Daniel P O'Connor

University of Houston, Houston, Texas, United States

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Publications (106)261.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The GoWoman project is developing and pilot testing the first small group weight management program designed to meet the unique needs of women with mobility impairments, a significantly underserved health disparity population. The project is conducted by a consortium of investigators at five universities in partnership with a Community Advisory Board of five women with mobility impairments. In adapting existing curriculum from the Diabetes Prevention Program, we added content related to the association between disability and weight gain, adaptive cooking, accessible kitchen design, an expanded range of physical activities, precautions against excessive activities and exercises, disability-related stress, and examples that reflect the life situation of women with disabilities. Participants track their progress through MyFitnessPal. Offering this intervention in the online virtual world of Second Life allows us to circumvent many of the geographic, transportation, logistic, disability, and personal barriers that women with mobility impairments face when attempting to participate in public weight loss programs. Our simulated accessible kitchen, caf, and physical activity venues also provide congenial and stigma-free environments for offering social interaction opportunities to reinforce the weight loss programming. The intervention consists of facilitated groups of 8-10 women who gather using their avatar and communicate using voice or text. Sessions last two hours and convene once a week for 16 weeks. We will demonstrate this virtual venue and present the results of the beta-test. We will discuss advantages and technical challenges of implementing interventions in virtual environments, and the implications of this study for mainstream weight loss programs.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The purpose of this study was to evaluate outcomes in patients with rotator cuff tear arthropathy after staged bilateral reverse shoulder arthroplasties (RSAs) and to compare them with an age-, gender-, and diagnosis-matched control group with a unilateral RSA. We identified 11 patients with bilateral RSAs for rotator cuff tear arthropathy with a minimum of 2-year follow-up in a prospective shoulder arthroplasty registry. The bilateral group was matched to a control group of 19 patients with a unilateral RSA. Shoulder function scores, mobility, patient satisfaction, and activities of daily living were assessed preoperatively and at final follow-up. There was no statistical difference between the first RSA or second RSA and the control group regarding age, gender, or follow-up. No group differences were noted preoperatively for shoulder function scores or mobility (P > .10). All groups significantly improved on all shoulder function scores (Constant score, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index, Single Assessment Numeric Evaluation score) and mobility at final follow-up (all P < .01). There were no significant differences in shoulder function scores or mobility between the first and second RSA in the bilateral group or between either shoulder in the bilateral group and the unilateral group (all P > .10). Patient satisfaction improved and patients were successfully able to perform many important activities of daily living after bilateral RSAs. Patients with bilateral rotator cuff tear arthropathy can be advised that staged bilateral RSAs can be successful when indicated. Improvements in shoulder function scores, patient satisfaction, and mobility are possible for both the first RSA and the second RSA. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2014; · 1.93 Impact Factor
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    ABSTRACT: Management of periprosthetic infection after reverse shoulder arthroplasty (RSA) remains a challenge. Whereas the infection rate after RSA has improved, more information would be helpful to identify patient risk factors for infection after RSA. The purpose of this study was to evaluate risk factors for infection after RSA.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2014; · 1.93 Impact Factor
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    ABSTRACT: The purpose of this study was to determine whether self-regulation of eating in minority preschool-aged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children's appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children's self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children's weight, B (SE) = -0.073 (0.036), p < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps >.05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions.
