Release of phthalate esters (PAEs) and microplastics (MPs) from face masks and gloves during the COVID-19 pandemic.

Marine pollution with personal protective equipment (PPE) has recently gained major attention. Multiple studies reported the release of microplastics (MPs) and chemical contaminants from face masks, the most used PPE type. However, not much is known concerning the release of phthalate esters (PAEs) in aquatic media, as well as the hazard posed by other types of PPE. In the present study, we investigated the release of MPs and PAEs from face masks and gloves recovered from the environment. The results indicated that both PPEs release MPs comparable to the literature, but higher concentrations were presented by face masks. In turn, the total concentration of six PAEs was higher in gloves than in face masks. The release of these contaminants is exacerbated over time. The present study allows researchers to understand the contribution of PPE to marine pollution while accounting for gloves, a generally overlooked source of contaminants.

Specialty income and career decision making: a qualitative study of medical student perceptions.

CONTEXT: Medical educators in the USA are interested in the ways medical students make career choices because shortages in key specialties, particularly primary care specialties, limit access to care. Although anticipated specialty income is a strong predictor of student interest, no studies have qualitatively explored the reasons why income is important to students. By better understanding students' perspectives on income and specialty choice, educators can help students make choices that fit their goals and better educate students about the specialties in which the need for expansion is greatest. METHODS: In 2012, Year-2 students at one USA medical school were invited to write an essay about how debt and anticipated income levels influence their career choices. A total of 132 essays (response rate: 67%) were qualitatively analysed using a hermeneutic phenomenology approach to conventional content analysis, in which themes emerge inductively from the data. Researchers employed peer debriefing, modified member checking, thick description, code-recode strategies, audit trails and reflexivity to ensure quality and rigour. Although this analysis initially focused on student perceptions of specialty income, prestige also emerged as an important related theme. RESULTS: Three major findings emerged. Income is of varying importance to different students. Students value income because it provides freedom and flexibility, and power and security. Students recognise that high income confers social prestige. Students also define specialty prestige in other ways, including match competitiveness, perceived expertise, opportunities for advancement through fellowships, and power and autonomy. CONCLUSIONS: Medical students' perspectives of specialty income, specialty choice and prestige are more complex than previously reported. Medical educators should frame conversations about specialty choices in ways that incorporate varied perspectives on income and prestige. Health policymakers should recognise that income and prestige influence medical students' decisions in complex ways. These insights may inform strategies to counteract shortages in key specialties, including primary care specialties.

Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions.

UNLABELLED: Phenomenon: Medical students in the United States face increasing educational debt because medical education costs have risen while public investment in higher education has declined. Contemporary students borrow more money and accumulate debt far surpassing that of previous generations of physicians, and both interest rates and terms of loan repayment have changed significantly in the last decade. As a result, the experiences of medical students differ from the experiences of physician educators. Little is known about how contemporary medical students view their debt in the context of career planning. Understanding contemporary U.S. medical students' lived experiences of educational debt is important, because high debt levels may affect medical students' well-being and professional development. APPROACH: The study's purpose was to explore contemporary students' views of their debt in the context of career planning. In 2012, 2nd-year medical students enrolled in a health policy course at one medical school were invited to write an essay about how debt influences their career choices. The authors analyzed 132 essays using immersion and crystallization and iterative, team-based coding. Code-recode strategies, member checking, and reflexivity ensured validity and rigor. FINDINGS: Three themes emerged about the meaning of debt: debt symbolizes lack of social investment, debt reinforces a sense of entitlement, and debt is a collective experience. Four approaches to debt management emerged: anticipation, avoidance, acceptance, and disempowerment. Insights: Medical students' views of debt are more complex than previously reported. Medical educators should recognize that many students experience debt as a stressor, acknowledge students' emotions about debt, and invite discussion about the culture of entitlement in medical education and how this culture affects students' professionalism. At the same time, educators should emphasize that students have many repayment options and that regardless of specialty choice, most physicians repay their debts without significant difficulty. Further exploration is needed of the relationships between the amount of debt owed, students' attitudes toward their debt, and other student characteristics. Because students experience debt in a range of ways, more nuanced approaches to understanding and reframing student perceptions of debt are necessary.

Incidence of alcohol use disorders among Hispanic subgroups in the USA.

