Plastic pollution affects ecosystem processes including community structure and functional traits in large rivers.

Plastics in aquatic ecosystems rapidly undergo biofouling, giving rise to a new ecosystem on their surface, the 'plastisphere.' Few studies quantify the impact of plastics and their associated community on ecosystem traits from biodiversity and functional traits to metabolic function. It has been suspected that impacts on ecosystems may depend on its state but comparative studies of ecosystem responses are rare in the published literature. We quantified algal biomass, bacterial and algal biodiversity (16S and 18S rRNA), and metabolic traits of the community growing on the surface of different plastic polymers incubated within rivers of the Lower Mekong Basin. The rivers selected have different ecological characteristics but are similar regarding their high degree of plastic pollution. We examined the effects of plastics colonized with biofilms on ecosystem production, community dark respiration, and the epiplastic community's capability to influence nitrogen, phosphorus, organic carbon, and oxygen in water. Finally, we present conceptual models to guide our understanding of plastic pollution within freshwaters. Our findings showed limited microalgal biomass and bacterial dominance, with potential pathogens present. The location significantly influenced community composition, highlighting the role of environmental conditions in shaping community development. When assessing the effects on ecosystem productivity, our experiments showed that biofouled plastics led to a significant drop in oxygen concentration within river water, leading to hypoxic/anoxic conditions with subsequent profound impacts on system metabolism and the capability of influencing biogeochemical cycles. Scaling our findings revealed that plastic pollution may exert a more substantial and ecosystem-altering impact than initially assumed, particularly in areas with poorly managed plastic waste. These results highlighted that the plastisphere functions as a habitat for biologically active organisms which play a pivotal role in essential ecosystem processes. This warrants dedicated attention and investigation, particularly in sensitive ecosystems like the Mekong River, which supports a rich biodiversity and the livelihoods of 65 million people.

Quality of Refractive Error Care in Cambodia: An Unannounced Standardized Patient Study.

PURPOSE: Quality-of-care in refractive error services is essential, as it directly affects vision outcomes, wellbeing, educational attainment, and workforce participation. In Cambodia, uncorrected refractive error is a leading cause of mild and moderate vision impairment in adults. We evaluated the quality of refractive error care in Cambodia by estimating the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and factors associated with spectacle quality. METHODS: A cross-sectional protocol was employed with 18 Khmer-speaking adult participants observing testing procedures in 156 optical services across six provinces in 2022. A total of 496 dispensed spectacles were assessed against spectacle quality indicators. RESULTS: The analysis revealed that 35.1% of dispensed spectacles were of optimal quality. The most common error observed in sub-optimal spectacles was the presence of horizontal prism outside of tolerance limits. The study also found that 44.0% of emmetrope visits involved unnecessary prescription spectacle recommendations, and 18.3% of written prescriptions did not correspond with dispensed spectacles. Sex differences were observed, with men predominantly providing refractive error care and women more likely to be unnecessarily recommended prescription spectacles. CONCLUSION: The findings highlight the importance of prioritizing quality-of-care in refractive error services. A key recommendation is to consider regulatory mechanisms to ensure optical services employ appropriately qualified staff. Additionally, efforts should be made to eliminate unnecessary prescriptions -- especially for emmetropes and females -- standardize written prescriptions, ensure consistent pupil distance measurements, reduce reliance on autorefraction, and address the gender imbalance in the refractive error workforce.