Culture

The partial re-opening of schools during the summer 2020 half-term in England was associated with a low risk of COVID-19 cases or outbreaks, with 113 single cases, nine co-primary cases, and 55 outbreaks recorded.

Outbreaks in schools correlated strongly with local infection rates, highlighting a need to reduce community transmission in order to protect educational settings.

Confirmed infections and outbreaks were more likely to involve staff members than students, though fewer students were in attendance than normal and their infection rates may be underestimated.

With little research in this area internationally, the authors note that their insights could have global implications, although the specific results are only applicable to England.

COVID-19 cases and outbreaks were low among staff and students in schools and nurseries in England that re-opened during the summer half-term after lockdown, according to research published in The Lancet Infectious Diseases journal.

Nurseries, primary and secondary schools were closed in late March 2020 as part of the first national lockdown to help reduce the spread of COVID-19. Following the rollout of strict infection control measures, including smaller classes separated into distinct social bubbles, most educational settings re-opened during the summer half-term from June 1 to July 17, 2020.

Educational settings re-opened to children in nurseries, primary school reception and years 1 and 6 (ages 4-5, 5-6 and 10-11 years, respectively), secondary school years 10 and 12 (ages 14-15 and 16-17 years, respectively), and children of any age whose parents were key workers, or who were classified as vulnerable. Of the 8.9 million students in England, 1.6 million attended school during the period. The new study included data from all early years settings, primary and secondary schools open in England during this time - spanning around 38,000 nurseries, 15,600 primary schools, and 4,000 secondary schools at any one time.

To date, few studies have assessed COVID-19 cases and outbreaks in educational settings, with most involving a single school with a small number of staff and students affected. The authors suggest that while their findings are specific to England, insights gained into the risks of infection and the impact of community transmission could have implications for infection control measures in schools and nurseries in other parts of the world.

The findings may not be generalisable to all schools and nurseries, since those that re-opened in summer 2020 did so at a time when COVID-19 cases had fallen nationally. Additionally, stringent infection control measures were in place with strict limits on bubble sizes, which might not be achievable in fully opened school settings.

Dr Shamez Ladhani, Public Health England, said: "SARS-CoV2 infections and outbreaks were uncommon in educational settings after they reopened during the summer term. The strong correlation with rates in the wider community also emphasises the importance of controlling transmission outside the school gates to protect educational settings. This is consistent with studies that have been conducted since this paper was completed in August, and forthcoming PHE research into transmission in schools during the autumn term." [1]

The authors used COVID-19 data recorded in Public Health England's online national database for recording events that need public health management, HPZone, to calculate case and event rates for staff and students in schools and nurseries that re-opened during the half-term. Events were classified as single cases, co-primary cases (two or more confirmed cases within 48hrs, typically children who live in the same household), and outbreaks (two or more linked cases diagnosed within 14 days in the same educational setting). All events were followed-up for 28 days after schools and nurseries closed for the summer holidays.

Statistical analyses were used to reveal how COVID-19 cases and events in schools and nurseries were affected by the size and density of the local population, and levels of community transmission on a regional level. Authors determined whether infections were passed from staff to students, students to staff, or within these groups based on the first identified cases, dates when symptoms began, and when testing was done.

Rates of COVID-19 infection and outbreaks were very low across all educational settings, with 113 single cases, nine co-primary cases, and 55 outbreaks between June 1 and July 17. The 113 single cases included 55 (49%) children and 58 (51%) staff, and occurred mainly in primary schools (61%, 69/113 cases). There were nine co-primary cases including 19 children and one staff member. Six co-primary cases were in primary schools, two were in nurseries, and one involved a parent and child at the same school. Of the 55 outbreaks identified in the analysis, 27 were in primary schools, with 16 in nurseries, seven in secondary schools, and five in schools of mixed age groups.

A strong association was identified between outbreaks in schools and levels of community transmission, with the risk of an outbreak rising by 72% for every increase of five cases per 100,000 within the local community. The analysis also revealed that cases brought into educational settings increased the risk of an outbreak by 40% in nurseries, 26% in primary schools, and 39% in secondary schools.

Infection rates were higher in staff than students, with 27 cases per 100,000 per day compared with 18 for children in nurseries, 6 in primary school students, and 6.8 in secondary school students. The virus was most often spread between staff, while student-to-student transmission was rare. Staff members accounted for 73% of cases (154/210 cases) linked to outbreaks compared with 27% (56/210) for students. The probable direction of transmission was staff to staff in 26 outbreaks, staff to student in eight, student to staff in 16, and student to student in five.

Dr Sharif Ismail, from the London School of Hygiene & Tropical Medicine, UK, said:: "While staff did have higher infection rates, it's important to note that the overall number of cases was very small and the vast majority of staff were completely fine and able to protect themselves and their students. Teachers were very cautious with physical distancing and infection control practices when they were in class with their students, but this was more difficult to maintain outside the classroom. Teachers are also more likely to develop symptoms than students and are, therefore, more easily identified, which almost certainly contributed to their higher infection rate."

Limitations in swab testing used to confirm COVID-19 infections, coupled with the fact few schools or nurseries were selected for wider testing, could mean the size of some outbreaks identified in the analysis were underestimated. Very few secondary school years were open during the summer half-term, therefore the results cannot be generalised to all secondary schools, especially since the risk of infection, disease, and transmission is likely to be higher in older than younger children. It is also likely that some populations, such as children of key workers, were over-represented in the analysis.

Writing in a linked Comment, lead authors Stefan Flasche and John Edwards (who were not involved in the study), from the London School of Hygiene & Tropical Medicine, note that the partial re-opening of schools during the UK in summer half-term, when COVID-19 levels were low, was reassuringly associated with very few confirmed outbreaks in schools. However, they say: "The partial opening of schools in June and July with small bubbles and much fewer children attending, particularly in secondary education, may have led to considerably less within-school transmission than the reopening of schools to all children after the summer." They also note that more transmission likely occurred among children than was recorded, saying: "Children rarely display obvious symptoms and are likely missed by the largely passive case finding that was in place at the time. In fact, in most instances where further symptom agnostic testing was initiated in response, a substantial number of additional cases were identified."

URBANA, Ill. - Careers in science, technology, engineering, and mathematics (STEM) are one of the fastest-growing areas of work in the United States, yet racial and gender disparities remain in STEM occupations.

A recent study from University of Illinois researchers examining reasons for such disparities shows the overall racial climate on a college campus--informed by experiences of racial microaggressions--is a contributing factor in the lack of representation of students of color in STEM education programs.

