Effects of classroom cleaning on student health: a longitudinal study.

BACKGROUND: School districts across the world have been grappling with how to keep their schools open, students healthy, and prevent the spread of viruses in their communities. OBJECTIVE: The aims of this study included assessing both (1) the effectiveness of enhanced classroom cleaning and disinfecting protocol on surface biocontamination and (2) the associations between surface biocontamination and student absence due to illnesses. METHODS: Cleaning effectiveness was assessed using quantitative adenosine triphosphate (ATP) measurements during a 10-week study period in a sample of 34 public schools (15,814 students), of a district located in the Western US. The schools were randomly assigned to 17 intervention schools implementing enhanced cleaning and disinfecting protocol and 17 control schools cleaning as usual. General estimating equations (GEEs) were used for modeling associations between ATP levels and weekly aggregates of student absences due to respiratory and gastrointestinal illnesses, which were recorded by the schools according to district wide protocol. RESULTS: The weekly average ATP levels on logarithmic scale were 5.02 (SD 0.53) and 5.26 (SD 0.48) in the intervention and control schools, respectively, where the difference is statistically significant (p < 0.001). The probability of weekly absence due to gastrointestinal illness was significantly associated with ATP levels (parameter estimate 1.16, 95% CI 1.01-1.34, per unit (log) increase of weekly average ATP), where the model accounts for student level, gender, ethnic group, and socioeconomic status as well as for school level attendance, total absence ratio, and ventilation adequacy in classrooms. Associations were not found between ATP levels and weekly probability of any absence, or absence due to respiratory illness. SIGNIFICANCE: Enhanced cleaning resulted in a significantly lower level of biocontamination on desktops in the intervention group. In addition, a statistically significant association was established between ATP levels on classroom desks and probability of absence due to gastrointestinal illness. IMPACT: We found that enhanced cleaning protocol, including bi-weekly cleaning of classroom desks, as well as training of custodians and teachers, monitoring of effectiveness, and feedback, yielded a moderate but statistically significantly lower level of biocontamination on desktops, indicated by quantitative ATP monitoring. Within the range of weekly average desktop ATP levels observed, the probability of reported absence due to gastrointestinal illness is estimated to increase from 0.021 to 0.026. Based on the results, enhanced surface cleaning and monitoring its effectiveness is a possible district, state, or even national level policy to support healthy school environments.

Aerosol fluorescence, airborne hexosaminidase, and quantitative genomics distinguish reductions in airborne fungal loads following major school renovations.

Fluorescent aerosol cytometry (FAC) was compared to concurrent recovery of airborne ß-N-acetylhexosaminidase (NAHA) and quantitative polymerase chain reaction (qPCR) for the respective ability of these methods to detect significant changes in airborne fungal loads in response to building renovations. Composite, site-randomized indoor aerosol samples for airborne fungi measurements were acquired from more than 70 occupied classrooms in 26 different public schools in the Colorado Rocky Mountain Front Range region of the United States. As judged by ANOVA and Pearson's correlation test, statistically significant associations were observed between real-time FAC and airborne NAHA levels, which detected significant reductions in airborne fungal loads immediately following building rehabilitations. With lower confidence, a statistically significant association was also resolved between fluorescing aerosols, NAHA levels, and the recovery of fungal 18S rRNA gene copies by qPCR from simultaneous, collocated aerosol samples. Quantitative differences encountered between the recovery of common genomic markers for airborne fungi and that of optical and biochemical methods are attributed to the variance in 18S rRNA target gene copies that different fungal species can host.

Combining Electromagnetic and Gravitational-Wave Constraints on Neutron-Star Masses and Radii.

We perform a joint Bayesian inference of neutron-star mass and radius constraints based on GW170817, observations of quiescent low-mass x-ray binaries (QLMXBs), photospheric radius expansion x-ray bursting sources, and x-ray timing observations of J0030+0451. With this dataset, the form of the prior distribution still has an impact on the posterior mass-radius curves and equation of state (EOS), but this impact is smaller than recently obtained when considering QLMXBs alone. We analyze the consistency of the electromagnetic data by including an "intrinsic scattering" contribution to the uncertainties, and find only a slight broadening of the posteriors. This suggests that the gravitational-wave and electromagnetic observations of neutron-star structure are providing a consistent picture of the neutron-star mass-radius curve and the EOS.

Occurrence of respiratory viruses on school desks.

