These case studies impressively reveal how much work remains to be done in both the laboratory and in the field, to reach the goal of providing sustainable solutions for the economically and ecologically compatible exploitation of fungal endophytes. Other papers included in this special issue focus more on basic research, especially with respect to the Bioactive Compound Library datasheet ecology of the endophytes

and the elucidation of their life cycle. Vázquez de Aldana [5] and co-workers analysed the endophytic fungi in surveys conducted in 14 grass species SN-38 and found that some of the most frequent taxa on each grass were also present across several host grasses. These taxa (Alternaria, Epicoccum, Cladosporium and Fusarium) produce abundant spores, and are commonly encountered in air samples where their spores, which are important respiratory allergens, attain high atmospheric selleck kinase inhibitor concentrations. The authors emphasise the potential importance

of this phenomenon, as an important link between climate, plant biology and public health. Unterseher and co-authors [6] have studied the level of seasonal overlap of cultivable microfungi in living and decaying tissues of Fagus sylvatica in Germany using dilution-to-extinction cultivation over 3 years. Based on microscopic identification and sequencing ITS DNA, a substantial compositional and phylogenetic overlap between leaf and litter fungi was revealed. The data from cultivated leaf-inhabiting beech endophytes were compared with a 454 sequence data set from beech phyllosphere, allowing the partition of species lists into active fungal endophytes, fungal “epiphytes” and dormant fungal propagules. Another molecular ecology study by Peršoh [7] investigated factors shaping the endophytic community structure in a hemiparasitic plant, Viscum album ssp. austriacum, and its host Pinus sylvestris, using pyrosequencing of rRNA genes. Fungal operational taxonomic units (154) represented by 953,385 sequences,

were found in at least two samples from Viscum album ssp. austriacum and/or its Pinus sylvestris host. In contrast to an earlier, cultivation based assessment (Peršoh et al. 2010), where predominantly Amine dehydrogenase xylarialean endophytes had been recovered from the same host-parasite system, the culture-independent approach predominantly yielded zygomycetes of the genus Morteriella. The study also revealed that host and/or organ preferences of putatively saprotrophic fungi are predominantly responsible for compositional differences in the endophytic fungal communities García and co-authors [8] have attempted to establish the “model plant”, Arabidopsis thaliana as model system for an integral approach to studying the principles governing the endophytic lifestyle, taking advantage of the molecular tools and the abundant knowledge accessible from this host plant.

The expression levels of all the tested genes for real-time RT-PCR were normalized using the 16S rRNA gene of S. mutans (Acc. No. X58303) as an internal standard (Additional file 2, Table S1). Each assay was performed with

at least two independent RNA samples in duplicate. Autoinducer-2 (AI-2) assay It has been suggested [27, 28] that AI-2 click here signaling may play an important role in the biofilm formation of S. mutans. It is conceivable that, the challenge of stressful condition during the transition to a new surface may alter the quorum sensing (QS) process in the bacteria. Consequently, we tested the secretion of AI-2 signal molecule by S. mutans immobilized in biofilms formed on the different surfaces to determine the impact of the tested material surfaces on the physiology of the attached bacteria. The AI-2 luminescence reporter assay was performed [29] to https://www.selleckchem.com/products/chir-98014.html detect AI-2 secretion levels, in cell-free conditioned

AZD2281 mw medium of S. mutans biofilms formed on the four tested surfaces. At the end of the biofilm incubation period, a supernatant fluid was collected and filtered through a 0.22 μm-pore size filter (Millipore). The cell-free conditioned medium was either used immediately or stored at -20°C. To determine the amount of AI-2, an overnight culture of Vibrio harveyi MM77, a mutant strain which does not produce either AI-1 nor AI-2, was diluted 1:5,000 in a mixture of 90% (v/v) fresh AB medium and 10% (v/v) conditioned medium to a total volume of 200 μl per well. The negative control contained bacteria in fresh AB medium alone and the positive control selleck inhibitor contained bacteria, fresh AB medium and 10% v/v spent medium containing AI-2 of V. harveyi BB152 (AI-1-, AI-2+). Readings were performed in triplicate in white 96-well plates with an optic bottom (NUNC) in a GENios reader (TECAN) at 30°C. Luminescence measurements were recorded every 30 min in parallel with optical density absorbance (A 595) readings. The value of each reading