    Appetite 06/2014; · 2.52 Impact Factor
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    ABSTRACT: The purpose of this study is to evaluate the effectiveness of a systematic approach to exchange nailing for the treatment of aseptic tibial nonunion. Retrospective cohort. Tertiary referral center. Forty-six aseptic tibial nonunion sites in forty patients (2 bilateral., 4 segmental) that presented with an intramedullary nail (IMN) an average of 16 months after the initial treatment. Insertion of an exchange nail of at least > 2 mm diameter than the prior nail using a different manufacturer's nail, static interlocking, partial fibulectomy in a select group of patients. and correction of underlying metabolic and endocrine abnormalities. Union rate, time to union. Forty-five of 46 tibial nonunion sites (98%) healed at an average of 4.8 months. Patient selection criteria and a systematic approach to exchange nailing for tibial nonunion is highly successful. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 05/2014; · 1.78 Impact Factor
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    ABSTRACT: Few studies have investigated changes in adiposity and fitness during the academic year (AY) and summer season (SS) in minority children. This study aimed to assess if adiposity indicators and fitness change during the school AY and SS in Hispanic children. One hundred nineteen low-income Hispanic children (9.2 ± 0.8) participated in the study. Demographic, body weight and height, percent body fat (% BF), and aerobic endurance were assessed at 3 time points: measurement 1 (M1), beginning of AY; M2, end of AY; and M3, end of SS. Using weight and height, body mass index (BMI) was calculated and normalized (BMI z-scores). Mixed effects between-within-subjects analysis of variance (ANOVA) design was used to examine changes in selected variables. A significant decrease of BMI z-scores in overweight children (p = .024) was observed during the AY only, but not during the SS. Percent BF increased significantly over the AY and SS (p < .001), particularly in girls. Aerobic endurance showed a significant increase over the AY (p < .001), but it did not change over the SS (p = .552). Results indicated that the SS might place Hispanic children at increased risk for additional adiposity and lower fitness.
    Journal of School Health 04/2014; 84(4):233-8. · 1.50 Impact Factor
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    ABSTRACT: This study assesses the failure rate of soft-tissue versus hardware fixation of biceps tenodesis by ultrasound to determine if the expense of a hardware tenodesis technique is warranted. Seventy-two patients that underwent arthroscopic biceps tenodesis over a 3-year period were evaluated using postoperative ultrasonography and clinical examination. The tenodesis technique employed was either a soft-tissue technique with sutures or an interference screw technique using hardware based on surgeon preference. Patient age was 57.9 years on average with ultrasound and clinical examination done at an average of 9.3 months postoperatively. Thirty-one patients had a hardware technique and 41 a soft-tissue technique. Overall, 67.7% of biceps tenodesis done with hardware were intact, compared with 75.6% for the soft-tissue technique by ultrasound (P = .46). Clinical evaluation indicated that 80.7% of hardware techniques and 78% of soft-tissue techniques were intact. Average material cost to the hospital for the hardware technique was $514.32, compared with $32.05 for the soft-tissue technique. Biceps tenodesis success, as determined by clinical deformity and ultrasound, was not improved using hardware as compared to soft-tissue techniques. Soft-tissue techniques are equally efficacious and more cost effective than hardware techniques.
    American journal of orthopedics (Belle Mead, N.J.) 02/2014; 43(2):62-5.
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    ABSTRACT: Fast-food restaurants (FFR) are prevalent. Binge eating is common among overweight and obese women. For women prone to binge eating, neighbourhood FFR availability (i.e. the neighbourhood around one's home) may promote poor diet and overweight/obesity. The present study tested the effects of binge eating and neighbourhood FFR availability on diet (fat and total energy intake) and BMI among African American and Hispanic/Latino women. All measures represent baseline data from the Health is Power randomized clinical trial. The numbers of FFR in participants' neighbourhoods were counted and dichotomized (0 or ≥1 neighbourhood FFR). Participants completed measures of binge eating status and diet. Weight and height were measured and BMI calculated. 2 (binge eating status) × 2 (neighbourhood FFR availability) ANCOVA tested effects on diet and BMI while controlling for demographics. Houston and Austin, TX, USA. African American and Hispanic/Latino women aged 25-60 years. Of the total sample (n 162), 48 % had 1-15 neighbourhood FFR and 29 % were binge eaters. There was an interaction effect on BMI (P = 0·05). Binge eaters with ≥1 neighbourhood FFR had higher BMI than non-binge eaters or binge eaters with no neighbourhood FFR. There were no significant interactions or neighbourhood FFR main effects on total energy or fat intake (P > 0·05). A main effect of binge eating showed that binge eaters consumed more total energy (P = 0·005) and fat (P = 0·005) than non-binge eaters. Binge eaters represented a substantial proportion of this predominantly overweight and obese sample of African American and Hispanic/Latino women. The association between neighbourhood FFR availability and weight status is complicated by binge eating status, which is related to diet.
