Professor's baby-friendly policy earns him admiration

Professor Sydney Engelberg, was unfazed when the child of a mother at his lecture on organizational behavior began to cry. The embarrassed mom tried to leave the class, but instead, the father-of-four and grandfather-of-five scooped the kid up and soothed him in his arms – without missing a beat in the lesson. He allows the mothers that attend his masters’ lectures to bring their children and even breastfeed. No mother should have to choose between a child and an education! cnn

Study Finds Multiple Problems In Fetuses Exposed To Zika Virus

The Zika virus has sparked international alarm largely because of fears that the pathogen is causing microcephaly, a condition in which babies are born with unusually small heads and damaged brains.

But the preliminary results of a study released Friday suggest Zika can also cause other potentially grave complications for fetuses carried by women who get infected while they are pregnant.

"There seems to be a whole spectrum of conditions that are related to this — not only microcephaly," says Karin Nielsen-Saines, a professor of clinical pediatrics at the David Geffen School of Medicine at UCLA who led the study.

The analysis, based on the first 42 women in a larger ongoing study, found that Zika appears to increase the risk for miscarriages, poorly developed placentas, low or no amniotic fluid, severe growth problems, other kinds of brain damage, blindness and deafness, according to a preliminary report published in the New England Journal of Medicine.

The results "make a very strong case for Zika virus being the cause of all these pregnancy outcomes that are not very good," Nielsen-Saines says.

She cautions, however, that the study is still small and needs to be confirmed by following many more women for longer periods of time.

The link between Zika and microcephaly remains largely circumstantial. It's based on the observation that the number of cases of microcephaly appear to have increased in Brazil since the virus became epidemic in that country. Researchers have also found evidence of Zika in the brains of a handful of babies with microcephaly who died shortly after birth.

Concern about a possible link sparked a rush of studies to test the possibility, as well as explore whether the virus is causing other problems.

The new results mark the first from a prospective study, which involves tracking the health of women who are infected with Zika and comparing them to very similar people who are not infected.

"The take-home message is that this is another important addition to the growing evidence that seems to now be quite compelling of the relationship between infection of pregnant women and the development of congenital abnormalities," says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

For the study, Nielsen-Saines and colleagues from Brazil identified 88 women in the Rio de Janeiro area who had symptoms of Zika when they were pregnant. Seventy-two of the women had their Zika infection confirmed by polymerase-chain reaction (PCR) testing, which can identify genetic material from the virus.

Forty-two of those women, as well as 16 women who did not test positive for Zika, underwent ultrasounds to examine their fetuses. The ultrasounds of 12 of the infected women — 29 percent — found abnormalities. None of the Zika-negative women's ultrasounds found any problems.

Five of the fetuses being carried by the Zika-infected women were not growing normally; seven had central nervous system abnormalities; and seven had abnormalities in amniotic fluid volume or blood flow. In some cases, placentas didn't seem to be developing normally.

The problems observed on the ultrasounds are being explored and confirmed as the babies are being born. For example, two of the infants have lesions in their retinas, Nielsen-Saines says, which means they might be blind. And she said that some may be deaf. Two were born extremely small, which means they could experience complications of low birth weight. One baby was born with microcephaly.

And some of the fetuses are not making it to birth. There were two miscarriages early in the pregnancies, and two stillbirths just a few weeks before the babies were due, Nielsen-Saines says.

Other experts say the results are alarming, given the scope of the Zika outbreak.

"Millions are being affected as the epidemic has spread throughout the Americas," says Albert Ko, a professor of epidemiology at the Yale School of Public Health, who is studying Zika in Brazil. So, yes, I think this is very disturbing." npr

Where The Girls Are (And Aren't)

Consider the girls who were never born.

On average, about 105 boys are born worldwide for every 100 girls. Girls tend to make up for this difference over time because of their greater resilience and resistance to disease.

But if you look at the two biggest countries in the top seven, you'll find a very different picture.