BACKGROUND: Schools represent high occupancy environments and well-documented high-risk locations for the transmission of respiratory viruses. The goal of this study was to report on the area density, occurrence, and type of respiratory viruses on desks in primary school classrooms. METHODS: Quantitative reverse transcription polymerase chain reaction (qPCR) techniques were employed to measure nucleic acid area densities from a broad range of human adenoviruses and rhinoviruses, as well as coronavirus OC43, influenza A, and norovirus GI. Every two weeks, virus monitoring was conducted on the desks of four primary school classrooms in Colorado, USA, during the 2019 respiratory virus season. RESULTS: DNA and RNA from respiratory viruses and norovirus were recovered from more than 20% of the desks sampled; occurrence patterns that indicate a greater than 60% probability of encountering any virus, if more than five desks were occupied in a day. Rhinoviruses and adenoviruses were the most commonly detected viruses as judged by the composite of occurrence and number of gene copies recovered. Desktop adenosine triphosphate monitoring did not predict the recovery of viral genomic materials on desks. School desks can be commonly contaminated with respiratory viruses. CONCLUSIONS: Genomic surveys of the identity, distribution and abundance of human viruses on "high-touch" surfaces, can help inform risk assessments, design cleaning interventions, and may be useful for infection surveillance.

Practitioner-driven research for improving the outcomes of mold inspection and remediation.

This commentary is intended to provide a research roadmap for utilizing recent chemical and molecular-biological technological advances for addressing dampness and mold in buildings. The perspective is unique in that both the mold industry practitioners and academic researchers drive the questions. Research needs were derived from a 2018 international workshop attended by practitioners, researchers and governmental representatives, where challenges and opportunities in the mold remediation and restoration field were discussed focusing on the need to develop new tools that improve building diagnosis and clearance certification for mold inspectors and remediators. Suggestions are made on how new technologies surrounding DNA-based sequence analysis for fungal and bacterial identification and real-time chemical sensor technology can be leveraged by practitioners to improve inspection and remediation. The workshop put into effect a logical progression to distill and extract practice-based implications and encourage the process of transfer of the science to practice. Goals for the workshop, and this subsequent paper, are also centered on encouraging US government-funding agencies to better position and define research on the built environment geared for end-user scientists and practitioners to better explore practical solutions to dampness and mold in indoor environments. By facilitating the workshop forum and targeting industry, field practitioners, and government agencies, a sharing of needed commonalities may be infused into future research agendas and outreach efforts.

DNA Sequence-Based Approach for Classifying the Mold Status of Buildings.

Dampness or water damage in buildings and human exposure to the resultant mold growth is an ever-present public health concern. This study provides quantitative evidence that the airborne fungal ecology of homes with known mold growth ("moldy") differs from the normal airborne fungal ecology of homes with no history of dampness, water damage, or visible mold ("no mold"). Settled dust from indoor air and outdoor air and direct samples from building materials with mold growth were examined in homes from 11 cities across dry, temperate, and continental climate regions within the United States. Community analysis based on the sequence of the internal transcribed spacer region of fungal ribosomal RNA encoding genes demonstrated consistent and quantifiable differences between the fungal ecology of settled dust in homes with inspector-verified water damage and visible mold versus the settled dust of homes with no history of dampness, water damage, or visible mold. These differences include lower community richness (padj = 0.01) in the settled dust of moldy homes versus no mold homes, as well as distinct community taxonomic structures between moldy and no mold homes (ANOSIM, R = 0.15, p = 0.001). We identified 11 Ascomycota taxa that were more highly enriched in moldy homes and 14 taxa from Ascomycota, Basidiomycota, and Zygomycota that were more highly enriched in no mold homes. The indoor air differences between moldy versus no mold homes were significant for all three climate regions considered. These distinct but complex differences between settled dust samples from moldy and no homes were used to train a machine learning-based model to classify the mold status of a home. The model was able to accurately classify 100% of moldy homes and 90% of no mold homes. The integration of DNA-based fungal ecology with advanced computational approaches can be used to accurately classify the presence of mold growth in homes, assist with inspection and remediation decisions, and potentially lead to reduced exposure to hazardous microbes indoors.

Anisotropies in the Astrophysical Gravitational-Wave Background: The Impact of Black Hole Distributions.