    Public Health Nutrition 01/2014; · 2.25 Impact Factor
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    ABSTRACT: Obesity has been associated with accelerated biological aging and immunosenescence. As the prevalence of childhood obesity is increasing, we wanted to determine if associations between obesity and immunosenescence would manifest in children. We studied 123 Mexican-American adolescents aged 10 to 14 (mean 12.3 ± 0.7) years, with body weights ranging from 30.1 to 115.2 kg (mean 52.5 ± 14.5 kg). Blood samples were obtained to determine proportions of naïve, central memory (CM), effector memory (EM), senescent and early, intermediate and highly differentiated subsets of CD4+ and CD8+ T-cells. Overweight and obese children had significantly lowered proportions of early CD8+ T-cells (B= -11.55% and - 5.51% respectively) compared to healthy weight. Overweight children also had more EM (B=+7.53%), late (B=+8.90%) and senescent (B=+4.86%) CD8+ T-cells than healthy weight children, while obese children had more intermediate CD8+ (B=+4.59%), EM CD8+ (B=+5.49%), late CD4+ (B=+2.01%) and senescent CD4+ (B=+0.98%) T-cells compared to healthy weight children. These findings withstood adjustment for potentially confounding variables including age, gender and latent CMV and EBV infections. We conclude that excess body mass, even in adolescence, may accelerate immunosenescence and predispose children to increased risks of incurring immune related health problems in adulthood.
    Clinical & Experimental Immunology 01/2014; · 3.28 Impact Factor
  • Mark R Brinker, Bryan D Hanus, Milan Sen, Daniel P O'Connor
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    ABSTRACT: Tibial nonunion is disabling, but to our knowledge no quantitative evaluation of its effect on health-related quality of life has been reported. We evaluated 243 tibial shaft fracture nonunions in 237 consecutive patients (seventy-nine female [age, 49.4 ± 14.9 years] and 158 male [age, 46.3 ± 15.4 years]) who were referred to a single surgeon at our tertiary care center over a ten-year period. The most frequently affected tibial segment was the distal third (49%), and infection was present in 18% of all cases. The Short Form (SF)-12 Physical Component Summary score averaged 27.4 ± 6.7, indicating an extremely disabling effect on physical health. The AAOS (American Academy or Orthopaedic Surgeons) Lower Limb Core Scale score averaged 52.0 ± 19.4, also consistent with high levels of physical disability attributable to the lower limb. The SF-12 Mental Component Summary score averaged 42.3 ± 7.1, indicating a substantial detrimental effect on mental health. The impact of tibial shaft fracture nonunion on physical health was comparable with the reported impact of end-stage hip arthrosis and worse than that of congestive heart failure. Tibial shaft fracture nonunion is a devastating chronic medical condition that negatively affects both physical and mental health and quality of life. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 12/2013; 95(24):2170-6. · 3.23 Impact Factor
  • Mark R Brinker, Daniel P O'Connor
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    ABSTRACT: Modern interest in patient-reported outcomes measures (PROMs) in orthopaedics dates back to the mid-1980s. While gradual growth of activity in this area has occurred over the past 25 years, the extent to which this research methodology is applied in clinical practice to improve patient care is unclear. WHERE ARE WE NOW?: Historically, clinical research in orthopaedics has focused on the technical success of treatment, and objective indicators such as mortality, morbidity, and complications. By contrast, the PROMs framework focuses on effects of treatment described in terms of relief of symptoms, restoring functional ability, and improving quality of life. PROMs can be used to study the relative effects of disease, injury, and treatment across different health conditions. WHERE DO WE NEED TO GO?: All clinical research should begin with identifying clear and meaningful research questions so that the resources and efforts required for data collection result in useful data. Different consumers of research data have different perspectives on what comprises meaningful information. Involving stakeholders such as patients, providers, payers, and policy-makers when defining priorities in the larger research endeavor is one way to inform what type of data should be collected in a particular study. HOW DO WE GET THERE?: Widespread collection of outcomes data would potentially aid these stakeholders by identifying best practices, benefits and costs, and important patient or practice characteristics related to outcomes. Several initiatives currently underway may help systematic collection of PROMs, create efficient systems, and foster collaborations to provide support and resources to minimize costs.