In other words, the study found when students of color in STEM majors felt excluded, invisible, or isolated on their college campus because of their race, sometimes combined with discouraging experiences in academic settings, they were less likely to continue in STEM.

"Racial microaggressions are subtle, as opposed to overt, behaviors or remarks that can serve to demean, degrade, invalidate, or otherwise make a person take a step back to try to figure out, 'was that because of my race?' That's the difficult thing about racial microaggressions, they can catch you off guard to a point where, in the moment, you may not necessarily know how to react," explains Jasmine Collins, assistant professor of organizational and community leadership in the Agricultural Leadership, Education and Communications program at Illinois and co-author of the study.

For the study, Collins and colleagues from disciplines including sociology and African American studies analyzed the experiences of students of color in STEM majors who reported experiencing racial microaggressions across three levels: on campus (characterized by students' general feelings about being a student of color on their university campus); in academic settings (e.g., classrooms or exchanges with instructors or academic advisers); and with peers (e.g.. interpersonal interactions with other students).

Using data collected from more than 4,800 students of color at a large, public university in the United States, the study also found Black students in STEM majors are more likely to experience racial microaggressions than other students of color in STEM, with Black women reporting the highest rates.

Black men and women, Latina women, Asian women, and Indigenous women in the study, in particular, reported experiencing racial microaggressions more frequently at the campus level than in classrooms or between peers.

The researchers hope the findings from the study, published in the International Journal of STEM Education, will encourage STEM-related academic programs to address the larger campus culture in their classrooms and other academic settings. "The aim is not to call attention to a particular campus, but we do make the connection to the broader national context. Colleges and universities play an important role in the STEM pipeline," Collins says.

Survey participants responded to questions asking, for example, if they have had their contributions minimized in classrooms because of their race; experienced negative and insulting comments because of their race; or felt invisible or unwelcome on their campus because of their race.

Some students reported dropping out of STEM majors because of these experiences or having been encouraged by advisers or instructors to change to a non-STEM major.

As one respondent in the study, a Latina woman who changed from a STEM to a non-STEM major, noted, "I changed my desired major from Engineering to Latin American Studies because of my race and sadly encountered others like myself within the humanities who had to change their major because of their race. If you aren't White, and you aren't Asian, and you aren't 'Indian,' you aren't an engineer."

One Black woman who is a STEM student noted, "A lot of people automatically assume that since I'm a Black female that I should be a [non-STEM] major. Every time I walk into a lab, I always get looks. I'm not sure if it's because I don't 'look' like a [STEM] major in general or if it's because I'm Black."

Others described eagerness to meet new people at the beginning of the school year, but experienced rejection when they tried to make friends.

A significant contribution of this study, Collins explains, is the layering of different levels at which students encountered microaggressions. "We introduce this framework of the campus racial climate to show how, for students of color in STEM who experience racial microaggressions, they not only receive messages in their classrooms, but it's part of the institutional fabric. It's the culture of the institution that tends to reinforce these messages."

Collins says universities must find ways to create more welcoming and supportive environments for students of color, for all majors, and employ a level of accountability at the campus and departmental level.

"In order to educate our workforce, students have to come through our doors and if these are the kinds of experiences [students of color] are facing--the campus signals to them they don't belong in STEM, their peers in class don't want to work with them because they think they're incompetent, or their adviser recommends they switch majors because this might be too hard for them--if it's just message after message saying, 'you don't belong here, you're not smart enough, you're not skilled enough to have this kind of job,' then we're losing a lot of talent in the pipeline," Collins says.

"It's one of the reasons why we see such stark racial and gender disparities in the STEM workforce. And it really is a pipeline issue."

Collins hopes to see a shift in research that focuses a little less on confirming that these things happen and focuses more on solutions. "I find it to be quite taxing as a scholar, and even personally as someone who also faces racial microaggressions, reading through the data in the midst of a global pandemic, in the midst of racial protests, and seeing that not a lot has changed," she says. "I think we have enough evidence that these things occur.

"If we can find those ways to reenergize ourselves toward solutions and toward working collaboratively to find solutions, that's where I would love to see future research in this field go."

(Boston)-- Prior research has revealed sexual minority youth (lesbian, gay, bisexual) are more likely to carry weapons both outside of and within school. However, until now, no study has examined the degree to which bullying and harassment is associated with weapon carrying among this group.

A new study has found youth who report carrying a weapon have higher odds of experiencing bullying and bullying-related victimization. Minoritized student populations, especially sexual minority youth disproportionately experience bullying and bullying victimization.

"Pediatricians should recognize that experiencing bullying and feeling unsafe are associated with weapon carrying, particularly among sexual minorities," says corresponding author Carl Streed, Jr., MD, MPH, FACP, assistant professor of medicine at Boston University School of Medicine (BUSM).

Using the Youth Risk Behavior Survey to examine the prevalence and likelihood of carrying weapons by sexual identity, the researchers examined self-report of adverse experiences (being bullied, skipping school due to fear for personal safety) and performed analysis to estimate the odds of carrying a weapon. When surveyed by sexual identity, 14 percent of heterosexual, 21.8 percent of gay/lesbian,18.5 percent of bisexual and 17.4 percent of "not sure" students reported carrying a weapon in the past 30 days.

The odds of carrying a weapon were significantly increased for youth who skipped school due to feeling unsafe at school, had ever been threatened with a weapon in the past year and had ever been in a physical fight. Compared to heterosexual female peers, sexual minority women had increased odds of carrying a weapon. "Pediatricians and professionals who work with youth should recognize that reported experiences of bullying may not be the most salient indicator of risk for weapon carrying among all youth, and that other fears of or experiences with bullying are crucial to screen for among sexual minorities in particular," adds Streed, who also is a primary care physician and research lead in the Center for Transgender Medicine & Surgery at Boston Medical Center.

According to the researchers, this work is critical in the current political climate that is witnessing an erosion of LGBTQ acceptance (GLAAD, 2019) and is leading to a potential increase in minority stress through the bullying of certain youth populations, particularly sexual minority youth. They believe future research should investigate associations between longitudinal trends in bullying and attitudes toward sexual and gender minority persons in U.S. politics.

