steckii 122389 IBT 19353 = IFO 6024; unrecorded source P steckii

steckii 122389 IBT 19353 = IFO 6024; unrecorded source P. steckii 122388 IBT 14691 = NRRL 6336; baled coastal grass hay, Bermuda P. steckii 122418 IBT 6452; Cynara scolymus (Artichoke), Egypt P. steckii 122417 IBT 20952; Ascidie (tunicate, urochordata), sand bottoms with corals, surface water 23°C, dept 2–3 m at Cabruta, Mochima Bay, Venezuela P. tropicoides 122410 Type; soil of rainforest, near Hua-Hin, Thailand P. tropicoides 122436 Soil of rainforest, near Hua-Hin, Thailand P. tropicum 112584 Ex-type; soil between Coffea arabica, Karnataka, India DNA isolation, amplification and analysis The strains were grown on Malt Extract agar (MEA, Oxoid) for 4–7 days

at 25°C. Genomic selleck chemicals DNA was isolated using the Ultraclean™ Microbial DNA Isolation Kit (MoBio, Solana Beach, U.S.A.) according the manufacturer’s instructions. Fragments, containing the ITS regions, a part of the β-tubulin or calmodulin gene, were amplified and subsequently sequenced according the procedure previously described (Houbraken et al. 2007). The alignments and analyses were preformed as described by Samson et al. (2009), with one modification: to prevent saturation of the computer’s memory, the maximum number of saved trees for the ITS dataset was set A-1210477 ic50 to 5,000. Penicillium corylophilum CBS 330.79, was used as an outgroup in all analyses. Additional sequences of P. sumatrense, P. manginii, P. decaturense, P. chrzaszcii,

P. waksmanii, P. westlingii, P. miczynskii, P. paxilli, P. roseopurpureum, Penicillium shearii and P. anatolicum were added to the ITS dataset to determine the phylogenetic relation with P. citrinum. The newly derived sequences used in this study were deposited in GenBank under accession numbers GU944519-GU944644, the alignments in TreeBASE (www.​treebase.​org/​treebase-web/​home.​html), and this website taxonomic novelties in MycoBank (www.​MycoBank.​org; Crous et al. 2004). Morphology and physiology The strains were inoculated in a three point position on Czapek yeast autolysate agar (CYA), malt extract Agar (MEA), creatine agar (CREA) and yeast extract sucrose agar (YES). Growth characteristics were measured and click here determined after an incubation period of 7 days at

25°C in darkness. Light microscopes (Olympus BH2 and Zeiss Axiokop two Plus) were used for microscopic examination and a set 25 micromorphological dimensions was obtained for each characteristic. Ripening of the cleistothecia was checked for up to 3 months. Colours of cleistothecia were determined on Oatmeal agar (OAT) after seven and 14 days of incubation at 25°C. Temperature-growth data was studied on CYA plates, which were inoculated in a three-point position and incubated at 12°C, 15°C, 18°C, 21°C, 24°C, 27°C, 30°C, 36°C, 37°C and 40°C. The colony diameters were recorded after 7 days of incubation in darkness. Extrolites Culture extracts were made from the agar media CYA and YES according the method described by Smedsgaard (1997).

30 and 36 26%, respectively Thus, the former composite exhibited

30 and 36.26%, respectively. Thus, the former composite exhibited selleck screening library higher while the latter showed lower PTC intensity. Similarly, the 55 wt % CB (90 nm)/high-density polyethylene (HDPE) composite with large crystallinity exhibited higher PTC intensity than polypropylene (PP) composite at the same filler loading [30]. Recently, Dang et al. reported that the PP and HDPE composites with hybrid C646 chemical structure fillers of CBs (50 nm) and carbon fibers at 8 vol % loading exhibit strong PTC intensity [32]. They attributed this to the ease of a conducting

network formation in the polymer matrix because of the large aspect ratio of carbon fibers. Analogously, hybridization of CBs (24 nm) with multiwalled carbon nanotubes also led to enhanced PTC intensity and reproducibility [31]. In this study, we aimed to improve electrical conduction behavior of TRG/PVDF composites by incorporating AgNWs. The AgNW/TRG/PVDF hybrid composites displayed interesting temperature-dependent electrical properties. PVDF is a Cell Cycle inhibitor semicrystalline polymer with high thermal stability, excellent chemical resistance, and high piezoelectric property. Methods Materials Graphite flakes, ethylene glycol (EG), N,N-dimethylformamide (DMF), ferrite chloride (FeCl3), and poly (vinylpyrrolidone) (PVP) were purchased from Sigma-Aldrich (St. Louis, MO, USA). PVDF (Kynar 500) pellets