We use population inference to explore the impact that uncertainties in the distribution of binary black holes (BBH) have on the astrophysical gravitational-wave background (AGWB). Our results show that the AGWB monopole is sensitive to the nature of the BBH population (particularly the local merger rate), while the anisotropic C_{ℓ} spectrum is only modified to within a few percent, at a level which is insignificant compared to other sources of uncertainty (such as cosmic variance). This is very promising news for future observational studies of the AGWB, as it shows that (i) the monopole can be used as a new probe of the population of compact objects throughout cosmic history, complementary to direct observations by LIGO and Virgo and (ii) we are able to make surprisingly robust predictions for the C_{ℓ} spectrum, even with only very approximate knowledge of the black hole population. As a result, the AGWB anisotropies have enormous potential as a new probe of the large-scale structure of the Universe, and of late-Universe cosmology in general.

Building and indoor environmental quality assessment of Nigerian primary schools: A pilot study.

A total of 15 classrooms went through on-site assessments/inspections, including measurements of temperature (T), and concentrations of carbon monoxide (CO) and carbon dioxide (CO2 ). In addition, the level of surface biocontamination/cleaning effectiveness was assessed by measuring adenosine triphosphate (ATP) levels on students' desks. Based on the data, the quality of facilities in the buildings was low. Classroom occupancy exceeded ASHRAE 50 person/100 m2 standard in all cases indicating overcrowding. However, concentrations of CO2 remained below 1000 ppm in most classrooms. On the other hand, indoor T was above the recommended levels for thermal comfort in all classrooms. Maximum indoor CO was 6 ppm. Median ATP concentrations on the desk tops were moderately high in all schools. The use of open incinerators and power generator sets near classrooms, which was suspected to be the main source of CO, should be discouraged. Improved hygiene could be achieved by providing the students access to functioning bathroom facilities and cafeteria, and by effective cleaning of high contact surfaces such as desks. Although ventilation seems adequate based on CO2 concentrations, thermal comfort was not attained especially in the afternoon during extreme sunlight. Therefore, installing passive and/or mechanical cooling systems should be considered in this regard.

Comparing bacterial, fungal, and human cell concentrations with rapid adenosine triphosphate measurements for indicating microbial surface contamination.

BACKGROUND: The goal of this study was to test for associations between adenosine triphosphate (ATP) content and microbial concentrations on desk surfaces in school classrooms. METHODS: ATP bioluminescence and quantitative polymerase chain reaction (qPCR) techniques were employed to measure total bacterial, fungal, and human cell concentrations on 66 high-traffic desks spread across 9 schools: 3 in Connecticut (CT) and 6 in Oklahoma (OK). In CT, 6 samples were taken from each desk, 1 precleaning and 5 postcleaning (after 30 minutes, 1 day, 3 days, 7 days, and 21 days). In OK, samples were taken immediately before and after cleaning each desk. RESULTS: Based on simple linear regression analyses, ATP values were good predictors of microbial concentrations (r = 0.8, P = .003) in both CT school postcleaning samples and OK pre- and postcleaning samples (r = 0.7, P = .00002). However, biomass reductions measured after cleaning were 1.5-2 times greater when measured by ATP than by qPCR (P = .007). CONCLUSIONS: Overall, ATP bioluminescence measurements correlate with qPCR-based surface measurements on school desks but may overestimate the physical removal of bacteria and fungi due to cleaning.

Natural History of Fetal Lower Urinary Tract Obstruction with Normal Amniotic Fluid Volume at Initial Diagnosis.

OBJECTIVE: The aim of this study was to define the natural history of lower urinary tract obstruction (LUTO) with normal midgestational amniotic fluid volumes. MATERIALS AND METHODS: We performed a retrospective review of 32 consecutive patients with LUTO with normal midgestational amniotic fluid volume followed at 11 North American Fetal Therapy Network (NAFTNet) centers from August 2007 to May 2012. Normal amniotic fluid volume was defined as an amniotic fluid index (AFI) of ≥9 cm. RESULTS: The mean gestational age (GA) and AFI at enrollment were 23.1 ± 2.1 weeks and 15.8 ± 3.9 cm, respectively. The mean GA at delivery was 37.3 ± 2.8 weeks. The mean creatinine level at discharge was 1.2 ± 0.8 mg/dL. Perinatal survival was 97%. Twenty-five patients returned for serial postnatal assessment. Renal replacement therapy (RRT) was required in 32%. Development of oligohydramnios and/or anhydramnios, development of cortical renal cysts, posterior urethral valves, prematurity, and prolonged neonatal intensive care unit stay were associated with need for RRT (p < 0.05) by univariate analysis. By multivariate analysis, preterm delivery remained predictive of need for RRT (p = 0.004). CONCLUSION: Prenatal diagnosis of LUTO with normal midgestational amniotic fluid volumes is associated with acceptable renal function in the majority of patients. Approximately one-third of these children require RRT. Surrogate markers of disease severity appear to be predictive of need for RRT.