A considerable number of existing and proposed post-2020 biodiversity targets by international organizations are at risk of being severely compromised due to climate change, even if other barriers such as habitat exploitation are removed argue the authors of a study led by Almut Arneth from Karlsruhe Institute of Technology (KIT). According to their analysis published in PNAS, global warming accelerates the loss of biodiversity. Vice versa, measures to protect biodiversity may also mitigate the impacts of climate change. The authors suggest that flexible approaches to conservation would allow dynamic responses to the effects of climate change on habitats and species. (DOI: 2009584117)

About a million plant and animal species are endangered worldwide. At least 13 of the 17 sustainable development goals of the United Nations, however, depend on biodiversity, including species diversity, the genetic diversity within species and the diversity of ecosystems. Biodiversity regulates fundamental processes, such as soil formation and water-, trace-gas-, and nutrient cycles and thus contributes notably l to regulating the climate. The continued loss of biodiversity makes humankind face ecological, social, and economic problems. "Apart from the over-exploitation of natural resources on land and in water, or environmental pollution, climate change also causes loss of biological diversity. This impact will increase in future," says Almut Arneth, Professor at the Atmospheric Environmental Research Division of the Institute of Meteorology and Climate Research (IMK-IFU), KIT's Campus Alpine in Garmisch-Partenkirchen. She led an international study that is now published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS) under the title "Post-2020 biodiversity targets need to embrace climate change."

Targets for Worldwide Biodiversity Conservation Missed

In their study, scientists from Germany, France, Italy, Spain, Russia, South Africa, Mexico, and Japan analyzed the so-called Aichi targets for the worldwide protection of biodiversity that were adopted by the 10th Conference of the Parties of the UN Convention on Biodiversity in Nagoya, prefecture of Aichi, in 2010 for compliance by 2020. Most of these targets will be missed. In addition, the researchers analyzed the set of revised biodiversity protection targets currently negotiated by the parties for the time after 2020, which are to be reached by 2030 or 2050. They found that many existing or proposed targets are at risk due to global warming, even if the mean global temperature increase would remain at the lower limit of projections. "It certainly is a big challenge, but also an important opportunity to better handle on the political level the interactions between climate change and biodiversity loss, and to better coordinate the biodiversity targets with the Paris Agreement on Climate Change and the Sustainable Development Goals," Arneth explains. The biodiversity targets proposed should therefore consider climate change much more explicitly, she thinks.

Species Are Leaving Nature Reserves

Arneth gives an example: A biodiversity target for nature reserves must consider the fact that composition and growth of vegetation will change with climate change and that certain species of plants and animals will either migrate or be threatened, if climatic conditions are changing. For instance, climate change causes mountain glaciers to shrink. In semi-arid regions, however, lower lying valley ecosystems depend on melting water from glaciers in summer. If this melt-water flow will decrease due to retreating glaciers, precipitation alone may not be sufficient to supply the plants in the catchment with water. This will then also affect the animals that are dependent on the plants.

The study underscores the demand to quickly and significantly reduce anthropogenic greenhouse gas emission and to halt climate change. Vice versa, it also shows that measures to protect biodiversity would contribute to climate protection. "Better coordination of political agreements and scientific findings may accelerate urgent decarbonization of economy and ensure slowdown of climate change by biodiversity protection measures," Arneth summarizes.

New research has shown how microbubbles carrying powerful cancer drugs can be guided to the site of a tumour using antibodies.

Microbubbles are small manufactured spheres half the size of a red blood cell - and scientists believe they can be used to transport drugs to highly specific locations within the body.

In a paper published in the journal Theranostics, the lead authors of the study, Drs Nicola Ingram and Laura McVeigh from the University of Leeds, describe how they have targeted microbubbles through the use of a 'navigational aid' - antibodies attracted to the growth hormone found in high levels in the blood vessels supplying a tumour.

The antibodies were attached to the microbubbles - and as a result of being attracted to the growth hormone, the microbubbles became concentrated at the site of the tumour. A pulse from an ultrasound device was used to burst open the microbubbles, and that released the anti-cancer agent.

Dr Ingram, Senior Research Fellow in the School of Medicine at Leeds, said being able to deliver anticancer drugs in a very targeted fashion would be a major advance in cancer therapy.

She added: "One of the big problems with cancer drugs is that they are highly toxic to the rest of the body too. Microbubble technology allows us to use these very powerful drugs with precision and that reduces the risk of the drug damaging healthy cells nearby.

"It is about finely focused drug delivery."

The animal-based study also revealed that by attaching the drug directly to the microbubbles allowed it to circulate in the body for longer, increasing delivery into the tumour - in effect making the drug more potent.

As a result, the scientists were able to slow cancer growth with a much smaller drug dose.

Professor Stephen Evans, head of the Molecular and Nanoscale Physics Group at Leeds and one of the paper's authors, said: "The results of this study are exciting because we not only show the very precise and targeted way microbubbles can be guided to cancer sites but that the efficacy of drug delivery is substantially improved, opening the way to use highly toxic drugs to fight cancer, without the harmful side effects.

"Put simply: you get more bang for your buck."

The next stage of the research is to look at using microbubbles to develop targeted, triggered, delivery systems in patients for the diagnosis and treatment of advanced colorectal cancer, the third most common cancer in the UK.

Professor Peter Simpson, Chief Scientific Officer at Medicines Discovery Catapult said: "Complex medicines have the potential to be the third wave of medicines, addressing patients' problems which conventionally administered small molecules and monoclonal antibodies cannot.

"This project is a very encouraging example of exploring how using an advanced drug delivery technology could improve biodistribution, targeting and efficacy of a potentially toxic therapeutic."

This study involved a research team from the universities of Leeds, Bradford, Manchester, and the Medicines Discovery Catapult in Cheshire. The study and a follow-on study were funded by the Engineering and Physical Sciences Research Council. In addition, several PhD students are also developing microbubbles for treatment of other diseases and have been funded by Alumni.

The University of Leeds has established the Leeds Microbubble Consortium, a group of cancer scientists, engineers, physicists and chemists to develop ways microbubble technology could enhance cancer treatment.

Animal Study/ Peer Review/ Experimental

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The University of Leeds is one of the largest higher education institutions in the UK, with more than 37,000 students from more than 150 different countries, and a member of the Russell Group of research-intensive universities. The University plays a significant role in the Turing, Rosalind Franklin and Royce Institutes.

We are a top ten university for research and impact power in the UK, according to the 2014 Research Excellence Framework, and are in the top 100 of the QS World University Rankings 2019.

