Eugene M. Laska, Ph.D.

Length of stay of pediatric mental health emergency department visits in the United States
Case, Sarah D; Case, Brady G; Olfson, Mark; Linakis, James G; Laska, Eugene M
2011 Nov;50(11):1110-1119, Journal of the American Academy of Child & Adolescent Psychiatry
OBJECTIVE: To compare pediatric mental health emergency department visits to other pediatric emergency department visits, focusing on length of stay. METHOD: We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of US emergency department visits from 2001 to 2008, for patients aged </=18 years (n = 73,015). Visits with a principal diagnosis of a mental disorder (n = 1,476) were compared to visits (n = 71,539) with regard to patient and hospital characteristics, treatment, and length of stay. Predictors of prolonged mental health visits were identified. RESULTS: Mental health visits were more likely than other visits to arrive by ambulance (21.8% versus 6.3%, p < .001), to be triaged to rapid evaluation (27.9% versus 14.9%, p < .001), and to be admitted (16.4% versus 7.6%, p < .001) or transferred (15.7% versus 1.5%, p < .001). The median length of stay for mental health visits (169 minutes) significantly exceeded that of other visits (108 minutes). The odds of extended stay beyond 4 hours for mental health visits was almost twice that for other visits (adjusted odds ratio 1.9, 95% CI = 1.5-2.4) and was not explained by observed differences in evaluation, treatment, or disposition. Among mental health visits, advancing calendar year of study, intentional self-injury, age 6-13 years, Northeastern, Southern, and metropolitan hospital location, use of laboratory studies, and patient transfer all predicted extended stays. CONCLUSIONS: Compared with other pediatric emergency visits, mental health visits are longer, are more frequently triaged to urgent evaluation, and more likely to result in patient admission or transfer, thereby placing distinctive burdens on US emergency departments
— id: 140503, year: 2011, vol: 50, page: 1110, stat: Journal Article,

Prevalence of autism spectrum disorders in a total population sample
Kim, Young Shin; Leventhal, Bennett L; Koh, Yun-Joo; Fombonne, Eric; Laska, Eugene; Lim, Eun-Chung; Cheon, Keun-Ah; Kim, Soo-Jeong; Kim, Young-Key; Lee, Hyunkyung; Song, Dong-Ho; Grinker, Roy Richard
2011 Sep;168(9):904-912, American journal of psychiatry
Objective: Experts disagree about the causes and significance of the recent increases in the prevalence of autism spectrum disorders (ASDs). Limited data on population base rates contribute to this uncertainty. Using a population-based sample, the authors sought to estimate the prevalence and describe the clinical characteristics of ASDs in school-age children. Method: The target population was all 7- to 12-year-old children (N=55,266) in a South Korean community; the study used a high-probability group from special education schools and a disability registry and a low-probability, general-population sample from regular schools. To identify cases, the authors used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of children who screened positive were offered comprehensive assessments using standardized diagnostic procedures. Results: The prevalence of ASDs was estimated to be 2.64% (95% CI=1.91-3.37), with 1.89% (95% CI=1.43-2.36) in the general-population sample and 0.75% (95% CI=0.58-0.93) in the high-probability group. ASD characteristics differed between the two groups: the male-to-female ratios were 2.5:1 and 5.1:1 in the general population sample and high-probability group, respectively, and the ratios of autistic disorders to other ASD subtypes were 1:2.6 and 2.6:1, respectively; 12% in the general-population sample had superior IQs, compared with 7% in the high-probability group; and 16% in the general-population sample had intellectual disability, compared with 59% in the high-probability group. Conclusions: Two-thirds of ASD cases in the overall sample were in the mainstream school population, undiagnosed and untreated. These findings suggest that rigorous screening and comprehensive population coverage are necessary to produce more accurate ASD prevalence estimates and underscore the need for better detection, assessment, and services
— id: 138006, year: 2011, vol: 168, page: 904, stat: Journal Article,

The Nathan Kline Institute cultural competency assessment scale: psychometrics and implications for disparity reduction
Siegel, Carole E; Haugland, Gary; Laska, Eugene M; Reid-Rose, Lenora M; Tang, Dei-In; Wanderling, Joseph A; Chambers, Ethel D; Case, Brady G
2011 Mar;38(2):120-130, Administration & policy in mental health
The NKI Cultural Competency Assessment Scale measures organizational CC in mental health outpatient settings. We describe its development and results of tests of its psychometric properties. When tested in 27 public mental health settings, factor analysis discerned three factors explaining 65% of the variance; each factor related to a stage of implementation of CC. Construct validity and inter-rater reliability were satisfactory. In tests of predictive validity, higher scores on items related to linguistic and service accommodations predicted a reduction in service disparities for engagement and retention outcomes for Hispanics. Disparities for Blacks essentially persisted independent of CC scores
— id: 138839, year: 2011, vol: 38, page: 120, stat: Journal Article,

Estimating treated prevalence and service utilization rates: assessing disparities in mental health
Laska, Eugene M; Meisner, Morris; Wanderling, Joseph; Siegel, Carole
2010 Jul 20;29(16):1673-1680, Statistics in medicine
There is considerable public concern about health disparities among different cultural/racial/ethnic groups. Important process measures that might reflect inequities are treated prevalence and the service utilization rate in a defined period of time. We have previously described a method for estimating N, the distinct number who received service in a year, from a survey of service users at a single point in time. The estimator is based on the random variable 'time since last service', which enables the estimation of treated prevalence. We show that this same data can be used to estimate the service utilization rate, E(J), the mean number of services in the year. If the sample is typical with respect to the time since last visit, the MLE of E(J) is asymptotically unbiased. Confidence intervals and a global test of equality of treated prevalence and service utilization rates among several groups are given. A data set of outpatient mental health services from a county in New York State for which the true values of the parameters are known is analyzed as an illustration of the methods and an appraisal of their accuracy
— id: 138838, year: 2010, vol: 29, page: 1673, stat: Journal Article,

Randomized, Double-Blind, Placebo-Controlled Trial of Vigabatrin for the Treatment of Cocaine Dependence in Mexican Parolees
Brodie, Jonathan D; Case, Brady G; Figueroa, Emilia; Dewey, Stephen L; Robinson, James A; Wanderling, Joseph A; Laska, Eugene M
2009 Nov;166(11):1269-1277, American journal of psychiatry
Objective Cocaine dependence is associated with severe medical, psychiatric, and social morbidity, but no pharmacotherapy is approved for its treatment in the United States. The atypical antiepileptic vigabatrin (gamma-vinyl gamma-aminobutyric acid [GABA]) has shown promise in animal studies and open-label trials. The purpose of the present study was to assess the efficacy of vigabatrin for short-term cocaine abstinence in cocaine-dependent individuals. Method Participants were treatment seeking parolees who were actively using cocaine and had a history of cocaine dependence. Subjects were randomly assigned to a fixed titration of vigabatrin (N=50) or placebo (N=53) in a 9-week double-blind trial and 4-week follow-up assessment. Cocaine use was determined by directly observed urine toxicology testing twice weekly. The primary endpoint was full abstinence for the last 3 weeks of the trial. Results Full end-of-trial abstinence was achieved in 14 vigabatrin-treated subjects (28.0%) versus four subjects in the placebo arm (7.5%). Twelve subjects in the vigabatrin group and two subjects in the placebo group maintained abstinence through the follow-up period. The retention rate was 62.0% in the vigabatrin arm versus 41.5% in the placebo arm. Among subjects who reported prestudy alcohol use, vigabatrin, relative to placebo, was associated with superior self-reported full end-of-trial abstinence from alcohol (43.5% versus 6.3%). There were no differences between the two groups in drug craving, depressed mood, anxiety, or Clinical Global Impression scores, and no group differences in adverse effects emerged. Conclusions This first randomized, double-blind, placebo-controlled trial supports the safety and efficacy of short-term vigabatrin treatment of cocaine dependence
— id: 101865, year: 2009, vol: 166, page: 1269, stat: Journal Article,

Assessing onset of treatment benefit in depression and anxiety: conceptual considerations
Laska, Eugene M; Mallinckrodt, Craig H; Mundt, Jim C; Leber, Paul; Vaccarino, Anthony L; Kalali, Amir H; Greist, John H
2009 Aug;70(8):1138-1145, Journal of clinical psychiatry
OBJECTIVE: Methods for characterizing the onset of treatment benefit in major depressive disorder and generalized anxiety disorder have been studied for some time, yet there is no universal agreement as to the best approaches. Our purpose is to summarize the conceptual framework underlying modern methods for characterizing onset and detailed approaches for which there is consensus from the perspective of a clinician, clinical researcher, and statistician. Possible alternatives to unresolved issues are discussed. PARTICIPANTS: There were 17 experts from academia, the pharmaceutical industry, and the US Food and Drug Administration who met on April 19, 2007, to consider the issues. Many others from sponsoring firms observed the proceedings. EVIDENCE: A series of papers was presented at a consensus meeting and, after discussions, a sense of the participants was obtained. A small group subsequently reviewed the material and articles from the literature and prepared this article, which was reviewed by all of the participants. CONCLUSIONS: The elements that form the basis for describing onset of treatment benefit include defining a clinical event or measurable threshold that validly signals that a treatment has begun to provide clinically meaningful and sustained improvement and utilizing methods for estimating the probability of crossing the onset threshold, the distribution of time to onset for those who do cross, and when to alter or change interventions if the treatment is unsuccessful
— id: 102499, year: 2009, vol: 70, page: 1138, stat: Journal Article,

Model-based multiplicity estimation of population size
Laska, Eugene M; Meisner, Morris; Wanderling, Joseph
2009 Jul 30;28(17):2230-2252, Statistics in medicine
A survey is conducted at w of K selection units or lists, e.g. health care institutions or weeks in a year, to estimate N, the total number of individuals with particular characteristics. Our estimator utilizes two items determined for each survey participant: the number, u, among the w lists in S and the number, j, among all K lists on which each survey participant appears. In its traditional form, selection units are chosen using probability sampling and the statistical properties of the estimator derive from the sampling mechanism. Here, selection units are purposively chosen to maximize the chance that they are 'typical' and a model-based analysis is used for inference. If the sample is typical, the ML estimators of N and E(J) are unbiased. If a condition on the second moment of U/J is satisfied, the model-based variance of the estimator of N based on a purposively chosen typical sample is smaller than one based on a randomly chosen sample. Methods to test whether the typical assumption is valid using data from the survey are not yet available. The importance of proper selection of the sample to maximize the chance that it is typical and model breakdown does not occur must be emphasized
— id: 100624, year: 2009, vol: 28, page: 2230, stat: Journal Article,

Placebo influences on dyskinesia in Parkinson's disease
Goetz, Christopher G; Laska, Eugene; Hicking, Christine; Damier, Philippe; Muller, Thomas; Nutt, John; Warren Olanow, C; Rascol, Olivier; Russ, Hermann
2008 Apr 15;23(5):700-707, Movement disorders
Clinical features that are prognostic indicators of placebo response among dyskinetic Parkinson's disease patients were determined. Placebo-associated improvements occur in Parkinsonism, but responses in dyskinesia have not been studied. Placebo data from two multicenter studies with identical design comparing sarizotan to placebo for treating dyskinesia were accessed. Sarizotan (2 mg/day) failed to improve dyskinesia compared with placebo, but both treatments improved dyskinesia compared with baseline. Stepwise regression identified baseline characteristics that influenced dyskinesia response to placebo, and these factors were entered into a logistic regression model to quantify their influence on placebo-related dyskinesia improvements and worsening. Because placebo-associated improvements in Parkinsonism have been attributed to heightened dopaminergic activity, we also examined the association between changes in Parkinsonism and dyskinesia. Four hundred eighty-four subjects received placebo treatment; 178 met criteria for placebo-associated dyskinesia improvement and 37 for dyskinesia worsening. Older age, lower baseline Parkinsonism score, and lower total daily levodopa doses were associated with placebo-associated improvement, whereas lower baseline dyskinesia score was associated with placebo-associated worsening. Placebo-associated dyskinesia changes were not correlated with Parkinsonism changes, and all effects in the sarizotan group were statistically explained by the placebo-effect regression model. Dyskinesias are affected by placebo treatment. The absence of correlation between placebo-induced changes in dyskinesia and Parkinsonism argues against a dopaminergic activation mechanism to explain placebo-associated improvements in dyskinesia. The magnitude and variance of placebo-related changes and the factors that influence them can be helpful in the design of future clinical trials of antidyskinetic agents
— id: 140505, year: 2008, vol: 23, page: 700, stat: Journal Article,

Estimating numbers of unsheltered homeless people through plant-capture and postcount survey methods
Hopper, Kim; Shinn, Marybeth; Laska, Eugene; Meisner, Morris; Wanderling, Joseph
2008 Aug;98(8):1438-1442, American journal of public health. AJPH
OBJECTIVES: We sought to increase the accuracy of New York City's estimates of its unsheltered homeless population. METHODS: We employed 2 approaches to increasing count accuracy: a plant-capture strategy in which embedded decoys (or 'plants') were used to estimate the proportion of visible homeless people missed by enumerators and a postcount survey of service users designed to estimate the proportion of unsheltered homeless people who were not visible. RESULTS: Plants at 17 sites (29%) reported being missed in the count, because counters either did not visit those sites or did not interview the plants. Of 293 homeless service users who were not in shelters, 31% to 41% were in locations deemed not visible to counters. CONCLUSIONS: Both plant-capture estimation and postcount surveys are feasible approaches that can increase the accuracy of estimates of unsheltered homeless populations
— id: 140510, year: 2008, vol: 98, page: 1438, stat: Journal Article,