were purchased from Arkema Inc. (King of Prussia, PA, USA). Silver nitrate (AgNO3) was obtained from Shanghai Chemical Reagent Company (Shanghai, China). All chemicals were used as received without further purification. Synthesis Graphite oxide was prepared using a typical Hummers process [39] and can be readily exfoliated into monolayer GO sheets as displayed by atomic force microscopic (AFM) image (Figure  1a). The GO sheets were dispersed in DMF to generate a 2 mg/mL solution. AgNWs were synthesized according to the polyol

method [18]. Typically, PVP (0.2 g) and AgNO3 (0.2 g) Adenosine triphosphate were dissolved in 20 ml EG at room temperature. Then, 60 μL of 0.5 mM FeCl3 solution (in EG) was pipetted, and the solution mixture was magnetically stirred for 5 min. Subsequently, the solution container was placed in an oil bath of 130°C and held at this temperature for 12 h. The obtained AgNW products were washed with ethanol for five times and then re-dispersed in DMF. The average diameter and length of nanowires were approximately 130 nm and 110 μm, respectively (Figure  1b,c), producing an average aspect ratio of approximately 850. Figure 1 AFM image of GO sheets and SEM micrographs of AgNWs. (a) AFM image of GO sheets deposited onto a mica substrate. The line profile across GO shows a sheet thickness of approximately 1 nm. (b, c) SEM micrographs of the as-synthesized AgNWs at low and high magnifications. The TRG/PVDF composites were prepared based on our previous strategy [16].

The irregular field algorithm takes into account the tissue inhom

The irregular field algorithm takes into account the tissue inhomogeneity and uses an integration scheme to evaluate the scatter component of the dose. Two opposed tangential radiotherapy YH25448 manufacturer fields were created (Figure 2). The beam centre was located in the chest wall. To reduce

the irradiated lung volume, incident beam angles were used to match the fields at the dorsal field edge non-divergently and lung tissue was shielded when necessary. The nominal prescribed dose was 50 Gy in 25 fractions using 6-MV photons. The calculated dose was normalized to a relevant point in the PTV to provide dose homogeneity. Figure 2 Tangential radiation field on digital reconstructed radiograph. Although a uniform dose to the CTV within 95% to 107% of the prescribed dose is recommended, a variation of plus or minus 10% from the prescribed dose is widely used in clinical practice [8]. In the present study, to accurately evaluate the dose contribution of later bolus applications, we planned that 90% to 110% of the prescribed dose to the PTV would be delivered before the bolus applications.

Maximum doses higher than 110% of the prescribed doses were ignored if they encompassed a point and not a volume. A 1-cm thick bolus with a 1 gr/cc density was placed over the chest wall for 0, 5, 10, 15, TEW-7197 manufacturer 20, or 25 treatment days in TPS calculations for all patients. Cumulative DVHs were generated for each bolus regimen and for each patient. The size of the dose bin used for the DVH calculation

was 0.01 Gy. The DVHs of skin structures for 0, 5, 10, 15, 20 and 25 days of bolus applications in one case are shown in Figure 3. Figure 3 The dose-volume histograms of skin structures according to days of bolus applications in one case. (White square) – 0 days; (upside Megestrol Acetate down white triangle) – 5 days; (white triangle) – 10 days; (White circle) – 15 days; (horizontal line) – 20 days; (small white square) – 25 days of bolus applications. Dosimetric Analysis To test the accuracy of TPS near-surface dose calculations, solid plate phantom (Iba Dosimetry, Schwarzenbruck, Germany) and EBT gafchromic (International Specialty Products, Wayne, NJ, USA) films were used for both calibration and experimental JNK-IN-8 measurements at a Synergy Platform 6-MV linear accelerator (Elekta, Crawley, UK). For calibration, 4 × 4 cm2 films were irradiated at 100-cm fixed SSD (source-to-skin distance) and 5-cm depth with different doses ranging from 4.128 cGy (5 MU) to 336.1 cGy (400 MU). After 24 hours later, irradiated films were scanned using Epson, Expression 10000 XL (Seiko Epson Corporation, Japan) scanner, read with Mephysto mc2 v1.3 (PTW, Freiburg, Germany) software and optic density-dose calibration curves were obtained. For dose measurements, 4 × 4 cm2 films were placed at the centre of the 10 × 10 cm2 field at specific depths (0, 1, 2, 3, 4, 5, 6, 8, 10, 12, 15, 20, 25 and 30-mm) and irradiated at 100-cm fixed SSD with a dose of 83.25 cGy (100 MU).

