Predictors of lung function in early adulthood: A population-based cohort study.

BACKGROUND AND OBJECTIVE: Lung function reaches a peak/plateau in early adulthood before declining with age. Lower early adult lung function may increase the risk for chronic obstructive pulmonary disease (COPD) in mid-late adult life. Understanding the effects of multiple childhood/adolescent exposures and their potential interactions on plateau lung function would provide insights into the natural history of COPD. METHODS: Longitudinal spirometry data from 688 participants with complete data from a population-based birth cohort (original n = 1037) were used to investigate associations between a wide range of childhood/adolescent exposures and repeated measures of FEV1, FVC and FEV1/FVC during the early-adult plateau phase. Generalized estimating equations were used to accommodate the multiple timepoints per participant. RESULTS: FEV1 reached a peak/plateau between ages 18 and 26 and FVC from 21 to 32 years, whereas FEV1/FVC declined throughout early adulthood. Childhood asthma and airway hyperresponsiveness were associated with lower early adult FEV1 and FEV1/FVC. Smoking by age 18 was associated with lower FEV1/FVC. Higher BMI during early adulthood was associated with lower FEV1 and FVC and lower FEV1/FVC. Physical activity during adolescence was positively associated with FEV1 and FEV1/FVC but this was only statistically significant in men. There was no convincing evidence of interactions between exposures. CONCLUSION: Childhood asthma and airway hyperresponsiveness are associated with lower lung function in early adulthood. Interventions targeting these may reduce the risk of COPD in mid-late adult life. Promotion of physical activity during adolescence, prevention of cigarette smoking and maintenance of a healthy body weight in early adulthood are also priorities.

A protocol for the conduct of a multicentre, prospective, randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures.

Aims: Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures. Methods: The HUmeral SHaft (HUSH) fracture study is a multicentre, prospective randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures in adult patients. Participants will be randomized to receive either functional bracing or surgery. With 334 participants, the trial will have 90% power to detect a clinically important difference for the Disabilities of the Arm, Shoulder and Hand questionnaire score, assuming 20% loss to follow-up. Secondary outcomes will include function, pain, quality of life, complications, cost-effectiveness, time off work, and ability to drive. Discussion: The results of this trial will provide evidence regarding clinical and cost-effectiveness between surgical and non-surgical treatment of humeral shaft fractures. Ethical approval has been obtained from East of England - Cambridge Central Research Ethics Committee. Publication is anticipated to occur in 2024.

The Hypoechoic Triangle: A New Sonographic Landmark for Rectus Sheath Block.

Rectus sheath blocks can provide analgesia for upper abdominal midline incisions. These blocks can be placed on patients who are anticoagulated, supine, and under general anesthesia. However, block success rates remain low, presumably because of the difficulty of placing local anesthetic between the correct fascial layers. Here we characterize a hypoechoic triangle with sonography, an anatomic space between adjacent rectus abdominis segments that can be accessed for easier needle tip and catheter placement. This approach could reduce reliance on hydrodissection to correctly identify the potential space and instead improve block efficacy by offering providers a discrete target for local anesthesia.

Post-surgical inflammatory neuropathy after anterior cruciate ligament repair: a case report.

BACKGROUND: Unanticipated symptoms of peripheral nerve damage following surgery are distressing to both the patient and their clinical team, including surgeons, anesthesiologists, and neurologists. The causes that are commonly considered for perioperative neuropathy can include surgical trauma, positioning-related injury, or injury related to a regional anesthetic technique. However, these cases often do not have a clear etiology and can occur without any apparent periprocedural anomalies. Postoperative inflammatory neuropathy is a more recently described, and potentially underrecognized cause of perioperative neuropathy which may improve with corticosteroid therapy. Therefore, it is an important etiology to consider early in the evaluation of perioperative neuropathy. CASE PRESENTATION: An otherwise healthy patient presented for left anterior cruciate ligament reconstruction. He underwent femoral and sciatic ultrasound-guided single-injection peripheral nerve blocks preoperatively, followed by a general anesthetic for the surgical procedure. He developed postoperative neuropathy in the sciatic distribution with both sensory and motor deficits. The patient received multi-disciplinary consultations, including neurology and pain management, and a broad differential diagnosis was considered. Based on neurological evaluation and imaging studies, a final diagnosis of post-surgical inflammatory neuropathy was made. The patient's course improved with conservative management, but immunosuppressive treatment may have been considered for a more severe or worsening clinical course. CONCLUSIONS: There are limited publications describing postoperative inflammatory neuropathy, and this case serves to illustrate a potentially under-recognized and multifactorial cause of postoperative neuropathy. Perioperative neuropathies are a complication that surgeons and anesthesiologists strive to avoid; however, prevention and treatment of this condition have been elusive. Increased reporting and investigation of postoperative inflammatory neuropathy as one cause for this complication will help to further our understanding of this potentially devastating complication.