Long-term efficacy and safety of iloperidone: results from 3 clinical trials for the treatment of schizophrenia
Kane, John M; Lauriello, John; Laska, Eugene; Di Marino, Michael; Wolfgang, Curt D
2008 Apr;28(2 Suppl 1):S29-S35, Journal of clinical psychopharmacology
This research compared the long-term efficacy and safety of iloperidone with those of haloperidol in individuals with schizophrenia. Data were pooled from 3 prospective multicenter studies, each with 6-week stabilization followed by 46-week double-blind maintenance phases. Patients were randomized to iloperidone 4 to 16 mg/d or haloperidol 5 to 20 mg/d. Patients included in this analysis completed the initial 6-week phase with at least 20% reduction in Positive and Negative Syndrome Scale (PANSS) total score at weeks 4 and 6, had 7-item Clinical Global Impressions of Change (CGI-C) scores less than 4, received 1 or more doses of long-term phase medication, and had 1 or more efficacy/safety assessments during the long-term phase. The primary efficacy variable was time to relapse, defined as a 25% or more increase in PANSS total score, including at least a 10-point change; discontinuation because of lack of efficacy; aggravated psychosis with hospitalization; or 2-point increase in the 7-item CGI-C after week 6. Of 1644 patients randomized and 1326 completing the 6-week phase, 473 (iloperidone, n = 359; haloperidol, n = 114) were included in the long-term efficacy analysis, and 489 (iloperidone, n = 371; haloperidol, n = 118) in the safety analysis. Iloperidone was equivalent to haloperidol in time to relapse. The most common adverse events were insomnia (18.1%), anxiety (10.8%), and schizophrenia aggravated (8.9%) with iloperidone, and insomnia (16.9%), akathisia (14.4%), tremor (12.7%), and muscle rigidity (12.7%) with haloperidol. The Extrapyramidal Symptoms Rating Scale scores improved with iloperidone and worsened with haloperidol. Metabolic changes were minimal for both groups. Mean changes in Fridericia's QT interval correction were 10.3 msec (iloperidone) and 9.4 msec (haloperidol) at end point. Iloperidone demonstrated long-term efficacy equivalent to haloperidol and a favorable long-term safety profile, potentially making this agent a suitable option as maintenance therapy for schizophrenia
— id: 135337, year: 2008, vol: 28, page: S29, stat: Journal Article,

Hippocampal hypometabolism predicts cognitive decline from normal aging
Mosconi, Lisa; De Santi, Susan; Li, Juan; Tsui, Wai Hon; Li, Yi; Boppana, Madhu; Laska, Eugene; Rusinek, Henry; de Leon, Mony J
2008 May;29(5):676-692, Neurobiology of aging
OBJECTIVE: This longitudinal study used FDG-PET imaging to predict and monitor cognitive decline from normal aging. METHODS: Seventy-seven 50-80-year-old normal (NL) elderly received longitudinal clinical examinations over 6-14 years (561 person-years, mean per person 7.2 years). All subjects had a baseline FDG-PET scan and 55 subjects received follow-up PET exams. Glucose metabolic rates (MRglc) in the hippocampus and cortical regions were examined as predictors and correlates of clinical decline. RESULTS: Eleven NL subjects developed dementia, including six with Alzheimer's disease (AD), and 19 declined to mild cognitive impairment (MCI), on average 8 years after the baseline exam. The baseline hippocampal MRglc predicted decline from NL to AD (81% accuracy), including two post-mortem confirmed cases, from NL to other dementias (77% accuracy), and from NL to MCI (71% accuracy). Greater rates of hippocampal and cortical MRglc reductions were found in the declining as compared to the non-declining NL. CONCLUSIONS: Hippocampal MRglc reductions using FDG-PET during normal aging predict cognitive decline years in advance of the clinical diagnosis. Future studies are needed to increase preclinical specificity in differentiating dementing disorders
— id: 70030, year: 2008, vol: 29, page: 676, stat: Journal Article,

Long-term mortality experience of international cohorts of persons with schizophrenia and related psychoses
Craig, Thomas J; Tang, Dei-In; Sartorius, Norman; Laska, Eugene M; Cancro, Robert
Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, the international study of schizophrenia New York, NY, US: Oxford University Press, 2007,
The mortality experience of persons with schizophrenia and related psychoses has been a topic of research interest for over a century (Simpson, 1988; Allebeck, 1989; Newman and Bland, 1991; Simpson and Tsuang, 1996). Usually, the Standardized Mortality Ratio (SMR) is used to compare mortality rates in such individuals with those of the general population. Despite the extensive literature on mortality among these patients, recent reviews (Simpson, 1988; Allebeck, 1989; Simpson and Tsuang, 1996) have identified a number of gaps in current knowledge. Simpson (1988) cites a lack of information about nonindustrialized societies where cultural issues and differences in medical care availability might result in mortality patterns that are different from those in industrialized societies. In addition, most reported studies involve patients who died before the 1980s, when diagnostic criteria were less standardized and medical and psychiatric treatments less advanced. Simpson and Tsuang (1996) also point to the need for larger sample sizes in order to analyze mortality experience in population subgroups. It is remarkable, as Allebeck (1989) states, that despite the use of varying methodological and diagnostic techniques, similar results have emerged from studies which were conducted over half a century (i.e., the 1920s to 1970s). However, none of these studies examined the pattern of mortality across diverse national and cultural settings using comparable methodology. We attempt to do so in this chapter.
— id: 4383, year: 2007, vol: , page: 61, stat: Chapter,

Sarizotan as a treatment for dyskinesias in Parkinson's disease: a double-blind placebo-controlled trial
Goetz, Christopher G; Damier, Philippe; Hicking, Christine; Laska, Eugene; Muller, Thomas; Olanow, C Warren; Rascol, Olivier; Russ, Hermann
2007 Jan 15;22(2):179-186, Movement disorders
The objective of this study is to conduct a dose-finding study of sarizotan in Parkinson's disease (PD) patients with dyskinesia to identify a safe dose and to identify a sensitive dyskinesia rating measure. Sarizotan is a novel compound with full 5-HT(1A) agonist properties and additional high affinity for D(3) and D(4) receptors. An open label study documented improvements in PD patients with levodopa-induced dyskinesia. There is no precedent for study designs or outcome measures in pivotal trials of antidyskinesia therapies. The approach used here was a multicenter, randomized, placebo-controlled, double-blind, parallel study. Included were PD patients optimized to levodopa and dopaminergic drugs with moderately disabling dyskinesias present greater than or equal to 25% of the waking day. Interventions included sarizotan 2, 4, or 10 mg/day or matching placebo, given in two doses. There were two outcome measures: the primary measure was change from baseline in diary-based on time without dyskinesia; the secondary measures were change from baseline in scores on the Abnormal Involuntary Movement Scale (AIMS), the composite score of Unified Parkinson's Disease Rating Scale (UPDRS) Items 32+33 (dyskinesia duration and disability) and total UPDRS. A total of 398 subjects were randomized, with 381 included in the intention-to-treat population. No significant changes occurred on sarizotan compared to placebo on any diary-based measure of dyskinesia or the AIMS score. The composite score of UPDRS Items 32+33 was significantly improved with 2 mg/day sarizotan, with a trend at 10 mg/day. Adverse events were not significantly different in sarizotan- and placebo-treated patients, but off time significantly increased with sarizotan 10 mg/day. Sarizotan 2 mg/day is a safe agent in PD patients with dyskinesia. To test its role in abating dyskinesia, future studies should focus on this dose and will use the composite score of UPDRS Items 32+33 as the primary outcome
— id: 140509, year: 2007, vol: 22, page: 179, stat: Journal Article,

Abraham Sunshine - January 3, 1928-January 2, 2007 - Obituary
Laska, E
2007 AUG ;130(3):199-200, Pain
— id: 74177, year: 2007, vol: 130, page: 199, stat: Journal Article,

Study methodology
Siegel, Carole; Laska, Eugene M; Wanderling, Joseph A; Baker, Sherryl; Harrison, Glynn; Bank, Rheta; Meisner, Morris
Recovery from schizophrenia: An international perspective: A report from the WHO Collaborative Project, the international study of schizophrenia New York, NY, US: Oxford University Press, 2007,
(from the chapter) The International Study of Schizophrenia (ISoS) is a follow-up study on the course of illness and outcomes of a subset of subjects who had been in previous WHO-coordinated research studies of schizophrenia--the International Pilot Study of Schizophrenia (IPSS), the study on the Determinants of Outcome of Severe Mental Disorders (DOSMeD), and the study on Reduction and Assessment of Psychiatric Disability (RAPyD or Disability)--and additionally, subjects who had been in studies conducted locally at three other centers (Retrospective Analysis or Invited). Throughout this volume, these four distinct long-term follow-up cohorts (IPSS, DOSMeD, RAPyD, and Retrospective Analysis) are referred to as the 'subsamples' of ISoS
— id: 4791, year: 2007, vol: , page: 10, stat: Chapter,

Safety and efficacy of gamma-vinyl GABA (GVG) for the treatment of methamphetamine and/or cocaine addiction
Brodie, Jonathan D; Figueroa, Emilia; Laska, Eugene M; Dewey, Stephen L
2005 Feb;55(2):122-125, Synapse
This study examined the safety and efficacy of gamma vinyl-GABA (GVG, vigabatrin) for the treatment of methamphetamine and/or cocaine addiction. A total of 30 subjects, who met DSM-IV criteria for methamphetamine and/or cocaine dependence, were enrolled in an open label 9-week safety study. The protocol was specifically designed to include extensive visual field monitoring as well as outcome measures of therapeutic efficacy. Patients were screened twice weekly for the presence of urinary cocaine, methamphetamine, heroin, alcohol, and marijuana. In total, 18/30 subjects completed the study and 16/18 tested negative for methamphetamine and cocaine during the last 6 weeks of the trial. GVG did not produce any visual field defects or alterations in visual acuity. Furthermore, it did not produce changes in vital signs even with continued use of methamphetamine and cocaine. Thus, under conditions that appear to be appropriate for the successful treatment of methamphetamine and/or cocaine addiction, GVG is safe. Synapse 55:122-125, 2005. (c) 2004 Wiley-Liss, Inc
— id: 46891, year: 2005, vol: 55, page: 122, stat: Journal Article,

Statistics and experimental design
Laska EM; Meisner M; Siegel C
Kaplan & Sadock's comprehensive textbook of psychiatry Philadelphia : Lippincott Williams & Wilkins, c2005,
— id: 3801, year: 2005, vol: , page: 672, stat: Chapter,

The sustained 6-month efficacy of eszopiclone in the treatment of chronic insomnia
Krystal, AD; Walsh, JK; Laska, E; Caron, J; Amato, DA; Wessel, TC; Roth, T
2004 MAR 15 ;27(2):346-347, Sleep
— id: 46545, year: 2004, vol: 27, page: 346, stat: Journal Article,

Predicting MCI and dementia in elderly subjects with subjective complaints
Reisberg, B; Laska, E; Monteiro, I; Boksay, I; Torossian, C; Javed, A; Khan, MA; Ferris, S
2004 JUL ;25(10):S26-S26, Neurobiology of aging
— id: 47711, year: 2004, vol: 25, page: S26, stat: Journal Article,

Estimating capacity requirements for mental health services after a disaster has occurred: a call for new data
Siegel, Carole E; Laska, Eugene; Meisner, Morris
2004 Apr;94(4):582-585, American journal of public health. AJPH
OBJECTIVES: We sought to estimate the extended mental health service capacity requirements of persons affected by the September 11, 2001, terrorist attacks. METHODS: We developed a formula to estimate the extended mental health service capacity requirements following disaster situations and assessed availability of the information required by the formula. RESULTS: Sparse data exist on current services and supports used by people with mental health problems outside of the formal mental health specialty sector. There also are few systematically collected data on mental health sequelae of disasters. CONCLUSIONS: We recommend research-based surveys to understand service usage in non-mental health settings and suggest that federal guidelines be established to promote uniform data collection of a core set of items in studies carried out after disasters
— id: 61279, year: 2004, vol: 94, page: 582, stat: Journal Article,

Coping with disasters: estimation of additional capacity of the mental health sector to meet extended service demands
Siegel, Carole; Wanderling, Joseph; Laska, Eugene
2004 Apr;7(1):29-35, Journal of Mental Health Policy & Economics
BACKGROUND: The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters. AIMS OF THE STUDY: Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th METHODS: Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall. RESULTS: There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%. LIMITATIONS: While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster. IMPLICATIONS FOR HEALTH POLICIES: A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors
— id: 46007, year: 2004, vol: 7, page: 29, stat: Journal Article,

Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia
Krystal, Andrew D; Walsh, James K; Laska, Eugene; Caron, Judy; Amato, David A; Wessel, Thomas C; Roth, Thomas
2003 Nov 1;26(7):793-799, Sleep
STUDY OBJECTIVES: To determine the long-term efficacy of eszopiclone in patients with chronic insomnia. DESIGN: Randomized, double-blind, multicenter, placebo-controlled. SETTING: Out-patient, with monthly visits. PATIENTS: Aged 21 to 69 years meeting DSM IV criteria for primary insomnia and reporting less than 6.5 hours of sleep per night, and/or a sleep latency of more than 30 minutes each night for at least 1 month before screening. INTERVENTIONS: Eszopiclone 3 mg (n = 593) or placebo (n = 195), nightly for 6 months MEASUREMENTS AND RESULTS: Efficacy was evaluated weekly using an interactive voice-response system. Endpoints included sleep latency; total sleep time; number of awakenings; wake time after sleep onset; quality of sleep; and next-day ratings of ability to function, daytime alertness, and sense of physical well-being. At the first week and each month for the study duration, eszopiclone produced significant and sustained improvements in sleep latency, wake time after sleep onset, number of awakenings, number of nights awakened per week, total sleep time, and quality of sleep compared with placebo (P < or = 0.003). Monthly ratings of next-day function, alertness, and sense of physical well-being were also significantly better with the use of eszopiclone than with placebo (P < or = 0.002). There was no evidence of tolerance, and the most common adverse events were unpleasant taste and headache. CONCLUSIONS: Throughout 6 months, eszopiclone improved all of the components of insomnia as defined by DSM-IV, including patient ratings of daytime function. This placebo-controlled study of eszopiclone provides compelling evidence that long-term pharmacologic treatment of insomnia is efficacious
— id: 64184, year: 2003, vol: 26, page: 793, stat: Journal Article,

Estimating population size and duplication rates when records cannot be linked
Laska, Eugene M; Meisner, Morris; Wanderling, Joseph; Siegel, Carole
2003 Nov 15;22(21):3403-3417, Statistics in medicine
The capture-recapture approach to estimating the size of a population is a well-studied area of statistics. The number of distinct individuals, N(A) and N(B), on each of two lists, A and B, and the number common to both lists, N(AB), are used to form an estimate of the binomial probability of being on one of the lists, which then allows an estimate to be made of the size of the population. Critical to the method is an accurate count of N(AB). We consider situations in which this count is not available. Such problems arise in a variety of behavioural health contexts in which the need for protection of privacy may prevent sharing identifying information, so it is not possible to specifically match an individual who appears on one list with an individual on the other. Suppose that the birth dates and/or other demographics of individuals on each list are known. We introduce two methods for estimating the duplication rates and the size of the population. Conditioning on the set beta of birth dates of those on list B, N(A) and N(B), the maximum likelihood estimators (MLEs) and their variance are derived. The MLEs are based on the proportion of individuals on list A whose birth dates fall in beta. This approach is particularly useful if list B itself contains duplicates. The second model utilizes the full sample distribution of the birth dates. We generalize this approach to accommodate multiple demographic characteristics. The approaches are applied to the problem of estimating duplication rates and the population size of veterans who have mental illness in Kings County, NY. The data are lists of those receiving service from the Veterans Administration system and from providers funded or certified by the New York State Office of Mental Health
— id: 60328, year: 2003, vol: 22, page: 3403, stat: Journal Article,

