More than the sum of its parts: uncovering emerging effects of microbial interactions in complex communities.

Microbial communities are not only shaped by the diversity of microorganisms and their individual metabolic potential, but also by the vast amount of intra- and interspecies interactions that can occur pairwise interactions among microorganisms, we suggest that more attention should be drawn towards the effects on the entire microbiome that emerge from individual interactions between community members. The production of certain metabolites that can be tied to a specific microbe-microbe interaction might subsequently influence the physicochemical parameters of the habitat, stimulate a change in the trophic network of the community or create new micro-habitats through the formation of biofilms, similar to the production of antimicrobial substances which might negatively affect only one microorganism but cause a ripple effect on the abundance of other community members. Here, we argue that combining established as well as innovative laboratory and computational methods is needed to predict novel interactions and assess their secondary effects. Such efforts will enable future microbiome studies to expand our knowledge on the dynamics of complex microbial communities.

Analysis of Adverse Effects of COVID-19 Vaccines in Spain following Booster Dose.

The present study evaluates the adverse effects of three vaccines: AstraZeneca (Vaxzevria), Pfizer/BioNTech (Comirnaty) and Moderna (Spikevax) according to the dose. From 733 participants collected, the vaccine schedule was as follows: 330 (45%) received a double dose of the AstraZeneca vaccine, 382 (52.1%) received a double dose of Pfizer, 18 (2.5%) received a heterologous prime boost and 3 (0.4%) received a single dose. Pfizer and Moderna vaccines were administered as a third dose in 70 and 121 individuals, respectively. Local and systemic reactions observed in the three vaccines were mild to moderate in severity. Only one AstraZeneca recipient (0.3%) presented a serious adverse effect: blurred vision. Adverse events were more frequent after the first dose of AstraZeneca and after the second dose of Pfizer. As the third dose, Moderna causes more adverse effects than Pfizer regardless of the type of vaccine previously administered, whereas the reactogenicity of a third dose of Pfizer is slightly higher in the group previously vaccinated with Pfizer than in that group with AstraZeneca. In short, secondary effects of the third dose of COVID-19 vaccines were similar to those after dose 2, but their frequency depends on the type of vaccine and the combinations of vaccines.

Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England.

Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the "primary effects" of AMR. Previous estimates of the burden of AMR have largely ignored the potential "secondary effects," such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.

A questionnaire to collect unintended effects of transcranial magnetic stimulation: A consensus based approach.

Transcranial magnetic stimulation (TMS) has been widely used in both clinical and research practice. However, TMS might induce unintended sensations and undesired effects as well as serious adverse effects. To date, no shared forms are available to report such unintended effects. This study aimed at developing a questionnaire enabling reporting of TMS unintended effects. A Delphi procedure was applied which allowed consensus among TMS experts. A steering committee nominated a number of experts to be involved in the Delphi procedure. Three rounds were conducted before reaching a consensus. Afterwards, the questionnaire was publicized on the International Federation of Clinical Neurophysiology website to collect further suggestions by the wider scientific community. A last Delphi round was then conducted to obtain consensus on the suggestions collected during the publicization and integrate them in the questionnaire. The procedure resulted in a questionnaire, that is the TMSens_Q, applicable in clinical and research settings. Routine use of the structured TMS questionnaire and standard reporting of unintended TMS effects will help to monitor the safety of TMS, particularly when applying new protocols. It will also improve the quality of data collection as well as the interpretation of experimental findings.

Products released from surgical face masks can provoke cytotoxicity in the marine diatom Phaeodactylum tricornutum.

