Anthony Fabio

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (34)97.49 Total impact

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    ABSTRACT: Introduction: This study examined systematic differences between commercial data in the relation between neighborhood racial and socioeconomic characteristics and the density of food and alcohol establishments. Methods: This study included two commercial datasets for 2003 and 2009 in Allegheny County, PA. Food and alcohol establishment densities were calculated by census tract (416 census tracts). Differences between the two commercial data sources of the food and alcohol environment across levels of neighborhood racial and socioeconomic characteristics were tested using correlations and two-way mixed analysis of variance (ANOVA). Results: There were differences by data source in the association between neighborhood racial and socioeconomic characteristics and food/alcohol establishment density. There was a positive correlation between grocery store/supermarket density and percentage black, poverty and percentage without a car among commercial data source #1 but not in data source #2. Alcohol outlet density (AOD) increased as neighborhood poverty increased for both data sources, but the mean difference in AOD between the two commercial data sources was highest among neighborhoods with 25-50% poverty (Cohen’s d -0.49, p<0.001) compared to neighborhoods with lower or higher poverty (2003 data). Mean grocery store density increased as percentage poverty increased, but only among commercial data source #1 (2009 data). Discussion: The location, numeration, and density of food and alcohol establishments are differentially associated with neighborhood racial and socioeconomic characteristics and may introduce systematic biases. Using multiple data sources may be important for addressing systematic biases and data limitations.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Neighborhood characteristics such as the built environment, perceived conditions, and social processes, impact local residents. The density of alcohol outlets in a neighborhood straddles each of these domains. Alcohol establishments are built structures where individuals congregate. They may influence social norms by weakening external controls making individuals more likely to engage in violent activities. Inadequate consideration of neighborhood social processes may have led to inconsistent findings. Most prior studies have adjusted for neighborhood effects using census variables as a proxy measure for social disadvantage. However, recent literature demonstrates the complexity of these social processes suggesting the need to consider more refined measures such as collective efficacy. Hypothesis: Using the availability of structural resources (parks, recreation centers, libraries, etc.) as a proxy for collective efficacy, we will examine the extent to which neighborhood structural resources mediate the relationship between alcohol outlet density (AOD) and violent crime. We hypothesize that the association between AOD and violence in neighborhoods will be smaller, or non-existent, in neighborhoods with access to a greater number of structural resources. Research Strategy: A combination of geo-spatial techniques and traditional quantitative methods will be used. We calculated neighborhood level rates of violence for Pittsburgh for the years 2008-2010. All aggravated assaults and robberies reported to the police were geocoded to a Pittsburgh neighborhood, defined by census tract. AOD for each neighborhood was calculated from a database created by combining data from InfoUSA and Dun & Bradstreet and geocoded for 2009 to a Pittsburgh neighborhood. Densities were calculated separate for on and off premise establishments. All density measures were calculated with neighborhood population levels. Neighborhood structural resources include: ball fields, bus shelters, bus routes, community pools, foreclosed properties, hospitals, libraries, museums, parks, recreation centers, schools, senior centers, universities, and vacant parcels. Using spatial analysis we will assess violent crime rates and geocoded density of structural components within neighborhood. Hot-spot analysis will be applied to identify statistically significant clusters. Upon identifying clusters, we will run factor analyses to analyze the relationships between each structural resource to identify the principal resources that mediate the association between AOD and violence. We will use Poisson regression to measure between-neighborhood variability in violence rates. Interactions between AOD and structural resources factor(s) will be tested to determine if these resources are mediators.
    Society for Prevention Research 22nd Annual Meeting 2013; 05/2014
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    ABSTRACT: To evaluate energy expenditure in a cohort of children with severe traumatic brain injury. A prospective observational study. A pediatric neurotrauma center within a tertiary care institution. Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension. Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted. Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13). Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.