OBJECTIVE: Hispanics are the largest ethnic minority group in the USA and a fairly heterogeneous group. But this heterogeneity has usually been ignored by grouping them into a single category. The objective of this study is to challenge that practice by providing alcohol use disorders (AUD) incidence and risk estimates across Hispanic subgroups. METHODS: A subsample of Hispanics (n = 2371) and non-Hispanic whites (n = 7741) at risk for AUD who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions was analyzed. Weighted incidence for AUD was calculated across Hispanic subgroups. A weighted modified Poisson generalized linear model was used to estimate relative risks. RESULTS: Compared with non-Hispanic whites, Puerto Ricans have the highest AUD incidence (3.6%; 95% CI: 0.5, 6.7) followed by Mexican-Americans (2.5%; 95% CI: 1.5, 3.6), Other Hispanics (1.6%; 95% CI: 0.1, 3.1) and Cuban-Americans (0.6%; 95% CI: 0.1, 1.2). In contrast, weighted adjusted relative risk estimates for Mexican-Americans were (RR = 3.2; 95% CI: 1.7, 6.2) but for Puerto Ricans (RR = 2.2; 95% CI: 1.0, 5.0) it was somewhat attenuated but still significant (P = 0.049). No difference was found for Cuban-Americans or Other Hispanics. CONCLUSIONS: The annual incidence and risk for AUD varies greatly among Hispanic subgroups. Nonetheless, the practice of categorizing Hispanics as a homogenous ethnic group still continues. Our findings suggest that this practice is not only inappropriate, but also hinders a better understanding of AUD etiology, prevention, treatment and rehabilitation in the largest ethnic minority group in the USA.

Floating microplastic pollution in the vicinity of a marine protected area and semi-enclosed bay of Peru.

A baseline survey for floating microplastics (MPs) in the vicinity of a marine protected area and semi-enclosed bay of northern Peru was carried out. An average concentration of 0.22 MPs/L was estimated, primarily dominated by blue polyethylene terephthalate fibers. The distribution of floating MPs suggests that they tend to accumulate within the semi-enclosed Sechura Bay regardless of the sampling season. This behavior may be explained by local surface currents in the bay, which flow inwards and exhibit vorticities that could entrap MPs. Future studies are suggested to investigate the trajectory and fate of floating MPs within semi-enclosed areas. On the other hand, the impact of floating MPs on the trophic chain of coastal marine protected areas requires further research.

Assessing the current state of plastic pollution research in Antarctica: Knowledge gaps and recommendations.

Antarctica stands as one of the most isolated and pristine regions on our planet. Regardless, recent studies have evidenced the presence of plastic pollution in Antarctic environments and biota. While these findings are alarming and put into perspective the reach of plastic pollution, it is necessary to assess the current knowledge of plastic pollution in Antarctica. In the present review, an updated literature review of plastic pollution in multiple Antarctic environmental compartments and biota was conducted. Studies were cataloged based on environmental compartments (e.g., sediments, seawater, soil, atmosphere) and biota from different ecological niches. A detailed analysis of the main findings, as well as the flaws and shortcomings across studies, was conducted. In general terms, several studies have shown a lack of adequate sampling and analytical procedures for plastic research (particularly in the case of microplastics) and standard procedures; thus, compromising the reliability of the data reported and comparability across studies. Aiming to guide future studies and highlight research needs, a list of knowledge gaps and recommendations were provided based on the analysis and discussion of the literature and following standardized procedures.

Micro- and mesoplastic pollution along the coast of Peru.

Peru suffers from poor solid waste and coastal management, as well as evidenced plastic pollution in various forms. However, studies in Peru focusing on small plastic debris (i.e., meso- and microplastics) are still limited and inconclusive. Thus, the present study investigated the abundance, characteristics, seasonality, and distribution of small plastic debris along the coast of Peru. The abundance of small plastic debris is predominantly driven by specific locations, where a source of contamination is present, rather than presenting seasonal patterns. Meso- and microplastics were strongly correlated in both seasons (summer and winter), suggesting meso-plastic constantly breaking down as microplastic sources. Additionally, heavy metals (e.g., Cu, Pb) were found in low concentrations (mean concentrations < 0.4%) on the surface of some mesoplastics. Here, we provided a baseline on the multiple factors involving small plastic debris on the Peruvian coast and preliminarily identify associated contaminants.

Plastic and paint debris in marine protected areas of Peru.

