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Lower limb loading rate is a major contributor to athletic injury because it represents the stress being absorbed by an athlete's lower limbs that makes them vulnerable to stress fractures, as well as knee and ankle joint injuries. This research therefore sought to identify a means by which lower limb loading rates could be reduced and therefore the risk of overloading injury reduced. A sports surface that encourages elastic deformation during contact in both the horizontal anterior-posterior direction and the horizontal medial-lateral direction through a process of horizontal deformation and displacement may result in reduced foot and limb loading. This surface should maximise horizontal energy attenuation in order to reduce the risk of injury while at the same time provide satisfactory energy return to avoid player fatigue. Effective product research and development methods centre on the ways in which the activities can be effectively planned, controlled and implemented. The process can be regarded as a sequence of activities and decisions which progress a problem solving process from the initial identification of the problem, through to a final implementable design solution. The process of design is fundamentally an iterative method, which comprises the articulation of the problem which is to be solved, collecting and codifying pertinent information, the divergent exploration of potential problem solutions, convergence towards a favourable solution, and finally, the detailed implementation and optimisation of the design solution. The creative process followed, has resulted in the design of a novel, and commercially improved modular plastic tile sports surface system. This has been realised through the development of an innovative, sustainable, shock attenuating tile and connector geometry, which aims to reduce braking forces on the sports surface to acceptable levels, and thus reduce the risk of athlete injury. This research is significant as currently no sports surface exists which specifically targets horizontal force reduction, as a means to reduce injury rates. [ABSTRACT FROM AUTHOR]

Objective: To examine nonvertebral fracture risk in relation to inhaled corticosteroid (ICS) exposure among adults with respiratory disease. Design and patients: Nested case-control study within a cohort of 89,877 UnitedHealthcare members aged ≥ 40 years with physician insurance claims for COPD or asthma, enrolled for ≥ 1 year from January 1, 1997 to June 30, 2001. Methods: Cases (n = 1,722) represented patients with a first treated nonvertebral fracture (the index date is the first fracture claim). Control subjects (n = 17,220) were randomly selected from the person-time and assigned a random index date. ICS exposure was ascertained 1 month, 3 months, 6 months, and 12 months before the index date, with estimated cumulative dose through 0 to 6 months, 7 to 12 months, and 0 to 12 months. Covariates included demographics, oral corticosteroid and other medication exposure, comorbidities, and indicators of respiratory disease severity. Odds ratios (ORs) adjusted for all covariates were estimated by logistic regression. Results: No increased fracture risk with ICS exposure as a class or with fluticasone propionate alone was detected. ORs for exposure in the preceding 30 days were 1.05 (95% confidence interval [CI], 0.89 to 1.24), 1.13 (95% CI, 0.90 to 1.40), and 0.97 (95% CI, 0.78 to 1.21) for all ICS, fluticasone propionate, and other ICS, respectively. No dose-response effect was present. Among patients with COPD only (n = 6,932), no increased risk was found for recent ICS exposure (OR, 0.86; 95% CI, 0.59 to 1.25). Conclusions: Concern about nonvertebral fracture risk should not strongly influence the decision to use recommended doses of ICS for adult patients with asthma or COPD in managed-care settings in the United States. This study could not evaluate very-high ICS dose, long-term ICS exposure, or vertebral fracture risk. [ABSTRACT FROM AUTHOR]

Background It remains unclear whether benzodiazepine use increases hip fracture incidence. We studied this relationship in a large cohort, controlling for multiple potential confounders. Methods We analyzed 42 months of New Jersey Medicaid health care claims data for all enrollees. Each eligible person-day was assigned to categories of benzodiazepine exposure and categories of other predictors, based on prior and current medication dispensing and diagnosis information. Hip fractures were identified based on hospital claims with primary discharge diagnosis International Classification of Diseases, Ninth Revision (ICD-9) codes 820.xx. Results Cohort members (n = 125 203) contributed 194 071 person-years and had 2312 eligible hip fractures. After adjustment for age, sex, race, Medicaid nursing home residence, exposure to other psychoactive medications, including antiparkinsonian medications, diagnoses of epilepsy and dementia, and hospitalization in the previous 6 months, the incidence rate of hip fracture was significantly higher compared with no benzodiazepine use for exposure to any benzodiazepine (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.06-1.44), to a short half-life, high-potency benzodiazepine (IRR, 1.27; 95% CI, 1.01-1.59), during the first 2 weeks after starting a benzodiazepine (IRR, 2.05; 95% CI, 1.28-3.28), during the second 2 weeks after starting a benzodiazepine (IRR, 1.88; 95% CI, 1.15-3.07), and for continued use (IRR, 1.18; 95% CI, 1.03-1.35). Conclusions The incidence of hip fracture appears to be associated with benzodiazepine use. Contrary to several previous studies, short half-life benzodiazepines are not safer than long half-life benzodiazepines. Hip fracture risk is highest during the first 2 weeks after starting a benzodiazepine and declines thereafter. [ABSTRACT FROM AUTHOR]