Predicting mild cognition impairment using multiple modalities
Reisberg, B; Laska, E; Prichep, LS; John, ER; Franssen, EH; Monteiro, IM; Boksay, I; Brula, AQ; Ferris, SH
2003 SEP 3 ;15(36):214-215, International psychogeriatrics
— id: 46540, year: 2003, vol: 15, page: 214, stat: Journal Article,

National Depressive and Manic-Depressive Association consensus statement on the use of placebo in clinical trials of mood disorders
Charney, Dennis S; Nemeroff, Charles B; Lewis, Lydia; Laden, Sally K; Gorman, Jack M; Laska, Eugene M; Borenstein, Michael; Bowden, Charles L; Caplan, Arthur; Emslie, Graham J; Evans, Dwight L; Geller, Barbara; Grabowski, Lenore E; Herson, Jay; Kalin, Ned H; Keck, Paul E Jr; Kirsch, Irving; Krishnan, K Ranga R; Kupfer, David J; Makuch, Robert W; Miller, Franklin G; Pardes, Herbert; Post, Robert; Reynolds, Mildred M; Roberts, Laura; Rosenbaum, Jerrold F; Rosenstein, Donald L; Rubinow, David R; Rush, A John; Ryan, Neal D; Sachs, Gary S; Schatzberg, Alan F; Solomon, Susan
2002 Mar;59(3):262-270, Archives of general psychiatry
A consensus conference on the use of placebo in mood disorder studies consisted of expert presentations on bioethics, biostatistics, unipolar depression, and bipolar disorder. Work groups considered evidence and presented statements to the group. Although it was not possible to write a document for which there was complete agreement on all issues, the final document incorporated input from all authors. There was consensus that placebo has a definite role in mood disorder studies. Findings of equivalence between a new drug and standard treatment in active control studies is not evidence of efficacy unless the new drug is also significantly more effective than placebo. Add-on studies in which patients are randomized to standard therapy plus the investigational drug or standard therapy plus placebo are especially indicated for high-risk patients. Mood disorders in elderly and pediatric patients are understudied, and properly designed trials are urgently needed. Research is needed on the ethical conduct of studies to limit risks of medication-free intervals and facilitate poststudy treatment. Patients must fully understand the risks and lack of individualized treatment involved in research
— id: 60332, year: 2002, vol: 59, page: 262, stat: Journal Article,

The use of capture-recapture methods in public health
Laska, Eugene M
2002 ;80(11):845-845, Bulletin of the World Health Organization
— id: 60329, year: 2002, vol: 80, page: 845, stat: Journal Article,

Statistical determination of cost-effectiveness frontier based on net health benefits
Laska, Eugene M; Meisner, Morris; Siegel, Carole; Wanderling, Joseph
2002 Apr;11(3):249-264, Health economics
Statistical methods are given for producing a cost-effectiveness frontier for an arbitrary number of programs. In the deterministic case, the net health benefit (NHB) decision rule is optimal; the rule funds the program with the largest positive NHB at each lambda, the amount a decision-maker is willing to pay for an additional unit of effectiveness. For bivariate normally distributed cost and effectiveness variables and a specified lambda, a statistical procedure is presented, based on the method of constrained multiple comparisons with the best (CMCB), for determining the program with the largest NHB. A one-tailed t test is used to determine if the NHB is positive. To obtain a statistical frontier in the lambda-NHB plane, we develop a method to produce the region in which each program has the largest NHB, by pivoting a CMCB confidence interval. A one-sided version of Fieller's theorem is used to determine the region where the NHB of each program is positive. At each lambda, the pointwise error rate is bounded by a prespecified alpha. Upper bounds on the familywise error rate, the probability of an error at any value of lambda, are given. The methods are applied to a hypothetical clinical trial of antipsychotic agents
— id: 60331, year: 2002, vol: 11, page: 249, stat: Journal Article,

The familywise error rate of a simultaneous confidence band for the incremental net health benefit
Meisner, Morris; Laska, Eugene M; Siegel, Carole; Wanderling, Joseph
2002 Apr;11(3):275-280, Health economics
Interest in the use of net health benefit in cost-effectiveness analysis derives from its optimality property for decision-making. A description of the results of an economic evaluation of health care interventions is incomplete if it does not include point and interval estimates of this outcome measure. A simultaneous confidence band for the incremental net health benefit, INHB(lambda), for all lambda may be obtained by forming a confidence interval based on student's t statistic, and letting the willingness-to-pay value, lambda, run over all values. The familywise error rate (FWER) of the simultaneous confidence band is the probability that the confidence interval does not cover the true INHB(lambda) for some value of lambda. We show that the FWER equals P(T(2)>t(2)), where T(2) follows Hotelling's central distribution and that the simultaneous confidence band does not cover the true INHB(lambda) if and only if a T(2) based confidence ellipsoid does not cover the true mean c-e vector
— id: 60330, year: 2002, vol: 11, page: 275, stat: Journal Article,

Recovery from psychotic illness: a 15- and 25-year international follow-up study
Harrison G; Hopper K; Craig T; Laska E; Siegel C; Wanderling J; Dube KC; Ganev K; Giel R; an der Heiden W; Holmberg SK; Janca A; Lee PW; Leon CA; Malhotra S; Marsella AJ; Nakane Y; Sartorius N; Shen Y; Skoda C; Thara R; Tsirkin SJ; Varma VK; Walsh D; Wiersma D
2001 Jun;178(4):506-517, British journal of psychiatry
BACKGROUND: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS: To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS: Historic prospective study. Standardised assessments of course and outcome. RESULTS: About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS: A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains
— id: 36538, year: 2001, vol: 178, page: 506, stat: Journal Article,

The prevalence and correlates of untreated serious mental illness
Kessler RC; Berglund PA; Bruce ML; Koch JR; Laska EM; Leaf PJ; Manderscheid RW; Rosenheck RA; Walters EE; Wang PS
2001 Dec;36(6 Pt 1):987-1007, Health services research
OBJECTIVE: To identify the number of people in the United States with untreated serious mental illness (SMI) and the reasons for their lack of treatment. DATA SOURCE/STUDY DESIGN: The National Comorbidity Survey; cross-sectional, nationally representative household survey. DATA COLLECTION: An operationalization of the SMI definition set forth in the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act identified individuals with SMI in the 12 months prior to the interview. The presence of SMI then was related to the use of mental health services in the past 12 months. PRINCIPAL FINDINGS: Of the 6.2 percent of respondents who had SMI in the year prior to interview, fewer than 40 percent received stable treatment. Young adults and those living in nonrural areas were more likely to have unmet needs for treatment. The majority of those who received no treatment felt that they did not have an emotional problem requiring treatment. Among those who did recognize this need, 52 percent reported situational barriers, 46 percent reported financial barriers, and 45 percent reported perceived lack of effectiveness as reasons for not seeking treatment. The most commonly reported reason both for failing to seek treatment (72 percent) and for treatment dropout (58 percent) was wanting to solve the problem on their own. CONCLUSIONS: Although changes in the financing of services are important, they are unlikely by themselves to eradicate unmet need for treatment of SMI. Efforts to increase both self-recognition of need for treatment and the patient centeredness of care also are needed
— id: 60333, year: 2001, vol: 36, page: 987, stat: Journal Article,

Statistical cost-effectiveness analysis of two treatments based on net health benefits
Laska EM; Meisner M; Siegel C; Wanderling J
2001 Apr 30;20(8):1279-1302, Statistics in medicine
Statistical methods for cost-effectiveness analysis (CEA) for two treatments that mimic the deterministic optimal rules of CEA are presented. In these rules the objective is to determine the treatment with the maximal effectiveness whose unit cost is less than an amount, lambda, that a decision-maker is willing to pay (WTP). This is accomplished by identifying the treatment with the largest positive net health benefit (NHB), which is a function of lambda, while controlling the familywise error rate both when the WTP value is given and when it is unspecified. Fieller's theorem is used to determine a region of WTP values where the NHBs of the treatments are not distinguishable. For each lambda outside of the confidence region, the larger treatment is identified. A newly developed one-tailed analogue of Fieller's theorem is used to determine the WTP values where a treatment's NHB is positive. The situation in which both treatments are experimental is distinguished from the case where one of the treatments is usual care. The one-tailed confidence region is used in the latter case to obtain the lambda values where the NHBs are not different, and determining the region of positivity of the NHBs may be unnecessary. An example is presented in which the cost-effectiveness of two antipsychotic treatments is evaluated
— id: 60334, year: 2001, vol: 20, page: 1279, stat: Journal Article,

Assessing the onset of relief of a treatment for migraine
Laska EM; Siegel C
2000 Oct;20(8):724-731, Cephalalgia
It is common for clinical trials designed to compare treatments for migraine to incorporate a component for estimating onset. Our objective is to describe a stopwatch method for collecting data on time to meaningful relief and a conceptual framework for describing and analysing the results. The survival distribution of onset is modelled in two parts: the probability that onset does not occur, and the survival distribution conditional on its occurrence. Using data from a clinical trial comparing an active treatment and placebo, we illustrate the method and find that the distributions of onset among those with onset do not differ, but the probabilities that onset occurs are substantially different. We illustrate how the model can be used to help determine how long patients without onset should wait before further intervention, how patients interpret the phrase meaningful relief, and how baseline clinical characteristics affect the onset
— id: 60335, year: 2000, vol: 20, page: 724, stat: Journal Article,

Oral aspirin in post-operative pain: a quantitative, systematic review. Edwards et al.,PAIN 81 (1999) 289-297
Sunshine, A; Laska, E; Meisner, M
2000 Dec 1;88(3):309-311, Pain
— id: 140506, year: 2000, vol: 88, page: 309, stat: Journal Article,

Power and sample size in cost-effectiveness analysis
Laska EM; Meisner M; Siegel C
1999 Jul-Sep;19(3):339-343, Medical decision making
For resource allocation under a constrained budget, optimal decision rules for mutually exclusive programs require that the treatment with the highest incremental cost-effectiveness ratio (ICER) below a willingness-to-pay (WTP) criterion be funded. This is equivalent to determining the treatment with the smallest net health cost. The designer of a cost-effectiveness study needs to select a sample size so that the power to reject the null hypothesis, the equality of the net health costs of two treatments, is high. A recently published formula derived under normal distribution theory overstates sample-size requirements. Using net health costs, the authors present simple methods for power analysis based on conventional normal and on nonparametric statistical theory
— id: 60336, year: 1999, vol: 19, page: 339, stat: Journal Article,

Ratio-based and net benefit-based approaches to health care resource allocation: proofs of optimality and equivalence
Laska EM; Meisner M; Siegel C; Stinnett AA
1999 Mar;8(2):171-174, Health economics
Both incremental cost-effectiveness ratios and net benefits have been proposed as summary measures for use in cost-effectiveness analyses. We present a unifying proof of the optimality and equivalence of ICER- and net benefit-based approaches to the health resource allocation problem, including both 'fixed budget' and 'fixed price' decision rules. If internally consistent willingness-to-pay values are used, ratio- and net benefit-based decision rules identify the same optimal allocation. Because they have identical resource allocation implications, use of one or other of the two approaches must be based on other criteria, such as their behaviour under conditions of uncertainty
— id: 60337, year: 1999, vol: 8, page: 171, stat: Journal Article,

Estimating the size of a population from a single sample: methodology and practical issues
Laska E; Lin S; Meisner M
1997 Oct;50(10):1143-1154, Journal of clinical epidemiology
In contrast to classical capture recapture methods, the single-sample method of Laska, Meisner, and Siegel (1988) (LMS) enables estimation of the size of a population, N*, on the basis of a single survey. For example, it may be desired to estimate the unduplicated number of individuals served by a mental health center during the last year on the basis of a 1-week sample. The time since each of the sampled individuals last engaged in the activity that defines the population is ascertained. The LMS estimator of N* and its unbiasedness property are motivated in a simple way, and an improved LMS estimator is introduced if additional information is available. An empirical assessment of the procedure is made using mental health service data for which the true population size is known. The performance of the extended LMS estimator is a substantial improvement over the standard LMS estimator
— id: 60292, year: 1997, vol: 50, page: 1143, stat: Journal Article,

Statistical inference for cost-effectiveness ratios
Laska EM; Meisner M; Siegel C
1997 May-Jun;6(3):229-242, Health economics
Methods for statistical inference for cost-effectiveness (C/E) ratios for individual treatment and for incremental cost-effectiveness (delta C/ delta E) ratios when two treatments are compared are presented. In a lemma, we relate the relative magnitude of two C/E ratios to the delta C/ delta E ratio. We describe a statistical procedure to test for dominance, or admissibility, that can be used to eliminate an inferior treatment. The one-sided Bonferroni's confidence interval procedure is generalized to the two-sided case. The method requires only that two confidence intervals be available, one for cost and one for effectiveness. We describe Fieller-based confidence intervals and show them to be shorter than Bonferroni intervals. When distribution assumptions hold and variance and covariance estimates are available, Fieller intervals are preferable. However, Bonferroni intervals can be applied in more diverse situations and are easier to calculate. A simple Bonferroni based technique, and a likelihood ratio statistic given by Siegel, Laska and Meisner, for testing the null hypothesis that the C/E ratios of two treatments are equal is presented. The approaches are applied to the data from a phase II clinical trial of a new treatment for sepsis considered previously by others
— id: 60340, year: 1997, vol: 6, page: 229, stat: Journal Article,

The usefulness of average cost-effective ratios
Laska EM; Meisner M; Siegel C
1997 Sep-Oct;6(5):497-504, Health economics
We demonstrate that average cost-effectiveness ratios (CERs) play an important role in the evaluation of the cost-effectiveness of treatments. Criticisms of the usefulness of CERs derive mostly from the context of resource allocation under a constrained budget in which some decisions are based on incremental CERs. However, we show that in many cases, these decision rules are equivalent to decision rules on CERs. This follows for mutually exclusive treatments first, because a treatment is eliminated by extended dominance if and only if there is a mixed treatment with a smaller CER, where the mixing parameter lies in a certain interval. Second, after elimination of treatments by dominance and by extended dominance, resources can be allocated in order of increasing CERs. Moreover, the CER is a parameter that characterizes clinical and economical properties of a treatment independent of its comparators
— id: 60338, year: 1997, vol: 6, page: 497, stat: Journal Article,