(biofilm on various materials) was divided by the absorbance values to normalize the luminescence value of each sample to its cell density and to avoid dissimilarities caused by differences in growth rates. Fold induction above the non-specific luminescence background of the negative control was determined at the end of bacterial growth after approximately 15 hrs of growth. Fold induction in luminescence of each sample was normalized by the value of total fluorescence of live bacteria within the relevant biofilm as detected by CLSM. Results Using DNA-microarray technology we identified the differentially expressed genes of S. mutans (Figure 1), reflecting the physiological state of biofilms formed on the different biomaterials tested. An empirical Bayesian method (B-test) was applied to test for differential expression in biofilms on various surfaces.

All authors worked read and approved the final manuscript.”
“Background The term “”energy drink”" refers to soft drinks believed to reduce or prevent fatigue, enhance physical performance, enhance disposition and improve cognitive performance [1]. Energy drinks are frequently consumed by athletes

prior to competitions with a view to improving their performance [2]. The belief in energy drinks is held by most athletes, check details particularly because the term “”energy drink”" conveys a message that the product has a connection with physical activity. Consequently, an uninformed consumer may assume that some benefits would be derived after consuming these beverages [3]. Paddock [3] indicated that the drive to improve athletic performance and exhibit one’s athletic identity could influence student-athletes in particular to consume energy drinks at a relatively higher level than the student population in general. Most energy drinks contain whopping quantities of sugar (up to a quarter of a cup per can) and caffeine, the main active ingredient, CAL-101 mw although other substances such as taurine, riboflavin, pyridoxine, nicotinamide, B vitamins, and various stimulating herbal derivatives (guarana, ginseng and ginkgo biloba) may be present [4]. The typical high sugar

content (usually approximately 9% or 10%) does not only make energy Selleckchem IBET762 drinks more calorific but also impedes fluid absorption and may lead to abdominal cramping. Caffeine concentrations may range from 70 to 80 milligrams per 8 ounce serving, about three to five times the concentration in cola. However, this has been found to have detrimental health consequences [5]. For instance, Riesenhuber Niclosamide et al. [6] reported that caffeine in energy drinks promotes natriuresis. It also acts as a diuretic agent, resulting in greater fluid losses. Another study revealed that high intakes of caffeine reduces insulin sensitivity [7] and raises the mean arterial blood pressure level of the body [8]. In sum, although

caffeine, a component in most energy drinks, provides the consumer with desirable effects such as increased alertness and improved memory, and enhances a person’s mood, caffeine also has harmful health consequences as well [1]. For example, energy drinks – such as Red Bull, Lucozade, Rox, Blue Jeans, Gluconade and Burn have become ubiquitous in shops on university campuses. Most athletes consume energy drinks with the hope of obtaining energy, although there is no scientific confirmation of the ergogenic effectiveness of energy drinks [9]. However, one experimental study found out that an intake of energy drinks, compared with a placebo, had energizing effects which were strongest 30 to 60 minutes after consumption, and which were sustained for at least 90 minutes [10].

Peridium thin, comprising one cell type of pigmented pseudoparenchymatous cells. Hamathecium of dense, long pseudoparaphyses, septate, embedded in mucilage. Asci 8-spored, bitunicate, fissitunicate, cylindrical, with furcate pedicel. Ascospores ellipsoid to filliform, multi-septate, selleck products deeply constricted at the primary septum (usually near apex), breaking into partspores. Anamorphs reported for genus: none. Literature: von Arx and Müller 1975; Barr 1992b; Selleckchem VS-4718 Eriksson 1967a; b; Holm 1957; Liew et al.