Effect of carbamide peroxide on biomechanical properties of vacuum-formed retainers: A split-mouth randomized controlled trial.

OBJECTIVE: To investigate the effect of tooth whitening on biomechanical properties of vacuum-formed retainers (VFRs). METHODS: Using a split-mouth, randomised controlled trial design, thirty participants were randomly allocated to receive whitening on either the upper or the lower arch, using 10 % carbamide peroxide for two weeks. Biomechanical properties such as hardness, tensile strength, and surface roughness were assessed two weeks after whitening was completed. RESULTS: Tensile strength of the whitening arch (mean ± SD: 40.93 ± 3.96 MPa) was significantly lower than that of the control (47.40 ± 5.03 MPa) (difference 6.47 MPa, 95 % CI 4.51 - 8.42, p < 0.001). Hardness and internal roughness of the whitening arch (VHN = 14.63 ± 2.29 N/mm2 and Ra = 1.33 ± 0.35 µm, respectively) were significantly greater than those of the control (12.22 ± 1.86 N/mm2 and 0.96 ± 0.29 µm, respectively) (differences 2.41 N/mm2, 95 % CI 1.56 - 3.25, p < 0.001 and 0.37 µm, 95 % CI 0.23 - 0.51, p < 0.001, respectively). The whitening arch showed greater tooth colour change (ΔE = 6.00 ± 3.32) than the control (ΔE = 2.50 ± 1.70) (difference = 3.50, 95 % CI 2.43 - 4.56, p < 0.001). CONCLUSIONS: Based on this short-term study, marked tooth colour change was achieved by whitening with VFRs as the whitening trays, but this changed the VFRs' biomechanical properties, including a decrease in tensile strength and an increase in hardness and internal roughness. CLINICAL SIGNIFICANCE: The application of carbamide peroxide in VFRs may compromise their mechanical properties.

Distinct trajectories of lung function from childhood to mid-adulthood.

RATIONALE: Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented. OBJECTIVE: To document lung function trajectories from childhood to mid-adult life. METHODS: We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45. RESULTS: Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV1 trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV1/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV1 trajectories leading to the lowest FEV1 values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45. CONCLUSIONS: Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.

How many microplastics do you need to (sub)sample?

Analysis of microplastics in the environment requires polymer characterization as a confirmation step for suspected microplastic particles found in a sample. Material characterization is costly and can take a long time per particle. When microplastic particle counts are high, many researchers cannot characterize every particle in their sample due to time or monetary constraints. Moreover, characterizing every particle in samples with high plastic particle counts is unnecessary for describing the sample properties. We propose an a priori approach to determine the number of suspected microplastic particles in a sample that should be randomly subsampled for characterization to accurately assess the polymer distribution in the environmental sample. The proposed equation is well-founded in statistics literature and was validated using published microplastic data and simulations for typical microplastic subsampling routines. We report values from the whole equation but also derive a simple way to calculate the necessary particle count for samples or subsamples by taking the error to the power of negative two. Assuming an error of 0.05 (5 %) with a confidence interval of 95 %, an unknown expected proportion, and a sample with many particles (> 100k), the minimum number of particles in a subsample should be 386 particles to accurately characterize the polymer distribution of the sample, given the particles are randomly characterized from the full population of suspected particles. Extending this equation to simultaneously estimate polymer, color, size, and morphology distributions reveals more particles (620) would be needed in the subsample to achieve the same high absolute error threshold for all properties. The above proposal for minimum subsample size also applies to the minimum count that should be present in samples to accurately characterize particle type presence and diversity in a given environmental compartment.