24 and 48 h after inoculation, bacterial cells were collected and

24 and 48 h after inoculation, bacterial cells were collected and thoroughly resuspended by vortexing in phosphate-buffered saline (PBS). Thereafter, Lactobacillus and coliform concentrations in the co-cultures and in the controls was determined on MRS agar plates additioned with vancomycin (0.2% w/v) and MacConkey agar plates,

which are selective for Lactobacillus spp. and coliforms, respectively. Antimicrobial activity was calculated by comparing the coliform growth in the co-culture and control [8]. Results were expressed as log10 CFU/ml. The experiment was performed in triplicate. Statistical Analyses Sample size was calculated based on a difference between groups of 1.5 CP673451 manufacturer log10 CFU/g faeces. Using α = 0.05, β = 0.20 and an estimated standard deviation within groups of 2 log10 CFU/g faeces, 30 patients were needed in each group. Counts (log10 CFU/g) of the total amount of coliform bacteria were calculated for each stool sample. Data are summarized by counts

and median and range for categorical and continuous variables respectively. Differences between groups were evaluated with SGC-CBP30 molecular weight Mann-Whitney’s U-test for continuous variables, whereas associations between categorical variables were evaluated with Fisher’s exact test. Differences between colicky infants and controls in total amount of each species detected were evaluated with Mann-Whitney’s Selleckchem ON-01910 test with Bonferroni correction. Statistical significance was set at a p-value < 0.05. All statistical calculations were performed with commercially available software

(SPSS for Windows release 15Æ0 SPSS Inc., Chicago, IL, USA). Results Isolation and identification of coliforms from colicky infants Tolmetin Coliform colonies were obtained on MacConkey agar plates from faeces of all the 45 colicky infants and 42 controls. The average count of total coliforms in the 45 faecal samples of colicky infants was 5.98 (2.00-8.76) log10 CFU/g of faeces, whereas total coliforms in the control group were 3.90 (2.50-7.10) log10 CFU/g of faeces. The difference between the two groups was statistically significant (p = 0.015). A total of 145 colonies was randomly picked up from the higher dilutions agar plates (10-6-10-8) and, only from colicky infants after sub-culturing in LB agar, each purified strain was examined for gas production and characterized at species level by DNA sequencing and carbohydrate fermentation profiling. All isolated strains were found to produce gas from lactose according to the method described above and the BBL™ Enterotube™ II system. They were ascribed to six different species (Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Enterococcus faecalis, Enterobacter aerogenes, and Enterobacter cloacae), as described in Table 3. The percentage of detection of each species in the faecal samples examined was reported in descending order (Table 3). The same taxonomic identification was obtained with the two methods employed.

As the external os was digitized on radiograph and CT, all refere

As the external os was digitized on radiograph and CT, all reference

points marked on orthogonal films were automatically transferred to CT films. The DVHs of tumor volumes and OARs were created for each application. The volumes were calculated for the dose matrices receiving 50% (3.5 Gy), 100% (7 Gy), 150% (10.5 Gy), and 200% (14 Gy) of the point-A doses obtained from the conventional plan and the 3D CT plan. The extent of tumor coverage within the prescribed 7 Gy isodose learn more volume obtained from orthogonal films and CT were compared. To compare the respective ICRU rectal and bladder HM781-36B price point doses with the 3D volume dose, the minimum dose value in the 2.0-cc volume receiving the highest dose (D2) was determined from DVHs for bladder, rectum. The dose of a 5-cc volume (D5), which is defined as the minimum dose value in the 5.0-cc volume receiving Evofosfamide the highest dose, was also calculated, because this volume was