2000; Shoemaker 1984a, b. Type species Entodesmium rude Reiss, Hedwigia 1: 28 (1854). (Fig. 30) Fig. 30 Entodesmium rude (from H, Krieger 1070). a Ascomata in groups on the host surface. Note the erumpent papilla which is cylindrical and has an inconspicuous ostiole. b Section of part of an ascoma. Note the arrangement of asci and pseudoparaphyses. c Section of the peridium comprising cells of textura angularis. d Part-spores inside the ascus. e Relatively immature ascus with filliform ascospores and low ocular chamber. f–h Mature and immature asci with pedicels. Scale bars: a = 0.5 mm, b, c = 50 μm, d–h = 10 μm Ascomata 160–250 μm selleck high × 150–300 μm diam., in groups, immersed with long and protruding

cylindrical papilla, globose to subglobose, black, coriaceous (Fig. 30a). Papilla 100–220 μm long, 70–120 μm broad, cylindrical, with periphysate ostiole. Peridium 25–33 μm wide, comprising pseudoparenchymatous cells, cells up to 10 × 7.5 μm diam., cell wall up to 2 μm thick, beak cells smaller and wall thicker (Fig. 30b and c). Hamathecium of dense, long pseudoparaphyses, septate, 2–3 μm wide, embedded in mucilage. Asci 100–175 × 8–13 μm (\( \barx = 147.5 \times 11.3\mu m \), n = 10), 8-spored, bitunicate, fissitunicate, cylindrical, with a furcate pedicel which is 18–50 μm long, and with a low ocular chamber (ca. 1 μm wide × 1 μm high) (Fig. 30e,f, g and h). Ascospores 108–138 × 3–3.5 μm (\( \barx = 123 \times 3.2\mu m \), n = 10), filliform,

brown, multi-septate, breaking into 22–28 partspores, 5–7 × 3–3.5 μm diam. (Fig. 30d). Anamorph: none reported. Material examined: GERMANY, Königstein, on stems of Coronilla varia L., 20 May 1895, W. Krieger (H, Krieger 1070). Notes Morphology Entodesmium is characterized by having immersed Phosphoglycerate kinase ascomata dark cylindrical, periphysate papillae, numerous clavate to cylindrical asci surrounded by narrowly cellular pseudoparaphyses, and ellipsoidal to filliform multi-septate ascospores (Barr 1992b; Shoemaker 1984b). Currently, five species, viz. Entodesmium eliassonii L. Holm, E. lapponicum (L. Holm) L. Holm, E. mayorii (E. Müll.) L. Holm, E. niessleanum (Rabenh. ex Niessl) L. Holm and E. rude are accepted in this genus (Holm 1957; Shoemaker 1984b). Von Arx and Müller (1975) assigned Entodesmium to the Pleosporaceae sensu lato, and Shoemaker (1976) assigned E. rude (as Ophiobolus rudis) to Ophiobolus sensu lato based on the fragmenting filliform ascospores.

The SEM and TEM images (Figure 2a,b) show that the as-synthesized product consists of hexagonal nanoplates. These nanoplates have a diameter of 70 to 350 nm and a thickness of ca. 20 nm. As shown in Figure 2c, the HRTEM image taken from the face of nanoplates exhibits clear lattice fringes with spacings of 0.33 nm, assigning to (10–10) planes of wurtzite CGS. The corresponding FFT pattern (Figure 2d) displays the bright spots with sixfold symmetry, consistent with the hexagonal wurtzite structure of CGS. Furthermore,