A randomized clinical trial investigating the effect of three vital tooth bleaching protocols on oral health-related quality of life.

Objectives: This study aimed to compare changes in oral health-related quality of life (OHRQoL) resulting from three vital tooth bleaching protocols. Methods: The participants (n = 105) were randomly assigned to one of three vital bleaching treatment groups: home bleaching (HB), in-office bleaching (IOB), or combined bleaching (CB). HB involved the use of custom-made trays and 10% carbamide peroxide for a 14-day treatment period. IOB utilized 37.5% hydrogen peroxide applied in three cycles. CB treatment involved the use of IOB followed by HB. Tooth colour change was evaluated using a shade guide (ΔVS) and a digital spectrophotometry device (ΔES). The Oral Health Impact Profile-14 (OHIP-14) and Oral Impact on Daily Performance-22 (OIDP-22) instruments were used to assess changes in OHRQoL at baseline, 15-days and 6-month recalls. Linear mixed models were used to estimate between- and within-group differences. Results: All bleaching protocols led to significant improvements in overall OHIP-14 scores at the 6-month recall (p ≤ 0.037). CB and IOB treatments were associated with more substantial positive impacts on overall scores, psychological discomfort, physical disability (CB only), and psychological disability (CB only) compared to HB (p ≤ 0.011). Significant enhancements in OIDP-22 scores were observed in the CB and HB groups at the 6-month recall compared to baseline (p ≤ 0.006), with evidence indicating that these improvements were greater in the CB group compared to the IOB group (p = 0.007). Conclusion: All bleaching treatments demonstrated a positive impact on OHRQoL. However, the positive impact was most consistent across domains and age groups in the CB group. The positive impact was less pronounced in older age groups.

Overcoming Obstacles: The Legacy of Fidel Pagés, Founder of the Epidural, 100 Years After His Passing.

Fidel Pagés, a Spanish surgeon, tragically died in 1923 at the age of 37, just 2 years after his publication "Anestesia Metamérica," the first description of human thoracolumbar epidural anesthesia. In the intervening 100 years, epidural anesthesia has faced countless obstacles, starting with the dissemination of his initial report, which was not widely read nor appreciated at the time. However, the merits of the technique have fueled innovations to meet these challenges over the years. Even today, while epidural anesthesia is widely embraced, particularly in obstetric and chronic pain medicine, the pressures of the operating room for efficiency and a low tolerance for failure, pose modern-day challenges. Here, we revisit Pagés' original report and highlight the key innovations that have allowed for the evolution of this essential anesthesia technique.

How did New Zealand's regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation.

OBJECTIVES: In Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four regional District Health Board (DHB) groupings, which, from 2011 to 2022, required the country's 20 DHBs to work together regionally. This research explores how this initiative functioned, examining how, for whom and in what circumstances regional DHB groupings worked to deliver improvements in system integration and health outcomes and equity. DESIGN: We used a realist-informed evaluation study design. We used documentary analysis to develop programme logic models to describe the context, structure, capabilities, implementation activities and impact of each of the four regional groupings and then conducted interviews with stakeholders. We developed a generalised context-mechanisms-outcomes model, identifying key commonalities explaining how regional work 'worked' across NZ while noting important regional differences. SETTING: NZ's four regional DHB groupings. PARTICIPANTS: Forty-nine stakeholders from across the four regional groupings. These included regional DHB governance groups and coordinating regional agencies, DHB senior leadership, Maori and Pasifika leadership and lead clinicians for regional work streams. RESULTS: Regional DHB working was layered on top of an already complex DHB environment. Organisational heterogeneity and tensions between local and regional priorities were key contextual factors. In response, regional DHB groupings leveraged a combination of 'hard' policy and planning processes, as well as 'soft', relationship-based mechanisms, aiming to improve system integration, population health outcomes and health equity. CONCLUSION: The complexity of DHB regional working meant that success hinged on building relationships, leadership and trust, alongside robust planning and process mechanisms. As NZ reorients its health system towards a more centralised model underpinned by collaborations between local providers, our findings point to a need to align policy expectations and foster environments that support connection and collegiality across the health system.

Intracerebral Transplantation of Autologous Mesenchymal Stem Cells Improves Functional Recovery in a Rat Model of Chronic Ischemic Stroke.