The University was awarded a Gold rating by the Government's Teaching Excellence Framework in 2017, recognising its 'consistently outstanding' teaching and learning provision. Twenty-six of our academics have been awarded National Teaching Fellowships - more than any other institution in England, Northern Ireland and Wales - reflecting the excellence of our teaching. http://www.leeds.ac.uk

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Journal

Theranostics

DOI

10.7150/thno.49670

Philadelphia, December 8, 2020--Researchers at Children's Hospital of Philadelphia (CHOP) have found elevated levels of a biomarker related to blood vessel damage in children with SARS-CoV-2 infection, even if the children had minimal or no symptoms of COVID-19. They also found that a high proportion of children with SARS-CoV-2 infection met clinical and diagnostic criteria for thrombotic microangiopathy (TMA). TMA is a syndrome that involves clotting in the small blood vessels and has been identified as a potential cause for severe manifestations of COVID-19 in adults.

The findings were published today in Blood Advances.

"We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms," said co-senior author David T. Teachey, MD, an attending physician, Co-Leader of the Immune Dysregulation Frontier Program, and Director of Clinical Research at the Center for Childhood Cancer Research at CHOP. "We should continue testing for and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term."

Most children infected with SARS-CoV-2 have mild or minimal symptoms, although a small proportion develop severe disease or Multisystem Inflammatory Syndrome in Children (MIS-C), a post-viral inflammatory response to COVID-19. Researchers have identified TMA mediated by the complement cascade as a potential cause for severe manifestations of COVID-19 in adults. The complement cascade is part of the immune system that enhances the immune response but also promotes inflammation. However, the role of complement-mediated TMA has not been studied in children.

To assess the role of complement activation in children with SARS-CoV-2, the Immune Dysregulation Frontier Program, including co-senior authors Edward Behrens, MD and Hamid Bassiri, MD, PhD and co-first authors Caroline Diorio, MD and Kevin McNerney, MD, analyzed 50 pediatric patients hospitalized at CHOP with acute SARS-CoV-2 infection between April and July 2020. Of those 50 patients, 21 had minimal COVID-19, 11 had severe COVID-19, and 18 were diagnosed with MIS-C. The researchers used soluble C5b9 (sC5b9) as a biomarker for complement activation and TMA. sC5b9 has been implicated as an indicator of severity in TMA after hematopoietic stem cell transplant; transplant patients with markedly elevated sC5b9 have increased mortality.

The researchers found elevations of C5b9 in patients with severe COVID-19 and MIS-C, but to their surprise, they also found that C5b9 was elevated in patients with minimal or asymptomatic disease. Although the study was prospective, meaning patients were enrolled and data collected from the time of hospitalization, the researchers obtained some of the laboratory data retrospectively when it came to evaluating whether they met the clinical criteria for TMA. Of the 22 patients for whom complete data were available, 19 (86%) met the criteria for TMA. Additionally, sC5b9 levels were elevated both in patients who did and did not meet criteria for TMA.

"Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-CoV-2 that are worthy of investigation," Dr. Teachey said. "Future studies are needed to determine if hospitalized children with SARS-CoV-2 should be screened for TMA, if TMA-directed management is helpful, and if there are any short- or long-term clinical consequences of complement activation and endothelial damage in children with COVID-19 or MIS-C. The most important takeaway from this study is we have more to learn about SARS-CoV-2. We should not make guesses about the short and long-term impact of infection."

Leipzig/Frankfurt/Main/Düsseldorf. Aerosols and their spread play an essential role in the transmission of COVID-19. However, the risk of transmission could be significantly reduced if more could be done to reduce indoor airborne viruses. The Working committee particulate matter (AAF) has therefore issued an statement with concrete recommendations. These include window ventilation, exhaust ventilation, air purification systems and CO2 measuring devices for indoor areas such as classrooms or transportation, and the increased use of N95 and FFP2 masks. These countermeasures could help in the short term to better contain the corona pandemic, especially in winter, until vaccination is effective on a large scale. They could also help in the long term to better control infections such as seasonal fluor even other pandemics in the future.

The German Working committee particulate matter (AAF) brings together experts from the fields of engineering, chemistry, physics, biology, meteorology and medicine, who are organised in the professional associations ProcessNet (DECHEMA/ VDI-GVC), Gesellschaft Deutscher Chemiker (GDCh) and VDI/DIN Commission Reinhaltung der Luft (KRdL). In its autumn meeting, the AAF discussed the role of aerosol particles in the spread of the SARS-CoV2 viruses and prepared a statement on this topic. On the basis of their expertise, the authors describe in the now published statement different aerosol types with regard to their formation, range, residence time in the air and derive recommendations for protection by various measures. The authors expressly support the current recommendations of the Robert Koch Institute (RKI), but suggest that even more should be done to reduce the number of viruses in indoor air.

The Working committee particulate matter (AAF) advises strict application of the recommendations based on the active aerosol propagation path: masks (especially the use of N95 and FFP2 masks) are helpful and necessary, ventilation is a good immediate measure and suitable air purifiers should be used.

Furthermore, the Panel concludes that more attention should be paid to the type of ventilation in addition to the measures already taken: Especially the smaller aerosol particles rise with the warm air we breathe and then spread below the ceiling. The experts on the working committee therefore recommend that in ventilation systems, care should be taken to ensure that fresh air is not supplied from top to bottom, as this leads to turbulence between the fresh air and the air we breathe and viruses can then float in the room air for longer. Ceiling fans, which are counterproductive in the current COVID 19 pandemic, would also contribute to this. Instead, care should be taken to ensure that air is actually extracted upwards. In the future, a reversal of the air supply and extraction in aircraft or public transport could help.

The panel of experts also advises to install ventilation and especially overhead exhaust suction systems in many areas at short notice, especially in classrooms or in the catering industry. Monitoring the CO2 concentration is a suitable indicator of how well the ventilation works. For cultural facilities, too, monitoring the CO2 content and thus the indoor air could later provide opportunities for normalising operation. In the Länder, funds should be made available so that ventilation, extraction, air purification systems and CO2 measuring devices can be installed in school classes. At the local level, it would be helpful if administrative regulations were relaxed and school managements were given more freedom of action. If these measures were implemented consistently, about 90 percent of all potentially viral aerosols could be removed from classrooms.