Classification of the effectiveness of combination treatments
Laska EM; Meisner M; Tang DI
1997 Oct 15;16(19):2211-2228, Statistics in medicine
According to FDA regulations, a combination drug is not efficacious unless each component contributes to the claimed effects. For a univariate endpoint, this implies that the combination at specific doses must be superior to each of its components at the same doses. More demanding is the property of synergy, in which the effect of the combination must be superior to the effect expected based on those of its components. If it is equal to those effects, it is additive, and if it is inferior, it is antagonistic. We give regions in the combination dose plane where these concepts are well defined. If the effect of the combination is greater than the greatest effect achievable by any of its components it is therapeutically synergistic. A combination can be antagonistic, yet its components can still contribute to the claimed effects. If it is additive, synergistic or therapeutically synergistic, its components must contribute to the claimed effects. We relate these concepts and provide designs and sequential procedures for determining whether a combination is therapeutically synergistic, synergistic, additive, antagonistic and contributing or antagonistic and non-contributing
— id: 60339, year: 1997, vol: 16, page: 2211, stat: Journal Article,

History of violent behaviour and schizophrenia in different cultures. Analyses based on the WHO study on Determinants of Outcome of Severe Mental Disorders
Volavka J; Laska E; Baker S; Meisner M; Czobor P; Krivelevich I
1997 Jul;171:9-14, British journal of psychiatry
BACKGROUND: Information on patterns and correlates of the violent behaviour of individuals with schizophrenia is largely limited to populations in developed countries. Data from a World Health Organization epidemiological study of schizophrenia and related disorders, the Determinants of Outcome of Severe Mental Disorders (DOSMD), presented an opportunity to study patterns of violence across multinational settings. METHOD: Centres in 10 countries participated in the DOSMD study. An incidence sample of 1017 patients with schizophrenia who had their first-in-lifetime contact with a helping agency as a result of their psychotic symptoms was obtained. Data were available on their history of violent behaviour, substance use, and demographics. RESULTS: The occurrence rate of assault in the entire cohort was 20.6 per hundred, but the rate was three times higher in the developing countries (31.5 per hundred) than in developed countries (10.5 per hundred). History of assault was associated with positive symptoms, such as excitement and auditory hallucinations, and with serious alcohol problems. CONCLUSIONS: The cultural context and the specific characteristics of the disease in individuals with schizophrenia may interactively affect rates of violent behaviour
— id: 61020, year: 1997, vol: 171, page: 9, stat: Journal Article,

Estimating population size when duplicates are present
Laska EM; Meisner M; Wanderling JA; Kushner HB
1996 Aug 15;15(15):1635-1646, Statistics in medicine
Each of K mental health programmes reports the number of patients served in a year. The sum of these numbers, y, is an overcount because some patients are seen in more than one programme. Health care planners need to know the unduplicated number served by the mental health system. Thus, there is an unknown number, M, of distinct individuals who appear on one or more of K lists; some appear on multiple lists and the duplicates are not readily identifiable. Let X be the number of lists on which a randomly selected individual appears. When E(X) is known, y/E(X) is the natural estimator of M. We assume that we know the number of programmes, Xi, used by the ith individual in a random sample of recipients of service. Here, the intuitive estimator, Y/X has desirable statistical properties. We give confidence interval estimators for M. We apply the method to estimate the number of individuals served in 1991 by the mental health programmes in New York State
— id: 60341, year: 1996, vol: 15, page: 1635, stat: Journal Article,

Mortality and temporal course of probable Alzheimer's disease: a 5-year prospective study
Reisberg B; Ferris SH; Franssen EH; Shulman E; Monteiro I; Sclan SG; Steinberg G; Kluger A; Torossian C; de Leon MJ; Laska E
1996 Summer;8(2):291-311, International psychogeriatrics
Alzheimer's disease (AD) is associated with an increased mortality in comparison with aged control populations. The relationship between the clinical and the temporal course of AD has not been well studied over significant intervals. Community-residing patients with probable AD (N = 103, 42 men, mean age = 70.2 +/- 8.0 years) were studied at baseline on demographic and clinical variables, including measures of global deterioration (Global Deterioration Scale; GDS), mental status and cognition (e.g., Mini-Mental State Examination; MMSE), and functional impairment (Functional Assessment Staging; FAST). Baseline characteristics included a GDS range of Stage 4, 5, or 6 (38.8%, 39.8%, and 21.4%, respectively) and a mean MMSE score of 15.4 +/- 5.6. The mean follow-up interval was 4.6 +/- 1.4 years. Follow-ups were done blind to baseline measures and when necessary were conducted in residential and nursing home settings. Of locatable subjects (n = 95, 92%), 30 (31.6%) were decreased. Survivors (n = 65) had a mean GDS stage of 6.2 +/- 0.9 and a mean MMSE score of 5.1 +/- 6.9; 51% had MMSE scores of 0. Increased age and male gender, but not baseline clinical dementia variables, increased the risk of death (ps < .01). Change in clinical variables correlated significantly with time elapsed (r = .32, p < .05, for MMSE change, to r = .48, p < .001, for GDS change). Significant variance in temporal change (i.e., time elapsed) was accounted for by change in two of the five clinical measures studied (i.e., GDS and FAST; multiple r = .53). The results support previous estimates of mean duration of the GDS and FAST stages. For subjects with probable AD followed over approximately 5 years, clinical variables changed significantly over time in survivors. However, the majority of temporal variance in the course of AD remains unexplained
— id: 9450, year: 1996, vol: 8, page: 291, stat: Journal Article,

Long-term follow-up of schizophrenia in 16 countries. A description of the International Study of Schizophrenia conducted by the World Health Organization
Sartorius, N; Gulbinat, W; Harrison, G; Laska, E; Siegel, C
1996 Sep;31(5):249-258, Social psychiatry & psychiatric epidemiology
An unexpected finding of the International Pilot Study of Schizophrenia, launched by the World Health Organization (WHO) in 1967, was that patients in countries outside Europe and the United States have a more favourable short- and medium-term course of the disease than those seen in developed countries. Since then, WHO has intensified its schizophrenia research programme and has initiated a set of international studies that have confirmed these initial findings and explored possible reasons for such differences in the course and outcome of schizophrenia. While such work has provided important findings and has generated additional pertinent hypotheses, it did not explain the differences in outcome. The present paper describes a new initiative in which approximately 2500 subjects involved in previous WHO multicentre schizophrenia studies are being followed up for between 15 and 25 years after initial examination. Nineteen research centres in 16 countries are taking part in this work. The research methodology is described
— id: 138843, year: 1996, vol: 31, page: 249, stat: Journal Article,

Statistical methods for cost-effectiveness analyses
Siegel, C; Laska, E; Meisner, M
1996 Oct;17(5):387-406, Controlled clinical trials
A statistical framework is presented for examining cost and effect data on competing interventions obtained from an RCT or from an observational study. Parameters of the join distribution of costs and effects or a regression function linking costs and effects are used to define cost-effectiveness (c-e) measures. Several new c-e measures are proposed that utilize the linkage between costs and effects on the patient level. These measures reflect perspectives that are different from those of the commonly used measures, such as the ratio of expected cost to expected effect, and they can lead to different relative rankings of the interventions. The cost-effectiveness of interventions are assessed statistically in a two stage procedure that first eliminates clearly inferior interventions. Members of the remaining admissible set are then rank ordered according to a c-e preference measure. Statistical techniques, particularly in the multivariate normal case, are given for several commonly used c-e measures. These techniques provide methods for obtaining confidence intervals, for testing the hypothesis of admissibility and for the equality of interventions, and for ranking interventions. The ideas are illustrated for a hypothetical clinical trial of antipsychotic agents for community-based persons with mental illness
— id: 138844, year: 1996, vol: 17, page: 387, stat: Journal Article,

Onset and duration of analgesia for graded doses of ketoprofen in postoperative dental pain
Sunshine, A; Olson, NZ; Marrero, I; Tirado, S; Laska, E
1996 FEB ;59(2):PI15-PI15, Clinical pharmacology & therapeutics
— id: 53057, year: 1996, vol: 59, page: PI15, stat: Journal Article,

Placebo washout in trials of antipsychotic drugs
Volavka J; Cooper TB; Laska EM; Meisner M
1996 ;22(4):567-576, Schizophrenia bulletin
For antipsychotic phase 3 clinical trials, we compare the relative merits of a placebo washout period with an alternate design strategy using a low-dose antipsychotic treatment. Evaluations are made with respect to the achievement of specific clinical trial design goals including the effect on power for detecting between-treatment and within-treatment pre-post differences. The relative merits of these two designs are discussed separately for those patients who enter the initial leadin period after withdrawal from previous antipsychotic medication and for those not on medication immediately before that period
— id: 60342, year: 1996, vol: 22, page: 567, stat: Journal Article,

Blunted change in cerebral glucose utilization after haloperidol treatment in schizophrenic patients with prominent negative symptoms
Wolkin A; Sanfilipo M; Duncan E; Angrist B; Wolf AP; Cooper TB; Brodie JD; Laska E; Rotrosen JP
1996 Mar;153(3):346-354, American journal of psychiatry
OBJECTIVE: The purpose of this report was to determine 1) the effects of chronic haloperidol treatment on cerebral metabolism in schizophrenic patients, 2) the relation between negative symptoms and haloperidol-induced regional changes in cerebral glucose utilization, and 3) the relation between metabolic change and clinical antipsychotic effect. METHOD: Cerebral glucose utilization, as determined by position emission tomography (PET), was studied in 18 male schizophrenic subjects before and after chronic treatment with haloperidol at a standardized plasma level. RESULTS: Overall, haloperidol caused a widespread decrease in absolute cerebral glucose metabolism. The cerebral metabolic response to haloperidol was blunted in patients with high pretreatment negative symptom scores. CONCLUSIONS: Taken together with the results from a previously reported PET study of the effects of an acute amphetamine challenge (in which 14 of the current subjects participated), these data suggest that the negative symptom complex is associated with diminished cerebral response to change in dopaminergic activity. This deficit cannot be solely accounted for by structural differences
— id: 7060, year: 1996, vol: 153, page: 346, stat: Journal Article,

Characterizing onset in psychopharmacological clinical trials
Laska EM; Siegel C
1995 ;31(1):29-35, Psychopharmacology bulletin
In addition to describing treatment efficacy in terms of changes in rating scale scores, the distributions of time to occurrence of major clinical events such as onset and response are clinically important information. Issues in the design, conduct and analysis of clinical trials in which the time to onset of effect or time to response is to be characterized are discussed. A criterion must be defined to signal that the clinical event has occurred. Onset properties are given in terms of (1) the probability of obtaining onset and (2) for patients who obtain onset, the distribution of time to onset. A statistical model and methods to estimate parameters and compare onset times of treatments are described. A simple formula that can be used to aid in clinical decision making as to when to alter treatment if onset has not yet occurred is presented
— id: 60343, year: 1995, vol: 31, page: 29, stat: Journal Article,

Simple designs and model-free tests for synergy
Laska EM; Meisner M; Siegel C
1994 Sep;50(3):834-841, Biometrics
Current statistical designs for studying whether two or more agents in combination act synergistically nearly always require the study of several doses of many dose ratios. The analysis is usually based on an assumed parametric model of the dose-response surface. In this paper, for both quantal and quantitative response variables, sufficient conditions are given for establishing synergy at a dose of the combination without the need to specify the model. This enables the use of simple designs with few doses even when there is sparse knowledge of the dose-response curves of the individual agents. The Min test, used for testing whether an identified treatment is best, may be used for testing synergy. Power issues are discussed
— id: 60344, year: 1994, vol: 50, page: 834, stat: Journal Article,

Acute d-amphetamine challenge in schizophrenia: effects on cerebral glucose utilization and clinical symptomatology
Wolkin A; Sanfilipo M; Angrist B; Duncan E; Wieland S; Wolf AP; Brodie JD; Cooper TB; Laska E; Rotrosen JP
1994 Sep 1;36(5):317-325, Biological psychiatry
The effects of d-amphetamine (0.5 mg/kg orally) on regional cerebral glucose utilization were measured with positron emission tomography (PET) in 17 schizophrenics (along with a placebo-control group of an additional six schizophrenic patients). The acute d-amphetamine challenge tended to decrease glucose utilization throughout much of the brain, with a regional effect that was statistically significant in the left temporal cortex. There was no apparent relationship between the effects of amphetamine-induced changes in regional cerebral metabolism and psychotic symptom exacerbation. An exploratory analysis suggested that features characteristic of Crow's type II syndrome were significant predictors of cerebral hyporesponsivity to stimulant challenge, however
— id: 8462, year: 1994, vol: 36, page: 317, stat: Journal Article,

A plant-capture method for estimating the size of a population from a single sample
Laska EM; Meisner M
1993 Mar;49(1):209-220, Biometrics
To estimate the size of a population a plant-capture method, an alternative to the classic capture-mark-recapture model, is presented. Known or marked individuals otherwise indistinguishable from the remainder of the population are planted followed by an effort to capture members from the augmented population. Maximum likelihood estimators and a confidence region together with the expected length of the confidence interval for the size of the population as a function of the number of plants are given. A methodology for comparing the cost efficiency of plant-capture to capture-recapture is developed. An application to counting the homeless is given
— id: 60345, year: 1993, vol: 49, page: 209, stat: Journal Article,

Nonparametric estimation and testing in a cure model
Laska EM; Meisner MJ
1992 Dec;48(4):1223-1234, Biometrics
Nonparametric generalized maximum likelihood product limit point estimators and confidence intervals are given for a cure model with random censorship. One-, two-, and K-sample likelihood ratio tests for inference on the cure rates are developed. In the two-sample case its power is compared to the power of several alternatives, including the log-rank and Gray and Tsiatis (1989, Biometrics 45, 899-904) tests. Implications for the use of the likelihood ratio test in a clinical trial designed to compare cure rates are discussed
— id: 60346, year: 1992, vol: 48, page: 1223, stat: Journal Article,

A risk-based prospective payment system that integrates patient, hospital and national costs
Siegel C; Jones K; Laska E; Meisner M; Lin S
1992 May;11(1):1-41, Journal of health economics
We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients
— id: 60314, year: 1992, vol: 11, page: 1, stat: Journal Article,