    Clinical Orthopaedics and Related Research 09/2013; · 2.79 Impact Factor
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    ABSTRACT: The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty-two of 40 patients (80%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .018). Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 09/2013; · 1.93 Impact Factor
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    ABSTRACT: The purpose of this study was to determine whether morphine would be as effective as bupivacaine for postoperative pain control after knee arthroscopy with no worsening of the side effect profile. Eighty-two patients who underwent partial meniscectomy, chondral debridement, or both were prospectively randomized to receive 10 mg of morphine (10-cc volume) or 10 cc of .5% bupivacaine immediately postoperatively. Visual analog scale scores and side effect profiles were recorded in the postanesthesia care unit, in the transitional care unit, and then every 4 hours postoperatively until 24 hours. In-hospital data were available for all 82 patients, but postdischarge data were available for only 64 patients. Visual analog scale scores in the postanesthesia care unit decreased from 3.4 on admission to 2.4 on discharge for the morphine group and from 2.6 to 2.4 for the bupivacaine group (P>.217, all time points). Medication use was the same for both groups in the hospital (62% and 78%, respectively) with no statistical difference. Visual analog scale scores decreased from 3.0 to 1.5 for the morphine group and from 2.8 to 1.8 for the bupivacaine group between 4 and 24 hours postoperatively (P>.376, all time points). Medication use decreased between 4 and 24 hours postoperatively for both groups, from 71.7% to 52.9%, respectively, with no statistical difference at all time points. Four patients in the morphine group and 1 patient in the bupivacaine group experienced side effects. This study indicates that 10 mg of intra-articular morphine is as effective as 10 cc of .5% bupivacaine for postoperative pain control for partial meniscectomy and chondral debridement of the knee. It minimally increases side effects initially and circumvents the issue of chondral toxicity of bupivacaine.
    Orthopedics 09/2013; 36(9):e1121-7. · 1.05 Impact Factor
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    ABSTRACT: The Energy Balance Study (EBS) was a comprehensive study designed to determine over a period of 12 months the associations of caloric intake and energy expenditure on changes in body weight and composition in a population of healthy men and women. EBS recruited men and women aged 21 to 35 years with a body mass index between 20 and 35 kg/m2. Measurements of energy intake and multiple objective measures of energy expenditure, as well as other physiological, anthropomorphic and psychosocial measurements, were made quarterly. Resting metabolic rate and blood chemistry were measured at baseline, 6 and 12 months. Four hundred and thirty (218 women and 212 men) completed all baseline measurements. There were statistically significant differences by sex uncovered for most anthropomorphic, physiological and behavioral variables. Only percent of kcals from fat and alcohol intake, as well as energy expenditure in light activity and very vigorous activity were not different. Self-reported weight change (mean +/- SD) over the previous year were 0.92 +/- 5.24 kg for women and--1.32 +/- 6.1 kg for men. Resting metabolic rate averages by sex were 2.88 +/- 0.35 ml/kg/min for women and 3.05 +/- 0.33 ml/kg/min for men. Results from EBS will inform our understanding of the impact of energy balance components as they relate to changes in body weight and composition. Initial findings suggest a satisfactory distribution of weight change to allow for robust statistical analyses. Resting metabolic rates well below the standard estimate suggest that the evaluation of the components of total energy expenditure will be impactful for our understanding of the roles of energy intake and expenditure on changes in energy utilization and storage.
    Research quarterly for exercise and sport 09/2013; 84(3):275-86. · 1.26 Impact Factor
  • Daniel P O'Connor, Mark R Brinker
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    ABSTRACT: Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity ("generalizability"). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges. WHERE ARE WE NOW?: Orthopaedic surgery research has many stakeholders, including patients, providers, payers, and policy makers. A major challenge in orthopaedic surgery outcome measurement and clinical research is providing all of these users with valid information for their respective decision making. At present, no plan exists for capturing data on such a broad scale and scope. WHERE DO WE NEED TO GO?: Practical challenges include identifying and obtaining resources for widespread data collection and merging multiple data sources. Challenges of study design include sampling to obtain representative data, timing of data collection in the episode of care, and minimizing missing data and study dropout. HOW DO WE GET THERE?: Resource limitations may be addressed by repurposing existing clinical resources and capitalizing on technologic advances to increase efficiencies. Increasing use of rigorous, well-designed observational research designs can provide information that may be unattainable in clinical trials. Such study designs should incorporate methods to minimize missing data, to sample multiple providers, facilities, and patients, and to include evaluation of potential confounding variables to minimize bias and allow generalization to broad populations.