Surgical face masks are more present than ever as personal protective equipment due to the COVID-19 pandemic. In this work, we show that the contents of regular surgical masks: i) polypropylene microfibres and ii) some added metals such as: Al, Fe, Cu, Mn, Zn and Ba, may be toxic to some marine life. This work has got two objectives: i) to study the release rate of the products from face masks in marine water and ii) to assess the toxicity in Phaeodactylum tricornutum of these by-products. To achieve these two objectives, we performed release kinetic experiments by adding masks in different stages of fragmentation to marine water (i.e. whole face masks and fragments of them 1.52 ± 0.86 mm). Released microfibres were found after one month in shaking marine water; 0.33 ± 0.24 and 21.13 ± 13.19 fibres·mL-1 were collected from the whole and fragmented face masks, respectively. Significant amounts of dissolved metals such as Mn, Zn and Ni, as well as functional groups only in the water containing the face mask fragments were detected. Water from both treatments was employed to study its toxicity on the marine diatom. Only the water from the face mask fragments showed a significant, dose-dependent, decrease in cell density in P. tricornutum; 53.09 % lower than in the controls. Although the water from the face mask fragments showed greater effects on the microalgae population than the water from the whole face mask, the latter treatment did show significant changes in the photosynthetic apparatus and intrinsic properties of the cells. These results indicate that during fragmentation and degradation face masks a significant chemical print can be observed in the marine environment.

Pandemia COVID-19 y Vacuna Sputnik V al personal de salud del Hospital Central de San Cristóbal, Venezuela / COVID-19 pandemic and Sputnik V vaccine to health personnel of the Central Hospital of San Cristóbal, Venezuela

A finales del 2019 una noticia empezó a circular en el mundo sobre un virus denominado SARS-CoV-2 que inició en Wuhan, China. Meses más tarde, marzo 2020, se presenta como una pandemia con el nombre de COVID-19, e inicia un problema de salud mundial inédito en el siglo XXI. Se plantearon medidas de protección, y el desarrollo de una vacuna para su control. Se emprende la investigación de varias vacunas, surgiendo la Sputnik V elaborada en el laboratorio ruso Gamaleya. Se ha especulado sobre sus efectos secundarios y eficacia, sin tener una referencia real. Dado que al Hospital Central de San Cristóbal llegó esta vacuna, se decidió realizar un estudio con el objetivo de: describir al personal vacunado; identificar los ESAVI (eventos supuestamente atribuibles a vacunación o inmunización), y conocer la incidencia de COVID-19 en los vacunados. Se planteó un estudio con diseño observacional, descriptivo, longitudinal y prospectivo. La población de 1.114 sujetos, personal de salud del Hospital Central de San Cristóbal vacunado con dos dosis de Sputnik V. La muestra de 355 sujetos encuestados por Google docs, reportando 32% masculinos, 68% femeninos; 30% menores de 30 años, 38,8% de 30-49 años y 31,1% de 50 años y más. Los ESAVI se reportaron fiebre en 4,9%, cefalea en 4,6%, malestar general en 2%, y dolor en el sitio de la vacuna 59,6%. La incidencia de COVID-19 fue de 10,7%, y hubo 0,6% de hospitalizados. Se concluye que las dos dosis de la vacuna Sputnik V ha sido efectiva en la prevención del COVID-19 en el personal vacunado(AU)

At the end of 2019, news began to circulate in the world about a virus called SARS-CoV-2 that began in Wuhan, China. Months later, March 2020, it appearedas a pandemic with the name of COVID-19, and began an unprecedented global health problem in the 21st century. Protection measures were proposed, and the development of a vaccine for its control. The investigation of several vaccines is undertaken, emerging the Sputnik V elaborated in the Russian laboratory Gamaleya. There has been speculation about its side effects and efficacy, without having a real reference. Given that, this vaccine arrived at the Central Hospital of San Cristóbal, a study was carried out with the objective of: Describing the vaccinated personnel; Identify the ESAVI, and know the incidence of COVID-19 in the vaccinated population. A study with an observational, descriptive, longitudinal and prospective design was proposed. The population of 1,114 subjects, health personnel from the Central Hospital of San Cristóbal vaccinated with two doses of Sputnik V. The sample of 355 subjects surveyed by Google docs, reporting 32% male, 68% female; 30% under 30 years old, 38.8% between 30-49 years old and 31.1% 50 years old and over. ESAVIs reported fever in 4.9%, headache in 4.6%, malaise in 2%, and pain at the site of the vaccine in 59.6%. The incidence of COVID-19 was 10.7%, and there were 0.6% hospitalized. It is concluded that the two doses of the Sputnik V vaccine have been effective in preventing COVID-19 in vaccinated personnel(AU)

Green taxes as ecosystem conservation: an analysis of the industrial sector's view in Peru.

