Current CIRCL Research Projects
- Improving the Diagnosis and Prognosis of Inflicted Head Trauma in Infants
- The Impact of Neuroendocrine Hormones & Pathophysiology & Outcomes After TBI
- Managing Return-to-Play Decisions Following Mild Traumatic Brain Injury
- The Impact of Pregnancy-Associated Crashes on Birth Outcomes and Infant Survival
- Why Some Generations Are More Violent Than Others
- Small Grant Projects
Improving the Diagnosis and Prognosis of Inflicted Head Trauma in Infants
Patrick Kochanek, MD - Principal Investigator
Director, Safar
Center
Professor and Vice Chair, Department of
Critical Care Medicine
University of Pittsburgh School of Medicine
Thomas J. Songer, PhD - Co-investigator
Assistant Professor, Epidemiology
University of Pittsburgh
Department
of Epidemiology
Rachel Berger, MD - Co-Investigator
Assistant Professor of Pediatrics
Children's Hospital of
Pittsburgh
Inflicted traumatic brain injury (iTBI) is the leading cause of death from brain injury in infants and young children. Proper diagnosis of iTBI is difficult even for experienced, astute physicians because its presentation can be subtle and important historical data are often lacking. Preliminary data in children show that serum levels of specific biomarkers are sensitive indicators of both inflicted and non-inflicted TBI.
The hypothesis of this project is that increased levels of these serum biomarkers can be used to indicate brain injury in a population of infants at increased risk for iTBI. A positive serum biomarker level does not imply a diagnosis of child abuse; however, a positive test would suggest the presence of brain injury and the need for further evaluation.
If this approach is successful, it could potentially help in reducing the incidence of misdiagnosis of iTBI and ultimately prevent severe or fatal re-injury of these infants.
The Impact of Neuroendocrine Hormones & Pathophysiology & Outcomes After TBI
Amy Wagner, MD - Principal Investigator
Department of Physical Medicine and
Rehabilitation
University of Pittsburgh
Ross Zafonte, DO
- Co-Investigator
Chairman, Department
of Physical Medicine and Rehabilitation
Professor, University of Pittsburgh
Sue Beers, PhD - Co-Investigator
Associate Professor of Psychiatry
University of Pittsburgh
Hulya Bair, MD -
Co-Investigator
University of Pittsburgh
Anthony Fabio, MPH, PhD -
Co-Investigator
Center for Injury Research and Control
Department of Neurological
Surgery
University of Pittsburgh
Sarah Berga, MD -
Co-Investigator
Emory University
Traumatic brain injury (TBI) is an epidemic in the United States, and over five million people live with disabilities associated with their injury. Approximately 25% of the population with TBI is female, and clinical research studies indicate that women may have worse outcomes compared to men with similar injuries. However, bench research studies indicate that ovarian hormones are "neuroprotective" and seem to reduce a variety of the adverse biochemical events associated with acute TBI. The purpose of this project is to evaluate the disparity between "acute neuroprotection" for females and increased risk for poor outcomes by studying a clinical population with severe TBI and determining how sex hormone levels affect clinical markers of injury as well as functional outcomes. This information will shed new light on possible gender differences in the evolution of TBI and in how men and women recover. This work will also be valuable for investigators in order to appropriately incorporate gender into their research design when testing interventions that reduce the effects of injury and promote recovery after TBI.
Managing Return-to-Play Decisions Following Mild Traumatic Brain Injury
Mark Stevenson, MD
- Principal Investigator:
Director, Injury Prevention and Trauma Care Division
The George Institute for International Health
Affiliated with The University of Sydney, Australia
Michael Collins,
PhD - Co-Investigator
Assistant Professor Orthopedic Surgery
Assistant Director, UPMC
Sports Medicine Concussion Program
University of Pittsburgh
Mark Lovell, PhD
- Co-Investigator
Assistant Professor Orthopedic Surgery
Director, UPMC Sports
Medicine Concussion Program
University of Pittsburgh
Caroline Finch,
PhD
- Co-Investigator
University of Sydney, Australia
Contact sports, such as football, carry a high risk of mild traumatic brain injury (mTBI). These injuries have the potential for adverse long-term effects. Despite the potential to significantly reduce the adverse outcomes of mTBI, there are conflicting guidelines about when a player should return to play. The aim of this study is to estimate the incidence of mTBI among high school and non-elite Australian football players and to develop guidelines to manage return-to-play decisions following mTBI.