    Pediatric Critical Care Medicine 01/2014; · 2.35 Impact Factor
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    ABSTRACT: Background. It was hypothesized that television viewing is predictive of cardiometabolic risk. Moreover, people with hostile personality type may be more susceptible to TV-induced negative emotions and harmful health habits which increase occurrence of cardiometabolic risk. Purpose. The prospective association of TV viewing on cardiometabolic risk was examined along with whether hostile personality trait was a modifier. Methods. A total of 3,269 Black and White participants in the coronary artery risk development in young adults (CARDIA) study were assessed from age 23 to age 35. A cross-lagged panel model at exam years 5, 10, 15, and 20, covering 15 years, was used to test whether hours of daily TV viewing predicted cardiometabolic risk, controlling confounding variables. Multiple group analysis of additional cross-lagged panel models stratified by high and low levels of hostility was used to evaluate whether the association was modified by the hostile personality trait. Results. The cross-lagged association of TV viewing at years 5 and 15 on clustered cardiometabolic risk score at years 10 and 20 was significant (B = 0.058 and 0.051), but not at 10 to 15 years. This association was significant for those with high hostility (B = 0.068 for exam years 5 to 10 and 0.057 for exam years 15 to 20) but not low hostility. Conclusion. These findings indicate that TV viewing is positively associated with cardiometabolic risk. Further, they indicate that hostility might be a modifier for the association between TV viewing and cardiometabolic risk.
    Journal of obesity. 01/2014; 2014:784594.
  • Proma Paul, Anthony Fabio
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    ABSTRACT: School-based vaccination is becoming a more widely considered method of delivering HPV immunizations to an adolescent population; however, many countries do not have experience with delivering adolescent vaccines or school-based programs. This literature review will summarize the experiences from countries implementing non-health facility-based and health facility-based vaccination programs and assess HPV vaccine coverage. In October 2012, a systematic search in PubMed for studies related to the evaluation of national/regional, pilot, or demonstration HPV immunization programs that worked within existing health system yielded nine articles, representing seventeen countries. School-based programs achieved high HPV vaccination coverage rates in 9- to13-year-old girls across the different studies and geographic locations, suggesting non-health facility-based programs are possible for HPV vaccine introduction. Grade-based, compared to age-based, eligibility criteria may be easier to implement in school settings. More studies are needed to explore the methods to standardize estimates for HPV vaccine coverage so that programs can be appropriately evaluated.
    Vaccine 11/2013; · 3.77 Impact Factor
  • Kerry ODonnell, Jessica Duell, Anthony Fabio
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    ABSTRACT: Background: Southwestern Pennsylvania experienced 100 homicides in 2012, the vast majority committed with firearms. Every year the Pittsburgh Bureau of Police takes nearly 1,000 guns off the street. The question is: Where are the guns coming from? Methods: We collected data on 893 firearms recovered by the Firearms Tracking Unit (FTU) of the Pittsburgh Police. Variables included type of gun, method of recovery, race and gender of the owner, whether the FTU was able to acquire contact information for the owner, whether the gun had been reported stolen, locality where it was reported stolen, and whether it was reported to an insurer. Results: An examination of one year, 2008, reveals that in 478 instances, perpetrators were found with guns that legally belonged to someone else. Of the 893 guns processed in that year, 691 were traced back to an individual, lawful owner. Of these, 292 guns were claimed to have been stolen. However, in 225 of those cases, either the gun was never reported stolen or there was no corresponding police report in the FTU file to confirm the theft. In 49 cases, the owners believed they knew who took their gun, and in 37 cases, a relationship was stated. Of the 691 guns traced to an owner, 161 (23%) were desired back by their owners and 111 (16%) were not wanted back. Conclusions: Further investigation is needed to determine how so many firearm owners are losing possession of their weapons.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • Pediatric Critical Care Medicine 10/2013; 14(8):811-818. · 2.35 Impact Factor
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    ABSTRACT: We explored the relationship between neighborhood socioeconomic disadvantage (NSED) and gestational weight gain and loss and if the association differed by race. A census tract level NSED index (categorized as low, mid-low, mid-high, and high) was generated from 12 measures from the 2000 US Census data. Gestational weight gain and other individual-level characteristics were derived from vital birth records for Allegheny County, PA for 2003-2010 (n = 55,608). Crude and adjusted relative risks were estimated using modified multilevel Poisson regression models to estimate the association between NSED and excessive and inadequate gestational weight gain (GWG) and weight loss (versus adequate GWG). Black women lived in neighborhoods that were more likely to be socioeconomically disadvantaged compared to white women. Almost 55 % of women gained an excessive amount of weight during pregnancy, and 2 % lost weight during pregnancy. Black women were more likely than white women to have inadequate weight gain or weight loss. Mid-high (aRR = 1.3, 95 % CI 1.2, 1.3) and high (aRR = 1.5, 95 % CI 1.5, 1.6) NSED compared to low NSED was associated with inadequate weight gain while NSED was not associated with excessive weight gain. Among black women, high versus low NSED was associated with weight loss during pregnancy (RR = 1.6, 95 % CI 1.1, 2.5). Among white women, each level of NSED compared to low NSED was associated with weight loss during pregnancy. This study demonstrates how neighborhood socioeconomic characteristics can contribute to our understanding of inadequate weight gain and weight loss during pregnancy, having implications for future research and interventions designed to advance pregnancy outcomes.