Based on 2010 numbers from the United Nations Population Fund, China is "missing" about 24 million girls between the ages of 0 and 19. That's over 14 percent of the female population in that age range.

Since the late 1970s, China has had a one child per family policy. Many families want that child to be a son. The increasing availability of prenatal ultrasounds and blood tests for gender makes it possible for parents to abort a female fetus if they want. The uneven ratio of boys to girls born in China suggests this is happening.

A similar dynamic is at play in India, and preliminary data suggest that as access to prenatal gender tests increases there, fewer girls are being born.

India's percentage of girls missing at birth is lower than China's at 5.6 percent of the female population between 0 and 19. But because India's population is so large, India is missing 13 million girls out of its under-20-year-old female population.

Adding up the unborn girls, there are currently about 37 million fewer 0- to 19-year-old girls in India and China than the world average ratio would predict. To put that number in perspective, that's about 2 million more than the entire population of Canada.

China and India aren't the only countries that show this trend. They are just the largest.

In India and China, the birth of a son is cause for celebration. The family has gained a future asset: a child who can earn money for his parents and support them when they are old.

That's not the case for girls. "It's more expensive for a family to have girls than boys," says Charles Kenny, a senior fellow at the Center for Global Development. A boy has greater earning potential in these societies because there is a stigma against women working outside the home. And in India, when a daughter gets married, her family usually makes a generous donation of money and gifts to the groom's family.

So a daughter is seen as a drain on the family's resources. There's an Indian saying: Raising a daughter is like "watering someone else's garden." In other words, the benefits of raising a daughter will be reaped by the family the daughter marries into, not her own family.

Early marriage (often forced) along with early pregnancies are two of the biggest barriers to girls getting more education. Almost 30 percent of girls in India are married before they turn 19, and marriage often means that the girl leaves school to live with her husband or because she becomes pregnant.  npr

Fetal Cells May Protect Mom From Disease Long After The Baby's Born

Back in the late 19th century, a German scientist named Georg Schmorl made a remarkable discovery: Cells from a baby can hide out in a mother's body, after birth.

More than a hundred years later, scientists are just beginning to figure out what these cells are doing. And their findings may have implications for how cancer and autoimmune diseases affect women.

But the discovery also means something else. Something that's a bit mind-boggling: You likely have cells from your older siblings in your body. And cells from your grandmother, maybe even your great-grandmother.

Here's how.

Pregnancy has every element of an alien invasion, says Dr. Hilary Gammill, a fetal medicine expert at the University of Washington in Seattle.

The fetus has different genes than the mom. So in a sense, she's a foreigner inside the mom's body. And the placenta literally invades the mother's body, Gammill says.

As the placenta grows, it reaches out and grabs onto the mom's arteries to control blood flow. "The human placenta is one of the most invasive placentas," compared to those in other animals, Gammill says.

This ensures the fetus has nutrients. But in the process the baby ends up giving the mother a gift. "There's a very large amount of fetal material that is sloughed off into the mother's circulation," says Dr. J. Lee Nelson, also at the University of Washington. "This material is widely circulating in the mom's body."

Nelson has been studying this rogue fetal material for more than 20 years. It contains DNA from the fetus, tiny pieces of the placenta and potent fetal cells. They travel around the mom's bloodstream and sneak into her organs.

"They can go to the liver and become liver cells, or go into the heart and become muscle cells," Nelson says. Fetal cells can even cross the blood-brain barrier and turn into neurons.

When scientists first started studying fetal cells in mothers, the cells got a bad reputation. They have been linked to preeclampsia and autoimmune diseases, such as scleroderma.

But, as time went on, more studies began to suggest that in some situations fetal cells can be beneficial to moms, Nelson says. "I think you've got to think of these cells as friends," she says.

Scientists have found fetal cells in scar tissues, specifically scars left by C-sections. These cells make collagen. So the fetus could be helping the mom recover after birth by repairing wounds.

Fetal cells also are linked to an overall reduced risk of rheumatoid arthritis and are thought to protect against breast cancer.