    Clinical Orthopaedics and Related Research 07/2013; · 2.79 Impact Factor
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    ABSTRACT: Latent cytomegalovirus (CMV) infection has been shown to alter the lymphocyte response to acute aerobic exercise, likely due to the corresponding increase in exercise-responsive memory CD8+T-cells. It is unknown if latent infection with another herpesvirus, herpes simplex virus 1 (HSV-1), also plays a role in shaping the lymphocyte response to exercise. Thirty two men (age: 39.3±14.7 yrs) counterbalanced by CMV and HSV-1 serostatus (pos/neg) cycled 30 minutes at ∼80% peak power. Blood sampled before, immediately after, and 1h after exercise was analyzed by flow cytometry for T-cell subset enumeration. In resting blood, HSV-1pos had fewer lymphocytes, CD4+ T-cells, KLRG1-CD28+CD4+T-cells, and CD45RA-CCR7+CD4+T-cells than HSV-1neg, whereas CMVpos had increased numbers of lymphocytes, CD8+T-cells, KLRG1+CD28-CD4+ and CD8+ T-cells, CD45RA+CCR7-CD8+T-cells, and a lower CD4:CD8 T-cell ratio than CMVneg. Following exercise, CMVpos had a greater mobilization of CD8+T-cells, KLRG1+CD28-CD4+ and CD8+ T-cells, and CD45RA+ CCR7-CD8+T-cells independently of HSV-1 serostatus, as well as a greater egress of these subsets 1h post-exercise. HSV serostatus did not influence total CD8+ T-cell response to exercise. The impact of latent CMV infection on the redeployment of T-cell subsets with exercise is independent of HSV-1 infection. This is most likely due to the unique ability of CMV to alter the composition of the memory T-cell pool in favor of exercise-responsive T-cell subsets.
    Medicine and science in sports and exercise 07/2013; · 4.48 Impact Factor
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    ABSTRACT: To effectively evaluate activity-based interventions for weight management and disease risk reduction, objective and accurate measures of exercise dose are needed. This study examined cumulative exercise exposure defined by heart rate-based intensity, duration, and frequency as a measure of compliance with a prescribed exercise program and a predictor of health outcomes. 1,150 adults (21.3 ± 2.7 yrs) completed a 15-week exercise protocol consisting of 30 min/day, three days/wk at 65-85% maximum heart rate reserve (HRR). Computerized HR monitor data were recorded at every exercise session (33,473 valid sessions). To quantify total exercise dose, duration for each session was adjusted for average exercise intensity (%HRR) to create a measure of intensity-minutes for each workout, which were summed over all exercise sessions to formulate a heart rate physical activity score (HRPAS). Regression analysis was used to examine the relationship between HRPAS and physiological responses to exercise training. Compliance with the exercise protocol based on achievement of the minimum prescribed HRPAS was compared to adherence defined by attendance. Using HRPAS, 868 participants were empirically defined as compliant, and 282 were non-compliant. HRPAS-based and attendance-based classifications of compliance and adherence differed for approximately 9% of participants. Higher HRPAS was associated with significant positive changes in body mass (p<0.001), BMI (p<0.001), waist and hip circumferences (p<0.001), percent body fat (%Fat, p<0.001), systolic blood pressure (p<0.011), resting heart rate (RHR, p<0.003), fasting glucose (p<0.001), and total cholesterol (p<.02). Attendance-based adherence was associated with body mass, hip circumference, %Fat, RHR, and cholesterol (p<0.05). The HRPAS is a quantifiable measure of exercise dose associated with improvement in health indicators beyond that observed when adherence is defined as session attendance.
    Medicine and science in sports and exercise 06/2013; · 4.48 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the relationships among depressive symptoms, stress and severity of binge eating symptoms in a community sample of African American and Hispanic or Latina women. Women (African American, n = 127; Hispanic or Latina, n = 44) completed measures of body composition, stress, depression, and binge eating. Scores on a depressive symptom scale indicated that 24.0 % of participants exhibited clinically significant levels of depressive symptoms. Mean binge eating scores were below the threshold for clinically diagnosed binge eating (12.99 ± 7.90). Mean stressful event scores were 25.86 ± 14.26 and the average stress impact score was 78.36 ± 55.43. Linear regression models found that body composition, stress impact score, and being classified as having clinically significant levels of depression were associated with severity of binge eating symptoms. Higher levels of percent body fat, a CES-D score ≥16 and higher WSI-Impact scores were associated with greater severity of binge eating symptoms.