    Maternal and Child Health Journal 09/2013; · 2.24 Impact Factor
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    ABSTRACT: Over the last decade, biomarker research has identified potential biomarkers for the diagnosis, prognosis, and management of traumatic brain injury (TBI). Several cerebrospinal fluid (CSF) and serum biomarkers have shown promise in predicting long-term outcome after severe TBI. Despite this increased focus on identifying biomarkers for outcome prognostication following a severe TBI, several challenges still exist in effectively modeling the significant heterogeneity observed in TBI-related pathology, as well as the biomarker-outcome relationships. Biomarker data collected over time are usually summarized into single point estimates (e.g. average or peak biomarker levels), which are in turn used to examine the relationships between biomarker levels and outcomes. Furthermore, many biomarker studies to date have focused on the prediction power of biomarkers without controlling for potential clinical and demographic confounders that have been previously shown to affect long-term outcome. In this manuscript, we demonstrate the application of a practical approach to delineate and describe distinct subpopulations having similar longitudinal biomarker profiles and to model the relationships between these biomarker profiles and outcomes, while taking into account potential confounding factors. As an example, we demonstrate a group based modeling technique to identify temporal S100b profiles, measured from cerebral spinal fluid over the first week post-injury, in a sample of adult subjects with TBI, and we use multivariate logistic regression to show that the prediction power of S100b biomarker profiles can be superior to the prediction power of single point estimates.
    Journal of neurotrauma 02/2013; · 4.25 Impact Factor
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    ABSTRACT: As an astrocytic protein specific to the central nervous system (CNS), S100b is a potentially useful marker in outcome prediction after traumatic brain injury (TBI). Some studies have questioned the validity of S100b, citing the extra-cerebral origins of the protein as reducing the specificity of the marker. This study evaluated S100b as a prognostic biomarker in adult subjects with severe TBI by comparing outcomes with S100b temporal profiles generated from both cerebrospinal fluid (CSF) (n=138 subjects) and serum (n=80 subjects) samples across a six-day time-course. Long bone fracture, injury severity score (ISS), and isolated head injury status were variables used to assess extra-cerebral sources of S100b in serum. After TBI, CSF and serum S100b levels were increased over healthy controls across the first 6 days post-TBI (p≤0.005 and p≤0.031). While CSF and serum levels were highly correlated during early time points post-TBI, this association disappeared over time. Bivariate analysis showed that subjects who had temporal CSF profiles with higher S100b concentrations had higher acute mortality (p<0.001) and with worse Glasgow Outcome Scale (GOS) scores (p=0.002) and Disability Rating Scale (DRS) scores (p=0.039) 6 months post-injury. It is possible that, due to extra-cerebral sources of S100b in serum as represented by high ISS scores (p=0.032), temporal serum profiles were associated with acute mortality (p=0.015). High CSF S100b levels were observed in women (p=0.022) and older subjects (p=0.004). Multivariate logistic regression confirmed CSF S100b profiles in predicting GOS and DRS and showed mean and peak serum S100b as acute mortality predictors following severe TBI.