While treatments exist for the acute phase of stroke, there are limited options for patients with chronic infarcts and long-term disability. Allogenic mesenchymal stem cells (alloMSCs) show promise for the treatment of stroke soon after ischemic injury. There is, however, no information on the use of autologous MSCs (autoMSCs), delivered intracerebrally in rats with a chronic infarct. In this study, rats underwent middle cerebral artery occlusion (MCAO) to induce stroke followed by bone marrow aspiration and MSC expansion in a closed bioreactor. Four weeks later, brain MRI was obtained and autoMSCs (1 × 106, 2.5 × 106 or 5 × 106; n = 6 each) were stereotactically injected into the peri-infarct and compared to controls (MCAO only; MCAO + PBS; n = 6-9). Behavior was assessed using the modified neurological severity score (mNSS). For comparison, an additional cohort of MCAO rats were implanted with 2.5 × 106 alloMSCs generated from a healthy rat. All doses of autoMSCs produced significant improvement (54-70%) in sensorimotor function 60 days later. In contrast, alloMSCs improved only 31.7%, similar to that in PBS controls 30%. Quantum dot-labeled auto/alloMSCs were found exclusively at the implantation site throughout the post-transplantation period with no tumor formation on MRI or Ki67 staining of engrafted MSCs. Small differences in stroke volume and no differences in corpus callosum width were observed after MSC treatment. Stroke-induced glial reactivity in the peri-infarct was long-lasting and unabated by auto/alloMSC transplantation. These studies suggest that intracerebral transplantation of autoMSCs as compared to alloMSCs may be a promising treatment in chronic stroke.

Use of historical isoscapes to develop an estuarine nutrient baseline.

Coastal eutrophication is a prevalent threat to the healthy functioning of ecosystems globally. While degraded water quality can be detected by monitoring oxygen, nutrient concentrations, and algal abundance, establishing regulatory guidelines is complicated by a lack of baseline data (e.g., pre-Anthropocene). We use historical carbon and nitrogen isoscapes over ~300 years from sediment cores to reconstruct spatial and temporal changes in nutrient dynamics for a central California estuary, Elkhorn Slough, where development and agriculture dramatically enhanced nutrient inputs over the past century. We found strong contrasts between current sediment stable isotopes and those from the recent past, demonstrating shifts exceeding those in previously studied eutrophic estuaries and substantial increases in nutrient inputs. Comparisons of contemporary with historical isoscapes also revealed that nitrogen sources shifted from a historical marine-terrestrial gradient with higher δ15N near the inlet to amplified denitrification at the head and mouth of the modern estuary driven by increased N inputs. Geospatial analysis of historical data suggests that an increase in fertilizer application - rather than population growth or increases in the extent of cultivated land - is chiefly responsible for increasing nutrient loads during the 20th century. This study demonstrates the ability of isotopic and stoichiometric maps to provide important perspectives on long-term shifts and spatial patterns of nutrients that can be used to improve management of nutrient pollution.

Rapid infant weight gain or point-in-time weight status: Which is the best predictor of later obesity and body composition?

OBJECTIVE: The aim of this study was to determine which growth indicator (weight, weight-for-length, BMI) and time frame (6- or 12-month intervals between 0 and 24 months) of rapid infant weight gain (RIWG) best predicted obesity risk and body composition at 11 years of age. METHODS: RIWG (increase ≥0.67 z scores between two time points) was calculated from weight and length/height at birth, 0.5, 1, 1.5, and 2 years. The predictive value of each measure and time frame was calculated in relation to obesity (BMI ≥95th percentile) and body fat (fat mass index [FMI], dual-energy X-ray absorptiometry scan) at 11 years. RESULTS: The sensitivity (1.5% to 62.1%) and positive predictive value (12.5% to 33.3%) of RIWG to predict obesity varied considerably. Having obesity at any time point appeared a stronger risk factor than any indicator of RIWG for obesity at 11 years. Obesity at any age during infancy consistently predicted a greater FMI of around 1.1 to 1.5 kg/m2 at 11 years, whereas differences for RIWG were inconsistent. CONCLUSIONS: A simple measure of obesity status at a single time point between 6 and 24 months of age appeared a stronger risk factor for later obesity and FMI than RIWG assessed by any indicator, over any time frame.