    Eating and weight disorders: EWD 06/2013; 18(2):221-7. · 0.53 Impact Factor
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    ABSTRACT: Orchestration of sensory-motor information and adaptation to internal or external, acute or chronic changes is one of the fundamental features of human postural control. The postural control system is challenged on a daily basis, and displays a remarkable ability to adapt to both long and short term challenges. To explore the interaction between support surface stability and Achilles tendon vibration during a period of adaptation we used both a linear measure and a non-linear measure derived from center-of-pressure (COP) data. An equilibrium score (ES), based upon peak amplitude of anterior-posterior sway towards theoretical limits of stability was the linear measure used to assess postural performance. We observed early effects of vibration on postural stability, depending on support characteristics. Participants were able to decrease sway with extended practice over days, independent of support surface stability. Approximate entropy analysis of COP data provided additional information about control adaptation processes.
    Human movement science 03/2013; · 2.15 Impact Factor
  • Houston L Braly, Daniel P O'Connor, Mark R Brinker
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    ABSTRACT: OBJECTIVE:: To report the outcomes of percutaneous autologous bone marrow injection for nonunion or delayed union of the distal tibial metaphysis in patients with prior plating. DESIGN:: Consecutive case series. SETTING:: Tertiary center. PATIENTS:: 11 consecutive patients (age 24 to 51 years) were referred to us with a nonunion or delayed union of the distal tibial metaphysis following open reduction and internal fixation (plates and screws) at the time of fracture. The average time from initial injury to nonunion or delayed union and bone marrow treatment was 8 months (range, 3 to 20 months). INTERVENTION:: 40-80 mL of bone marrow aspirated from the posterior iliac crest and injected in and around the nonunion or delayed union site under fluoroscopic guidance. MEASUREMENTS:: Healing at the injury site was evaluated using clinical and radiographic criteria, including computed tomography. Measures included AAOS Lower Limb Core Scale (LLCS); Brief Pain Inventory (BPI); and SF-12 Physical Component Scale (PCS). RESULTS:: Nine of the 11 patients attained bony union within 6 months of bone marrow injection. Six of these 9 patients who were followed-up an average of 4.4 years (range, 1.3 to 8.2 years) after the injection reported significant (P<0.05) improvements in LLCS (59.9 to 89.7), pain intensity (2.9 to 1.7), pain interference (4.6 to 2.3), and SF-12 PCS (29.5 to 46.6), and 5.6 years improvement in quality-adjusted life years. CONCLUSION:: Percutaneous autologous bone marrow injection is a minimally invasive, safe, and inexpensive treatment option for distal metaphyseal tibial nonunions or delayed unions following internal fixation and should be considered when the retained hardware appears to be intact and stable. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Journal of orthopaedic trauma 02/2013; · 1.78 Impact Factor

Publication Stats

1k Citations
261.73 Total Impact Points


  • 2009–2014
    • University of Houston
      • Department of Health and Human Performance
      Houston, Texas, United States
  • 2013
    • University of South Carolina
      • Department of Exercise Science
      Columbia, South Carolina, United States
  • 2011–2012
    • Southern Methodist University
      • Department of Applied Physiology & Wellness
      Dallas, Texas, United States
    • University of Alabama at Birmingham
      • Department of Epidemiology
      Birmingham, AL, United States
  • 2010
    • Edinburgh Napier University
      Edinburgh, Scotland, United Kingdom
  • 2005–2007
    • Clinique Sainte Anne
      Strasburg, Alsace, France
    • University of Texas Medical School
      • Department of Orthopaedic Surgery
      Houston, Texas, United States
    • University of Pécs
      Fuenfkirchen, Baranya county, Hungary
  • 2004–2006
    • Baylor College of Medicine
      Houston, Texas, United States
    • University of Texas at Arlington
      Arlington, Texas, United States
    • University of Texas Health Science Center at Houston
      Houston, Texas, United States
  • 2003
    • Tulane University
      • Department of Orthopaedics
      New Orleans, Louisiana, United States