    Journal of neurotrauma 11/2012; · 4.25 Impact Factor
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    ABSTRACT: Background: It is unknown what impact large scale sporting events, which may influence both alcohol consumption and criminal behavior, have on the relationship between alcohol outlet density (AOD) and violent crime. We analyzed five years (2005-2009) of data to determine the impact that games played by Pittsburgh's professional football team had on violence in Pittsburgh city neighborhoods and assess whether this relationship varied by AOD. Methods: Rates of violent crime (including homicides, robberies, and aggravated assaults) were calculated at the neighborhood level for all Sundays with and without games from 2005-2009 based on data provided by the Pittsburgh Police. Drinking establishments and retail liquor stores were geocoded with ArcGIS using address data from InfoUSA, and the density per square mile was calculated for each neighborhood. Using Poisson regression, adjusted for measures of neighborhood disadvantage, we discovered an interaction between alcohol outlet density and football games. Neighborhoods were subsequently stratified into those with and without drinking or retail alcohol establishments and analyzed separately. Results: Neighborhoods in the low density group experienced a drop in violent crime on game days vs. non-game days (68.19 vs. 73.53 per 1000 Sundays, respectively; p=0.001). The high density neighborhoods had a slight increase in violent crime on game days, but this difference was not significant. Conclusions: Our results suggest that violence decreases on game days in neighborhoods without alcohol establishments but not in neighborhoods with alcohol establishments. Additional studies are needed to clarify the relationships between AOD, violent crime, and professional sporting events.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: To evaluate the rate of abusive head trauma (AHT) in 3 regions of the United States before and during an economic recession and assess whether there is a relationship between the rate of AHT and county-level unemployment rates. Clinical data were collected for AHT cases diagnosed in children younger than 5 years from January 1, 2004 until June 30, 2009, by hospital-based child protection teams within 3 geographic regions. The recession was defined as December 1, 2007 through June 30, 2009. Quarterly unemployment rates were collected for every county in which an AHT case occurred. During the 5½-year study period, a total of 422 children were diagnosed with AHT in a 74-county region. The overall rate of AHT increased from 8.9 in 100,000 (95% confidence interval [CI]: 7.8-10.0) before the recession to 14.7 in 100,000 (95% CI: 12.5-16.9) during the recession (P < .001). There was no difference in the clinical characteristics of subjects in the prerecession versus recession period. There was no relationship between the rate of AHT and county-level unemployment rates. The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship.
    PEDIATRICS 09/2011; 128(4):637-43. · 4.47 Impact Factor
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    ABSTRACT: We sought to better determine the way in which neighborhood disadvantage affects the shape of the age-crime curve. We used data from the Pittsburgh Youth Study (PYS), a 14-year longitudinal study, to compare the age-crime curves of individuals in neighborhoods of different disadvantage. We visually compared observed age-crime curves, and then used generalized linear mixed models to test for differences in curve parameters. Adjusted for individual risk factors, the mixed models found that the parameters for interactions of neighborhood disadvantage with both linear age and quadratic age were significant (P < .05) and consistent with higher and longer age-crime curves in more disadvantaged neighborhoods. This implied that compared with boys in advantaged neighborhoods, rates of violence among boys in disadvantaged neighborhoods rose to higher levels that were sustained significantly longer. These results suggested that residing in a disadvantaged neighborhood during early adolescence may have an enduring effect on the shape of the age-crime curve throughout an individual's life.
    American Journal of Public Health 07/2011; 101 Suppl 1:S325-32. · 3.93 Impact Factor
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    ABSTRACT: Experimental traumatic brain injury (TBI) studies report the neuroprotective effects of female sex steroids on multiple mechanisms of injury, with the clinical assumption that women have hormonally mediated neuroprotection because of the endogenous presence of these hormones. Other literature indicates that testosterone may exacerbate injury. Further, stress hormone abnormalities that accompany critical illness may both amplify or blunt sex steroid levels. To better understand the role of sex steroid exposure in mediating TBI, we 1) characterized temporal profiles of serum gonadal and stress hormones in a population with severe TBI during the acute phases of their injury; and 2) used a biological systems approach to evaluate these hormones as biomarkers predicting global outcome. The study population was 117 adults (28 women; 89 men) with severe TBI. Serum samples (n=536) were collected for 7 days post-TBI for cortisol, progesterone, testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Hormone data were linked with clinical data, including acute care mortality and Glasgow Outcome Scale (GOS) scores at 6 months. Hormone levels after TBI were compared to those in healthy controls (n=14). Group based trajectory analysis (TRAJ) was used to develop temporal hormone profiles that delineate distinct subpopulations in the cohort. Structural equations models were used to determine inter-relationships between hormones and outcomes within a multivariate model. Compared to controls, acute serum hormone levels were significantly altered after severe TBI. Changes in the post-TBI adrenal response and peripheral aromatization influenced hormone TRAJ profiles and contributed to the abnormalities, including increased estradiol in men and increased testosterone in women. In addition to older age and greater injury severity, increased estradiol and testosterone levels over time were associated with increased mortality and worse global outcome for both men and women. These findings represent a paradigm shift when thinking about the role of sex steroids in neuroprotection clinically after TBI.