Pseudomonas aeruginosa is oxygen-deprived during infection in cystic fibrosis lungs, reducing the effectiveness of antibiotics.

Pseudomonas aeruginosa infects the lungs of patients with cystic fibrosis. Sputum expectorated from the lungs of patients contains low levels of oxygen, indicating that P. aeruginosa may be oxygen-deprived during infection. During in vitro growth under oxygen-limiting conditions, a P. aeruginosa reference strain increases expression of a cytochrome oxidase with a high affinity for oxygen, and of nitrate and nitrite reductases that enable it to use nitrate instead of oxygen during respiration. Here, we quantified transcription of the genes encoding these three enzymes in sputum samples from 18 infected patients, and in bacteria isolated from the sputum samples and grown in aerobic and anaerobic culture. In culture, expression of all three genes was increased by averages of 20- to 500-fold in anaerobically grown bacteria compared with those grown aerobically, although expression levels varied greatly between isolates. Expression of the same genes in sputum was similar to that of the corresponding bacteria in anaerobic culture. The isolated bacteria were less susceptible to tobramycin and ciprofloxacin, two widely used anti-pseudomonal antibiotics, when grown anaerobically than when grown aerobically. Our findings show that P. aeruginosa experiences oxygen starvation during infection in cystic fibrosis, reducing the effectiveness of antibiotic treatment.

Violence and Suicidal/Nonsuicidal Self-Injury Among Adolescents Undergoing Residential Treatment: An Examination of the Predictive Validity of the SAVRY, START:AV, and VRS-YV.

Using a retrospective study design, predictive validity of the Structured Assessment of Violence Risk in Youth, Short-Term Assessment of Risk and Treatability: Adolescent Version (START: AV), and the Violence Risk Scale-Youth Version (VRS-YV) was examined among 87 adolescents referred to a residential treatment program. With few exceptions, moderate to high accuracy was achieved for the three measures in predicting violence and suicidal/nonsuicidal self-injury occurring during the adolescents' time in treatment. Accuracy of the measures peaked within 90 days for violence and gradually increased over the 180-day follow-up for suicidal/nonsuicidal self-injury. Dynamic factors were more predictive of repeated events involving violence relative to static/historical factors, whereas only factors from the START: AV were predictive of repeated events involving suicidal/nonsuicidal self-injury. These results emphasize the need for further examining the risk of adverse outcomes beyond violence among adolescents.

Comparing the Effects of Consuming Almonds or Biscuits on Body Weight in Habitual Snackers: A 1-Year Randomized Controlled Trial.

BACKGROUND: Almonds are nutrient rich, providing a healthier alternative to many snacks. Studies report health benefits with regular almond consumption without adverse weight gain. However, most interventions have been relatively short or have included additional dietary advice. OBJECTIVES: Taking a pragmatic approach, we compared consumption of almonds compared with biscuits on body weight and other health outcomes in a population of regular snackers of discretionary foods, hypothesizing the almonds will displace some of the less-healthful snacks in their current diets. METHODS: We randomly assigned 136 nonobese habitual discretionary snackers to receive almonds or biscuits daily for 1 y. These isocaloric snacks provided either 10% of participants' total energy (TE) requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever was greater. Anthropometry, blood biomarkers, diet, appetite, sleep, and physical activity were assessed at baseline, 3, 6, and 12 mo, and body composition and RMR at baseline and 12 mo. RESULTS: The difference in changes for body weight from baseline to 12 mo was not statistically significant (geometric means: 67.1 and 69.5 kg for almonds and 66.3 and 66.3 kg for biscuits, P = 0.275). There were no statistically significant differences in changes for body composition or other nondietary outcomes (all P ≥ 0.112). Absolute intakes of protein; total, polyunsaturated, and monosaturated fat; fiber; vitamin E; calcium; copper; magnesium; phosphorous; and zinc, and % TE from total monounsaturated, and polyunsaturated fat statistically significantly increased from baseline (all P ≤ 0.033), whereas % TE from carbohydrate and sugar statistically significantly (both P ≤ 0.014) decreased from baseline, in the almond compared with the biscuit group. CONCLUSIONS: Almonds can be incorporated into the diets of habitual snackers to improve diet quality, without evidence for changes in body weight, compared with a popular discretionary snack food. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375610&isReview=true), registration number ACTRN12618001758291.

