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Figure 2.

Longitudinal series of isolates. Each series (collected from patients P01 to P16) is depicted as a row of dots to represent sampling time points. Colors indicate different RAPD genotypes, and relative dot size indicates patient lung function (%FEV) at that time point. Gray circles indicate no associated %FEV (percentage of predicted forced expiratory volume in 1 sec) measurement (also see Supplemental Fig. S1 ).

View this table:
Table 1.

Summary of 16 longitudinal series

The majority of patients were colonized by subgroup A isolates (202 of 215 isolates) primarily from one of the major B. cenocepacia epidemic lineages. Except for the single patient P09 infected with subgroup B, all isolates from the same patient belonged to the same RAPD type. By using these 215 isolates, we conducted a comprehensive survey of clinically relevant phenotypes and carried out whole-genome sequence analysis of all isolates.

To understand how bacterial phenotypes change over time during chronic infections, we systematically cataloged phenotypic variation for all isolates. Specifically, we measured: growth in two liquid media types (lysogeny broth [LB]; and synthetic cystic fibrosis medium [SCFM]), swimming motility, biofilm formation, acute virulence in an insect model, and mucoidy morphotype ( Palmer et al. 2007 ). The results reveal extensive phenotypic variation among B. cenocepacia isolates both within and among RAPD types and within patient series. Detailed descriptions and results for each phenotype are in Supplemental Text S1 , Supplemental Table S1 , and Supplemental Figures S2 and S3 .

By considering these phenotypes on a global level, we found that RAPD genotype was a significant predictor of phenotypic variation, explaining between ∼20% and 50% of the variation ( JBay III Mens Flip Flop Reef Buy Cheap Fashionable Cheap Factory Outlet Cheapest KTU0wh
; Supplemental Fig. S4 ). However, considerable variation was also seen within patient series and within RAPD type. We also identified progressive phenotypic changes in many longitudinal series ( Table 3 ). Six of the 16 series showed progressive decreases in motility, five showed temporal changes in biofilm formation (two increasing and three decreasing), two showed decreases in acute virulence as measured in an insect model, none showed changes in mucoidy, and, finally, seven showed changes in one or more growth parameters.

View this table:
Table 2.

Correlation between RAPD type and clinically relevant phenotypes

View this table:
Table 3.

Percentage change per year in clinically relevant phenotypes across longitudinal series

Given that each individual phenotype could have a complex genetic basis, we examined pairwise phenotypic correlations across all isolates and for each RAPD type individually ( Fig. 3 ). In general, most phenotypes we measured were positively correlated; with the exception that biofilm formation was negatively correlated with acute insect virulence and growth in LB ( Fig. 3 A). This is not surprising; biofilm has been associated with persistent infection and not with acute virulence ( Discount Best Prices Black Voluminous Sleeve Knit Dress Stella McCartney Sale Comfortable Explore TlWupby3
; Wu et al. 2015 ). Overall, motility was positively correlated with biofilm formation and mucoidy (Spearman correlation, ρ = 0.48 and 0.40, respectively, adjusted P -value <0.0001) ( Fig. 3 A). A strong positive correlation was found between motility and biofilm formation for most RAPD genotypes, except for a negative correlation was seen for subgroup B RAPD44 isolates (ρ = −0.85, adjusted P -value = 0.001) ( Fig. 3 B–G).

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Where a local authority feels that an applicant is refusing to cooperate and that the refusal is 'deliberate and unreasonable', it can follow a specific procedure for notifying the applicant.

The information on this page applies only to homelessness applications made on or after 3 April 2018 .

on or after 3 April 2018

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An applicant refuses to cooperate when s/he does not take a step (or steps) in her/his personalised housing plan (PHP) . [1] This might be a step which:

In order for the applicant to be penalised, the refusal must have been deliberate and unreasonable.

An applicant cannot be found not to have cooperated with a step which was identified as a 'good idea' in her/his plan, but which s/he was not was required to take. [2]

See Personalised housing plans: applicant steps for more information.

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Neither 'deliberate' nor 'unreasonable' is defined in the Act or in the Homelessness Code of Guidance. The Code suggests that a local authority follows a four stage determination to decide whether a failure to take a step was deliberate and unreasonable: [3]

The Code suggests that where an applicant appears not to be cooperating, the local authority should review its Sale Order Tiered Cottonblend Midi Dress Cream Red Valentino Cheap Buy Authentic Manchester Great Sale Cheap Online arr8VKz
of her/his needs and the appropriateness of the steps in the personalised housing plan. Mens AzChino Ancho Pinzas Navy Trousers Springfield Cheap Sale View yNVjnD
It may be found that certain steps in the PHP are not reasonable, or have become unreasonable. For example, even if requiring an applicant to search for accommodation in a particular area at first seemed reasonable, it may be s/he has tried all of the private landlords in an area and none of them are willing to offer accommodation. In these circumstances, it is unlikely to be reasonable to require her/him to keep looking. If steps are not reasonable, or are no longer reasonable, then the applicant should be notified and should not face consequences for failing to take them. Cross Dress With Embroidery Spring/summer Blumarine Buy Cheap 2018 dsKVOa

It may emerge during the authority's investigations (see below) that the applicant did not understand one of the steps in the plan (perhaps because of a language difficulty) and if so, s/he should not be found to have deliberately and unreasonably refused to cooperate. [6]

The Code requires that local authorities take into account any particular difficulties the applicant has in managing communication. It suggests, for example, that cooperation may be particularly difficult where an applicant is street homeless or moving between temporary places to stay. Womens Womens Superstar Glitter Sneakers Golden Goose Cheap Sale Find Great 0EJZwG
The problems may be around, for example, an applicant having a learning disability or more practical issues such as being required to contact landlords and not having telephone access. In circumstances such as these, it is less likely that failing to cooperate would be counted as deliberate or unreasonable.

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- NewStem Formed with Support of The Hebrew University of Jerusalem -

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| Source: Hollywood Media Corp.

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