Sequences of the three integral membrane subunits (subunits a, b and c) of the F , sector of the proton-translocating F-type (F, F, -) ATPases of bacteria, chloroplasts and mitochondria have been analysed. All homologous-sequenced proteins of these subunits, comprising three distinct families, have been identified by database searches, and the homologous protein sequences have been aligned and analysed for phylogenetic relatedness. The results serve to define the relationships of the members of each of these three families of proteins, to identify regions of relative conservation, and to define relative rates of evolutionary divergence. Of these three subunits, c-subunits exhibited the slowest rate of evolutionary divergence, b-subunits exhibited the most rapid rate of evolutionary divergence, and a-subunits exhibited an intermediate rate of evolutionary divergence. The results allow definition of the relative times of occurrence of specific events during evolutionary history, such as the intragenic duplication event that gave rise to large c-subunits in eukaryotic vacuolar-type ATPases after eukaryotes diverged from archaea, and the extragenic duplication of F-type ATPase b-subunits that occurred in bluegreen bacteria before the advent of chloroplasts. The results generally show that the three F , subunits evolved as a unit from a primordial set of genes without appreciable horizontal transmission of the encoding genetic information although a f e w possible exceptions were noted.
Objectives:
Our aim was to perform an antimicrobial time-out 48–72 hours after commencing therapy in order to achieve a decrease in days of therapy per 1,000 patient days for vancomycin, meropenem, and piperacillin/tazobactam in all PICU patients during an 8-month period.
Design:
This is a pre- and postimplementation quality improvement study.
Settings:
A 30-bed PICU at a tertiary children’s hospital.
Patients:
Patients less than 21 years old admitted to the PICU from July 1, 2015, until March 31, 2016, or from July 1, 2016, until March 31, 2017, who received antibiotics for greater than 48 hours were eligible for inclusion.
Intervention:
An antimicrobial time-out was performed after 48–72 hours of antimicrobials for all patients in the PICU during postimplementation.
Measurements and Main Results:
The primary outcome measure was days of therapy per 1,000 patient-days for three target antibiotics: vancomycin, meropenem, and piperacillin/tazobactam. Ninety-five patients meeting inclusion criteria were admitted to the PICU during the pre–time-out period and 95 patients during the post–time-out period. The cohort that underwent time-outs had lower days of therapy for vancomycin (81.3 vs 138.1; p = 0.037) and meropenem (34.7 vs 67.1; p = 0.045). Total acquisition cost was 31 % lower for piperacillin/tazobactam and vancomycin and 46% for meropenem post implementation. Time-outs led to antimicrobial duration being defined 63% of the time and deescalation or discontinuation of antimicrobials 29% of the time.
Conclusions:
A 48–72-hour time-out process in rounds is associated with a reduction in days of therapy for antibiotics commonly used in the PICU and may lead to more appropriate usage. The time-outs are associated with discontinuation, deescalation, or duration being defined, which are key elements of Centers for Disease Control and Prevention–recommended antimicrobial stewardship programs.
The concept of Internet of Things (IoT) is rapidly moving from a vision to being pervasive in our everyday lives. This can be observed in the integration of connected sensors from a multitude of devices such as mobile phones, healthcare equipment, and vehicles. There is a need for the development of infrastructure support and analytical tools to handle IoT data, which are naturally big and complex. But, research on IoT data can be constrained by concerns about the release of privately owned data. In this paper, we present the design and implementation results of a synthetic IoT data generation framework. The framework enables research on synthetic data that exhibit the complex characteristics of original data without compromising proprietary information and personal privacy.
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