Background: Environmental problems are becoming more recurrent nowadays, which is why many countries have acted on the matter, through different forms, laws and taxes that can contribute and reduce the polluting impact of companies at the time of manufacturing their products. One of the reforms has been environmental taxes, which are not only aimed at raising money, but also at taking corrective action on the behavior of companies that damage both the environment and the health of the population. The research is intended to finding out the opinion and interest of managers of different companies in the industrial sector on environmental taxes, also known as green taxes, and whether they consider it necessary to add green taxes to the current tax system. Method: For data collection of the research, 120 managers of small and medium-sized enterprises in the industrial sector were questioned about whether green taxes could have an influence on ecosystem conservation and several other questions. Results: 63.3% of the managers surveyed agree that the application of an environmental tax is necessary. Conclusion: It is concluded that managers are in favor of green taxes and  approve that  such taxes should be given as part of ecosystem conservation and environmental protection for all businesses, and that they promote businesses that do not generate any side effects or transformations to the environmental balance, thus improving the quality of life of residents.

Collateral Child and Parent Effects of Function­Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism.

This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.

Health economic analyses of secondary vaccine effects: a systematic review and policy insights.

INTRODUCTION: Numerous analyses demonstrate substantial health-economic impacts of primary vaccine effects (preventing or mitigating clinical manifestations of the diseases they target), but vaccines may also be associated with secondary effects, previously known as nonspecific, heterologous, or off-target effects. AREAS COVERED: We define key concepts to distinguish primary and secondary vaccine effects for health economic analyses, summarized terminology used in different fields, and perform a systematic review of health economic analyses focused on secondary vaccine effects (SVEs). EXPERT OPINION: Health economists integrate evidence from multiple fields, which often use incomplete or inconsistent definitions. Like regulators and policy makers, health economists require high-quality evidence of specific effects. Consistent with the limited evidence on mechanisms of action for SVEs, the associated health economic literature remains highly limited, with 4 studies identified by our systematic review. The lack of specific and well-controlled evidence that supports quantification of specific SVEs limits the consideration of these effects in vaccine research, development, regulatory, and recommendation decisions and health economic analyses.

Ropivacaine:An Unusual Cause of Neuroleptic Malignant-Like Syndrome.

Ropivacaine is commonly used for post-operative pain management. We describe a case of neuroleptic malignant-like syndrome in a woman administered ropivacaine delivered using a drug infusion balloon. The presenting symptoms were confusion, agitation and fever. Blood analysis showed elevated C-reactive protein, leucocytosis and increased creatine phosphokinase. As intoxication was suspected, ropivacaine was suspended and the patient gradually improved. Possible leakage of ropivacaine into the intrathecal space may have resulted in central nervous system toxicity. LEARNING POINTS: It is important to be aware of the secondary effects of common drugs.The differential diagnosis should always include side effects and drug interactions.Intoxication can lead to poor outcomes, so early recognition is key.

A Rare Case of Henoch-Schönlein Purpura Following a COVID-19 Vaccine-Case Report.

In the COVID-19 pandemic era, anti-SARS-CoV-2 vaccination is considered to be the most efficient way to overtake the COVID-19 scourge. Like all medicines, vaccines are not devoid of risks and can in rare cases cause some various side effects. The objective of this case report is to highlight this unusual presentation of Henoch-Schönlein purpura following an anti-COVID-19 vaccination in a 62-year-old adult. The 62-year-old patient admitted to the emergency room for a petechial purpuric rash, sloping, occurring within hours, involving both legs and ascending. The clinical signs also included polyarthralgia and hematuria. Reported in the history the notion of an anti-COVID-19 vaccination 8 days prior to the onset of symptomatology. In the case of our patient, we retain the diagnosis of rheumatoid purpura based on the EULAR/PRINTO/PReS diagnostic criteria. Corticosteroid therapy (prednisone) was started, resulting to a rapid regression of clinical and laboratory symptoms, few days after the treatment. Patient was asymptomatic on subsequent visits. The low number of published cases of post-vaccine vasculitis does not question the safety of vaccines, but knowledge of such complications deserves to be known in order to avoid new immunizations that could have more serious consequences, and to avoid aggravating or reactivating a pre-existing vasculitis.