HRTEM image was also LY2606368 mouse taken from the sides of nanoplates, as shown in Figure 2e. The AB-stacking of the layers in the hexagonal domains and the ABC-stacking in the cubic domains are clearly distinguishable in the HRTEM image shown in Figure 2e, which suggests the coexistence of wurtzite and zincblende structures within each nanoplate. Therefore, the crystal phase of the as-synthesized

nanoplates is wurtzite-zincblende polytypism, wherein the hexagonal wurtzite domains are interfaced with the cubic zincblende domains across (0002)WZ/(111)ZB stacking faults. This crystal structure of CGS nanoplates is similar I-BET151 to that of our previously synthesized CuInS2 nanoplates [23]. Figure 2 SEM (a), TEM (b), and HRTEM (c,e) images of as-synthesized product and FFT pattern (d) of (c). In particular, the HRTEM image (c) was taken from the face of nanoplates while the HRTEM image (e) was taken from the sides of nanoplates. The valence states and composition of the as-synthesized nanoplates were studied by XPS, as shown

in Figure 3. The full-scan spectra (Figure 3a) show the presence of the Cu 2p, Ga 2p and S 2p peaks, confirming the presence of these elements in as-synthesized C59 research buy nanoplates. The Cu 2p, Ga 2p and S 2p core levels were also examined, respectively. The peaks observed at 931.9 and 951.7 eV, with a peak MK0683 chemical structure splitting of 19.8 eV, are indicative of monovalent Cu [23]. The two peaks centered at 1,117 and 1,144 eV, with a peak separation of 27 eV, are attributed to trivalent Ga [20]. The two peaks of S 2p were located at 162.4 and 163.6 eV, with a peak splitting of 1.2 eV, which are consistent with the literature values in metal sulfides [24]. Through quantification of peaks, the molar ratio of Cu/Ga/S of 1.22:1:1.93 is given, indicating that the as-synthesized nanoplates are Cu-rich with respect to the stoichiometric CGS. Figure 3 XPS of as-synthesized nanoplates: (a) a survey spectrum, (b) Cu 2 p , (c) Ga 2 p , and (d) S 2 p . In our synthesis, metal chlorides (CuCl and GaCl3) could react with 1-dodecanethiol to form metal thiolates, which then decomposed into nanocrystals at elevated temperature [9, 23]. When heating a mixture of CuCl, GaCl3, 1-dodecanethiol, and 1-octadecene to 140°C, a clear yellow solution formed, suggesting the formation of metal thiolates because of the reaction between metal chlorides and 1-dodecanethiol.

We explored these genomes to construct phylogenies for each of the two GS-1101 research buy chromosomes using three approaches. First, single copy genes from each chromosome were assembled en suite and a phylogeny for each chromosome was inferred from these concatenated Selleckchem RG7112 sequences. Second, the organization and gene content at the origins of replication of each chromosome (OriI and OriII for chromosomes I and II, respectively) were studied. Third, the genes from near the two chromosomal origins of replication were studied and their phylogenies estimated individually. Results and Discussion Chromosome Phylogenies The inferred phylogenies for the

two chromosomes are congruent (Figures 1 and 2) and contain the expected major features, such as Photobacterium being basal to the Vibrionaceae and V. fisheri forming the next most basal clade. There are no unexpected sister taxa. The results of this analysis are compatible with published multi-locus analyses. However, instead of using 6 or 8 genes commonly used in MLSA, this analysis included 142 genes from chromosome I and 42 from chromosome II. These single

copy genes include a range of functions including metabolism, information processing, flagellar structure and cytoskeletal components; as such, they represent sampling points from various pathways and genomic sections from around the entire genome. The concatenation of these well conserved genes provides a shared signal for the chromosomes as a whole, despite only composing a small fraction of the entire genome. The genes included in the analysis Y-27632 supplier are listed under Additional files 1 and 2. The chromosome I tree is easily rooted by the various other genomes included in the analysis. All of these other clades fell together along accepted taxonomic lines. The most closely related strains in the tree are the V. cholerae Aspartate strains; that clade is effectively unresolved because the internal distances are too short. The chromosome II tree cannot be