Haloperidol blood levels and clinical effects
Volavka J; Cooper T; Czobor P; Bitter I; Meisner M; Laska E; Gastanaga P; Krakowski M; Chou JC; Crowner M
1992 May;49(5):354-361, Archives of general psychiatry
This study explored the relationships between plasma levels and the clinical effects of haloperidol in 176 acutely exacerbated schizophrenic or schizoaffective patients. After a single-blind placebo period of 1 week (period 1), they entered the double-blind period 2 randomly assigned to one of three plasma levels of haloperidol: low (2 to 13 ng/mL), medium (13.1 to 24 ng/mL), or high (24.1 to 35 ng/mL). Patients whose conditions did not improve in period 2 continued on one of the three haloperidol levels (period 3). Periods 2 and 3 lasted 6 weeks each. Only minor differences in clinical responses were noted among the three levels of haloperidol. These results imply that low or moderate doses of neuroleptics are appropriate for many acutely psychotic patients
— id: 8268, year: 1992, vol: 49, page: 354, stat: Journal Article,

Importance of pharmacologic control in PET studies: effects of thiothixene and haloperidol on cerebral glucose utilization in chronic schizophrenia
Bartlett EJ; Wolkin A; Brodie JD; Laska EM; Wolf AP; Sanfilipo M
1991 Oct;40(2):115-124, Psychiatry research
This study compares the effects of two neuroleptic drugs with different pharmacologic characteristics (thiothixene and haloperidol) on cerebral glucose utilization in chronic schizophrenic inpatients. Positron emission tomographic (PET) scans were obtained from all subjects in a neuroleptic-free condition and again after 4-6 weeks of neuroleptic treatment. Eight subjects were treated with thiothixene and 12 with haloperidol. Thiothixene and haloperidol had different metabolic effects. For example, all thiothixene-treated subjects showed increased whole brain glucose utilization; all but one haloperidol-treated subject showed decreased utilization. Different patterns of relative prefrontal and striatal metabolism were also observed. These results highlight the importance of controlling for the effects of neuroleptic treatment and indicate the difficulty of interpreting data from studies with complex or poorly defined drug regimens
— id: 13887, year: 1991, vol: 40, page: 115, stat: Journal Article,

A BARTLETT CORRECTION FACTOR FOR A LIKELIHOOD RATIO STATISTIC IN MULTIVARIATE BIOASSAY
Kushner, HB; Meisner, M; Laska, EM
1991 Jul-Aug;20(5-6):1549-1555, Communications in statistics: theory & methods
A more accurate Bartlett correction factor is proposed for a likelihood ratio statistic in multivariate bioassay
— id: 32158, year: 1991, vol: 20, page: 1549, stat: Journal Article,

A CONFIDENCE REGION WITH MULTIPLE INTERVALS IN MULTIVARIATE BIOASSAY
Kushner, HB; Meisner, M; Laska, EM
1991 Jul-Aug;20(5-6):1533-1547, Communications in statistics: theory & methods
The exact confidence region for log relative potency resulting from likelihood score methods (Williams (1988) An exact confidence interval for the relative potency estimated from a multivariate bioassay, Biometrics, 44:861-868) will very likely consist of two disjoint confidence intervals. The two methods proposed by Williams which aim to select just one (the same) confidence interval from the confidence region are nearly -- but not completely -- consistent. The likelihood score interval and likelihood ratio interval are asymptotically equivalent. Williams' very strong claim concerning the confidence coefficient in the second selection method is still theoretically unproved; yet, simulations show that it is true for a wide range of practical experimental situations
— id: 32157, year: 1991, vol: 20, page: 1533, stat: Journal Article,

Onset and duration: measurement and analysis
Laska EM; Siegel C; Sunshine A
1991 Jan;49(1):1-5, Clinical pharmacology & therapeutics
— id: 10131, year: 1991, vol: 49, page: 1, stat: Journal Article,

STATISTICAL-METHODS IN UNIVARIATE AND MULTIVARIATE BIOASSAY
LASKA, EM; MEISNER, M
1991 APR ;18(4):683-690, Advances in pain research & therapy
— id: 51694, year: 1991, vol: 18, page: 683, stat: Journal Article,

ANALYTIC APPROACHES TO QUANTIFYING PAIN SCORES
LASKA, EM; MEISNER, M; SIEGEL, C
1991 APR ;18(4):675-682, Advances in pain research & therapy
— id: 51693, year: 1991, vol: 18, page: 675, stat: Journal Article,

ONSET AND DURATION - MEASUREMENT AND ANALYSIS
LASKA, EM; SIEGEL, C; SUNSHINE, A
1991 APR ;18(4):691-698, Advances in pain research & therapy
— id: 51695, year: 1991, vol: 18, page: 691, stat: Journal Article,

The spectral signature method for the analysis of PET brain images
Levy, A V; Laska, E; Brodie, J D; Volkow, N D; Wolf, A P
1991 Mar;11(2):A103-A113, Journal of cerebral blood flow & metabolism
We introduce the concept of the metabolic centroid spectrum as the feature space to characterize the distribution of metabolic activity in three-dimensional brains. The method computes the metabolic centroid of a brain subvolume for each increment of metabolic activity occurring in the whole brain. The result is the metabolic spectral signature, a continuous three-dimensional curve whose shape reflects the distribution of metabolic rates in the brain. The method's sensitivity to metabolic distribution asymmetries is greatly increased over that of the metabolic centroid method, while retaining its advantages; it is almost invariant to head size, head positioning, photon scatter, and the positron emission tomography (PET) camera's full width at half-maximum. It does not require magnetic resonance, computed tomography, or x-ray images. To test the method we analyzed the metabolic PET images of 40 normal subjects and 20 schizophrenics. The results show a unification of several metabolic characteristics of schizophrenic brains, such as laterality, hypofrontality, cortical/subcortical abnormalities, and overall brain hypometabolism, which were identified by different laboratories in separate studies using differing methodologies. Here they are presented by a single automatic objective method
— id: 140511, year: 1991, vol: 11, page: A103, stat: Journal Article,

SINGLE-DOSE ANALGESIC COMPARISONS
MAX, MB; LASKA, EM
1991 APR ;18(4):55-95, Advances in pain research & therapy
— id: 51691, year: 1991, vol: 18, page: 55, stat: Journal Article,

The Design of analgesic clinical trials
Max, Mitchell.; Portenoy, Russell K.; Laska, Eugene M
New York : Raven Press, c1991,
— id: 278, year: 1991, vol: , page: , stat: ,

THE METABOLIC CENTROID METHOD FOR PET BRAIN IMAGE-ANALYSIS - REPLY
Levy, AV; Brodie, JD; Russell, JAG; Volkow, ND; Laska, EM; Wolf, AP
1990 May;10(3):439-440, Journal of cerebral blood flow & metabolism
— id: 31949, year: 1990, vol: 10, page: 439, stat: Journal Article,

ANALGESIC EFFICACY OF CHOLINE MAGNESIUM TRISALICYLATE (TRILISATE) ALONE AND IN COMBINATION WITH CODEINE CONTIN COMPARED TO ACETAMINOPHEN PLUS CODEINE
Sunshine, A; Marrero, I; Olson, NZ; Tirado, S; Kaiko, R; Grandy, R; Siegel, C; Laska, E
1990 Jul;183(6):2274-2275, European journal of pharmacology
— id: 31926, year: 1990, vol: 183, page: 2274, stat: Journal Article,

Testing whether an identified treatment is best
Laska EM; Meisner MJ
1989 Dec;45(4):1139-1151, Biometrics
We consider the problem of testing whether an identified treatment is better than each of K treatments. Suppose there are univariate test statistics Si that contrast the identified treatment with treatment i for i = 1, 2,...., K. The min test is defined to be the alpha-level procedure that rejects the null hypothesis that the identified treatment is not best when, for all i, Si rejects the one-sided hypothesis, at the alpha-level, that the identified treatment is not better than the ith treatment. In the normal case where Si are t statistics the min test is the likelihood ratio test. For distributions satisfying mild regularity conditions, if attention is restricted to test statistics that are monotone nondecreasing functions of Si, then regardless of their covariance structure the min test is an optimal alpha-level test. Tables of the sample size needed to achieve power .5, .8, .90, and .95 are given for the min test when the Si are Student's t and Wilcoxon
— id: 60347, year: 1989, vol: 45, page: 1139, stat: Journal Article,

A BIVARIATE MODEL OF ONSET AND DURATION
Laska, E; Siegel, C; Meisner, M
1989 Feb;45(2):159-159, Clinical pharmacology & therapeutics
— id: 31745, year: 1989, vol: 45, page: 159, stat: Journal Article,

The metabolic centroid method for PET brain image analysis
Levy, A V; Brodie, J D; Russell, A G; Volkow, N D; Laska, E; Wolf, A P
1989 Jun;9(3):388-397, Journal of cerebral blood flow & metabolism
The method of centroids is an approach to the analysis of three-dimensional whole-brain positron emission tomography (PET) metabolic images. It utilizes the brain's geometric centroid and metabolic centroid so as to objectively characterize the central tendency of the distribution of metabolic activity in the brain. The method characterizes the three-dimensional PET metabolic image in terms of four parameters: the coordinates of the metabolic centroid and the mean metabolic rate of the whole brain. These parameters are not sensitive to spatially uniform random noise or to the position of the subject's head within a uniform PET camera field of view. The method has been applied to 40 normal subjects, 22 schizophrenics who were treated with neuroleptics, and 20 schizophrenics who were neuroleptic-free. The mean metabolic centroid of the normal subjects was found to be superior to the mean geometric centroid of the brain. The mean metabolic centroid of chronic schizophrenics is lower and more posterior to the mean geometric centroid than is that of normals. This difference is greater in medicated than in unmedicated schizophrenics. The posterior and downward displacement of the mean metabolic centroid is consistent with the concepts of hypofrontality, hyperactivity of subcortical structures, and neuroleptic effect in schizophrenics
— id: 140512, year: 1989, vol: 9, page: 388, stat: Journal Article,

Meptazinol and morphine in postoperative pain assessed with a new method for onset and duration
Siegel C; Sunshine A; Richman H; Olson NZ; Robissa N; Cordone R; Estrada N; Laska E
1989 Nov;29(11):1017-1025, Journal of clinical pharmacology
Meptazinol, m-(3-ethyl-1-methyl-hexahydro-1-H-azepin-3-yl) phenol hydrochloride is a centrally active opioid analgesic with a specificity for the mu-1 receptor. It has been reported to lack many of the side effects commonly observed with morphine and morphinelike drugs in man. The objective of this study was to assess the analgesic efficacy and safety of meptazinol (50 mg and 100 mg) relative to morphine (5 mg and 10 mg) when administered intramuscularly for the treatment of postoperative pain. In addition, a new clinical method for measuring onset and duration and a statistical technique for evaluating the study data are presented. One hundred and seventeen patients were evaluated for 6 hours in a randomized double blind, single dose, parallel-groups trial. Estimates of relative potency for hourly pain and relief parameters, and the summary variables sum of pain intensity differences (SPID) and total pain relief (TOTPAR) were performed. The estimate of relative potency of meptazinol to morphine for pain relief was 0.19 at 1/2 hour (i.e. 100 mg of meptazinol was approximately equivalent to 20 mg of morphine). Thereafter, there was a rapid decline of efficacy for meptazinol, with a relative potency estimate of 0.12 at 1 hour and 0.06 at 2 hours. The distribution functions for several time related events were estimated including time to onset, duration and time to remedication. The two drugs had approximately equal onset, but meptazinol had significantly shorter duration. More patients on meptazinol required remedication with a rescue analgesic and at an earlier time than patients on morphine.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10132, year: 1989, vol: 29, page: 1017, stat: Journal Article,

ANALGESIC ADJUVANCY OF CAFFEINE WITH IBUPROFEN IN 3 DIFFERENT POSTPARTUM PAIN POPULATIONS
Sunshine, A; Laska, E; Siegel, C; Zighelboim, I; Decastro, A; Sorrentino, J; Smith, D; Bartizek, R
1989 Feb;45(2):174-174, Clinical pharmacology & therapeutics
— id: 31747, year: 1989, vol: 45, page: 174, stat: Journal Article,

IBUPROFEN, ASPIRIN, AND PLACEBO IN POSTPARTUM PAIN
Sunshine, A; Zighelboim, I; Hoburg, A; Byrd, W; Olson, NZ; Laska, E; Siegel, C
1989 Feb;45(2):174-174, Clinical pharmacology & therapeutics
— id: 31746, year: 1989, vol: 45, page: 174, stat: Journal Article,

Reproducibility of cerebral glucose metabolic measurements in resting human subjects
Bartlett EJ; Brodie JD; Wolf AP; Christman DR; Laska E; Meissner M
1988 Aug;8(4):502-512, Journal of cerebral blood flow & metabolism
Positron emission tomography with 11C-2-deoxyglucose was used to determine the test-retest variability of regional cerebral glucose metabolism in 22 young normal right-handed men scanned twice in a 24-h period under baseline (resting) conditions. To assess the effects of scan order and time of day on variability, 12 subjects were scanned in the morning and afternoon of the same day (a.m.-p.m.) and 10 in the reverse order (p.m.-a.m.) with a night in between. The effect of anxiety on metabolism was also assessed. Seventy-three percent of the total subject group showed changes in whole brain metabolism from the first to the second measurement of 10% or less, with comparable changes in various cortical and subcortical regions. When a scaling factor was used to equate the whole brain metabolism in the two scans for each individual, the resulting average regional changes for each group were no more than 1%. This suggests that the proportion of the whole brain metabolism utilized regionally is stable in a group of subjects over time. Both groups of subjects had lower morning than afternoon metabolism, but the differences were slight in the p.m.-a.m. group. One measure of anxiety (pulse at run 1) was correlated with run 1 metabolism and with the percentage of change from run 1 to run 2. No significant run 2 correlations were observed. This is the first study to measure test-retest variability in cerebral glucose metabolism in a large sample of young normal subjects. It demonstrates that the deoxyglucose method yields low intrasubject variability and high stability over a 24-h period
— id: 11005, year: 1988, vol: 8, page: 502, stat: Journal Article,

ESTIMATING THE SIZE OF A POPULATION FROM A SINGLE SAMPLE
LASKA, EM; MEISNER, M; SIEGEL, C
1988 JUN ;44(2):461-472, Biometrics
— id: 41767, year: 1988, vol: 44, page: 461, stat: Journal Article,

Neuroleptic plasma level may predict response in patients who meet a criterion for improvement
Levinson, D F; Simpson, G M; Singh, H; Cooper, T B; Laska, E V; Midha, K K
1988 Sep;45(9):878-879, Archives of general psychiatry
— id: 137570, year: 1988, vol: 45, page: 878, stat: Journal Article,