"We clearly see the human and technical effort involved in the short and medium term, but we are convinced that the appropriate consideration of the virus spread via the aerosol path can lead to a short-term and also sustainable containment of the current incidence of infection. Such investments would also be beneficial for later, for example for the air quality in classrooms", explains Prof. Hartmut Herrmann of the Leibniz Institute for Tropospheric Research (TROPOS), who is chairman of the Working Committee on Particulate Matter (AAF). Herrmann also contributes torecommendations by an international group of aerosol researchers) and via the VDI/DIN Commission on Air Pollution Control (KRdL), which were incorporated into specific recommendations for German conditions. Even if the World Health Organization (WHO) still pays too little attention to this, experts have long been convinced that aerosols, i.e. tiny suspended particles in the air, contribute strongly to the spread of the SARS-CoV2 viruses. "We are aware that the technical implementation of more efficient ventilation measures is probably one of the most demanding measures in the current situation in Germany. However, protection against infection from virus-contaminated aerosol particles in indoor rooms and means of transport through improved ventilation technology is particularly important in the cold winter months in order to avoid corona superspreader events", emphasises Prof. Peter Wiesen from the Bergische Universität Wuppertal, who is one of the authors of the statement.

Protective measures against the spread of SARS-CoV-2 via indoor aerosols currently pose major challenges for many sectors of society. The risk of infection is particularly high in hospitals and nursing homes because infected and healthy people can stay sometimes in the same room for long periods of time. According to media reports, COVID-19 infections are already reported in almost one tenth of the 12,000 old people's homes and nursing homes in Germany. Homes are now also considered as hotspot for the spread of the virus among new infections in Saxony. An international group of aerosol researchers proposes therefore a variety of measures to prevent the spread of the virus in hospitals and nursing homes. It is particularly important to develop an appropriate strategy to protect healthcare workers from airborne transmission. Their recommendations in the International Journal of Environmental Research and Public Health include regular ventilation, controlling fresh air consumption via CO2 monitor and using humidifiers to keep the relative humidity indoors at 40 to 60 percent. If it is not possible to ventilate sufficiently, the use of portable air purifiers are also advisable.

In addition to the recommendations already made by the Robert Koch Institute and the National Academy of Sciences Leopoldina in Germany, the Working Committee sees an opportunity to take additional protective measures to contain the Covid-19 pandemic, initially in the short term, until a vaccine has reached a really broad section of the population. In addition, these measures could in the future also help to reduce infections such as seasonal influenza, which are spread through the air.

Bartonella bacteria are increasingly recognized as an emerging infectious disease threat. A new study by North Carolina State University researchers has found additional instances of Bartonella infection in humans who exhibited neuropsychiatric symptoms, a subset of whom also had skin lesions. This research adds to the body of evidence that not only can Bartonella infection mimic a spectrum of chronic illnesses - including mental illness - but also that dermatological symptoms may accompany infection.

Bartonella henselae is a bacterium historically associated with cat-scratch disease, which until recently was thought to be a short-lived (or self-limiting) infection. There are at least 30 different known Bartonella species, of which 13 have been found to infect humans. Improved methods for detecting Bartonella infection in animals and humans - it is notorious for "hiding" in the linings of blood vessels and potentially the skin - has led to the diagnosis of bartonelloses in patients with a host of chronic illnesses.

In 2019, Dr. Edward Breitschwerdt, Melanie S. Steele Distinguished Professor of Internal Medicine at NC State, published a case study involving an adolescent boy diagnosed with rapid onset schizophrenia, who had accompanying skin lesions. After Breitschwerdt's research group documented Bartonella henselae infection, the patient received antimicrobial therapy and all neuropsychiatric symptoms resolved.

The new study is a follow-up to the 2019 work and is published in the journal Pathogens. Thirty-three participants suffering from neuropsychiatric symptoms ranging from sleep disorders and migraines to depression and anxiety enrolled in the study. Twenty-nine of 33 participants were found to have Bartonella infections based upon serology and enrichment blood culture polymerase chain reaction (PCR) testing. Twenty-four of the 29 Bartonella-positive participants (83%) reported the appearance of skin lesions during their illness.

Skin lesions ranged from cutaneous eruptions to red, irregular linear lesions randomly located on various parts of the patient's body. Many of these lesions resembled striae distensae (stretch marks); however, typical risk factors for striae distensae, such as body building activities, obesity, pregnancy, prednisone treatment and other known disease associations, were either infrequently or not reported by study participants.

"This research, a follow-up to our initial case report of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS), was initiated to further investigate a possible association between neuropsychiatric illness, skin lesions and a bacterial infection of emerging biomedical importance," Breitschwerdt says. "We hope that this research will enable physicians to suspect connections between disparate symptoms involving the nervous system and skin that could be associated with an underlying bacterial cause."

While a certain level of trust is needed for autonomous cars and smart technologies to reach their full potential, these technologies are not infallible - hence why we're supposed to keep our hands on the wheel of self-driving cars and follow traffic laws, even if they contradict our map app instructions. Recognizing the significance of trust in devices - and the dangers when there is too much of it - Erin MacDonald, assistant professor of mechanical engineering at Stanford University, researches whether products can be designed to encourage more appropriate levels of trust among consumers.

In a paper published last month in The Journal of Mechanical Design, MacDonald and Ting Liao, her former graduate student, examined how altering peoples' moods influenced their trust in a smart speaker. Their results were so surprising, they conducted the experiment a second time and with more participants - but the results didn't change.

"We definitely thought that if people were sad, they would be more suspicious of the speaker and if people were happy, they would be more trusting," said MacDonald, who is a senior author of the paper. "It wasn't even close to that simple."

Overall, the experiments support the notion that a user's opinion of how well technology performs is the biggest determining factor of whether or not they trust it. However, user trust also differed by age group, gender and education level. The most peculiar result was that, among the people who said the smart speaker met their expectations, participants trusted it more if the researchers had tried to put them in either a positive or a negative mood - participants in the neutral mood group did not exhibit this same elevation in trust.

"An important takeaway from this research is that negative emotions are not always bad for forming trust. We want to keep this in mind because trust is not always good," said Liao, who is now an assistant professor at the Stevens Institute of Technology in New Jersey and lead author of the paper.

Manipulating trust

Scientific models of interpersonal trustworthiness suggest that our trust in other people can rely on our perceptions of their abilities, but that we also consider whether or not they are caring, objective, fair and honest, among many other characteristics. Beyond the qualities of who you are interacting with, it's also been shown that our own personal qualities affect our trust in any situation. But when studying how people interact with technology, most research concentrates on the influence of the technology's performance, overlooking trust and user perception.

In their new study, MacDonald and Liao decided to address this gap - by studying mood - because previous research has shown that emotional states can affect the perceptions that inform interpersonal trustworthiness, with negative moods generally reducing trust.