Contamination with anthropogenic debris, such as plastic and paint particles, has been widely investigated in the global marine environment. However, there is a lack of information regarding their presence in marine protected areas (MPAs). In the present study, the abundance, distribution, and chemical characteristics of microplastics (MPs; <5 mm), mesoplastics (MePs; 5-25 mm), and paint particles were investigated in multiple environmental compartments of two MPAs from Peru. The characteristics of MPs across surface water, bottom sediments, and fish guts were similar, primarily dominated by blue fibers. On the other hand, MePs and large MPs (1-5 mm) were similar across sandy beaches. Several particles were composite materials consisting of multiple layers confirmed as alkyd resins by Fourier-transformed infrared spectroscopy, which were typical indicators of marine coatings. The microstructure of paint particles showed differentiated topography across layers, as well as different elemental compositions. Some layers displayed amorphous structures with Ba-, Cr-, and Ti-based additives. However, the leaching and impact of potentially toxic additives in paint particles require further investigation. The accumulation of multiple types of plastic and paint debris in MPAs could pose a threat to conservation goals. The current study contributed to the knowledge regarding anthropogenic debris contamination in MPAs and further elucidated the physical and chemical properties of paint particles in marine environments. While paint particles may look similar to MPs and MePs, more attention should be given to these contaminants in places where intense maritime activity takes place.

Rajids ovipositing on marine litter: A potential threat to their survival.

Marine litter is a complex environmental issue threatening the well-being of multiple organisms. In the present study, we present an overlooked pathway by which marine litter interaction with certain ovigerous skates (Family: Rajidae) communities could compromise their survival. We propose that skates from the genus Sympterygia deposit their egg capsules on marine litter substrates by accident, which are then washed ashore still unhatched. We conducted 10 monitoring surveys on three beaches of La Libertad Region, on the north coast of Peru, looking for marine litter conglomerates to determine the presence of egg capsules. We registered a total of 75 marine litter conglomerates, containing 1595 egg capsules, out of which only 15.9 % were presumably hatched, and 15.8 % were still fresh. Fishing materials were identified as the main item in marine litter conglomerates. We conclude that this behavior could contribute to the decline of Sympterygia communities, although further research is needed.

Physical and chemical degradation of littered personal protective equipment (PPE) under simulated environmental conditions.

Investigations of the physicochemical degradation of personal protective equipment (PPE) under controlled environmental conditions are largely lacking. Here the chemical and physical changes of face masks and gloves (recovered from the marine environment) were evaluated after exposure time up to 60 days of simulated environmental conditions. The results suggested that the polymer backbone of PPE suffers typical changes induced by sun exposure. Changes in the intensity of diffraction peaks indicated shifts in the crystallinity of PPE, possibly altering their thermal behavior. Signs of physical degradation in PPE, such as ruptures, and rough surfaces, which exacerbated over time were also detected. Additionally, signals of some elements of concern, such as Cu and Mo, and elements typically found in seawater were detected. The results of this study allowed us to better understand the degradation of typical PPE items in the marine environment, ultimately resulting in the release of microplastics and chemical contaminants.

Face masks invading protected areas: Risks and recommendations.

Among the indirect environmental impacts generated by the global COVID-19 pandemic, contamination with personal protective equipment (PPE), like face masks, may be one of the most relevant ones. PPE has been found in multiple aquatic, marine, and terrestrial environments, including places of absolute relevancy to biodiversity conservation, such as protected areas (PAs). Here, a brief report of the presence of PPE in six PAs of Peru is presented. PPE pollution in PAs consisted mainly of single-use and reusable face masks, as well as plastics associated with PAs, such as KN95 respirator wrappings. The mean PPE density was estimated as 1.32 × 10-3 PPE/m2. FTIR spectroscopy confirmed that face masks and wrappers mainly consisted of polypropylene and polyethylene, two of the most commonly available synthetic polymers. The material was poorly degraded according to their FTIR spectra, possibly suggesting that they were discarded recently. The recent ban on single-use plastic in Peruvian PAs is regarded as a great step forward toward the efforts made to preserve these invaluable places. However, these measures seemed insufficient to prevent PPE and other types of litter from contaminating areas of ecological importance. Considering the current scenario, several recommendations were proposed to be implemented in PAs in order to prevent PPE from becoming a new plastic issue to tackle. These recommendations are expected to also serve for future events where the use of single-use plastics becomes inevitable, like global pandemics.

First record of plastiglomerates, pyroplastics, and plasticrusts in South America.