previously reported as the minimal volume required for fistula formation [7, 8, 15]. The Student’s t test was performed for comparison of GTV, CTV, rectum, bladder, sigmoid colon, and small bowel volumes between groups. A comparison of the conventional plan and CT-plan was performed using the Wilcoxon signed-ranks test for all doses and volumes. P values less than 0.05 were considered statistically significant. Results The mean age of the patients was 56 years (range, 26–77 years). Tumor stage was evaluated according to the International Federation of Gynecology and Obstetrics (FIGO) classification [16]. Two patients (7%) had Stage IB2, 3 (10%) had Stage IIA, 15 (52%) had Stage IIB, 1 (3%) had Stage IIIA, and 8 (28%) had Stage IIIB disease. Plans were categorized into group 1 (n = 24, 39%), where > 95% of the isodose line prescribed to point A in the conventional

plan encompassed the CTV, and group 2 (n = 38, 61%), where < 95% of the prescribed point-A dose on the CT plan encompassed the CTV. The mean GTV and CTV in all patients were 14.1 cc (2.1–38.2 cc) and 36.3 cc (9.7–80.0 cc), respectively. The mean GTV, CTV, rectum, bladder, sigmoid, and bowel volumes according to groups are presented in Table 1. many The mean GTV and CTV were smaller in group 1 than in group 2 (P < 0.001). The rectum, bladder, sigmoid colon, and small bowel volumes in all patients were 81.6 cc (37.5–177.6 cc), 60.3 cc (30.1–114.5 cc), 40.2 cc (10.8–62.8 cc), and 499.6 (158.1–973.3 cc), respectively. No significant differences were found between groups 1 and 2 in mean OAR volumes (Table 1). Table 1 Mean values of GTV, CTV, and rectum, bladder, sigmoid colon, and small bowel volumes according to groups.   Group 1 (cc ± SD) Group 2 (cc ± SD) P GTV 8.1 ± 5.4 20.6 ± 12.3 < 0.001 CTV 24.7 ± 10.7 48.4 ± 20.8 < 0.001 Rectum 76.1 ± 37.7 82.3 ± 36.9 0.19 Bladder 57.8 ± 19.5 63.0 ± 19.9 0.24 Sigmoid colon 38.2 ± 15.2 40.5 ± 16.3 0.72 Small bowel 508.9 ± 193.6 488.9 ± 226.1 0.

Moreover,

since other next generation sequencing platform

Moreover,

since other next generation sequencing platforms will allow a greater sequencing depth, this may allow a deeper characterization of the microbial community and could reveal additional differences in the microbial community composition for the various conditions measured in this study. Finally, our study also reveals that microbial disruption by bead-beating allows greater detection of Gram-positive bacteria such as Blautia (Firmicutes phylum) and Bifidobacterium (Actinobacteria phylum), commonly detected in human ML323 order stools. In conclusion, the hydration of faecal samples and their degree of homogenisation do not significantly alter their microbial community composition and structure. However, although the mechanical disruption of microbial cells causes genomic DNA degradation in Quisinostat nmr simulated diarrhoeic stool samples, our findings confirm that this step is necessary for the detection of Gram-positive bacteria such as Blautia and Bifidobacterium. Methods Ethics statement Subjects provided their written consent to participate selleck chemical in this study, and the Institutional Review Board of the Vall d’Hebron Hospital (Barcelona, Spain)

approved this consent procedure. Sample collection protocol Stools were collected from eight healthy participants. The collection protocol involved providing participants with an ice bag containing an emesis basin (Ref. 104AA200, PRIM S.A, Spain), a 50-mL sterile sampling bottle (Ref. 409526.1, Deltalab, Spain), a sterile spatula (Ref. 441142.2, Deltalab, Spain), and gloves (Additional file Lepirudin 3: Figure S2) during their visit to the laboratory. For the purpose of stool collection, the participants were instructed to do the following once at home: 1) use the emesis basin to collect the stool; 2) after the deposit, transfer it to the sampling bottle ensuring no homogenisation; 3) take it to the lab within the first 3 hours after deposit; and 4) in the laboratory, the samples were processed as mentioned in the experimental design, and then the samples were stored at -80°C. Naming convention Since

the samples from same individuals were used to test different factors that could affect microbial composition, a labeling nomenclature had to be settled down as indicated in Table 1. The “D” stands for “diarrhoea” in the water content study. The “L” stands for “layer”, “O” for “outer”" and “I” for the “inner”" layer of the stool, and “H” for “homogenised stool” in the homogenisation evaluation. The “P” stands for samples that contained PBS to simulate diarrhoea not undergoing bead-beating, while “B” stands for samples that did not contain PBS, but underwent bead-beating. Samples with the “C” label are controls that did not contain PBS and did not undergo bead-beating. The numbers 1–8 signify the 8 different volunteers. Genomic DNA extraction To evaluate the need for stool homogenisation during collection, aliquots (250 mg) of each sample were suspended in 0.1 M Tris (pH 7.