Inferences about Supernova Physics from Gravitational-Wave Measurements: GW151226 Spin Misalignment as an Indicator of Strong Black-Hole Natal Kicks.

The inferred parameters of the binary black hole GW151226 are consistent with nonzero spin for the most massive black hole, misaligned from the binary's orbital angular momentum. If the black holes formed through isolated binary evolution from an initially aligned binary star, this misalignment would then arise from a natal kick imparted to the first-born black hole at its birth during stellar collapse. We use simple kinematic arguments to constrain the characteristic magnitude of this kick, and find that a natal kick v_{k}≳50 km/s must be imparted to the black hole at birth to produce misalignments consistent with GW151226. Such large natal kicks exceed those adopted by default in most of the current supernova and binary evolution models.

Circulating Cell-Free DNA to Determine the Fetal RHD Status in All Three Trimesters of Pregnancy.

OBJECTIVE: To estimate the accuracy of a new assay to determine the fetal RHD status using circulating cell-free DNA. METHODS: This was a prospective, observational study. Maternal blood samples were collected in each trimester of pregnancy in 520 nonalloimmunized RhD-negative patients. Plasma samples were analyzed for circulating cell-free DNA using the SensiGENE RHD test, which used primers for exons 4 and 7 as previously described and incorporated a new primer design for exon 5 of the RHD gene. Neonatal serology for RhD typing using cord blood at birth was undertaken and results were stored in a separate clinical database. After unblinding the data, results of the DNA analysis were compared with the neonatal serology. RESULTS: Inconclusive results secondary to the presence of the RHD pseudogene or an RHD variant were noted in 5.6%, 5.7%, and 6.1% of the first-, second-, and third-trimester samples, respectively. The incidence of false-positive rates for RhD (an RhD-negative fetus with an RHD-positive result) was 1.54% (95% confidence interval [CI] 0.42-5.44%), 1.53% (CI 0.42-5.40%), and 0.82% (CI 0.04-4.50%), respectively. There was only one false-negative diagnosis (an RhD-positive fetus with an RHD-negative result), which occurred in the first trimester (0.32%; 95% CI 0.08-1.78%). Genotyping for mismatches across repeated samples revealed that this error was related to mislabeling of samples from two patients collected on the same day at one of the collection sites. Overall test results were in agreement across all three trimesters (P>.99). CONCLUSION: Circulating cell-free DNA can accurately predict the fetal RhD status in all three trimesters of pregnancy.

The first gravitational-wave source from the isolated evolution of two stars in the 40-100 solar mass range.

The merger of two massive (about 30 solar masses) black holes has been detected in gravitational waves. This discovery validates recent predictions that massive binary black holes would constitute the first detection. Previous calculations, however, have not sampled the relevant binary-black-hole progenitors--massive, low-metallicity binary stars--with sufficient accuracy nor included sufficiently realistic physics to enable robust predictions to better than several orders of magnitude. Here we report high-precision numerical simulations of the formation of binary black holes via the evolution of isolated binary stars, providing a framework within which to interpret the first gravitational-wave source, GW150914, and to predict the properties of subsequent binary-black-hole gravitational-wave events. Our models imply that these events form in an environment in which the metallicity is less than ten per cent of solar metallicity, and involve stars with initial masses of 40-100 solar masses that interact through mass transfer and a common-envelope phase. These progenitor stars probably formed either about 2 billion years or, with a smaller probability, 11 billion years after the Big Bang. Most binary black holes form without supernova explosions, and their spins are nearly unchanged since birth, but do not have to be parallel. The classical field formation of binary black holes we propose, with low natal kicks (the velocity of the black hole at birth) and restricted common-envelope evolution, produces approximately 40 times more binary-black-holes mergers than do dynamical formation channels involving globular clusters; our predicted detection rate of these mergers is comparable to that from homogeneous evolution channels. Our calculations predict detections of about 1,000 black-hole mergers per year with total masses of 20-80 solar masses once second-generation ground-based gravitational-wave observatories reach full sensitivity.

North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome.