Beaches in the Anthropocene carry the heavy burden of human-derived pollution, like that induced by plastic litter. For decades, plastic debris has been classified based on its source or physical size. In recent years, studies described and documented new forms of plastic formations, including plastiglomerates, plasticrusts, and pyroplastics. However, reports of these newly described formations are substantially lacking. Therefore, in the present study, we reported the first evidence of plasticrusts (plastic encrusting rock surfaces), plastiglomerates (organic/inorganic composite materials in a plastic matrix), and pyroplastics (burned and weathered plastics) in Peru. The plastic pollutants were recovered from the field through marine litter surveys on four beaches where illegal litter burning and campfires take place. All the suspected plastic formations were analyzed and confirmed using Fourier transformed infrared (FTIR) spectroscopy, and one of each type was analyzed by X-Ray fluorescence (EDX) spectrometry. Plastiglomerates consisted of a high-density polyethylene (HDPE) or polypropylene (PP) matrix with rock and sand inclusions. Pyroplastics were found in various stages of weathering and consisted of various polymers, including HDPE, PP, polyethylene terephthalate (PET), and polyamide (PA). Interestingly, our field observations suggest a new plasticrust formation pathway based on plastic burning and filling of rock crevices with molten plastic. The latter was identified as either PP or HDPE. Elements typically found in the sand and seawater (e.g., Na, Cl, Ca, Si, Fe) were identified on the surface of the plastic formations, as well as others that could potentially be associated with the leaching of additives (e.g., Ti, Br). Although the present study contributed to the knowledge concerning the occurrence of the new types of plastic formations, as well as possible formation pathways, there are still many questions to answer. Hence, we encourage future studies to focus on the toxicity that new plastic formations may induce in contrast with conventional plastics, the release of secondary contaminants (e.g., microplastics, additives), and their degradation in the environment. Lastly, standardized sampling and data treatment protocols are required.

Degradation of plastics associated with the COVID-19 pandemic.

The ongoing COVID-19 pandemic has resulted in an unprecedented form of plastic pollution: personal protective equipment (PPE). Numerous studies have reported the occurrence of PPE in the marine environment. However, their degradation in the environment and consequences are poorly understood. Studies have reported that face masks, the most abundant type of PPE, are significant sources of microplastics due to their fibrous microstructure. The fibrous material (mostly consisting of polypropylene) exhibits physical changes in the environment, leading to its fracture and detachment of microfibers. Most studies have evaluated PPE degradation under controlled laboratory conditions. However, in situ degradation experiments, including the colonization of PPE, are largely lacking. Although ecotoxicological studies are largely lacking, the first attempts to understand the impact of MPs released from face masks showed various types of impacts, such as fertility and reproduction deficiencies in both aquatic and terrestrial organisms.

Are we underestimating floating microplastic pollution? A quantitative analysis of two sampling methodologies.

Microplastics (MPs) are widespread in the water column of several aquatic ecosystems. Thus, the sampling methodology is considered as a basic factor influencing MPs abundance. In this baseline, a total of 67 investigations were chosen to conduct a quantitative analysis between two sampling methods: Trawl and bulk. The aim is to report a general overview of the MPs abundance and characteristic differences based on the sampling procedures and provide methodological recommendations. MPs abundance reported by bulk studies is 3500 higher than trawl studies. Furthermore, the morphological types and polymers abundances were statistically affected by the type of sampling tool. Conversely, MPs size ranges were significantly different between sampling procedures, suggesting that trawling underestimates the smaller MPs fractions. The analysis confirms that the sampling methods should be selected based on the research objectives. In this sense, it is recommended to combine both types of sampling procedures to obtain comprehensive data.

Binational survey of personal protective equipment (PPE) pollution driven by the COVID-19 pandemic in coastal environments: Abundance, distribution, and analytical characterization.

In the present contribution, two nationwide surveys of personal protective equipment (PPE) pollution were conducted in Peru and Argentina aiming to provide valuable information regarding the abundance and distribution of PPE in coastal sites. Additionally, PPE items were recovered from the environment and analyzed by Fourier transformed infrared (FTIR) spectroscopy, Scanning electron microscopy (SEM) with Energy dispersive X-ray (EDX), and X-ray diffraction (XRD), and compared to brand-new PPE in order to investigate the chemical and structural degradation of PPE in the environment. PPE density (PPE m-2) found in both countries were comparable to previous studies. FTIR analysis revealed multiple polymer types comprising common PPE, mainly polypropylene, polyamide, polyethylene terephthalate, and polyester. SEM micrographs showed clear weathering signs, such as cracks, cavities, and rough surfaces in face masks and gloves. EDX elemental mapping revealed the presence of elemental additives, such as Ca in gloves and face masks and AgNPs as an antimicrobial agent. Other metals found on the surface of PPE were Mo, P, Ti, and Zn. XRD patterns displayed a notorious decrease in the crystallinity of polypropylene face masks, which could alter its interaction with external contaminants and stability. The next steps in this line of research were discussed.