Over the span of two identical experiments, the researchers analyzed the interactions of sixty-three participants with a simulated smart speaker that consisted of a mic and pre-recorded answers hidden under a deactivated smart speaker. Before participants used the speaker, they were surveyed about their feelings regarding their trust of machines and shown images that, according to previous research, would put them in a good or a bad mood, or not alter their mood at all.

The participants asked the speaker 10 predetermined questions and received 10 prerecorded answers of varying accuracy or helpfulness. After each question, the participant would rate their satisfaction with the answer and report whether it met their expectations. At the end of the study, they described how much they trusted the speaker.

If participants didn't think the speaker delivered satisfactory answers, none of the variables measured or manipulated in the experiment - including age, gender, education and mood - changed their minds. However, among participants who said the speaker lived up to their expectations, men and people with less education were more likely to trust the speaker, while people over age 65 were significantly less likely to trust the device. The biggest surprise for the researchers was that, in the group whose expectations were met, mood priming led to increased trust regardless of whether the researchers tried to put them in a good mood or a bad mood. The researchers did not follow up on why this happened, but they noted that existing theory suggests that people may become more tolerant or empathetic with a product when they are emotional.

"Product designers always try to make people happy when they're interacting with a product," said Liao. "This result is quite powerful because it suggests that we should not only focus on positive emotions but that there is a whole emotional spectrum that is worth studying."

Proceed with caution

This research suggests there is a nuanced and complicated relationship between who we are and how we feel about technology. Parsing out the details will take further work, but the researchers emphasize that the issue of trust between humans and autonomous technologies deserves increased attention now more than ever.

"It bothers me that engineers pretend that they're neutral to affecting people's emotions and their decisions and judgments, but everything they design says, 'Trust me, I've got this totally under control. I'm the most high-tech thing you've ever used,'?" said MacDonald. "We test cars for safety, so why should we not test autonomous cars to determine whether the driver has the right level of knowledge and trust in the vehicle to operate it?"

As an example of a feature that might better regulate user trust, MacDonald recalled the more visible warnings she saw on navigation apps during the Glass Fire that burned north of Stanford in fall, which instructed people to drive cautiously since the fire may have altered road conditions. Following their findings, the researchers would also like to see design-based solutions that factor in the influence of users' moods, both good and bad.

"The ultimate goal is to see whether we can calibrate people's emotions through design so that, if a product isn't mature enough or if the environment is complicated, we can adjust their trust appropriately," said Liao. "That is probably the future in five to 10 years."

Late-onset Alzheimer's disease (LOAD) is the most common form of dementia in the elderly, affecting almost 44 million people worldwide. Despite decades of research, genetic factors that predispose individuals to LOAD are not clearly understood. With a growing elderly population in the U.S. and many other developed countries, there is an urgent need for precise prognostic biomarkers and viable treatment options. Apart from advanced age, variants in the apolipoprotein E (APOE) gene are a strong predictor of disease risk. Those who carry the ε4 variant have a higher risk of developing Alzheimer's, while those who carry a different variant, ?2, are typically protected. Surprisingly, many individuals do not conform to these rules -- a puzzle that has confounded researchers. Some people with APOE?4 remain disease-free while some APOE?2 carriers develop the disease.

Using a novel methodology, researchers at Baylor College of Medicine and Texas Children's Hospital examined the genomes of these "rule-breaker" individuals, which led to the identification of 216 new gene variants, many previously not suspected to play a role in this disease. This is an exciting first step toward understanding this paradox. The newly-identified biomarkers could potentially be used in the future to refine risk assessment and patient prognosis in APOE?2 and APOE?4 carrier populations and act as therapeutic targets for this untreatable condition.

The study, led by Drs. Olivier Lichtarge and Juan Botas, professors of molecular and human genetics at Baylor College of Medicine and investigators at the Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, was published in Alzheimer's and Dementia.

"We wanted to test if people who show paradoxical outcomes might have other genetic variants that blunted the risky or protective effects of the APOE genotype they carry," Lichtarge said. "To search for those variants, Young Won Kim, a graduate student in my lab, designed new algorithms to compare and contrast the genetic variants present in each patient. We were then fortunate to be able to test these with a unique high-throughput fruit fly screen developed by Juan and his team at the Duncan NRI. This is a good example of the power of comparative studies across species and only feasible through multidisciplinary collaborations."

A novel computational approach finds 216 genes with differential variants in paradoxical populations

The wide spectrum of clinical presentations and complex inheritance patterns of LOAD, and its co-occurrence with other neuropathologies, heart-related disorders and age-associated cognitive impairments are some of the reasons why scientists have found the puzzle of paradoxical APOE ?2 and ?4 patients particularly challenging.

In this study, researchers tapped into the largest whole exome dataset available for this condition, called the Alzheimer's Disease Sequencing Project (ADSP).

"To screen for potential candidate variants, I focused on the coding regions of the human genome and estimated the functional impact of genetic variants by factoring in all the past evolutionary changes at the same gene positions. Through a series of regression analyses, we found 216 genes with significant differences in mutational load between the two paradoxical patient groups. Many of these genes showed involvement in known Alzheimer's disease pathways such as synaptic biology, dendritic spine pruning, and inflammatory responses in the brain. Also, we were able to use machine learning algorithms to predict which APOE?4 carriers would remain healthy and which APOE?2 carriers would develop Alzheimer's based on the variants they carry in the 216 genes," lead author, Young Won Kim, said.

High-throughput robotic screen of fruit flies validates candidate genes

The researchers' next step was to experimentally test the biological relevance of these 216 gene variants in modifying Alzheimer's disease pathogenesis.

"Testing so many genes for their impact on neuronal dysfunction in vivo is a daunting task. So, we leveraged fruit flies engineered in our lab to develop Alzheimer's pathology and used a high-throughput behavioral screen based on custom-made robots unique to the Duncan NRI to test the ability of each variant-associated gene to modify the disease pathology. This allowed us to validate many candidate genes and experimentally demonstrate their ability to modify disease pathology," Botas said.

"The robotic assays provided us with a quantitative assessment of the actual neuronal impairment. We used movement-specific behavioral assays as the main readout of nervous system function. Additionally, we obtained precise information of how variants in each gene modified its physiological function, meaning whether the impact on neuronal function was a result of the gene's under-performance (loss-of-function) or over-performance (gain-of-function). This information is critical for the future development of these biomarkers for therapeutic interventions, either by inhibiting or activating these genes in the future," Dr. Ismael Al-Ramahi, co-lead author and assistant professor at Baylor, added.