Comprehending the complexity of microplastic organismal exposures and effects, to improve testing frameworks.

Microplastics (MPs) have been identified as a threat to global ecosystems. Current projections indicate that the negative impacts of MPs will increase in the environment. Traditional toxicity testing does not account for the diversity of MP particles, the inherent diversity in potential exposure routes, and complex impacts in exposed organisms. Here we present and discuss factors influencing organismal exposure to MPs driven by fate and behavior of MPs in different environmental matrices and organisms behavioral niches. We then provide a structured classification of potential effects of MPs, chemical or particulate, generic or specific to MPs. Using these analyses, we discuss appropriateness and limitations of applying traditional, chemical-based ecotoxicity testing for the study of MPs, and propose practical recommendations and guidelines. Future laboratory based studies can be improved to increase understanding of potential real world effects of MPs by careful selection of appropriate exposure systems and conditions, test organism, MP characteristics, endpoints and required controls. We build upon recommendations provided in previous publications and complement them with a list of parameters and practical information that should be checked and/or reported in MP studies.

The mental health impact of parole on families of indeterminate-sentenced prisoners in England and Wales.

BACKGROUND: The indeterminate sentence of Imprisonment for Public Protection (IPP), was created in England and Wales in 2003. After its abolition in 2012, many IPP-prisoners have become stuck in the prison system, facing considerable problems of sentence progression. The extant literature makes clear that the uncertainty and hopelessness caused by the indeterminacy of the IPP sentence are compounded by the negative impacts experienced by families and others providing support to people serving these sentences. AIMS: The mental strains caused for family members by the IPP sentence were examined. Of particular interest is the role and weight of the parole process experience, and its potential mental and physiological health impact on families. METHODS: This article draws on findings from two qualitative research projects conducted with families of prisoners serving the IPP sentence in England and Wales. Their experiences will be examined by reference to literature on the mental health impact of indeterminate sentences on prisoners and their families and the wider literature on the symbiotic harms of imprisonment for families. The aim was to add to this by focusing on families' experiences of cumulative stress caused by the sentence. FINDINGS: We demonstrate that the IPP parole process exerts specific weight and mental strains on family members occupying the negative end of the stress spectrum. Drawing on a body of neuroscientific, neuroendocrinological and criminological literature, we argue that these mental health impacts on families may represent a public health risk in need of practical and policy mitigation. IMPLICATIONS: There is a pressing need for recognition of what are often hidden symbiotic harms experienced by families of people sentenced to IPP. Families require more information as well as considerably greater practical and emotional support on an institutional and communal level.

A study of SARS-CoV-2 epidemiology in Italy: from early days to secondary effects after social distancing.

BACKGROUND: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 101,739 confirmed cases, in Italy, as of March 30th, 2020. While the analogous event in China appears to be under control at the moment, the outbreaks in western countries are still at an early stage of development. Italy, at present, is playing a major role in understanding the transmission dynamics of these new infections and evaluating the effectiveness of control measures in a western social context. METHODS: We combined a quarantined model with early-stage development data in Italy (during the period February 20th-March 30th) to predict longer-term progression (from March 30th, till June 25th, 2020 in a long-term view) with different control measures. Due to significant variations in the control strategies, which have been changing over time, and thanks to the introduction of detection technologies leading to faster confirmation of the SARS-CoV-2 infections, we made use of time-dependent contact and diagnosis rates to estimate when the effective daily reproduction ratio can fall below 1. Within the same framework, we analyze the possible secondary infection event after relaxing the isolation measures. OUTCOMES AND INTERPRETATION: We study two simplified scenarios compatible with the observation data and the effects of two stringent measures on the evolution of the epidemic. On one side, the contact rate must be kept as low as possible, but it is also clear that, in a modern developed country, it cannot fall under certain minimum levels and for a long time. The complementary parameter tuned is the transition rate of the symptomatic infected individuals to the quarantined class, a parameter δI I connected with the time tI = 1/δI  needed to perform diagnostic tests. Within the conditions of the outbreak in Italy, this time must fall under 12-8 h in order to make the reproduction number less than 1 to minimize the case numbers. Moreover, we show how the same parameter plays an even more important role in mitigating the effects of a possible secondary infection event.