BACKGROUND: Stage I twin-twin transfusion syndrome presents a management dilemma. Intervention may lead to procedure-related complications while expectant management risks deterioration. Insufficient data exist to inform decision-making. OBJECTIVE: The aim of this retrospective observational study was to describe the natural history of stage I twin-twin transfusion syndrome, to assess for predictors of disease behavior, and to compare pregnancy outcomes after intervention at stage I vs expectant management. STUDY DESIGN: Ten North American Fetal Therapy Network centers submitted well-documented cases of stage I twin-twin transfusion syndrome for analysis. Cases were retrospectively divided into 3 management strategies: those managed expectantly, those who underwent amnioreduction at stage I, and those who underwent laser therapy at stage I. Outcomes were categorized as no survivors, 1 survivor, 2 survivors, or at least 1 survivor to live birth, and good (twin live birth ≥30.0 weeks), mixed (single fetal demise or delivery between 26.0-29.9 weeks), and poor (double fetal demise or delivery <26.0 weeks) pregnancy outcomes. Outcomes were analyzed by initial management strategy. RESULTS: A total of 124 cases of stage I twin-twin transfusion syndrome were studied. In all, 49 (40%) cases were managed expectantly while 30 (24%) underwent amnioreduction and 45 (36%) underwent laser therapy at stage I. The overall fetal mortality rate was 20.2% (50 of 248 fetuses). Of those managed expectantly, 11 patients regressed (22%), 4 remained stage I (8%), 29 advanced in stage (60%), and 5 experienced spontaneous previable preterm birth (10%) during observation. The mean number of days from diagnosis of stage I to a change in status (progression, regression, loss, or delivery) was 11.1 (SD 14.3) days. Intervention by amniocentesis or laser therapy was associated with a lower risk of fetal loss (P = .01) than expectant management. The unadjusted odds of poor outcome were 0.33 (95% confidence interval, 0.09-01.20), for amnioreduction and 0.26 (95% confidence interval, 0.09-0.77) for laser therapy vs expectant management. Adjusting for nulliparity, recipient maximum vertical pocket, gestational age at diagnosis, and placenta location had negligible effect. Both amnioreduction and laser therapy at stage I decreased the likelihood of no survivors (odds ratio, 0.11; 95% confidence interval, 0.02-0.68 and odds ratio, 0.07; 95% confidence interval, 0.01-0.37, respectively). Only laser therapy, however, was protective against poor outcome in our data (odds ratio, 0.29; 95% confidence interval, 0.07-1.30 for amnioreduction vs odds ratio, 0.12, 95% confidence interval, 0.03-0.44 for laser), although the estimate for amnioreduction suggests a protective effect. CONCLUSION: Stage I twin-twin transfusion syndrome was associated with substantial fetal mortality. Spontaneous resolution was observed, although the majority of expectantly managed cases progressed. Progression was associated with a worse prognosis. Both amnioreduction and laser therapy decreased the chance of no survivors, and laser was particularly protective against poor outcome independent of multiple factors. Further studies are justified to corroborate these findings and to further define risk stratification and surveillance strategies for stage I disease.

Modeling Associations between Principals' Reported Indoor Environmental Quality and Students' Self-Reported Respiratory Health Outcomes Using GLMM and ZIP Models.

BACKGROUND: The aim of this paper was to examine associations between school building characteristics, indoor environmental quality (IEQ), and health responses using questionnaire data from both school principals and students. METHODS: From 334 randomly sampled schools, 4248 sixth grade students from 297 schools participated in a questionnaire. From these schools, 134 principals returned questionnaires concerning 51 IEQ related questions of their school. Generalized linear mixed models (GLMM) were used to study the associations between IEQ indicators and existence of self-reported upper respiratory symptoms, while hierarchical Zero Inflated Poisson (ZIP)-models were used to model the number of symptoms. RESULTS: Significant associations were established between existence of upper respiratory symptoms and unsatisfactory classroom temperature during the heating season (ORs 1.45 for too hot and cold, and 1.27 for too cold as compared to satisfactory temperature) and dampness or moisture damage during the year 2006-2007 (OR: 1.80 as compared to no moisture damage), respectively. The number of upper respiratory symptoms was significantly associated with inadequate ventilation and dampness or moisture damage. A higher number of missed school days due to respiratory infections were reported in schools with inadequate ventilation (RR: 1.16). CONCLUSIONS: The school level IEQ indicator variables described in this paper could explain a relatively large part of the school level variation observed in the self-reported upper respiratory symptoms and missed school days due to respiratory infections among students.