Effects of prenatal exposure to neuroleptic drugs on children's growth
Platt JE; Friedhoff AJ; Broman SH; Bond RN; Laska E; Lin SP
1988 Sep;1(3):205-212, Neuropsychopharmacology
The effect of prenatal exposure to neuroleptic drugs on height and weight from birth to 7 years was examined in children of psychiatrically normal parents and of parents with a history of psychiatric treatment, using data from the Collaborative Perinatal Project of the National Institute of Neurological Diseases, Communicative Disorders, and Stroke. Analysis of covariance was used to control for potential confounding factors. We found that prenatal exposure to dopamine receptor-blocking neuroleptic drugs was associated with increased height in one or more of our groups at 4 months, 1 year, and 7 years and less consistently with increased weight. Seven-year-old children who had been exposed to these drugs for more than 2 months during gestation were approximately 3 cm taller than unexposed controls (p less than 0.05). Prenatal exposure to dopamine-depleting agents was associated with decreased height at 4 months but not later. Possible mechanisms for these effects, including a permanent decrease in the number of brain dopamine receptors and effects on various hormones, are discussed
— id: 10985, year: 1988, vol: 1, page: 205, stat: Journal Article,

Analgesic efficacy of piroxicam in the treatment of postoperative pain
Sunshine A; Roure C; Colon A; Olson NZ; Gonzalez L; Siegel C; Laska E
1988 May 20;84(5A):16-22, American journal of medicine
Two randomized, double-blind, single-dose studies were conducted to assess the analgesic efficacy and safety of piroxicam for the treatment of moderate or severe postoperative pain. Study 1 evaluated the analgesic efficacy of piroxicam 20 mg compared with that of codeine sulfate 60 mg and placebo. A final patient population of 149 subjects rated pain intensity and pain relief at one half hour and one hour following treatment and then hourly for six hours, with a global assessment made at the completion of 24 hours. Piroxicam 20 mg was significantly more efficacious than placebo for all analgesic variables, including the sum of the pain intensity differences (SPID), total pain relief (TOTAL), percent SPID, duration of effect, and time to remedication. Codeine 60 mg was significantly superior to placebo for percent SPID and some hourly measures. Piroxicam 20 mg was significantly more effective than codeine 60 mg for percent SPID and a few hourly measures including time to remedication. Study 2 assessed the efficacy of piroxicam 20 mg or 40 mg compared with aspirin 648 mg and placebo. Sixty patients rated their pain intensity and relief hourly for 12 hours and at 24 hours after administration of study medication. Both doses of piroxicam were significantly more effective than placebo from Hours 2 to 12 for pain intensity difference (PID) and relief scores, as well as for SPID and TOTAL. Aspirin was significantly more effective than placebo from Hours 2 to 8 for relief and Hours 2 to 10 for PID as well as SPID and TOTAL. Piroxicam 40 mg was significantly more effective than aspirin 648 mg for SPID, TOTAL, and hourly measures beginning with Hour 6 through Hour 12. Piroxicam 20 mg was significantly better than aspirin for a few hourly measures: Hours 7 to 9 for relief and Hour 7 for PID. In addition, effects of piroxicam 20 mg had a significantly longer duration than aspirin. Similarly, piroxicam 20 mg had a significantly longer time to remedication compared with aspirin and placebo. The results of these studies provide evidence in support of the longer duration of analgesic efficacy of piroxicam compared with codeine or aspirin in patients with postoperative pain
— id: 10137, year: 1988, vol: 84, page: 16, stat: Journal Article,

CORRELATION OF ASPIRIN BLOOD-LEVELS AND ANALGESIC RESPONSE
Sunshine, A; Marrero, I; Wagner, D; Freshwater, L; Olson, N; Siegel, C; Laska, E
1988 Feb;43(2):141-141, Clinical pharmacology & therapeutics
— id: 31546, year: 1988, vol: 43, page: 141, stat: Journal Article,

Statistical methods and applications of bioassay
Laska EM; Meisner MJ
1987 ;27:385-397, Annual review of pharmacology & toxicology
— id: 60348, year: 1987, vol: 27, page: 385, stat: Journal Article,

PIROXICAM, ASPIRIN AND PLACEBO IN DENTAL PAIN
Olson, N; Sunshine, A; Marrero, I; Ramos, I; Laska, E
1987 Feb;41(2):162-162, Clinical pharmacology & therapeutics
— id: 31271, year: 1987, vol: 41, page: 162, stat: Journal Article,

Decision theory models for choosing prospective payment schemes: a negotiated approach between payers and providers
Siegel, C; Laska, E; Lin, S
1987 ;8:143-155, Advances in health economics & health services research
— id: 138837, year: 1987, vol: 8, page: 143, stat: Journal Article,

Analgesic efficacy of two ibuprofen-codeine combinations for the treatment of postepisiotomy and postoperative pain
Sunshine A; Roure C; Olson N; Laska EM; Zorrilla C; Rivera J
1987 Oct;42(4):374-380, Clinical pharmacology & therapeutics
Our purpose was to compare the analgesic efficacy and safety of single oral doses of the combination of ibuprofen 400 mg plus codeine 60 mg and the combination of ibuprofen 200 mg plus codeine 30 mg with ibuprofen 400 mg alone, codeine sulfate 60 mg alone, and placebo. One hundred ninety-five patients with severe pain resulting from episiotomy, cesarean section, or gynecologic surgery completed a randomized, double-blind, stratified, parallel-group study. Patients were observed during a 4-hour period after medication. Based on the sum of the pain intensity differences (SPID), total pain relief (TOTPAR), and most of the hourly direct measures of pain and relief, both doses of the combination and ibuprofen 400 mg alone were statistically superior to placebo. Codeine 60 mg was statistically superior to placebo based on TOTPAR, the global ratings, and a few hourly measures. The mean effect of the combination of ibuprofen 400 mg plus codeine 60 mg was significantly superior to the mean effect of ibuprofen 400 mg alone 1/2, 1, and 2 hours after medication and to the mean effect of ibuprofen 400 mg alone and codeine 60 mg alone for SPID, TOTPAR, and other measures as well. The low-dose combination was significantly more effective than codeine 60 mg for a few hourly measures but was not significantly superior to ibuprofen 400 mg. Based on these findings it appears that the combination of ibuprofen 400 mg plus codeine 60 mg, particularly in the first few hours after medication, is more efficacious than its constituents
— id: 10138, year: 1987, vol: 42, page: 374, stat: Journal Article,

FLURBIPROFEN, FLURBIPROFEN DEXTROROTATORY COMPONENT (BTS 24332) AND PLACEBO IN POSTEPISIOTOMY PAIN
Sunshine, A; Zighelboim, I; Olson, N; Laska, E
1987 Feb;41(2):162-162, Clinical pharmacology & therapeutics
— id: 31270, year: 1987, vol: 41, page: 162, stat: Journal Article,

An analytic approach to quantifying pain scores
Laska EM; Meisner M; Takeuchi K; Wanderling JA; Siegel C; Sunshine A
1986 Sep-Oct;6(5):276-282, Pharmacotherapy
Statistical problems in clinical trials frequently involve fitting regression lines when the underlying data are categorical or ordinal response variables. Usually an ad hoc a priori quantification is used to assign values to these ordinal responses. For pain intensity data collected in analgesic trials, the usual approach is to set none equal to 0, mild equal to 1, moderate equal to 2, and severe equal to 3. While this scheme has been generally accepted, on the basis that for similar clinical trials reasonably similar results are obtained by different investigators, concern exists that the distances between pain scores are probably not equal. A method is presented for quantifying categorical responses so that the resulting scores maximize the simultaneous fit of the dose-response regression lines. The optimal scores derived by this technique may then be used in a bioassay analysis to estimate the relative potency of 2 compounds. As illustrative examples, this method was applied to data from 2 clinical trials and the results were compared to the usual method.
— id: 10141, year: 1986, vol: 6, page: 276, stat: Journal Article,

The correlation between blood levels of ibuprofen and clinical analgesic response
Laska EM; Sunshine A; Marrero I; Olson N; Siegel C; McCormick N
1986 Jul;40(1):1-7, Clinical pharmacology & therapeutics
A clinical trial comparing ibuprofen, 400, 600, and 800 mg, with aluminum ibuprofen, 400 mg, and placebo was conducted in patients with moderate or severe pain subsequent to third molar extraction. Pain intensity ratings and ibuprofen serum levels were obtained at baseline, 30 minutes, 1 hour, and hourly thereafter for 3 hours. Pain intensity ratings were also obtained at hours 4, 5, and 6. Serum levels at 1, 2, and 3 hours correlated significantly with the log dose of ibuprofen (r = 0.35, 0.49, and 0.48, respectively) and with global analgesic response as measured by the percentage of the sum of the pain intensity scores (r = 0.28, 0.34, and 0.26, respectively). However, possibly because of differences in drug formulation, the percentage of the sum of the pain intensity scores did not correlate significantly with log dose. The highest correlations were found between contemporaneous serum levels and pain intensity difference values, particularly at hour 1 (r = 0.54). Our results support the proposition that increased ibuprofen serum levels lead to increased analgesia
— id: 10142, year: 1986, vol: 40, page: 1, stat: Journal Article,

Combining multivariate bioassays
Meisner M; Kushner HB; Laska EM
1986 Jun;42(2):421-427, Biometrics
Linear multivariate theory is applied to the problem of combining several multivariate bioassays. Results are an asymptotic test of the hypothesis of a common log relative potency; the maximum likelihood estimator of the common log relative potency; and an exact and asymptotic confidence interval estimator for log relative potency
— id: 60349, year: 1986, vol: 42, page: 421, stat: Journal Article,

An alternative to DRGs. A clinically meaningful and cost-reducing approach
Siegel, C; Alexander, M J; Lin, S; Laska, E
1986 May;24(5):407-417, Medical care
A statistical methodology based on the Cox proportional hazards model (a survival time analysis method), an alternative to the approach underlying DRGs, is presented. The method is used to obtain an estimate of the length-of-stay (LOS) distribution of a patient incorporating either patient-specific or hospital variables. A percentile of the distribution chosen to minimize prediction error serves as the assigned LOS. Absolute deviation is used as the loss function both to determine the choice of a predicted LOS and to examine how well the scheme works. Multiple assignment schemes may also be developed from this approach. The results of the method, tested on a national probability sample of 4,608 psychiatric patients treated in psychiatric units of general hospitals, suggest that with respect to average absolute deviation, the proposed methodology may provide a scheme that is superior to the present DRG scheme. For the sample, the average percent improvement obtained using the median of the estimated LOS distribution as the predicted LOS over the sample mean of the DRG group is 19%. A two assignment strategy results in average improvements over DRGs of 43%
— id: 138841, year: 1986, vol: 24, page: 407, stat: Journal Article,

Comparative study of flurbiprofen, zomepirac sodium, acetaminophen plus codeine, and acetaminophen for the relief of postsurgical dental pain
Sunshine A; Marrero I; Olson N; McCormick N; Laska EM
1986 Mar 24;80(3A):50-54, American journal of medicine
The relative analgesic efficacy and safety of single oral doses of 50 and 100 mg of flurbiprofen (Ansaid, Upjohn) were compared with 100 mg of zomepirac sodium, 650 mg of acetaminophen plus 60 mg of codeine, 650 mg of acetaminophen alone, and placebo in a randomized, double-blind, parallel-group study. A total of 182 patients entered the study with moderate pain from a third molar extraction and were evaluated for six hours. For many efficacy variables, all active treatments were significantly (p less than or equal to 0.05) more effective than placebo. The two doses of flurbiprofen gave approximately similar results, suggesting a plateau effect above 50 mg. With the exception of relief at one hour, there were no significant differences between zomepirac and either dose of flurbiprofen. However, the mean response with zomepirac was greater than with either 50 or 100 mg of flurbiprofen during the first four hours and lower during the last two hours. The analgesic effects of acetaminophen alone were not significantly different from acetaminophen in combination with codeine. At the first hour, acetaminophen plus codeine led to significantly better pain relief than did 100 mg of flurbiprofen. After the first hour, flurbiprofen resulted in greater mean scores than acetaminophen alone or acetaminophen plus codeine, and these differences were significant at the fifth and sixth hours. Five patients had adverse reactions while receiving acetaminophen, acetaminophen plus codeine, or placebo. There were no adverse effects with flurbiprofen or zomepirac.
— id: 10143, year: 1986, vol: 80, page: 50, stat: Journal Article,

A double-blind, parallel comparison of ketoprofen, aspirin, and placebo in patients with postpartum pain
Sunshine A; Zighelboim I; Laska E; Siegel C; Olson NZ; De Castro A
1986 Nov-Dec;26(8):706-711, Journal of clinical pharmacology
Our purpose was to evaluate the analgesic efficacy of single oral doses of ketoprofen 25, 50, and 100 mg compared with aspirin 650 mg and placebo in the relief of moderate to severe postepisiotomy, uterine cramping, or cesarean section pain. One hundred and fifty-six patients participated in a randomized, double-blind, stratified, parallel-group study. They were observed over a six-hour period by one nurse-observer. Several of the standard summary measures of analgesia were derived from the interview data, including the sum of pain intensity differences (SPID) and the sum of the hourly relief values (TOTAL). The study showed significant differences between aspirin and placebo for four-hour SPID and several other parameters and between ketoprofen at all dose levels and placebo for the four- and six-hour SPID and many other parameters. The two higher doses of ketoprofen were significantly more effective than aspirin as as assessed by the four- and six-hour SPID, TOTAL, and other summary measures. The low dose of ketoprofen, although not significantly different from aspirin for SPID and TOTAL, showed a significantly faster onset of relief and had a better global rating. This study suggests that 50 mg of ketoprofen may be the clinical dose of choice as an analgesic. There were no adverse effects reported.
— id: 10140, year: 1986, vol: 26, page: 706, stat: Journal Article,

ANALGESIC EFFECTS OF ORAL OXYCODONE AND CODEINE IN THE TREATMENT OF PATIENTS WITH POSTOPERATIVE, POSTFRACTURE, OR SOMATIC PAIN
SUNSHINE, A; LASKA, EM; OLSON, NZ
1986 APR ;8(4):225-234, Advances in pain research & therapy
— id: 41475, year: 1986, vol: 8, page: 225, stat: Journal Article,

HUMAN PHENOL SULFOTRANSFERASE - CORRELATION OF INTESTINAL AND PLATELET ACTIVITIES AND THERMAL STABILITIES
SUNSHINE, A; OLSON, N; AXTMAYER, R; RAMOS, I; LASKA, E
1986 FEB ;39(2):232-232, Clinical pharmacology & therapeutics
— id: 41506, year: 1986, vol: 39, page: 232, stat: Journal Article,