Febrile neutropenia management in cancer patients receiving anti-cancer agents' treatment: Deepening the search to offer the best care. A critical review follow-up.

INTRODUCTION: Febrile neutropenia is a common complication in cancer patients. Emergency departments are in most countries the unique entry point to tertiary care. However, some challenges restrain emergency department professionals from complying with the protocol. OBJECTIVE: To update the published review in 2018: "Critical review of emergency department management of chemotherapy complications in cancer patients", and explore improvement opportunities. METHODS: MEDLINE, TROVE and SCOPUS databases were used to conduct a broad electronic literature search. Out of 74 articles yielded, nine responding to our questions were selected. CONCLUSIONS: Febrile neutropenia management in cancer patients still represents a challenge for emergency departments that have difficulties to comply with international guidelines. It is critical to identify the best venue and which professionals to manage the target population. Appropriate care pathways and a more efficient tool to classify low and high risk patients, would improve clinical outcomes, while costs would be reduced.

Essentiality of the Maltase AmlE in Maltose Utilization and Its Transcriptional Regulation by the Repressor AmlR in the Acarbose-Producing Bacterium Actinoplanes sp. SE50/110.

Actinoplanes sp. SE50/110 is the wild type of industrial production strains of the fine-chemical acarbose (acarviosyl-maltose), which is used as α-glucosidase inhibitor in the treatment of type II diabetes. Although maltose is an important building block of acarbose, the maltose/maltodextrin metabolism has not been studied in Actinoplanes sp. SE50/110 yet. Bioinformatic analysis located a putative maltase gene amlE (ACSP50_2474, previously named malL; Wendler et al., 2015a), in an operon with an upstream PurR/LacI-type transcriptional regulator gene, named amlR (ACSP50_2475), and a gene downstream (ACSP50_2473) encoding a GGDEF-EAL-domain-containing protein putatively involved in c-di-GMP signaling. Targeted gene deletion mutants of amlE and amlR were constructed by use of the CRISPR/Cas9 technology. By growth experiments and functional assays of ΔamlE, we could show that AmlE is essential for the maltose utilization in Actinoplanes sp. SE50/110. Neither a gene encoding a maltose phosphorylase (MalP) nor MalP enzyme activity were detected in the wild type. By this, the maltose/maltodextrin system appears to be fundamentally different from other described prokaryotic systems. By sequence similarity analysis and functional assays from the species Streptomyces lividans TK23, S. coelicolor A3(2) and S. glaucescens GLA.O, first hints for a widespread lack of MalP and presence of AmlE in the class Actinobacteria were given. Transcription of the aml operon is significantly repressed in the wild type when growing on glucose and repression is absent in an ΔamlR deletion mutant. Although AmlR apparently is a local transcriptional regulator of the aml operon, the ΔamlR strain shows severe growth inhibitions on glucose and - concomitantly - differential transcription of several genes of various functional classes. We ascribe these effects to ACSP50_2473, which is localized downstream of amlE and presumably involved in the metabolism of the second messenger c-di-GMP. It can be assumed, that maltose does not only represent the most important carbon source of Actinoplanes sp. SE50/110, but that its metabolism is coupled to the nucleotide messenger system of c-di-GMP.

[Corticosteroids and culture: a case of acute cortico-induced psychotic episode]. / Corticoïdes et culture: un cas d'épisode psychotique aigu cortico-induit.