Hemolytic Disease of the Fetus and Newborn due to Intravenous Drug Use.

Objectives The objective is to present a pregnancy complication associated with intravenous drug use, namely, that of red blood cell alloimmunization and hemolytic disease of the fetus and newborn. Methods An observational case series is presented including women with red blood cell alloimmunization most likely secondary to intravenous drug abuse Results Five pregnancies were identified that were complicated by red blood cell alloimmunization and significant hemolytic disease of the fetus and newborn, necessitating intrauterine transfusion, an indicated preterm birth, or neonatal therapy. Conclusions As opioid abuse continues to increase in the United States, clinicians should be aware of the potential for alloimmunization to red blood cell antibodies as yet another negative outcome from intravenous drug abuse.

Effects of antepartum therapy for fetal alloimmune thrombocytopenia on maternal lifestyle.

OBJECTIVE: The objective of this study is to describe the effects of antepartum therapy for fetal alloimmune thrombocytopenia (FAIT) on lifestyle. With the goal of preventing intraventricular hemorrhage in all fetuses without cordocentesis to measure fetal platelets, empiric treatment with intravenous immune globulin (IVIG), with or without prednisone, is recommended. It is hypothesized that these treatments negatively affect women's lifestyle. This information is needed for pre-conceptual counseling and developing management strategies. METHODS: A survey was mailed to 62 women treated by one provider from 2005 to 2013 asking if they experienced side effects from IVIG and prednisone, if their lives were negatively affected, if they would plan another affected pregnancy and if they needed help managing side effects. RESULTS: Three-quarters of 32 respondents reported that the treatments negatively affected their lifestyle. Thirty-one percent of women would not plan another pregnancy due to their experience and 22% were uncertain. All women experienced adverse effects and required additional medications or healthcare resources. Ninety-four percent contacted healthcare providers for help managing side effects. CONCLUSION: The significant negative effects on the lifestyle of women treated for FAIT emphasizes the need to identify the lowest effective doses and duration of pharmacotherapy and develop management strategies. Women undergoing treatment may need additional healthcare resources, including coordination of care.

Precessional Instability in Binary Black Holes with Aligned Spins.

Binary black holes on quasicircular orbits with spins aligned with their orbital angular momentum have been test beds for analytic and numerical relativity for decades, not least because symmetry ensures that such configurations are equilibrium solutions to the spin-precession equations. In this work, we show that these solutions can be unstable when the spin of the higher-mass black hole is aligned with the orbital angular momentum and the spin of the lower-mass black hole is antialigned. Spins in these configurations are unstable to precession to large misalignment when the binary separation r is between the values r(ud±)=(√(χ(1))±âˆš(qχ(2)))(4)(1-q)(-2)M, where M is the total mass, q≡m(2)/m(1) is the mass ratio, and χ(1) (χ(2)) is the dimensionless spin of the more (less) massive black hole. This instability exists for a wide range of spin magnitudes and mass ratios and can occur in the strong-field regime near the merger. We describe the origin and nature of the instability using recently developed analytical techniques to characterize fully generic spin precession. This instability provides a channel to circumvent astrophysical spin alignment at large binary separations, allowing significant spin precession prior to merger affecting both gravitational-wave and electromagnetic signatures of stellar-mass and supermassive binary black holes.

Effects of Classroom Ventilation Rate and Temperature on Students' Test Scores.

Using a multilevel approach, we estimated the effects of classroom ventilation rate and temperature on academic achievement. The analysis is based on measurement data from a 70 elementary school district (140 fifth grade classrooms) from Southwestern United States, and student level data (N = 3109) on socioeconomic variables and standardized test scores. There was a statistically significant association between ventilation rates and mathematics scores, and it was stronger when the six classrooms with high ventilation rates that were indicated as outliers were filtered (> 7.1 l/s per person). The association remained significant when prior year test scores were included in the model, resulting in less unexplained variability. Students' mean mathematics scores (average 2286 points) were increased by up to eleven points (0.5%) per each liter per second per person increase in ventilation rate within the range of 0.9-7.1 l/s per person (estimated effect size 74 points). There was an additional increase of 12-13 points per each 1°C decrease in temperature within the observed range of 20-25°C (estimated effect size 67 points). Effects of similar magnitude but higher variability were observed for reading and science scores. In conclusion, maintaining adequate ventilation and thermal comfort in classrooms could significantly improve academic achievement of students.