The Impact of Pregnancy-Associated Crashes on Birth Outcomes and Infant Survival
Hank Weiss,
MPH, PhD - Principal Investigator
Center for Injury Research and Control
Associate Professor, Department of Neurological Surgery
University of Pittsburgh
Motor vehicle crashes are the leading cause of maternal death during pregnancy, the leading cause of hospitalized trauma during pregnancy, and the leading cause of traumatic fetal injury mortality. Three percent of all pregnancies may be involved in a police-reported crash. This will be a retrospective study of approximately 14,000 female drivers in Pennsylvania who were pregnant at the time of a police-reported motor vehicle crash. The project will use modern data linkage methods to better understand and quantify the impact of pregnant-driver crashes on birth outcomes including fetal and infant survival, low birth weight and prematurity. Crash factors, including severity and geometries, will be derived from police reports. Information regarding maternal injuries will be identified from linked police, EMS and hospital data. Infant birth and fetal death certificates will provide information on adverse reproductive outcomes and those will be correlated with crash and injury factors as predictors.
Why Some Generations Are More Violent Than Others: A Contextual Developmental Model for Understanding Crime Trends
Anthony
Fabio, MPH, PhD - Principal Investigator
Center for Injury Research and Control
Department of Neurological Surgery,
University of Pittsburgh
The purpose of the grant, "Why Some Generations Are More Violent Than Others": A Contextual Model for Understanding Crime Trends, is to study trends in youth violence and to determine the role of social influence on violence in adolescents over time.
Using data from the Pittsburgh Youth Study, a study of 1,517 inner-city boys from Pittsburgh, between the ages of 7 and 25 to better understand how and why boys get involved in delinquent behaviors. Dr. Fabio will look at two age groups from the study: those 7 years old at the beginning of the study in 1987, and those aged 13 years at the beginning of the study.
The older group reported higher rates of violence than the younger group throughout the study. The primary question that Dr. Fabio and his colleagues plan to answer is whether this difference is due to some inherent distinction between the groups, or to some special or cultural factor such as poor economy, increased gang participation or drug dealing that played a greater risk during the time that the older group was growing up. Understanding these differences may help to predict future increase in violence.
Small Grant Projects
Exploring the Relationship Between Functional Status and Quality of Life After Traumatic Brian Injury (TBI)
Dianxu Ren, MD, PhD- Principal Investigator
Assistant Professor,
University of Pittsburgh, School of Nursing
This study will explore the relationship between functional status and quality of life after Traumatic Brain Injury Traumatic brain injury (TBI) results in the disturbance of cognitive, behavioral, emotional, and physical functioning that leads to functional deficits (impairments), disability, and decreases in quality of life. The investigations of functional status and Quality of life (QoL) after TBI have been widely studied. However, very few studies to date have sought to determine the relationship between objective functional status evaluations and subjective QoL measures in individuals after TBI and the influence of potential factors on their relationship. This proposal aims to determine the relationship between functional status and QoL after TBI and explore some possible mediator/moderator effects between them using standard methods as well as structural equations modeling (SEM). This prospective study will use longitudinal data collected from patient questionnaires and from medical records of patients with moderate and severe TBI from a current CIRCL funded project.
Traumatic Brain Injury Markers in Exhaled Breath Condensate
Martina Stippler, MD - Principal Investigator
Senior Resident, Department of Neurological Surgery
University of Pittsburgh, School of Medicine
Dr. Stippler will conduct a seed project to assess traumatic brain injury markers in exhaled breath condensate. Clinically, severe head injuries result in cognitive deficits, and in impaired memory, judgment, and perception. Early diagnosis and detection of head injuries is critical to improve outcome. It has been shown that proteins in exhaled breath condensate closely reflect the arterial concentration of biological substances. Breath samples are much easier to obtain than blood or cerebrospinal fluid samples. This is particularly advantageous if serial samples are required, e.g., in monitoring a patient. A diagnostic test based on exhaled breath condensate (EBC) would make it feasible to diagnose brain injury in the field, start therapy earlier, monitor it non-invasively, prevent secondary injury and improve outcome. The objective of this pilot feasibility study is to determine if well established brain injury markers are detectable in EBC. The future direction of this project is to develop a non-invasive diagnostic test based on EBC to diagnose TBI early, monitor severity non-invasively and predict outcome.