A comparative oral analgesic study of indoprofen, aspirin, and placebo in postpartum pain
Sunshine A; Zighelboim I; Olson NZ; De Sarrazin C; Laska E
1985 Jul-Aug;25(5):374-380, Journal of clinical pharmacology
The purpose of this study was to evaluate the analgesic efficacy and adverse effect liability of single oral doses of indoprofen, 50 mg, 100 mg, and 200 mg, compared with aspirin, 300 mg and 600 mg, and placebo in the relief of moderate to severe postpartum pain. Two hundred-ten patients entered a randomized, double-blind, parallel group study and were evaluated over a six-hour period by a single nurse-observer. There was a significant imbalance in the distribution of pain types across treatments that compromises the interpretation of the results. In addition to analyzing the data from all patients, the subsets with episiotomy/cesarean section pain and uterine cramp pain were examined separately. The latter group had too few patients to permit distinction between drugs. The 100 mg and 200 mg doses of indoprofen were significantly (P less than or equal to .05) more effective than placebo for many variables including the following summary values: sum of pain intensity difference (SPID), sum of hourly relief values (TOTPAR), and % SPID for all patients as well as in the subset of patients with episiotomy/cesarean section pain. Aspirin, 600 mg, was also significantly more effective than placebo for many of the same measures of analgesia in the episiotomy/cesarean section subset. Pairwise differences were also seen between placebo and aspirin, 300 mg, but on fewer variables. Indoprofen, 100 mg, was significantly more effective than aspirin, 600 mg, at hour 6 for pain intensity difference (PID) in the episiotomy/cesarean section subset. The effect of indoprofen appeared to plateau above 100 mg.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10144, year: 1985, vol: 25, page: 374, stat: Journal Article,

"THE ANALGESIC EFFICACY, OF IBUPROFEN, CODEINE AND PLACEBO"
Sunshine, A; Roure, C; Zorrilla, C; Laska, E; Olson, N; Rivera, J
1985 ;37(2):232-232, Clinical pharmacology & therapeutics
— id: 30980, year: 1985, vol: 37, page: 232, stat: Journal Article,

Caffeine as an analgesic adjuvant
Laska EM; Sunshine A; Mueller F; Elvers WB; Siegel C; Rubin A
1984 Apr 6;251(13):1711-1718, JAMA
Thirty clinical studies involving more than 10,000 patients conducted during the last 20 years have been analyzed to assess the value of caffeine as an analgesic adjuvant. Although most studies included patients with postpartum uterine cramping or episiotomy pain, some involved patients with pain from oral surgery or headache. In 21 of 26 studies, the relative potency estimates of an analgesic with caffeine to an analgesic without caffeine is greater than one. The pooled relative potency estimates in each of several major categories of combination analgesics are significantly greater than one. The overall pooled relative potency estimate is 1.41, with 95% confidence limits of 1.23 to 1.63; that is, to obtain the same amount of response from an analgesic without caffeine requires a dose that is approximately 40% greater than one with caffeine.
— id: 10146, year: 1984, vol: 251, page: 1711, stat: Journal Article,

Analgesic efficacy of intramuscular flunixin meglumine compared to meperidine: a preliminary report
Sunshine A; Zighelboim I; Olson N; De Castro A; Laska E
1984 ;55:145-150, NIDA research monograph series
— id: 10147, year: 1984, vol: 55, page: 145, stat: Journal Article,

Deinstitutionalization and the survival of the state hospital
Craig TJ; Laska EM
1983 Jul;34(7):616-622, Hospital & community psychiatry
Despite vigorous efforts at deinstitutionalization, the state mental hospital continues to be the locus of care for a wide variety of patient populations. The authors examined the changes in one state hospital's clientele between 1972 and 1980 and discovered a 50 percent reduction in long-stay patients, a 27 percent increase in admissions, and the emergence of a new long-stay population. The authors say that the modern state hospital can be conceptualized as several different facilities under a single administrative roof rather than as a monolithic structure. They conclude that mental health planners must acknowledge the continued existence of a group of patients whose needs are perhaps best served by the state hospital. Strategies must be developed to use the existing hospital resources in the most efficient and effective manner
— id: 60350, year: 1983, vol: 34, page: 616, stat: Journal Article,

Effect of caffeine on acetaminophen analgesia
Laska EM; Sunshine A; Zighelboim I; Roure C; Marrero I; Wanderling J; Olson N
1983 Apr;33(4):498-509, Clinical pharmacology & therapeutics
Our objective was to determine the value of caffeine in combination with acetaminophen in the relief of pain from uterine cramping, episiotomy, and third molar extraction. In the dental study, 173 patients received two or four tablets of 500 mg acetaminophen or the combination of 500 mg acetaminophen and 65 mg caffeine. In the three postpartum studies, 1345 patients received one, two, or three tablets of acetaminophen, the combination, or a placebo. The mean scores for the summary variable percent sum of the pain intensity differences (% SPID) were higher in all for the combination than for acetaminophen alone, and in two studies the null hypothesis of no differences was rejected. The relative potency estimates for % SPID were 1.9, 1.8, and 1.3 for the three studies in which bioassays could be performed and the pooled relative potency was 1.7 with a 95% confidence interval of 1.1 to 3.1. The results were essentially the same among pain models and among patient groups with similar habitual caffeine consumption. Onset of analgesia was also faster with the combination. We conclude that caffeine enhances the analgesic efficacy of acetaminophen
— id: 10151, year: 1983, vol: 33, page: 498, stat: Journal Article,

Optimal crossover designs in the presence of carryover effects
Laska, E; Meisner, M; Kushner, H B
1983 Dec;39(4):1087-1091, Biometrics
Under either the random patient-effect model with sequence effects or the fixed patient-effect model, the usual two-period, two-treatment crossover design, AB,BA, cannot be used to estimate the contrast between direct treatment effects when unequal carryover effects are present. If baseline observations are available, the design AB,BA can validly be used to estimate a treatment contrast. However, the design AB,BA,AA,BB with baseline observations is more efficient. In fact, we show that this design is optimal whether or not baseline observations are available. For experiments with more than two periods, universally optimal designs are found for both models, with and without carryover effects. It is shown that uncertainty about the presence of carryover effects is of little or no consequence, and the addition of baseline observations is of little or no added value for designs with three or more periods; however, if the experiment is limited to only two periods the investigator pays a heavy penalty
— id: 140514, year: 1983, vol: 39, page: 1087, stat: Journal Article,

CROSSOVER DESIGN AND INFERENCE IN CLINICAL ANALGESIC TRIALS
LASKA, E; MEISNER, M; SUNSHINE, A
1983 ;33(2):214-214, Clinical pharmacology & therapeutics
— id: 40738, year: 1983, vol: 33, page: 214, stat: Journal Article,

Analgesic effects of oral propiram fumarate, codeine sulfate and placebo in postoperative pain
Sunshine A; Laska EM; Olson NZ; Colon A; Gonzalez L; Tirado S
1983 Sep-Oct;3(5):299-303, Pharmacotherapy
Our purpose was to evaluate the analgesic efficacy and safety of single oral doses of propiram fumarate 50 mg, codeine sulfate 60 mg and placebo in the relief of moderate to severe postoperative pain. One hundred and twenty patients completed a randomized, double-blind, single-dose, stratified, parallel-groups trial and were observed for either 4 or 6 hours. Based upon each of the summary efficacy measures--SPID, % SPID and TOTAL--propiram and codeine were approximately equally effective and both were statistically superior to placebo. Propiram was significantly more effective than codeine at hour 5 for Pain Intensity Difference. Two adverse effects were attributed to propiram. Propiram fumarate 50 mg is an effective oral analgesic similar to codeine sulfate 60 mg, with the possibility of a longer duration of action
— id: 10148, year: 1983, vol: 3, page: 299, stat: Journal Article,

Oral analgesic efficacy of suprofen compared to aspirin, aspirin plus codeine, and placebo in patients with postoperative dental pain
Sunshine A; Marrero I; Olson NZ; Laska EM; McCormick N
1983 ;27 Suppl 1:31-40, Pharmacology
The purpose of this study was to evaluate the analgesic efficacy and safety of single oral doses of suprofen 200 and 400 mg, compared with aspirin 650 plus codeine 60 mg, aspirin 650 mg, and placebo in the relief of moderate to severe pain resulting from the surgical removal of impacted third molars. 157 patients completed a randomized, double-blind, single-dose, stratified, parallel-groups trial, and were observed for at least 4 h. Based upon each of the summary efficacy measures, sum pain intensity difference (SPID), percent SPID, TOTPAR and a global evaluation, all four active treatments were approximately equally effective and all were statistically superior to placebo. In addition, suprofen at both dose levels was significantly more effective than placebo beginning at the 0.5-hour observation for mean pain intensity, whereas the two aspirin treatments were not superior to placebo until the 1-hour observation. Side effects were minimal; there was one in the suprofen 200 mg, three in the aspirin 650 mg, and one in the placebo treatment group. Thus, it appears that suprofen at 200 and 400 mg is a safe and effective oral analgesic for the relief of moderate or severe postoperative dental pain, and it is possible that compared to aspirin 650 mg and aspirin 650 mg plus codeine 60 mg, it has a more rapid onset of action
— id: 10152, year: 1983, vol: 27 Suppl 1, page: 31, stat: Journal Article,

Analgesic effect of graded doses of flurbiprofen in post-episiotomy pain
Sunshine A; Olson NZ; Laska EM; Zighelboim I; De Castro A; De Sarrazin C
1983 May-Jun;3(3):177-181, Pharmacotherapy
Our purpose was to evaluate the analgesic efficacy and safety of single oral doses of flurbiprofen 25, 50 and 100 mg, aspirin 600 mg, and placebo in the relief of moderate to severe post-episiotomy pain. One hundred and fifty-two evaluable patients completed a randomized, double-blind, stratified, parallel groups study. They were observed over a six hour period by one nurse-observer. Based upon each of the summary efficacy measures SPID, TOTAL and PEAK % and most of the hourly direct measures of pain intensity and pain relief, each of the four active treatments were statistically superior to placebo. Flurbiprofen 25 mg appeared to be slightly less effective than aspirin 600 mg, but the differences were not statistically significant. Flurbiprofen 50 and 100 mg were quite similar and were significantly more effective than aspirin 600 mg and flurbiprofen 25 mg. There were no observed or reported adverse effects
— id: 10150, year: 1983, vol: 3, page: 177, stat: Journal Article,

Ibuprofen, zomepirac, aspirin, and placebo in the relief of postepisiotomy pain
Sunshine A; Olson NZ; Laska EM; Zighelboim I; De Castro A; De Sarrazin C
1983 Aug;34(2):254-258, Clinical pharmacology & therapeutics
Our purpose was to compare the analgesic efficacy of single oral doses of ibuprofen, zomepirac, aspirin, and placebo in severe postepisiotomy pain. One hundred twenty subjects participated in a double-blind, single-dose, parallel-group, 4-hr trial comparing 400 mg ibuprofen, 100 mg zomepirac sodium, 600 mg aspirin, and placebo. For most parameters, including the sum of the pain intensity differences (SPID) and the sum of the hourly pain relief values (TOTAL), which are summary variables, each of the drugs was more effective than placebo. Ibuprofen was more effective than aspirin and zomepirac. Zomepirac and aspirin were equally effective for most of the analgesic variables. There were no adverse effects. Ibuprofen, 400 mg, is an effective oral analgesic and is more effective than 100 mg zomepirac and 600 mg aspirin in most parameters of pain
— id: 10149, year: 1983, vol: 34, page: 254, stat: Journal Article,

"ORAL ANALGESIC STUDY OF IBUPROFEN, ZOMEPIRAC, ASPIRIN AND PLACEBO"
SUNSHINE, A; OLSON, NZ; LASKA, E
1983 ;33(2):198-198, Clinical pharmacology & therapeutics
— id: 40736, year: 1983, vol: 33, page: 198, stat: Journal Article,

"ORAL ANALGESIC STUDY OF KETOPROFEN, ASPIRIN AND PLACEBO IN POSTPARTUM PAIN"
SUNSHINE, A; OLSON, NZ; SIEGEL, C; LASKA, E
1983 ;33(2):199-199, Clinical pharmacology & therapeutics
— id: 40737, year: 1983, vol: 33, page: 199, stat: Journal Article,

A STUDY OF THE ANALGESIC EFFICACY OF NALBUPHINE HYDROCHLORIDE IN PATIENTS WITH POSTPARTUM PAIN
Sunshine, A; Zighelboim, I; Desarrazin, C; Decastro, A; Olson, NZ; Laska, E
1983 ;33(1):108-114, Current therapeutic research
— id: 30681, year: 1983, vol: 33, page: 108, stat: Journal Article,

Quantitative differences in aspirin analgesia in three models of clinical pain
Laska EM; Sunshine A; Wanderling JA; Meisner MJ
1982 Nov-Dec;22(11-12):531-542, Journal of clinical pharmacology
An analysis was made of data from over 4000 postepisiotomy, uterine cramping, and postsurgical patients complaining of moderate or severe pain. They had received 325, 650, or 1300 mg aspirin or placebo while they were subjects in 10 analgesic clinical trials. On the average, for the same verbally expressed pain intensity level and the same treatment, more relief was obtained by a patient with uterine cramping than one with episiotomy pain, who in turn obtained more relief than a patient with surgical pain. A new mathematical model which characterizes the probability that an analgesic provides complete relief as a function of dose, severity of pain intensity, and pain etiology is developed. The model utilizes the data itself to estimate the numerical score corresponding to verbal pain intensities. The results indicate that the numerical score quantifying severe surgical pain is 1.4 times greater than the score for severe episiotomy pain, which in turn is 3.2 times greater than the score for severe uterine cramping. Clinical trials must be designed to take these differences into account. Also, clinicians must be cognizant of such differences when choosing among drugs and dosages for patients with different pain intensity and etiology.
— id: 10153, year: 1982, vol: 22, page: 531, stat: Journal Article,

Adverse effects of commonly ordered oral narcotics
Kantor, T G; Hopper, M; Laska, E
1981 Jan;21(1):1-8, Journal of clinical pharmacology
Approximately equianalgesic oral doses of codeine, an oxycodone compound resembling Percodan, and pentazocine were compared for adverse effects in a double-blind, randomized study of four doses of each drug given over two days to 247 postsurgical patients with pain. Placebo and parenteral morphine were also treated as negative and positive controls, respectively. Approximately 50 patients each received one of the five drugs. Codeine, pentazocine, and morphine had the same incidence of adverse effects (22 to 28 per cent). One capsule of oxycodone compound was the analgesic equivalent of 12.5 mg morphine with an adverse effect incidence of 4 per cent (placebo 8 per cent). Smoking made no difference in analgesic effect or adverse effects. Analgesics given in the evening intervening between the two days may have affected the analgesic performance of placebo
— id: 78246, year: 1981, vol: 21, page: 1, stat: Journal Article,