"To summarize, by focusing on paradoxical patient populations, we can now study the genetic modifiers that give them their special power to live a disease course different than expected. Here, in Alzheimer's disease, this may improve risk evaluation and point to gene targets for drugs that blunt the disease pathogenesis. Also, the massive use of evolutionary information seems to have made up for a relatively small number of patients (just 480) in this study, which is much less than a typical genome-wide association study. We think this makes our study design an attractive alternative way to study other health conditions with 'rule-breaking' patients. To conclude, this is the first proof-of-concept study to demonstrate the feasibility of integrating evolutionary biology and machine learning with high-throughput Drosophila genetics and neurobiology assays, to examine why some patients 'break free' of the genetic rules of disease," Lichtarge concluded.

WASHINGTON (December 8, 2020) -- Researchers say they've identified a way to disrupt a process that promotes the growth of pancreatic cancers -- one of the most difficult and deadly cancers to treat.

The team, led by scientists at Georgetown Lombardi Comprehensive Cancer Center and including investigators from Lawrence Livermore National Laboratories, STCube and Fluidigm, published their findings today in the journal Gastroenterology.

Pancreatic cancer is on course to be the second leading cause of cancer-related death in the country, according to the American Cancer Society, with most people surviving less than a year after diagnosis. Therapies approved to treat the cancer are poorly effective and extend survival by only a few months.

One of the hallmarks of the disease is a build-up of scar tissue called fibrosis, in which the cancer-associated fibroblasts (CAF) that trigger fibrosis serve a tricky dual role -- depletion of CAF is just as likely to promote as inhibit pancreatic cancer.

"We hypothesized that if we can alter the microenvironment where cross-talk between the fibroblasts, immune cells and cancer cells happens, then we can cause just enough disruption to push back tumor growth," says lead author, Ivana Peran, PhD, a research instructor of oncology at Georgetown Lombardi.

To do that, the team focused on adhesion molecule cadherin 11 (CDH11), which is expressed by CAFs in the pancreatic tumor environment and has been associated with other fibrotic disorders where it is expressed by activated fibroblasts. They examined inhibiting CDH11 in tumors growing in mice.

Their hypothesis turned out correct. For the first time, the team demonstrated that CDH11 is important in the natural history of pancreatic cancer. "Knocking out" the ability of mice to produce CDH11 reduced the growth of pancreatic tumors, increased the tumor's response to a common chemotherapy called gemcitabine, reversed immunosuppression and significantly extended the survival of mice.

"Separately, we have identified a drug that can inhibit CDH11," said Stephen Byers, PhD, professor of oncology at Georgetown Lombardi. "This drug also inhibited the growth of pancreatic tumors and taken together with our earlier work, this finding warrants study in human clinical trials for people with pancreatic cancer whose tumors express CDH11."

HOUSTON - (Dec. 8, 2020) - The wage gap between men and women is no secret, but another form of gender discrimination directly and disproportionately affects women worldwide: the "pink tax" imposed by import tariffs that target female products.

But new Rice University research concludes the "pink tax" is generally lower in countries where more women are elected to political office.

"Women's Descriptive Representation and Gendered Import Tax Discrimination" will appear in an upcoming edition of the American Political Science Review. The article not only highlights a previously unacknowledged trade policy that penalizes women -- gender-biased import taxes -- but also provides evidence that political representation can have a substantial, direct impact on discriminatory policies.

Import tariffs, which can differ for otherwise identical gender-specific products, often impose direct penalties on women consumers, said researchers Diana O'Brien of Rice, Timm Betz of the Technical University of Munich and David Fortunato of the University of California, San Diego. When they compared nearly 200,000 tariff rates on identical men's and women's apparel products in 167 countries between 1995 and 2015, they found that the difference varied from country to country but it negatively impacted women on average.

Importers ended up paying more for merchandise like jeans, boots, robes and T-shirts aimed at women than identical items sold to men. Women's and men's products were taxed at different levels nearly 40% of the time, and women's items were, on average, taxed 0.7% more than identical products aimed at men. The higher costs were passed on to wholesalers, then retailers and finally female consumers.

But the researchers found political representation is a key factor in lowering import tax penalties on women's goods.

"Just like in other areas of politics, inequalities in representation are reflected in inequalities in government policy," O'Brien said.

Across all democracies, women hold only about 25% of the seats in national legislatures, O'Brien said. In countries with more women in their legislatures, and in countries where women have been able to increase their share of legislative seats, the tax penalty on female consumers has been reduced.

Scientists from Johns Hopkins University and Medicine have developed a possible new antibiotic for a pathogen that is notoriously resistant to medications and frequently lethal for people with cystic fibrosis and other lung ailments.

The pathogen, called Mycobacterium abscessus, is related to a better-known bacterium that causes tuberculosis and leprosy but has recently emerged as a distinct species presenting most often as a virulent lung infection. The team of scientists from the Krieger School of Arts & Sciences' Department of Chemistry and the School of Medicine's infectious diseases department published their findings in the journal Communications Biology.

The team has developed one of the first potential treatments of a bacterium that has no FDA-approved treatments and a cure rate less than 50%. Before the compound, called T405, can move closer to becoming a clinical treatment, researchers need to improve its pharmacological potency using a preclinical animal model of the infection.

"People die of this in our hospitals every week," said Craig Townsend, a professor of chemistry who served as a principal investigator on the study along with Gyanu Lamichhane, an associate professor of medicine. "The data we have is very promising."

Despite years of urgent calls for more studies to understand the bacteria and to explore possible treatments, researchers have been wary of experimenting with the most dangerous member of its Non-Tuberculosis Mycobacteria (NTM) family.

"It's still considered an emerging disease," Lamichhane said. "There are now more NTM than tuberculosis cases in the United States. And this is the most virulent of all of them."

The compound T405 has demonstrated a "superior potency against M. abscessus" over two commonly used antibiotics, the paper states. When combined with an existing medication called avibactam, T405 also demonstrated an ability to prevent the bacteria from developing resistance.

T405 was also well tolerated in mice and could be administered less than current treatments, exposing patients to fewer toxic side effects such as deafness.

People with depressed immune systems and lung diseases are also at risk of developing an infection that is most frequently found in cystic fibrosis patients. Transmission is not well understood, but the bacteria can be found in soil, dust and water. It causes infections in lungs, soft tissue and skin.