Many different genes have been targeted in previous studies [16,

Many different genes have been targeted in previous studies [16, 22, 25, 26, 30, 47, 48, 50–54]. However, the above targets did not prove to be specific enough for unique detection and identification. The IAC used is a synthetic and unique oligonucleotide designed de novo for this study. The fact that this IAC is co-amplified with the invA fragment using the same primer set but detected by a distinct beacon, does not appear to alter the precision and accuracy of the real-time PCR, and quantification

of original target DNA is still possible even in the presence of the control. However, the standard curve protocol for invA in the presence of the IAC should be performed for a correct Omipalisib molecular weight quantitative approach if the assay is to be used for quantification. The invA gene has been used as an internal amplification control in other studies [18], but its selleck chemicals application is limited to Salmonella assays alone. Furthermore, it has been found that in some

rare cases, this gene may be absent and is therefore unreliable as an amplification control even for studies incorporating Salmonella specimens alone. This IAC sequence matches no organism in the NCBI libraries and could potentially be used in any such detection assays. The assays for the invA, fliC and prot6E genes all had a sensitivity and specifiCity score of 100%. All 45 Salmonella samples were positive, with 100% sensitivity. TPCA-1 concentration Positive results (>10 copies of DNA per reaction) had CT values ranging from PRKACG 15 to 25. One exception, the commercially available specimen of S. Enteritidis (Table 3), had a CT value of approximately 30. Since the prot6E gene is located on a virulence plasmid, its absence would not be surprising. Plasmid profiling should be performed to explain the unusually high CT value observed for this specific specimen. This raises the question of whether selecting a target on a plasmid is a wise choice, but this absence of this plasmid has been found to be rare from S. Enteritidis and the low copy numbers (1–2) of the plasmid in the cells make possible the conversion of the assay to a quantitative one which would

be correct to a factor of 2. Therefore, using this target for quantification would depend on the accuracy required. Our study is the first to incorporate four molecular beacons with real-time PCR in a double duplex PCR protocol to detect Salmonella spp., Salmonella Enteritidis and Salmonella Typhimurium in a single assay. Strong fluorescence signals were observed in all positive PCR results in both the uniplex and the duplex assays, indicating the efficiency of the design in the primers and beacons. The sensitivity and specifiCity of the design and procedure described here give the assay the potential to be converted into a quantitative method, directly applied to samples without the requirement of pre-enrichment stages, making use of the standard curves.

Conclusions The results obtained in this study show that adhesion

Conclusions The results obtained in this study show that adhesion and invasion are not necessarily coupled processes. Adhesion rates are not strictly correlated with pili formation and in summary the pili repertoire of the investigated strains is highly variable. As shown by genome comparisons [23] it is A-769662 solubility dmso necessary to investigate various isolates on a molecular level to understand and to predict the colonization process of different C. diphtheriae strains.

Methods Bacterial strains and growth Strains used in this study are listed in Table 1. C. diphtheriae strains were grown in Heart Infusion (HI) broth or on Columbia agar with sheep blood (Oxoid, Wesel, Germany) at 37°C. S. Typhimurium and Escherichia coli DH5αMCR were grown in Luria Broth (LB) [25] at 37°C. If appropriate, kanamycin was added (30 μg ml-1 for E. coli; 50 μg ml-1 for C. diphtheriae).

