↗
PubMed1993

The epidemiological and economic consequences of AIDS clinical trials.

The Food and Drug Administration (FDA) must manage the delicate balance between speed and safety in the evaluation and approval of new drugs. To explore how these competing obligations might be formalized with respect to the AIDS epidemic, we present a simple decision-theoretic optimization model of the clinical trials process against a backdrop of HIV transmission. Our framework sheds light on such issues as the economic consequences of decisions, the potential savings of a new therapy, the costs to society of delay, the value of better information, and how and when to undertake a clinical trial. We believe that this article represents a first effort to unravel the tangled web of epidemiological, economic, and statistical considerations that plague this policy issue.

Acquired Immunodeficiency Syndrome↗