Current therapeutic guidelines for the infection require 12 to 18 months of multidrug therapy that have resulted in cure rates between 30-50 percent, underscoring the "need for new antibiotics with improved activity," the paper states.

Thanks to a new technique developed by plant pathologists in Connecticut, scientists now have access to an affordable and effective tool to facilitate the study of the entire non-bacterial microbiomes of any plant species.

Like humans, plants have microbiomes. As plants grow, they recruit beneficial microorganisms from the surrounding soil to colonize the roots. Most plant microbiome research focuses on bacteria and fungi, though there are many other microorganisms that can impact plant health, such as nematodes, mites, protists, and fungi.

However, not much is known about the impact of these other microorganisms, in large part because of technical limitations. One such limitation is that samples from plant roots or tissues are full of plant DNA, which overrides the DNA signal that scientists use to detect specific microorganisms.

To more accurately sequence and identify the DNA from nematodes, mites, protists, and fungi, scientists from The Connecticut Agricultural Experiment Station and the University of Connecticut adapted a technology known as "peptide nucleic acid (PNA) clamps" to block plant DNA. They published their results in Phytobiomes Journal.

"These clamps allowed us to examine the entire non-bacterial microbiomes with minimal contamination from the plant itself," explained first author Stephen Taerum. "By adding the clamp, we were able to get three times the sequence information from each plant sample and detect thousands of sequences from rare microorganisms that were otherwise undetectable."

The clamp they designed blocked DNA from corn, wheat, sorghum, and barley. With small changes, this method can be used to develop clamps that block DNA from other plant species.

"It's a technique that adds only small change to the type of methods many researchers are already using and reveals the presence of many new and different organisms, so we hope people will be encouraged to try it," added project leader Lindsay Triplett. "We are also very accessible, so we encourage researchers to contact us with any questions about PNA clamps."

Triplett, Taerum, and colleagues are now focusing their studies on the role of protists in the rhizosphere microbiome, with the hope to build upon the rich foundation of research laid by marine, soil, and plant protistologists around the world.

There is growing evidence that pregnant women who go beyond term, especially first time mothers and their infants, will benefit from induction of labour at 41 weeks, instead of expectant management with subsequent induction of labour at 42 weeks if labour will not start spontaneously. This is clearer now that researchers from Sweden and the Netherlands have appraised results from three previous investigations.

The present study, an individual participant data meta-analysis, is published in the journal PLOS Medicine. Most of the researchers are connected to the University of Gothenburg and the University of Amsterdam.

In Sweden and the Netherlands, the risk of a baby dying before, during or shortly after birth ("perinatal death") is generally very low. The same is true of the risk of harm or injury to the baby in conjunction with the birth. However, these risks -- of perinatal death and morbidity (ill-health, trauma or other injury) alike -- are known to rise somewhat, from a low level, the longer a pregnancy goes on after the 40th week.

The purpose of the meta-analysis was to compare outcomes from induction at 41 and expectant management and if not delivered induction at 42 weeks, by combining individual studies addressing the same question. To date, in some respects, it has been unclear what measures best protect the woman and child.

Three randomized studies of the same question have been published, all since the year 2000: SWEPIS (the SWEdish Post-term Induction Study), covering 2,760 women; a Dutch INDEX study (INDuction or Expectant management) of 1,801 women; and a Turkish study of 600 women.

The Swedish and Dutch studies were able to contribute findings at individual level, and the Turkish study was also included in the aggregate appraisal of perinatal death and the proportion of cesarean deliveries. All the women had reached 41 weeks, were healthy and expecting one baby when they participated in the respective studies.

Of the 4561 women included in the analysis of individual data, 2,281 were assigned for induction at 41 full week. In this group, 80 percent underwent induction. For the others, the delivery started spontaneously.

In the Expectant Management group of 2,280 women, spontaneous delivery start was awaited until 42 weeks when induction was otherwise planned. This has been the routine management practice at most birth centers in Sweden and the Netherlands in uncomplicated pregnancies. In the Expectant Management group, 30 percent of the women needed to be induced, while for the others labor began spontaneously.

In terms of the combination of perinatal death and severe morbidity, 10 (0.4%) were affected in the group induced at 41 weeks and 23 (1.0%) in the 42 week group. The difference between the groups is statistically significant. These results hold for women who deliver for the first time. For women who already gave birth once the number of perinatal deaths and morbidity was too low to demonstrate any effect.

There was no difference in the women's state of health after birth between the groups. The proportions of cesarean sections and of instrumental births, using a ventouse (suction cup) or forceps, were also comparable.

Mårten Alkmark, a doctoral student in obstetrics and gynecology at Sahlgrenska Academy, University of Gothenburg, and senior consultant physician at the University Hospital, is one of the two first authors of the study.

"Being able to combine studies at individual level is a good, robust way of investigating questions where what we're studying is very unusual. It means that we've increased the number of women taking part, thereby also boosting the reliability of the results," Alkmark says.

"Our study shows, in agreement with previous research, that the risks of morbidity and perinatal death are lower when induction is carried out at 41 weeks than when it's done at 42 weeks, while it doesn't increase the risks of impaired health in the mothers."

Esteriek de Miranda, assistant professor of Amsterdam UMC of the University of Amsterdam and one of both last authors: "This reduction in risk was only found for women having their first childbirth, not for women who had given birth already one or more times, earlier induction had no benefit for these women and their babies."

Henrik Hagberg, professor of obstetrics and gynecology at Sahlgrenska Academy at the University of Gothenburg and senior consultant physician at the Sahlgrenska University Hospital, is one of the co-authors.

"If these results are extrapolated to Swedish conditions, where roughly 20,000 women a year are still pregnant at 41 weeks, one might prevent at least 100 cases a year of severe illness or death in the babies when they're induced at 41 weeks' gestation. The other side of the coin is that a lot of inductions then have to be done. To save one child from severe illness or death, statistically, 175 women have to undergo induction at 41 weeks," Hagberg says.

Judit Keulen, doctoral student of Amsterdam UMC and University of Amsterdam and one of both first authors:"Choosing for expectant management means an overall 99% chance of a good perinatal outcome for all women, for multiparous women choosing expectant management, the chance of a good outcome is not different than after induction of labour."

Ulla-Britt Wennerholm, senior clinical physician and associate professor of obstetrics and gynecology at Sahlgrenska Academy at the University of Gothenburg, is one of the two senior authors.

"Pregnant women whose pregnancies last 41 weeks should be informed about the advantages and disadvantages of induction, and those who then want to be induced should be offered this option," Wennerholm says.