Psychiatric side effects secondary to corticosteroids have been described for a long time. Some reactions are severe, occurring in approximately 5% of patients. These side effects are more difficult to evaluate when corticosteroids are assumed without medical supervision, practicing self-medication influenced by some cultural factors. We here report the case of a young woman with acute corticosteroid-induced psychotic episode. The patient had assumed corticosteroids in an attempt to gain weight. We here highlight the role of diagnostic tests and early management of patients as well as of an effective multidisciplinary strategy, in particular when cultural involvement of patients occurs, as in the case of our patient.

Nonglycemic Effects of GLP-1 Agonists: From a Starling to Lizards to People.

With the approval of exenatide in 2005, physicians had a new class of hypoglycemic agents available for the treatment of type 2 diabetes-the glucagon-like peptide-1 receptor agonists (or GLP-1 receptor agonists). As of this writing, there are seven drugs in this class available in the United States. In addition to demonstrating either cardiovascular risk neutrality or overt benefit, as now mandated by the United States Food and Drug Administration (FDA), many of these drugs have other, unexpected actions. It is our goal to outline these actions, some beneficial, some not. We have reviewed English-language articles in this area, not for an exhaustive study, but rather a broad search to define current understanding and perhaps generate further investigation.

Exposure to Sub-inhibitory Concentrations of the Chemosensitizer 1-(1-Naphthylmethyl)-Piperazine Creates Membrane Destabilization in Multi-Drug Resistant Klebsiella pneumoniae.

Antimicrobial efflux is one of the important mechanisms causing multi-drug resistance (MDR) in bacteria. Chemosensitizers like 1-(1-naphthylmethyl)-piperazine (NMP) can inhibit an efflux pump and therefore can overcome MDR. However, secondary effects of NMP other than efflux pump inhibition are rarely investigated. Here, using phenotypic assays, phenotypic microarray and transcriptomic assays we show that NMP creates membrane destabilization in MDR Klebsiella pneumoniae MGH 78578 strain. The NMP mediated membrane destabilization activity was measured using ß-lactamase activity, membrane potential alteration studies, and transmission electron microscopy assays. Results from both ß-lactamase and membrane potential alteration studies shows that both outer and inner membranes are destabilized in NMP exposed K. pneumoniae MGH 78578 cells. Phenotypic Microarray and RNA-seq were further used to elucidate the metabolic and transcriptional signals underpinning membrane destabilization. Membrane destabilization happens as early as 15 min post-NMP treatment. Our RNA-seq data shows that many genes involved in envelope stress response were differentially regulated in the NMP treated cells. Up-regulation of genes encoding the envelope stress response and repair systems show the distortion in membrane homeostasis during survival in an environment containing sub-inhibitory concentration of NMP. In addition, the lsr operon encoding the production of autoinducer-2 responsible for biofilm production was down-regulated resulting in reduced biofilm formation in NMP treated cells, a phenotype confirmed by crystal violet-based assays. We postulate that the early membrane disruption leads to destabilization of inner membrane potential, impairing ATP production and consequently resulting in efflux pump inhibition.

Disability differentials in educational attainment in England: primary and secondary effects.

Childhood disability has been largely overlooked in social stratification and life course research. As a result, we know remarkably little about mechanisms behind well-documented disability differentials in educational outcomes. This study investigates educational transitions of disabled youth using data from the Longitudinal Study of Young People in England. We draw on social stratification literature on primary and secondary effects as well as that on stigma and labelling in order to explain disabled young people's educational outcomes. We find that disability differentials in transition rates to full-time academic upper secondary education and to university are largely the result of primary effects, reflected in differences in school performance between disabled and non-disabled young people. However, we also find evidence for secondary effects, with similarly achieving disabled young people less likely to pursue full-time academic upper secondary education compared to their non-disabled peers. We examine the extent to which these effects can be explained by disabled youth's suppressed educational expectations as well as their experiences of being bullied at school, which we link to the stigma experienced by disabled young people and their families. We find that educational expectations play an important role at crucial transitions in the English school system, while the effect of bullying is considerably smaller. By drawing attention to different social processes contributing to disability differentials in attainment, our study moves beyond medical models that implicitly assume a naturalized association of disability with poor educational outcomes, and demonstrates the parallels of disability with other ascriptive inequalities.