New plastic formations in the Anthropocene.

Plastic pollution is one of the major challenges in the Anthropocene. Upon reaching the marine environment, plastic debris is subject to anthropogenic and environmental conditions that result in novel items that vary in composition, physical and chemical characteristics. Here, we reviewed and discussed the potential fate and threat to the environment of four recently described plastic formations: Plastiglomerates, pyroplastics, plasticrusts, and anthropoquinas. The threats identified were mostly related to the release of toxic chemicals and plastic ingestion. Transportation of alien invasive species or microbial pathogens and fragmentation of larger plastics into microplastics (<5 mm), potentially reaching marine trophic webs, are suspected as potential impacts based on the characteristics of these plastic formations. Some plastic forms may persist in the environment and voyage across the ocean, while others are denser and less likely to enter the plastic cycle or interact with biota. In the latter case, plastics are expected to become buried in the sediment and incorporate into the geological record. It is necessary to establish sampling protocols or standards that are specific to each plastic formation and start reporting the occurrence of these new plastic categories as such to avoid underestimating plastic pollution in marine environments. It is suggested that monitoring plans include these categories and identify potential sources. Further research must focus on investigating whether the suspected impacts are a matter of concern. In this sense, we have suggested research questions to address the knowledge gaps and have a better understanding of the impacts and distribution of the new plastic forms.

Investigating the current status of COVID-19 related plastics and their potential impact on human health.

The COVID-19 pandemic led to a sudden global increase in the production, consumption, and mismanagement of personal protective equipment (PPE). As plastic-based PPE such as disposable face masks and gloves have become widely used, human exposure to PPE-derived pollutants may occur through indirect and direct pathways. This review explores the potential health impacts related to plastic-based PPE through these pathways. Face masks release microplastics, which are directly inhaled during use or transported through the environment. The latter can adsorb chemical contaminants and harbor pathogenic microbiota, and once consumed by organisms, they can translocate to multiple organs upon intake, potentially causing detrimental and cytotoxic effects. However, more research is required to have a comprehensive overview of the human health effects.

Personal protective equipment (PPE) pollution driven by the COVID-19 pandemic in Cox's Bazar, the longest natural beach in the world.

The extensive use of personal protective equipment (PPE) driven by the COVID-19 pandemic has become an important contributor to marine plastic pollution. However, there are very few studies quantifying and characterizing this type of pollution in coastal areas. In the present study, we monitored the occurrence of PPE (face masks, bouffant caps, and gloves) discarded in 13 sites along Cox's Bazar beach, the longest naturally occurring beach in the world. The vast majority of the items were face masks (97.9%), and the mean PPE density across sites was 6.29 × 10-3 PPE m-2. The presence of illegal dumping sites was the main source of PPE, which was mainly located on touristic/recreational beaches. Fishing activity contributed to PPE pollution at a lower level. Poor solid waste management practices in Cox's Bazar demonstrated to be a major driver of PPE pollution. The potential solutions and sustainable alternatives were discussed.

Occurrence of personal protective equipment (PPE) associated with the COVID-19 pandemic along the coast of Lima, Peru.

The use and disposal of face masks, gloves, face shields, and other types of personal protective equipment (PPE) have increased dramatically due to the ongoing COVID-19 pandemic. Many governments enforce the use of PPE as an efficient and inexpensive way to reduce the transmission of the virus. However, this may pose a new challenge to solid waste management and exacerbate plastic pollution. The aim of the present study was to report the occurrence and distribution of COVID-19-associated PPE along the coast of the overpopulated city of Lima, Peru, and determine the influence of the activities carried out in each study site. In general terms, 138 PPE items were found in 11 beaches during 12 sampling weeks. The density was in the range of 0 to 7.44 × 10-4 PPE m-2. Microplastic release, colonization of invasive species, and entanglement or ingestion by apex predators are some of the potential threats identified. Recreational beaches were the most polluted sites, followed by surfing, and fishing sites. This may be because recreational beaches are many times overcrowded by beachgoers. Additionally, most of the PPE was found to be discarded by beachgoers rather than washed ashore. The lack of environmental awareness, education, and coastal mismanagement may pose a threat to the marine environment through marine litter and plastic pollution. Significant efforts are required to shift towards a sustainable solid waste management. Novel alternatives involve redesigning masks based on degradable plastics and recycling PPE by obtaining liquid fuels through pyrolysis.