One hypothesis is that fetal cells may act like little sentinels, watching out for breast cancer cells and killing them. "We haven't caught them in the act yet to say for sure that's what they are doing," Gammill says. But some studies suggest this could be the case.

For autoimmune diseases, the baby's genes likely determine whether the fetal cells are friends or foes, Nelson says. Specifically, if a gene involved in immune recognition matches too closely to the mom's genes, the cells could trigger autoimmunity. But otherwise, they may be protective.

"Being an optimist, I think the benefits will outweigh the times when they're problematical," Nelson says. "So it's actually a beautiful cooperation."

And it's not just the mom that gets an extra set of cells.

"We've been talking about a very one-sided story. ... This is a bidirectional process," says Amy Boddy, a postdoctoral fellow at Arizona State University who recently wrote a review on this topic.

"Cells from the mom also cross the placenta and enter the fetal body," Boddy says. And that means you've got your mom's cells inside you.

But it also means you're likely closer to your older brother or sister than you might think.

Since your mom had cells in her body from all her other pregnancies and her mom, that means you likely have cells from your older siblings, and from your grandmother, and maybe even your great-grandmother.

"You can keep going up the family tree pretty far," Boddy says.

So far, scientists haven't actually seen these "grandma cells" in anyone's body. But if they do exist, then it means we are all walking around with a whole family tree inside of us.

'Becoming Nicole' Recounts One Family's Acceptance Of Their Transgender Child

When Wayne and Kelly Maines adopted identical twin boys, Jonas and Wyatt, at birth in 1997, they were thrilled at the idea of having two sons. For a while, it was virtually impossible to tell the boys apart. But as they grew older, one child, Wyatt, started insisting that he was a girl.

"I [was] like, 'Hmm, I've got twins but one's not like the other. They're very different,' " Kelly Maines, the twins' mother, tells Fresh Air's Terry Gross. "I spent a lot of time trying to figure out what was going on: ... Is she gay? Is she transvestite? Is she transgender? I honestly had no experience in understanding what any of that meant."

Over the course of several years, Kelly and Wayne began to accept that one of the twins was transgender. They had Wyatt's name changed to Nicole and began buying her dolls and girls' clothes, which she had been asking for.

Wayne acknowledges that it wasn't always easy. He worried about what the neighbors would think, but those concerns faded when Nicole began being bullied and harassed. "When people start coming after your kid, you get your head right: 'This is my baby. Don't mess with my kids.' That's probably when I turned a corner," he says.

The Maines went on to file a discrimination lawsuit against Nicole's school district, which they won on appeal last year. This year, Nicole and her twin brother, Jonas, graduated from high school and Nicole had gender reassignment surgery.

Together with Pulitzer Prize-winning journalist Amy Ellis Nutt, Wayne and Kelly Maines tell their family's story in the new book, Becoming Nicole. Nutt joins Kelly and Wayne Maines in the studio to discuss the book and how biology affects gender identity.

On Wayne's initial reaction to Nicole insisting she wanted to be a girl
Wayne Maines: I tried to influence it in other ways, you know, you meet Nicole, even at that age, extremely strong personality. If I would say to her, 'You don't want to be a girl,' she'd say, 'Yes I do.' I'm a 40-year-old guy having this debate with this little kid and I'm losing, you know? It was hard. ... You have this vision of what you think the American dream is and your family, and it's not what it is. I've learned more from my two children and Kelly than I ever thought possible. I learned that everybody needs to be who they need to be, and I learned that people, little children, know who they are at that age.

On Kelly taking the lead on accepting Nicole
Kelly Maines: Back then ... the popular way of proceeding was gender neutral, try to keep her gender neutral. But Nicole did not like that at all. It took a while. I think it was about when she was 7 ... we had a birthday party for her and Jonas and we gave her all the boys toys ... and she was very unhappy and I looked at Wayne and I said, 'That's it. I'm not doing this anymore. It's not working. She's angry. She's doubting herself. This is not healthy. She has to have a safe place here.' So we took the toys back and we got her some mermaid things, and she was very, very happy with that and about then that's when I was like, 'This is crazy. I just gotta do what's gonna make this kid the best person she can be.' ...