Table 1 Bacterial strains and eukaryotic cell lines used in this study Strains Description Reference C. diphtheriae     DSM43988 non-toxigenic, isolated from throat culture DSMZ, Braunschweig, Germany DSM43989 tox +, unknown source DSMZ, Braunschweig, Germany DSM44123 non-toxigenic isolate, type-strain, unknown source DSMZ, Braunschweig, Germany ISS3319 C. diphtheriae var. mitis, non-toxigenic, isolated from patients affected by pharyngitis/tonsilitis [1] ISS4060 Selleck RepSox C. diphtheriae var. gravis, non-toxigenic, isolated from patients affected by pharyngitis/tonsilitis [1] ISS4746 C. diphtheriae var. gravis, non-toxigenic, isolated from patients affected by pharyngitis/tonsilitis [21] Alpelisib price ISS4749 C. diphtheriae

var. gravis, non-toxigenic, isolated from patients affected by pharyngitis/tonsilitis [21] NCTC13129 C. diphtheriae var. gravis, non-toxigenic, isolated from pharyngeal membrane, patient with clinical diphtheria [2] E. coli     DH5αMCR endA1 supE44 thi-1 λ- recA1 gyrA96 relA1 deoR Δ(lacZYA-argF) U196 ϕ80ΔlacZ ΔM15mcrA Δ(mmr hsdRMSmcrBC) [9] Salmonella enterica serovar Typhimurium ( S . Typhimurium)     NCTC12023 wild type identical to ATCC14028 NCTC, Colindale, UK Cell lines     Detroit562 human hypopharyngeal carcinoma cells [20] Transformation of competent C. diphtheriae ADAM7 For preparation of electrocompetent cells, 10 ml of an overnight culture of C. diphtheriae were inoculated in 200 ml of Brain Heart Infusion (BHI) containing 2% glycine and 15% sucrose, at 37°C in an orbital shaker until an OD600 nm of 0.5 was reached. After storing the cells on ice for 15 min, bacteria were harvested by centrifugation (4,000 × g, 4°C), washed thrice with 15% glycerol, and resuspended in 1 ml of 15% glycerol. 100 μl aliquots of the competent cells were frozen in liquid nitrogen and stored at -80°C. For transformation the aliquots were thawed on ice. Plasmid DNA used for transformation was extracted from E. coli strain DH5αMCR, which is unable to methylate DNA. One microgram of plasmid DNA was used to transform C. diphtheriae cells using a GenePulser II apparatus (Bio-Rad, Munich, Germany) and 200 Ω, 2.5 kV, 25 μF.

Unfortunately, by restricting the Osteoporosis Strategy coordinat

Unfortunately, by restricting the Osteoporosis Strategy coordinators to medium and large volume hospitals with fracture clinics, the program misses about one third of fracture patients in Ontario who are treated in small community hospitals as funding an osteoporosis Avapritinib ic50 coordinator is not justifiable this website in each small community

hospital. Yet, similar to others [12, 13], we have previously shown that an educational intervention alone was not sufficient to improve practice [14], suggesting the need for a more targeted intervention in smaller communities. There have been a number of recent randomized controlled trials of post-fracture care interventions that have reported positive effects [15–23] with a pooled absolute improvement in osteoporosis treatment rates of 20% over and above usual care [24]. However, in all of these trials the majority of patients were recruited from academic learn more centres or health maintenance organizations with high fracture volumes and access to osteoporosis specialists. The current cluster randomized trial was conducted

to determine if an intervention based on the osteoporosis coordinator role in the focused environment of a high-volume urban fracture clinic can be effective when adapted to smaller community hospitals. We hypothesized that a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians by telephone and mail will increase the proportion of patients who receive appropriate investigation and treatment

for osteoporosis compared with simple fall prevention advice among patients. Methods Study design We conducted a cluster randomized trial in which the hospital emergency department was the unit (cluster) of allocation and men and women with a low trauma fracture were the unit of analysis. Since the purpose of the trial was to change practice behaviour and patients in these communities were likely to have the same primary care physician, a cluster design Methane monooxygenase was chosen to minimize contamination. Setting and participants Hospital eligibility criteria and recruitment Hospitals without a dedicated osteoporosis screening coordinator that treated more than 60 fracture patients per year in their Emergency Department (ED) and who were members of the Ontario Telemedicine Network were potentially eligible (n = 54). Information letters were sent to the hospitals explaining the study and site visits were conducted by the centralized coordinator. Ethics approval was obtained from the Research Ethics Board of the Toronto Rehabilitation Institute and each of the participating sites. Patient eligibility criteria and recruitment Emergency Department records provided through the National Ambulatory Care Reporting System database at each hospital site were used to identify all new cases of fracture.

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