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Stars form in clusters, while planets form in gaseous disks around young stars. Cluster dissolution occurs on longer time scales than disk dispersal. Planet formation thus typically takes place while the host star is still inside the cluster. We explore how the presence of other stars affects the evolution of circumstellar disks. Our numerical approach requires multi-scale and multi-physics simulations where the relevant components and their interactions are resolved. The simulations start with the collapse of a turbulent cloud, from which stars with disks form, which are able to influence each other. We focus on the effect of extinction due to residual cloud gas on the early evolution of circumstellar disks. We find that this extinction protects circumstellar disks against external photoevaporation, but these disks then become vulnerable to dynamic truncation by passing stars. We conclude that circumstellar disk evolution is heavily affected by the early evolution of the cluster.
Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.
To conduct a systematic review of health outcomes and long-term sequelae attributable to CPE infection.
We followed PRISMA reporting guidelines and published our review protocol on PROSPERO (CRD42018097357). We searched Medline, Embase, CINAHL and the Cochrane Library. We included primary studies with a carbapenem-susceptible control group in high-income countries, published in English. Quality appraisal was completed using Joanna Briggs Institute checklists. We qualitatively summarized frequently reported outcomes and conducted a meta-analysis.
Our systematic review identified 8,671 studies; 17 met the eligibility criteria for inclusion. All studies reported health outcomes; none reported health-related quality-of-life. Most studies were from Europe (65%), were conducted in teaching or university-affiliated hospitals (76%), and used case-control designs (53%). Mortality was the most commonly reported consequence of CPE-infections; in-hospital mortality was most often reported (62%). Our meta-analysis (n = 5 studies) estimated an absolute risk difference (ARD) for in-hospital bloodstream infection mortality of 0.25 (95% confidence interval [CI], 0.17–0.32). Duration of antibiotic therapy (range, 4–29.7 vs 1–23.6 days) and length of hospital stay (range, 21–87 vs 15–43 days) were relatively higher for CPE-infected patients than for patients infected with carbapenem-susceptible pathogens. Most studies (82%) met >80% of their respective quality appraisal criteria.
The risk of in-hospital mortality due to CPE bloodstream infection is considerably greater than carbapenem-susceptible bloodstream infection (ARD, 0.25; 95% CI, 0.17–0.32). Health outcome studies associated with CPE infection are focused on short-term (eg, in-hospital) outcomes; long-term sequelae and quality-of-life are not well studied.
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