I would be in those aisles in Target with girl's clothes like, "I wish I could get this for her, for Wyatt. I know Wyatt would love this. I can't. I can't." Or sometimes I would [buy the girl's clothes] and it would be like, "These are your home clothes. These are your school clothes." It just got so much better when we finally said, "Enough. You can like it or leave it: This kid is who they are."

For a parent, too, when you do finally make that turn, the biggest fears are she's gonna get hurt. Somebody's not gonna like it. And when we ended up having our problems the anger [of others toward Nicole] was the thing that was so shocking.

On the DSM [Diagnostic and Statistical Manual of Mental Disorders]changing gender identity disorder to gender identity dysphoria in 2013,and the significance of that change
Nutt: I think the most important thing is that it changes the view of gender identity, or of an anomalous gender identity, as being somehow abnormal. It's not a disorder. The problem for kids, for transgender people, isn't within, it's without. In other words, their trouble with their gender identity comes essentially because others view them one way when they view themselves another. Nicole, for instance, even as Wyatt, always described herself as a "boy-girl," or a "girl-boy." She was completely confident in who she was. She knew that she was a girl, but she also knew that people referred to her as a boy and that she had a boy anatomy. So this was a child who was never unsure of who she was, but she knew there was a problem with how other people and the rest of the world viewed her. And that's where the dysphoria comes in — when there's a mismatch between what we expect and what, perhaps, the sexual anatomy says, and what the brain is telling us.

On how gender anatomy, sexuality and identity are set prenatally
Nutt: In the first six weeks our gender anatomy, our sexual anatomy, is set. Essentially we all begin in life asexual and then certain genes and hormones kick in, and our sexual anatomy is determined to either have male genitalia and male reproductive organs, or female. However, scientists are learning that while that happens at six weeks, it's not until six months that the brain masculinizes or feminizes. That is, that the hormones in the brain determine is this the brain of a girl or is this the brain of a boy? Sexual orientation, they're also discovering, is a third process, but what they're really focusing on is trying to understand that they're not all congruent.

Normally, prenatally we develop along the same lines, that our sexual anatomy matches up with our gender identity, but what they've discovered is that there's a space in-between. There are weeks in-between in pre-natal development when many things can happen. We know that many things can influence the environment of the womb and the environment of the womb influences the level of hormones and the chemicals that go into the development of a fetus. And so there are many things that can happen between the time that a fetus' sexual identity is set and their gender identity is set.

On how gender identity is in the brain
Nutt: Identical twins obviously have the exact same DNA. What they don't have is the exact same epigenome, which means not all of the genetic switches are turned off and on in identical ways. ... The explanation for that, scientists give, is that in the womb identical twins have separate amniotic sac[s] and umbilical cord[s] and therefore they get various and different amounts of hormones and nourishment. And they've discovered that even your placement in the womb — where you are located in the womb — for identical twins can affect the ratio of hormones and nutrients that you get, and, therefore, it is a different environment. The environment affects who we are, our gender identity, and the environment of the womb, even the top of the womb, the lower part of the womb, can affect how the brain is set, even in identical twins.

On the fluidity of gender
Nutt: Gender isn't something that's necessarily fixed, that it's dynamic, that it's fluid. ... There are very few people that are 100 percent totally masculine or 100 percent totally feminine. We have traits of both, and so, ordinarily, it's something in between. I think, people are feeling more comfortable now saying, "Yeah, I've never felt 100 percent masculine, but I'm mostly masculine." And, I think, it has become a more comfortable society to say that in. But I think it's also because the science is now supporting that. npr