rooted in the same manner as chromosome I because there is no obviously available outgroup: the chromosome II of P. atlantica is not homologous to the chromosome II of the Vibrionaceae being analyzed. However, rooting it identically by using the information from the chromosome I tree preserves the branching order of each tree. Thus, the ‘mean field’ approximation for the phylogeny of the two chromosomes is congruent at the species level. There is insufficient resolution among V. cholerae strains and too few members of other species to make inferences at a finer phylogenetic scale. Figure 1 Tree (Chromosome I). Inferred mean-field phylogeny of Chromosome I derived from a sampled concatenated gene sequence of single-copy orthologs distributed around the entire Chromosome I. The species tree is fully resolved and has 100% bootstrap support on all nodes outside of V. cholerae (1000 replicates). The list of genes and included locus tags is found in Additional file 1, supplementary materials.

In [8] it was speculated that one of the major OM proteins of E. coli, OmpA, would be one of the “immobile” proteins in the OM due to its PG binding domain. The PG interaction of OmpA originates from a separate C-terminal domain in the bacterial periplasm, and genetically truncated OmpA-177 consisting of only the TM domain assembles into the outer membrane as efficiently as the full-length protein [9, 10]. In this study, we have exploited these features of OmpA to determine its mobility in vivo using fluorescence recovery after photobleaching (FRAP), as well as to establish whether the presence of the PG binding domain has an effect on the mobility of the OmpA

TM domain. FRAP is a relatively simple technique to measure mobility and diffusion of fluorescent proteins inside living cells. For E. coli, it has Adriamycin cost been used to measure diffusion constants for GFP in the cytoplasm and periplasm [11, 12], as well as for various GFP fusions to inner membrane proteins [12–14]. The full-length, AZD3965 datasheet processed OmpA protein (325 residues) consists of two domains, an N-terminal transmembrane (TM) domain of 170 residues, connected via a short 19-residue Ala-Pro rich hinge region to a C-terminal periplasmic domain of 136 residues [15]. The periplasmic domain plays a structural role by

non-covalently tethering the OM to the peptidoglycan cell wall layer [16]. For a comprehensive Guanylate cyclase 2C review on OmpA structure and function see [17]. We have taken advantage from the availability of a red fluorescent protein reporter (mCherry, Emricasan [18]) that fluoresces in the periplasm of E. coli[19–21] to create fluorescent OmpA variants with and without PG binding domain. We used the by-now standard approach of elongating the bacterial cells using the antibiotic cephalexin [8, 11, 12]. We find that

full-length OmpA exhibits an absence of long-range (> 100 nm) diffusion in the OM. Surprisingly, removing the PG binding domain genetically does not increase protein mobility. From this we conclude that the absence of long-range diffusion of OmpA is not caused by its PG binding domain. Results and discussion Functionality of the constructs In previous work, we have shown that full-length OmpA with a small C-terminal linker (LEDPPAEF), as well as truncated OmpA with an epitope tag (SA-1, [22]) inserted in the first surface-exposed loop, expressed from plasmid in the presence of wild-type OmpA, are properly assembled into the outer membrane [10]. In this work, we have constructed C-terminal mCherry fusions to the constructs mentioned above, creating OmpA-mCherry (full-length) and OmpA-177-(SA-1)-mCherry (truncated) (pGI10 and pGV30, respectively, see Table 1). Since its discovery as fluorescent periplasmic reporter in E.