Fenoprofen and codeine analgesia
Laska EM; Sunshine A
1981 May;29(5):606-616, Clinical pharmacology & therapeutics
Studies were conducted on postpartum and postoperative patients to estimate the dose-response line of fenoprofen and to contrast it with codeine and placebo. The postpartum patients included women with episiotomy pain and with uterine cramping. This mix allowed contrast of ability of the various pain models to distinguish codeine from placebo. The methodology for the studies was single-dose parallel groups design with interviews conducted by trained nurse observers to obtain subjective responses. More than 850 patients participated in the trial. The results indicate that fenoprofen at doses as low as 12.5 mg has analgesic properties. In each of the five studies, the mean value of 100- and/or 200-mg doses of fenoprofen for the variable sum of the pain intensity difference (SPID) was higher than that of 65 mg codeine. The pooled relative potency calculation based on SPID suggests that 100 mg fenoprofen is approximately equivalent to 60 mg codeine. In their ability to distinguish codeine from placebo, patients with uterine cramp, episiotomy, or surgical pain did not appear to differ.
— id: 10154, year: 1981, vol: 29, page: 606, stat: Journal Article,

QUANTITATIVE DIFFERENCES IN ASPIRIN ANALGESIA IN 3 MODELS OF CLINICAL PAIN
LASKA, E; SUNSHINE, A
1981 ;29(2):260-260, Clinical pharmacology & therapeutics
— id: 40263, year: 1981, vol: 29, page: 260, stat: Journal Article,

A COMPARISON OF THE ANALGESIC RESPONSES OF FENOPROFEN, CODEINE, AND PLACEBO IN POSTPARTUM AND POSTOPERATIVE PAIN
SUNSHINE, A; LASKA, E; ZIGHELBOIM, I; DESENNE, J
1981 ;29(5):771-777, Current therapeutic research
— id: 40338, year: 1981, vol: 29, page: 771, stat: Journal Article,

Medical information systems
Laska EM; Abbey SG
1980 ;9:581-604, Annual review of biophysics & bioengineering
— id: 60351, year: 1980, vol: 9, page: 581, stat: Journal Article,

Automated review system for orders of psychotropic drugs
Laska, E; Siegel, C; Simpson, G
1980 Jul;37(7):824-827, Archives of general psychiatry
A computerized drug-review system both reviews drug orders and notifies clinicians of orders that are considered exceptions to some clinical guidelines. The impact of this system in a psychiatric center in which it has been used since December 1975 is examined in terms of the reduction of the percentage of orders of psychotropic drugs that involve polypharmacy or dose-range exceptions. The results show a substantial reduction in orders in exception since the implementation of the system
— id: 138842, year: 1980, vol: 37, page: 824, stat: Journal Article,

Protecting privacy and confidentiality in a multiple use, multiple user mental health information system
Bank R; Laska EM
1978 ;1(2):151-157, Evaluation & program planning
— id: 60352, year: 1978, vol: 1, page: 151, stat: Journal Article,

Quantitative care norms for a psychiatric ambulatory population in a county medical assistance program
Siegel C; Laska E; Griffis A; Wanderling J
1978 Apr;68(4):352-358, American journal of public health. AJPH
An approach for developing quantitative care norms for outpatient acute psychiatric patients is presented. Both the methodological concept of the norming procedure and its application to the needs of Medicaid in Rockland County, New York are given. The methodology is totally general in that it could be applied to concerns related to characterization of services rendered in a wide variety of applications ranging from planning to utilization review. The norms developed relate both to monthly quantity of services rendered and length of active treatment period. Further, the impact of a review rule is discussed in terms of its implication to number of cases reviewed
— id: 61280, year: 1978, vol: 68, page: 352, stat: Journal Article,

Oral nefopam and aspirin
Sunshine A; Laska E; Slafta J
1978 Nov;24(5):555-559, Clinical pharmacology & therapeutics
Analgesia through nefopam (30 mg, 60 mg, 90 mg), aspirin (325 mg, 650 mg), and placebo were compared in 122 hospitalized patients with moderate to severe postoperative, fracture, or other somatic pain. A double-blind noncrossover study design was used, and patients were evaluated for pain intensity and pain relief over a 6-hr period. Based on sum of pain intensity differences (SPID) scores, treatment effects were consistent and indicative of good dose response to both active medications. Pain relief scores were more variable but were generally in accordance with SPID values. Time-effect curves were similar. Estimated relative potency of nefopam to aspirin was 10.4 with a 95% confidence interval of 6.3 to 20.8 for SPID, indicating that the analgesic potency of nefopam, 60 mg, was equivalent to that of aspirin, 650 mg. Side effects were minimal
— id: 10159, year: 1978, vol: 24, page: 555, stat: Journal Article,

Hypnotic activity of diphenhydramine, methapyrilene, and placebo
Sunshine A; Zighelboim I; Laska E
1978 Aug-Sep;18(8-9):425-431, Journal of clinical pharmacology
In a double-blind controlled study, an oral dose of diphenhydramine hydrochloride (12.5, 25, or 50 mg), methapyrilene fumarate (36, 72, or 144 mg), or placebo was administered to 1295 post-partum patients if they complained of, or anticipated, a sleep problem. Hypnotic activity was assessed clinically by subjective and objective techniques. Methapyrilene and diphenhydramine, at all doses, were found to be effective hypnotics in comparison to placebo, based on sleep latency, sleep duration, awakening in the night, global evaluation, and morning alertness. Increasing the dose of these drugs, in the range studied, produced a minimal increase in effectiveness
— id: 10160, year: 1978, vol: 18, page: 425, stat: Journal Article,

Estimates of doses of antiinflammatory drugs in man by testing for analgesic potency. I. 1-isopropyl-4 phenyl-7-methyl-2 (1H) quinazolone versus aspirin
Kantor, T G; Streem, A; Laska, E
1977 Sep-Oct;20(7):1381-1387, Arthritis & rheumatism
Dosage estimates of antiinflammatory drugs in human arthritis Phase II trials are difficult to obtain and prolong such trials unnecessarily. Antiinflammatory drugs almost always have analgesic properties in man and good dose estimates for analgesic activity can be obtained. In 140 patients with surgical pain, 300, 600, and 1200 mg of aspirin were compared to 75, 150, and 300 mg of 43-715 (1-isopropyl-4-phenyl-7-methyl-2 (1H) quinazolone), an antiinflammatory quinazolone derivative, for analgesia in a double-blind trial using subjective response methodology. The test drug was shown to be analgesic at a level four times more potent, milligram for milligram, than aspirin, an estimate that should be useful for later definitive Phase II trials in arthritis
— id: 78248, year: 1977, vol: 20, page: 1381, stat: Journal Article,

"COMPARISON OF HYPNOTIC ACTIVITY OF DIPHENHYDRAMINE, METHYLPYRALINE, AND PLACEBO"
SUNSHINE, A; ZIGHELBOIM, I; LASKA, E
1977 ;21(1):119-119, Clinical pharmacology & therapeutics
— id: 40019, year: 1977, vol: 21, page: 119, stat: Journal Article,

Nefopam hydrochloride (Acupan) and morphine sulfate comparisons in man
Laska E; Sunshine A
1976 ;1:543-551, Advances in pain research & therapy
— id: 70458, year: 1976, vol: 1, page: 543, stat: Journal Article,

29. The Multi-State Information System for Psychiatric patients
Laska EM
1976 May;14(5 Suppl):223-229, Medical care
The Multi-State Information System for Psychiatric Patients (MSIS) is a computer based, clinical and administrative management information system used by numerous mental health programs and facilities for patient and program management. Structured forms are used for the collection of core information on patients, on services rendered, on affiliated agencies, and on fiscal and administrative processes. A variety of output reports and general retrieval techniques are being used to help administer and evaluate patient care programs, monitor clinical and program management functions, refer clients to other service agencies, and review individual cases, as well as for administrative functions such as cost finding, rate setting, billing, and inventory control. MSIS is currently field testing an automated problem-oriented psychiatric record, and a goal-oriented record to be used with the mentally retarded is under development
— id: 60353, year: 1976, vol: 14, page: 223, stat: Journal Article,

Matched-pairs study of reserpine use and breast cancer
Laska EM; Siegel C; Meisner M; Fischer S; Wanderling J
1975 Aug 16;2(7929):296-300, Lancet
This paper reports on an analysis of psychiatric population. 55 female patients with breast cancer were matched with non-cancer patients on age, year of admission, psychiatric diagnosis, race, and religion. Reserpine use was examined for yearly use by each year preceding the diagnosis of breast cancer, by cumulative yearly use, and by other defined time periods. Regardless of the definition of reserpine user, there were no significant increased relative risks of breast cancer for those women on reserpine. There was a fairly low proportion of patients from each group who were on the drug in any given year, and a fairly wide range of total dosage received. Over half of the women used reserpine at some time during their hospital stay
— id: 60354, year: 1975, vol: 2, page: 296, stat: Journal Article,

Data systems in mental health
Laska, E; Siegel, C; Meisner, M; Bank, R; Zeitz, B
1975 Jan;14(1):1-6, Methods of information in medicine
— id: 138840, year: 1975, vol: 14, page: 1, stat: Journal Article,

Nefopam and morphine in man
Sunshine A; Laska E
1975 Nov;18(5 Pt 1):530-534, Clinical pharmacology & therapeutics
A new analgesic, nefopam, is chemically distinct and pharmacologically unrelated to any presently known analgesic. A comparison was made of morphine and nefopam in 74 patients who required parenteral analgesia for moderate to severe postoperative and somatic pain, using a single administration, 2-dose level, double-blind design. A significant dose-response curve was obtained with nefopam and with morphine, and there was no significant deviation from parallelism. The time-effect curves for the 2 drugs were similar. The estimated relative potency of nefopam to morphine indicates that 20 mg of nefopam HCl is the approximate analgesic equal of 12 mg of morphine SO4. There were no adverse effects with nefopam and one adverse reaction to morphine
— id: 10162, year: 1975, vol: 18, page: 530, stat: Journal Article,

Protection of privacy and confidentiality
Curran WJ; Laska EM; Kaplan H; Bank R
1973 Nov 23;182(114):797-802, Science
— id: 60355, year: 1973, vol: 182, page: 797, stat: Journal Article,

An apparent algesic effect of meprobamate
Kantor, T G; Laska, E; Streem, A
1973 Apr;13(4):152-159, Journal of clinical pharmacology & new drugs
— id: 78250, year: 1973, vol: 13, page: 152, stat: Journal Article,

Anticipation of analgesia. A placebo effect
Laska E; Sunshine A
1973 Apr;13(1):1-11, Headache
— id: 10167, year: 1973, vol: 13, page: 1, stat: Journal Article,

Patterns of psychotropic drug use for schizophrenia
Laska, E; Varga, E; Wanderling, J; Simpson, G; Logemann, G W; Shah, B K
1973 Aug-Sep;34(6):294-305, Diseases of the nervous system
— id: 140513, year: 1973, vol: 34, page: 294, stat: Journal Article,

A comparative analgesia study of propoxyphene hydrochloride, propoxyphene napsylate, and placebo
Sunshine, A; Laska, E; Slafta, J; Fleischman, E
1971 Jul;19(3):512-518, Toxicology & applied pharmacology
— id: 10168, year: 1971, vol: 19, page: 512, stat: Journal Article,

Response of experimental pain to analgesic drugs. 3. Codeine, aspirin, secobarbital, and placebo
Wolff BB; Kantor TG; Jarvik ME; Laska E
1969 Mar-Apr;10(2):217-228, Clinical pharmacology & therapeutics
— id: 22259, year: 1969, vol: 10, page: 217, stat: Journal Article,

A bioassay computer program for analgesic clinical trials
Laska E; Gormley M; Sunshine A; Bellville JW; Kantor TG; Forrest WH; Siegel C; Meisner M
1967 Sep-Oct;8(5):658-669, Clinical pharmacology & therapeutics
— id: 10169, year: 1967, vol: 8, page: 658, stat: Journal Article,

The use of computers at a state psychiatric hospital
Laska EM; Weinstein A; Logemann G; Bank R; Breuer F
1967 Dec;8(6):476-490, Comprehensive psychiatry
— id: 60356, year: 1967, vol: 8, page: 476, stat: Journal Article,

SCRIBE--a method for producing automated narrative psychiatric case histories
Laska, E; Kline, N S; Hackett, E; Simpson, G M; Morrill, D
1967 Jul;124(1):82-84, American journal of psychiatry
— id: 125714, year: 1967, vol: 124, page: 82, stat: Journal Article,

Oral analgesic studies: pentazocine hydrochloride, codeine, aspirin, and placebo and their influence on response to placebo
Kantor TG; Sunshine A; Laska E; Meisner M; Hopper M
1966 Jul-Aug;7(4):447-454, Clinical pharmacology & therapeutics
— id: 10170, year: 1966, vol: 7, page: 447, stat: Journal Article,

Response of experimental pain to analgesic drugs. 1. Morphine, aspirin, and placebo
Wolff BB; Kantor TG; Jarvik ME; Laska E
1966 Mar-Apr;7(2):224-238, Clinical pharmacology & therapeutics
— id: 22263, year: 1966, vol: 7, page: 224, stat: Journal Article,

Response of experimental pain to analgesic drugs. II. Codeine and placebo
Wolff BB; Kantor TG; Jarvik ME; Laska E
1966 May-Jun;7(3):323-331, Clinical pharmacology & therapeutics
— id: 22262, year: 1966, vol: 7, page: 323, stat: Journal Article,

ANALGESIC STUDIES OF INDOMETHACIN AS ANALYZED BY COMPUTER TECHNIQUES
SUNSHINE, A; LASKA, E; MEISNER, M; MORGAN, S
1964 Nov-Dec;5:699-707, Clinical pharmacology & therapeutics
— id: 140508, year: 1964, vol: 5, page: 699, stat: Journal Article,

A uniform method for collecting and processing analgesic data
FORREST, W H; BELLVILLE, J W; SEED, J C; HOUDE, R; WALLENSTEIN, S L; SUNSHINE, A; LASKA, E
1963 May;2:1-10, Psychopharmacology Service Center bulletin
— id: 140507, year: 1963, vol: 2, page: 1, stat: Journal Article,