Why Paid Family Leave Has Become A Major Campaign Issue

Lance Mercier knows his job gets harder when a co-worker goes out on leave. But he recently also learned that raising a newborn involves, as he puts it, an "insurmountable" amount of work.
The 39-year-old bank manager from Silver Spring, Md., is currently on leave from work taking care of his newborn son with his wife, Luz.
"As a manager who has had a lot of people go out on leave of absence, it absolutely sucks when they go out on leave," he said. "This puts everything back into perspective for me."
In fact, he will likely end up taking more time off from work than his wife will. Lance's job provides full pay for three months. Luz, meanwhile, gets eight weeks off at 60 percent pay. She can take extra eight weeks of unpaid leave if she wants.
Lance has a new appreciation for family leave, and he's not the only one. For the first time, paid leave has a prominent place in a presidential election. In this week's Democratic presidential debate, for example, Hillary Clinton took a swipe at California Republican Carly Fiorina's opposition to paid family leave.
"California has had a paid-leave program for a number of years," Clinton said, adding, "and it has not had the ill effects that the Republicans are always saying it will have. We can design a system and pay for it that does not put the burden on small business."
NPR has tackled the question of why the U.S. stands virtually alone in not mandating paid family leave, but here's another perplexing one — why now? New parents have needed leave for, well, for as long as there have been working parents. And it's true that workers did get unpaid leave in the 1990s. But what happened in the last few years to nudge paid family leave onto the national political stage?

Here is a list of factors that brought the policy into the spotlight:

1. Moms are working (and earning) more

No, paid leave isn't purely a women's issue, but it is true that with more moms working (not to mention the rise of single parenting, usually by moms), families need someone to mind the kids. Two-thirds of children live in homes where all parents work, as the White House reported last year, up from 40 percent in 1970.
Women are also one-third more likely to take leave from work than men are, according to the Labor Department, and the gap is greater for women taking time off to care for family members. Indeed, moms are far more often the caregivers to sick children than dads are.
Moreover, it's an issue that spans all sorts of divides — race, education and class, for example. The conversation surrounding women and work may have been loud among the white-collar set (think Sheryl Sandberg and Ann-Marie Slaughter), but the women with the least access to paid leave of any kind are, in fact, the least-educated and lowest-paid women.
Finally, women are increasingly better-educated than men — we just learned recently that for the first time, more American women have bachelor's degrees than men. As women's economic potential catches up to men's, it makes sense that they'd also push for a policy that allows them to hold onto that power.

2. Women vote
Not only do women use paid leave; they also turn out to vote in greater numbers than men — a gap that has only widened over the years, according to data compiled by Rutgers University.
It's only a 4-percentage-point gap, but it has grown considerably, and in presidential elections, small shifts in voter participation can make a huge difference.
Once again, paid leave isn't purely a women's issue (see No. 3 below for proof), but it is still something women take more advantage of than men, thanks to both access and cultural values. Women are twice as likely as men to get paid leave, according to one Labor Department study. And to the extent that that drives their votes, it could drive women to candidates that support paid leave policies.

3. Men

Quite simply, it appears that men have been changing how they feel about work-life issues. Men are increasingly minding the kids — the number of stay-at-home dads is on the rise, as is the amount of time men are spending with the kids.One 2014 study showed that Millennial men are less traditional in their views than their older counterparts (and those older men's views have also shifted substantially), overwhelmingly rejecting the notion that it's the woman's job to stay home with the kids, while the man goes to work.
"As the conversation becomes less gendered, the number of people interested in this issue increases," said Linda Hauser, a professor at Widener University, who has studied the economic effect of paid leave. And she adds it's not just about having kids. "It's also becoming care-giving neutral, as well. The care-giving support needs of aging adults are also becoming more prominent."
You could look at this cynically — more men wanted paid leave, so we started talking about it. And you wouldn't be entirely wrong. Men are, after all, still overwhelmingly the ones running the country.
But when you consider how many men are now supporting their families alongside wives with equal (or higher) earning potential — and working alongside an increasingly better-educated female workforce — it makes sense that men would start wanting to help women stay on an upward career (and earnings) trajectory.