    Journal of neurotrauma 06/2011; 28(6):871-88. · 4.25 Impact Factor
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    ABSTRACT: Background: In order to optimize care and improve outcomes in people with diabetes, adequate access to health care facilities and resources for self-management is required. Methods: Data on 3369 individuals with type 2 diabetes who received education at 7 diabetes centers were collected prospectively between June 2005 and January 2007. The driving distances of subjects who were in good control [hemoglobin A1c (A1C) ≤7.0%] were compared with the driving distances of those who were not (A1C >7.0%). The association between A1C and improvement in A1C with travel burden was tested. Results: The mean distance subjects traveled to visit their center was 13.3 miles. The results indicated that residing more than 10 miles from the diabetes management center [odds ratio (OR) = 1.91, p < .0001], being younger (OR = 0.99, p = .00015), and having a longer duration of diabetes (OR = 1.03, p = .0007) were significant contributors to a A1C >7% adjusted for individual- and community-level factors. In addition, those who lived within 10 miles of their center were 2.5 times more likely to have improved their A1C values between their first and last office visits. Conclusion: Health care providers should be aware of travel burden as a potential barrier to glycemic control. In the future, it may be useful to minimize driving distance for individuals with diabetes, perhaps by improved public transportation, more diabetes center locations in rural areas, telemedicine, or home visits.
    Journal of diabetes science and technology 05/2011; 5(3):494-500.
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    ABSTRACT: The biochemical cascades associated with cell death after traumatic brain injury (TBI) involve both pro-survival and pro-apoptotic proteins. We hypothesized that elevated cerebrospinal fluid (CSF) Bcl-2 and cytochrome C (CytoC) levels over time would reflect cellular injury response and predict long-term outcomes after TBI. Cerebrospinal fluid Bcl-2 and CytoC levels were measured for 6 days after injury for adults with severe TBI (N=76 subjects; N=277 samples). Group-based trajectory analysis was used to generate distinct temporal biomarker profiles that were compared with Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS) scores at 6 and 12 months after TBI. Subjects with persistently elevated temporal Bcl-2 and CytoC profiles compared with healthy controls had the worst outcomes at 6 and 12 months (P≤0.027). Those with CytoC profiles near controls had better long-term outcomes, and those with declining CytoC levels over time had intermediate outcomes. Subjects with Bcl-2 profiles that remained near controls had better outcomes than those with consistently elevated Bcl-2 profiles. However, subjects with Bcl-2 values that started near controls and steadily rose over time had 100% good outcomes by 12 months after TBI. These results show the prognostic value of Bcl-2 and CytoC profiles and suggest a dynamic apoptotic and pro-survival response to TBI.
    Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 03/2011; 31(9):1886-96. · 5.46 Impact Factor
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    ABSTRACT: Cali, Colombia, has a high incidence of interpersonal violence deaths. Various alcohol control policies have been implemented to reduce alcohol-related problems. The objective of this study was to determine whether different alcohol control policies were associated with changes in the incidence rate of homicides. Ecologic study conducted during 2004-08 using a time-series design. Policies were implemented with variations in hours of restriction of sales and consumption of alcohol. Most restrictive policies prohibited alcohol between 2 a.m. and 10 a.m. for 446 non-consecutive days. Moderately restrictive policies prohibited alcohol between 3 a.m. and 10 a.m. for 1277 non-consecutive days. Lax policies prohibited alcohol between 4 a.m. and 10 a.m. for 104 non-consecutive days. In conditional autoregressive negative binomial regressions, rates of homicides and unintentional injury deaths (excluding traffic events) were compared between different periods of days when different policies were in effect. There was an increased risk of homicides in periods when the moderately restrictive policies were in effect compared with periods when the most restrictive policies were in effect [incidence rate ratio (IRR) 1.15, 90% confidence interval (CI) 1.05-1.26, P = 0.012], and there was an even higher risk of homicides in periods when the lax policies were in effect compared with periods when the most restrictive policies were in effect (IRR 1.42, 90% CI 1.26-1.61, P < 0.001). Less restrictive policies were not associated with increased risk of unintentional injury deaths. Extended hours of sales and consumption of alcohol were associated with increased risk of homicides. Strong restrictions on alcohol availability could reduce the incidence of interpersonal violence events in communities where homicides are high.