: Genome sequences of Chlamydia trachomatis MoPn and Chlamydia pneumoniae AR39. Nucleic selleck compound Acids Res 2000,28(6):1397–1406.CH5183284 PubMedCrossRef 9. Heddema ER, van Hannen EJ, Duim B, Vandenbroucke-Grauls CM, Pannekoek Y: Genotyping of Chlamydophila psittaci in human samples. Emerg Infect Dis 2006,12(12):1989–1990.PubMed 10. Read TD, Myers GS, Brunham RC, Nelson WC,

Paulsen IT, Heidelberg J, Holtzapple E, Khouri H, Federova NB, Carty HA, et al.: Genome sequence of Chlamydophila caviae (Chlamydia psittaci GPIC): examining the role of niche-specific genes in the evolution of the Chlamydiaceae. Nucleic Acids Res 2003,31(8):2134–2147.PubMedCrossRef 11. Stephens RS, Kalman S, Lammel C, Fan J, Marathe R, Aravind L, Mitchell W, Olinger L, Tatusov RL, Zhao Q, et al.: Genome sequence of an obligate

intracellular pathogen of humans: Chlamydia trachomatis. Science 1998,282(5389):754–759.PubMedCrossRef 12. Hackstadt T, Fischer ER, Scidmore MA, Rockey DD, Heinzen RA: Origins and functions of the chlamydial inclusion. Trends Microbiol 1997,5(7):288–293.PubMedCrossRef 13. Su H, McClarty G, Dong F, Hatch GM, Pan ZK, Zhong G: Activation of Raf/MEK/ERK/cPLA2 signaling pathway is essential for chlamydial acquisition of host glycerophospholipids. J Biol Chem 2004,279(10):9409–9416.PubMedCrossRef 14. Hackstadt T, Scidmore MA, Rockey DD: Selleck Proteasome inhibitor Lipid metabolism in Chlamydia trachomatis-infected cells: directed trafficking of Golgi-derived sphingolipids to the chlamydial inclusion. Proc Natl Acad Sci USA 1995,92(11):4877–4881.PubMedCrossRef 15. Cocchiaro

JL, Kumar Y, Fischer ER, Hackstadt T, Valdivia RH: Cytoplasmic lipid droplets are translocated into the lumen of the Chlamydia trachomatis parasitophorous vacuole. Proc Natl Acad Sci USA 2008,105(27):9379–9384.PubMedCrossRef 16. McClarty G: Chlamydiae and the biochemistry of intracellular parasitism. Trends Microbiol 1994,2(5):157–164.PubMedCrossRef 17. Zhong G: Killing me softly: chlamydial use of proteolysis for evading host defenses. Trends Microbiol 2009,17(10):467–474.PubMedCrossRef 18. Rockey DD, Scidmore MA, Bannantine JP, Brown WJ: Proteins in the chlamydial inclusion membrane. Microbes Infect 2002,4(3):333–340.PubMedCrossRef 19. Li Z, Chen C, Chen D, Wu Y, Zhong Y, crotamiton Zhong G: Characterization of fifty putative inclusion membrane proteins encoded in the Chlamydia trachomatis genome. Infect Immun 2008,76(6):2746–2757.PubMedCrossRef 20. Valdivia RH: Chlamydia effector proteins and new insights into chlamydial cellular microbiology. Curr Opin Microbiol 2008,11(1):53–59.PubMedCrossRef 21. Fields KA, Mead DJ, Dooley CA, Hackstadt T: Chlamydia trachomatis type III secretion: evidence for a functional apparatus during early-cycle development. Mol Microbiol 2003,48(3):671–683.PubMedCrossRef 22.

These results when considered alongside the works by Walberg et al. [32] and Mettler

et al. [29] imply that the higher the protein intake, the lower the chance for LBM loss. However, it should be noted that this study did not include a low protein see more control and not all studies show a linear increase in LBM preservation with increases in protein [40]. Furthermore, two subjects did lose significant amounts of LBM (1.5 kg and 1.8 kg), and the authors noted that these specific bodybuilders were among the leanest of the subjects. These two subjects lost the majority of their LBM (approximately 1 kg) during the latter half of the intervention as their percentage of calories from protein increased from 28% to 32-33% by the end of the study. The group as a whole progressively decreased their calories by reducing all three macronutrients throughout the investigation. Thus, the two subjects uniquely increased their proportion ZD1839 mouse of buy MK0683 protein, possibly reducing fat and carbohydrate to the point of detriment [6]. That said it is also plausible that the lost LBM seen by these two subjects was necessary in order to achieve their low levels of body fat. It is unknown whether or not the lost LBM influenced their competitive outcome and it is possible that had the competitors not been as lean, they may have retained more LBM but also not have placed