4. The president talked about it. A lot

Think back to 2008, when paid leave just wasn't a big issue on the presidential campaign trail. Fast forward to today — President Obama hosts summits on working families, brought paid family leave into the State of the Union for the first time and mandated it for federal workers.
And when the leader of the country drags an issue into the spotlight, that makes it fair game.

"Support from Obama is important in this most recent wave," said Ruth Milkman, professor of sociology at The Graduate Center at City University of New York. "He's not in a position to do anything at the federal level, but I think using the bully pulpit of the presidency has helped."

But then, what nudged Obama to finally make this a policy priority? His second-term "bucket list" might be one answer. You could also argue it was people like Sandberg and Slaughter and other activists for paid leave expanding the conversation around work-life balance. Or the three states (New Jersey, California and Washington) that have passed paid-leave laws.
To be clear, President Obama wasn't — by a long shot — the first politician to push paid family leave. But raising its profile almost certainly made more room for other politicians to talk about it as well.

5. People like it (conditionally)
Of course, it doesn't hurt that family-friendly policies like paid leave are popular. A recent poll from pro-leave group Make it Work found that 81 percent of likely 2016 voters thought policies like paid sick and family leave are a good idea.
But then there's a catch: people like paid leave, but it's not at the very top of their priority lists.
"I think when you talk about some of these policies that we think can really provide some relief for working families ... generally, people think about these policies, and they make sense," as Democratic strategist Karen Hicks told NPR's Tamara Keith last week. "But I think people tend to have a narrow view of it. And so if everything's going OK for them right now, this is not a top-of-the-list kind of priority."
And that brings us back to Lance Mercier. Paid leave just wasn't something he thought much about — until he had a kid to take care of.
"My mindset was different," he said of when he was in his 20s. "It was all about work, work, work, work," he said. "But now, as soon as that baby comes out, your life changes. I know you've heard that time and time again, but everything changes."

 npr

So It Turns Out There's A Lot We Don't Know About Ebola

"If there's anything that this outbreak has taught me, it's that I'm often wrong," says Dr. Daniel Bausch.

He's talking about Ebola. He's one of the world's leading experts on the virus — an infectious disease specialist at Tulane University and a senior consultant to the World Health Organization.

And as he makes clear, he's still got a lot to learn.

The virus came roaring back into headlines this past week. A Scottish nurse who survived Ebola is back in isolation in London, being "treated for Ebola," according to the Royal Free Hospital. The hospital says the patient's "condition has deteriorated and she is now critically ill."

And two new research papers found that the virus can live in a male survivor's semen for up to nine months, and that one man passed it to his sexual partner months after he was released from the Ebola ward.

"If you look back at the classic teaching about Ebola and survivors, it was that once you get better from this disease, even though it may take a while to recover, you made a full recovery and that kind of was the end of it," says Bausch.

And now, with an estimated 17,000 survivors, researchers are discovering all kinds of twists and turns. The semen study is particularly puzzling to Ilhem Messaoudi.

"It's an explosive virus. It replicates like crazy ... and it destroys everything in its path," says Messaoudi, a viral immunologist and professor of biomedical sciences at the University of California, Riverside, who is studying how the virus works in the human body. "So, how is it just hanging out in the testes for like nine months?"

There hasn't been much research — in animals or humans — about what happens after survival. What we do know is mostly from past outbreaks of the virus, in particular, two studies looking at past survivors of the disease and comparing their health to Ebola-free friends and family.

Research on 19 survivors of a 1995 outbreak in Kikwit in the Democratic Republic of the Congo found that most had joint pain and vision problems after the virus. One lost sight. Studies from the 1970s and 1980s had, like recent research, found the virus persisting in the semen and eyes of survivors.

Researchers following 49 survivors of a 2007 Ebola outbreak in Uganda found that— even two years after the illness — they had eye problems like inflammation and blurred vision as well as joint pain, difficulty sleeping, difficulty swallowing and even hearing loss, memory loss and confusion.