California's harvested wood products: A time-dependent assessment of life cycle greenhouse gas emissions.

Following life-cycle assessment (LCA) methodology, this study presents a state-level estimation of embodied carbon of wood products harvested in 2019 from California and subsequently processed, manufactured, transported, used, and disposed at the end-of-life (EoL). In a conventional static approach to LCA, all GHG emissions were aggregated and considered to occur at year 0 of the given time horizon (500 years in this study) and used a static characterization factor (CF). In dynamic LCA, GHG emissions occurring in different years were considered, and their global warming impact (GWI) was determined using a time-dependent CF over the selected time horizon of 500 years. Four scenarios were developed to examine the impact of EoL choices on GWI. It was found that dynamic GWI for all scenarios ranged from 0.27 to 0.93 million tonne CO2e, which were 45-73 % lower than those estimated with static LCA approach, indicating that the static LCA approach could lead to an underestimation of the benefits of substituting wood for non-wood products, compared to those based on dynamic LCA approach. This analysis also demonstrated that the choice of EoL treatment option is a key factor affecting the estimated GWI as it directly determines the annual emission of GHGs released into atmosphere and subsequently their warming effect depending on the time harvested wood products (HWPs) spend in the horizon of assessment. Overall, the dynamic LCA performed in this study enabled more robust interpretations of embodied carbon by including temporal boundaries associated with the HWPs life cycle.

Patterns of microparticles in blank samples: A study to inform best practices for microplastic analysis.

Quality assurance and quality control (QA/QC) techniques are critical to analytical chemistry, and thus the analysis of microplastics. Procedural blanks are a key component of QA/QC for quantifying and characterizing background contamination. Although procedural blanks are becoming increasingly common in microplastics research, how researchers acquire a blank and report and/or use blank contamination data varies. Here, we use the results of laboratory procedural blanks from a method evaluation study to inform QA/QC procedures for microplastics quantification and characterization. Suspected microplastic contamination in the procedural blanks, collected by 12 participating laboratories, had between 7 and 511 particles, with a mean of 80 particles per sample (±SD 134). The most common color and morphology reported were black fibers, and the most common size fraction reported was 20-212 µm. The lack of even smaller particles is likely due to limits of detection versus lack of contamination, as very few labs reported particles <20 µm. Participating labs used a range of QA/QC techniques, including air filtration, filtered water, and working in contained/'enclosed' environments. Our analyses showed that these procedures did not significantly affect blank contamination. To inform blank subtraction, several subtraction methods were tested. No clear pattern based on total recovery was observed. Despite our results, we recommend commonly accepted procedures such as thorough training and cleaning procedures, air filtration, filtered water (e.g., MilliQ, deionized or reverse osmosis), non-synthetic clothing policies and 'enclosed' air flow systems (e.g., clean cabinet). We also recommend blank subtracting by a combination of particle characteristics (color, morphology and size fraction), as it likely provides final microplastic particle characteristics that are most representative of the sample. Further work should be done to assess other QA/QC parameters, such as the use of other types of blanks (e.g., field blanks, matrix blanks) and limits of detection and quantification.

The influence of complex matrices on method performance in extracting and monitoring for microplastics.

Previous studies have evaluated method performance for quantifying and characterizing microplastics in clean water, but little is known about the efficacy of procedures used to extract microplastics from complex matrices. Here we provided 15 laboratories with samples representing four matrices (i.e., drinking water, fish tissue, sediment, and surface water) each spiked with a known number of microplastic particles spanning a variety of polymers, morphologies, colors, and sizes. Percent recovery (i.e., accuracy) in complex matrices was particle size dependent, with ∼60-70% recovery for particles >212 µm, but as little as 2% recovery for particles <20 µm. Extraction from sediment was most problematic, with recoveries reduced by at least one-third relative to drinking water. Though accuracy was low, the extraction procedures had no observed effect on precision or chemical identification using spectroscopy. Extraction procedures greatly increased sample processing times for all matrices with the extraction of sediment, tissue, and surface water taking approximately 16, 9, and 4 times longer than drinking water, respectively. Overall, our findings indicate that increasing accuracy and reducing sample processing times present the greatest opportunities for method improvement rather than particle identification and characterization.