as well. In a review by Phillips and Van Loon [28], it is suggested that a protein intake of 1.8-2.7 g/kg for athletes training in

hypocaloric conditions may be optimal. While this is one of the only recommendations existing that targets athletes during caloric restriction, this recommendation is not given with consideration to bodybuilders performing concurrent endurance and resistance training at very low levels of body fat. However, the recently published systematic review by Helms et al. [33] on protein intakes in resistance-trained, lean athletes during caloric restriction suggests a range of 2.3-3.1 g/kg of LBM, which may be more appropriate for bodybuilding. Moreover, the authors suggest that the lower the body Myosin fat of the individual, the greater the imposed caloric deficit and when the primary goal is to retain LBM, the higher the protein intake (within the range of 2.3-3.1 g/kg of LBM) should be. Carbohydrate High carbohydrate diets are typically thought to be the athletic performance standard. However, like protein, carbohydrate intake needs to be customized to the individual. Inadequate carbohydrate can impair strength training [41] and consuming adequate carbohydrate prior to training can reduce glycogen depletion [42] and may therefore enhance performance. While it is true that resistance training utilizes glycogen as its main fuel source [43], total caloric expenditure of strength athletes is less than that of mixed sport and endurance athletes.

This risk profile consists of the following nine items: two or more falls in the preceding year, regular dizziness, functional limitations, poor grip strength, low body weight, having a cat Thiazovivin clinical trial or dog in the household, fear of falling, high alcohol intake and a high level of education. After the first home visit, 36 participants did not meet the inclusion criteria and were excluded. Participants who scored 7 points or lower on the fall risk profile were considered at low risk of recurrent falling and were excluded from the

RCT and economic evaluation. Participants with a risk score of 8 or higher and participants living in a residential home were considered to be at high risk of recurrent falling. These high-risk participants were randomly allocated to the intervention and usual care groups. At the end of the home Selleck ARRY-438162 visit, an appointment was made to visit the geriatric outpatient clinic for persons in the intervention group. No extra assessments or visits were done in the usual care group. Intervention

The multifactorial transmural intervention started with a visit to the geriatric outpatient clinic. A multifactorial fall risk assessment was conducted by the geriatrician to identify modifiable fall risk factors. The assessment of fall risk factors and the design of the treatment plan were based on the Dutch Institute for Healthcare Improvement (CBO) guideline “Prevention of fall incidents in older persons” [20]. The assessment consisted of a general medical history, a fall and mobility history, and physical examination

with special emphasis on signs of postural hypotension, neurological deficits, visual disturbances, gait and mobility disorders and medication. Additional diagnostic tests were performed if indicated (e.g. laboratory tests or imaging). Based on the assessment of fall risk factors, an individually tailored treatment regimen aimed at reduction of the fall risk was composed in collaboration with the general practitioner of the participant. The multifactorial treatment consisted of, for example, withdrawal of psychotropic drugs, balance and 4EGI-1 strength exercises by a physical therapist, Celecoxib home hazard reduction by an occupational therapist or referral to an ophthalmologist or cardiologist. Usual care During the study period, usual care in The Netherlands after a fall mainly consisted of treatment of the consequences of the fall. Although a national guideline was released in 2004 [20], multifactorial fall risk prevention had not yet been implemented by general practitioners or at the A&E departments. Clinical outcome measures Clinical outcome measures of the economic evaluation were the prevalence of fallers and recurrent fallers and utility (quality of life). All participants reported falls during at least 1 year using a fall calendar [4]. The participants ticked per week whether they did or did not fall.