Dr. Ian Crozier survived Ebola, only to have his normally blue left eye turn green because of inflammation. Though the rest of his body was Ebola-free, his eye was teeming with the virus.

A third study examining 105 survivors of the 2014-15 outbreak in Guinea found that about 90 percent had chronic joint pain and 98 percent had poor appetites or an aversion to food. They also reported difficulty with short-term memory, headaches, sleeplessness, insomnia, dizziness, abdominal pain, constipation, sexual dysfunction, and decreased libido and exercise tolerance.

Bausch says, aside from arthritis and eye inflammation, it's still unclear which issues are directly related to the Ebola virus and which could be caused by the physical and emotional toll on the body. But something is going on.

"It's clear that there is a post-Ebola syndrome," he says.

Individual cases have opened a window into where the virus goes, and what it's capable of — even after a survivor's body has eliminated it from the bloodstream.

One well-reported example is Dr. Ian Crozier, who survived Ebola contracted in Sierra Leone, only to have one of his normally blue eyes turn green. Though the rest of his body, including his tears, was Ebola-free, his eye was teeming with the virus. The infection almost blinded him.

In a few other cases, Ebola hid out in the uterus. Most women who were pregnant when they got the virus miscarried. But, Bausch says, "a few women have survived with pregnancies intact." When they went into labor, the babies were stillborn and often anatomically abnormal. For months, the recovered mothers had carried babies stricken with Ebola.

How could healthy survivors who tested negative for Ebola still harbor the virus? As Messaoudi explains, it's because the immune system, which is capable of wiping out the virus in the bloodstream, doesn't reach every nook and cranny of the body.

"The immune system is a little heavy-handed at times," she says. Inflammation caused by the immune system's activity could cause serious damage in places like the eyes, brain, placenta, fetus, testes, joint spaces and central nervous system. Messaoudi likens members of the immune system to the Navy SEALs. "They are trained killers," she says, "so if you drop them in the wrong place and they misread their orders, it could lead to really big damage."

So, for the most part, the immune system stays away from those sites, making them great spots for viruses to hide out. (That's what other viruses do, like hepatitis B, and herpes viruses, including chicken pox, which hides in neurons for years and has the potential to re-emerge as shingles.)

But those viruses are different from Ebola, says Messaoudi. "Acute viruses like influenza, Ebola, yellow fever, West Nile [virus] — they infect, they replicate, and they're cleared. That's just how we've always thought of them. I've never heard of a yellow fever reservoir or a West Nile reservoir. Maybe they exist, and we just don't know about it."

Messaoudi says one of the most confusing things about the Ebola virus is its size. It's a "no-frills virus" with a tiny genome, she says. Viruses that can hide in immune-privileged places and live for years usually have a lot more genes that allow them to quietly survive.

But Ebola is managing to scrape by in some corners of survivors' bodies, and those places are, by nature, hard to get to. "It presents a huge challenge, because how do we get enough antivirals into these sites?" says Messaoudi. Getting to fluid in the spine requires a spinal tap. Patients with the virus inside their eye might need a fine needle to go straight into the space between the iris and the cornea. "So how do we eradicate those reservoirs?" she asks. "And why do some people end up developing these reservoirs and other people don't?"

Bausch says these questions are important scientifically but not necessarily in terms of disease control. For example, there's a small possibility that the arthritis that so many survivors report is from the virus itself, sitting inside joint spaces. But that would not pose a public health risk.

"Because how do you get infected from someone's joint space? You don't," he says.

But there are some potentially worrisome sites where the virus holds on, like in semen.

As data on survivors trickles in, Bausch says, "There is a sense across WHO and U.N. systems that we need to have renewed efforts in terms of not only caring for survivors but recognizing that there are still transmission issues that may relate to survivors. And that's a tough thing for people to take on, both in terms of the logistics, but also just emotionally."