    International Journal of Epidemiology 03/2011; 40(4):1037-46. · 6.98 Impact Factor
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    ABSTRACT: We examined changes in suicide rates among 10-24-year-olds in the United States from 1992 to 2006. The overall suicide rate and the rate by firearms, poisoning, and other methods declined markedly, whereas the hanging/suffocation rate increased significantly from 1992 to 2006. This increase occurred across every major demographic subgroup, but was most dramatic for females.
    Journal of Adolescent Health 05/2010; 46(5):503-5. · 2.97 Impact Factor
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    ABSTRACT: Traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE) are leading causes of morbidity and mortality in children. Several studies over the past several years have evaluated the use of serum biomarkers to predict outcome after pediatric brain injury. These studies have all used simple point estimates such as initial and peak biomarker concentrations to predict outcome. However, this approach does not recognize patterns of change over time. Trajectory analysis is a type of analysis which can capture variance in biomarker concentrations over time and has been used with success in the social sciences. We used trajectory analysis to evaluate the ability of the serum concentrations of 3 brain-specific biomarkers - S100B, neuron-specific enolase (NSE) and myelin basic protein (MBP) - to predict poor outcome (Glasgow Outcome Scale scores 3-5) after pediatric TBI and HIE. Clinical and biomarker data from 100 children with TBI or HIE were evaluated. For each biomarker, we validated 2-, 3- and 4-group models for outcome prediction, using sensitivity and specificity. For S100B, the 3-group model predicted poor outcome with a sensitivity of 59% and specificity of 100%. For NSE, the 3-group model predicted poor outcome with a sensitivity of 48% and specificity of 98%. For MBP, the 3-group model predicted poor outcome with a sensitivity of 73% and specificity of 61%. Thus, when the models predicted a poor outcome, there was a very high probability of a poor outcome. In contrast, 17% of subjects with a poor outcome were predicted to have a good outcome by all 3 biomarker trajectories. These data suggest that trajectory analysis of biomarker data may provide a useful approach for predicting outcome after pediatric brain injury.
    Developmental Neuroscience 01/2010; 32(5-6):396-405. · 3.41 Impact Factor
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    ABSTRACT: We report the morbidity and mortality associated with fractures of the clivus and discuss management approaches specific to this unique diagnostic entity. We performed a boolean search of our electronic medical record database to identify patients with fractures of the clivus that were diagnosed using computed tomography of the head. A retrospective imaging and chart analysis was completed to further characterize the fractures and to analyze outcomes. Between January 1999 and December 2007, 41 patients were identified with fractures of the clivus. We found a 0.21% overall incidence among all head-injured patients presenting to our institution and a 2.3% incidence among those patients with a cranial fracture. Ten of 41 patients (24.4%) died, and neurological and vascular complications associated with central cranial base fractures were observed in 19 of 41 patients (46%). Furthermore, associated cranial fractures remote from the central cranial base and associated intracranial hemorrhages were observed in 40 of 41 (97.6%) and 33 of 41 (80.5%) patients, respectively. In terms of outcomes, 26 of 41 patients (63.5%) had a Glasgow Coma Scale score of 12 or greater at the time of discharge from the hospital. We demonstrate a lower than previously reported mortality rate in patients with clival fractures. Nevertheless, as a result of location, fractures of the clivus were frequently associated with a high rate of complications and neurological sequelae.
    Neurosurgery 12/2009; 65(6):1063-9; discussion 1069. · 2.53 Impact Factor

Publication Stats

277 Citations
97.49 Total Impact Points


  • 2002–2014
    • University of Pittsburgh
      • • Department of Epidemiology
      • • Department of Physical Medicine and Rehabilitation
      • • Center for Injury Research and Control
      • • Department of Psychiatry
      • • School of Medicine
      Pittsburgh, Pennsylvania, United States
  • 2010–2011
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, PA, United States