"The whole thought over the course of this outbreak and previous Ebola outbreaks is: You get down to zero cases, and then you count 42 days, and then you say it's over," he says.

Cases where Ebola lingers in the semen, eyes or even uterus of survivors push the outbreak's finish line farther away.

"We've always known that it wasn't completely over," says Bausch. There's always the possibility that whatever first seeded this outbreak, likely a fruit bat, is still out there. "So, we've always known that there was the potential for reintroduction from the wild. But I think more recently and with these data coming in, we're understanding that there's also this potential for reintroduction from persistent virus production in humans, most notably from sexual transmission" — even though experts still think sexual transmission is rare.

Meanwhile, he says all the evidence points to survivors clearing their systems of Ebola virus over time. But, says Bausch, it's probably not the day that they walk out of the Ebola treatment unit.

To see just how long the virus might linger, the U.S. National Institute of Allergy and Infectious Diseases and the Ministry of Health of Liberia have launched a five-year project to follow 1,500 survivors of the latest outbreak along with 6,000 of their close contacts. They'll monitor health issues, organ and eye function, and possibly bodily fluid content. It will be the largest controlled study of Ebola survivors to date. npr

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Microbe Mix May Play Role In Preterm Birth Risk

The assortment of microbes in a pregnant woman's vagina appears to play a role in her chances of giving birth prematurely, new research suggests.

The study of 49 pregnant women, published in this week's Proceedings of the National Academy of Sciences, found that those who had a diverse array of microbes were more likely to give birth prematurely.

Though the study is small, the findings are the latest in a flood of new insights into the roles that microbes may play in human health.

In the latest study, David Relman, a professor of medicine, microbiology and immunology at Stanford University and his colleagues, took samples from 49 women weekly during their pregnancies and monthly after they had their babies.

Fifteen of the women ended up giving birth prematurely. Most of the women had microbes dominated by lactobacillus bacteria, which has previously been associated with better health. Those whose microbes were more diverse — having high levels of gardnerella and ureaplasma microbes and low levels of lactobacillus — were at increased risk for giving birth more than three weeks early, the researchers found.

In addition, all the women's microbes tended to change significantly after they had their babies, becoming significantly more diverse. That shift could help explain why women who have babies close together are more likely to have the subsequent baby prematurely, the researchers said.

Babies born prematurely are at increased risk for a host of health problems. While the findings need to be confirmed in a bigger study, the researchers say the findings may eventually help doctors identify women at risk for giving birth prematurely and find ways to prevent that from happening. For example, researchers may be able to find probiotics women could take to reduce their risk for premature births. npr

First penile transplant recipient 'to become father'

His girlfriend has reported that she is about four months pregnant, and this showed that the "transplant worked", said Andre van der Merwe.

The 21-year-old recipient, whose identify is being protected, lost his penis in a botched circumcision.

The operation took place in December.

Surgeons at Stellenbosch University and Tygerberg Hospital performed a nine-hour operation to attach a donated penis.

Dr Van der Merwe said he was "very pleased" when he heard that the man's girlfriend was pregnant, and had not asked for a paternity test as there was no reason not to believe the couple.

Further transplants

"This is what we intended, that he should be able to stand up and be able to urinate and have intercourse, so it is a milestone for him," Dr Van der Merwe told the BBC.

He had not expected the man to be infertile, as he had an issue with his penis, not his testicles, the surgeon added.

Dr Van der Merwe said the surgical team is yet to review the success of the operation, and may then carry out further transplants.

The boy had been left with just 1cm of his original penis as a result of the botched circumcision. He was 18 and sexually active at the time.

When attaching the donated penis, the surgical team used some of the techniques that had been developed to perform the first face transplants in order to connect the tiny blood vessels and nerves.

There have been attempts at penis transplants before, including one in China.

Accounts suggested the operation went well, but the penis was later rejected.

Doctors say South Africa has some of the greatest need for penis transplants in the world.

Dozens, some say hundreds, of boys are maimed or die each year during traditional initiation ceremonies. bbc