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Lowndes County is a predominantly Black rural county in Alabama, in the United States, which has a historical and current legacy of racial discrimination, creating inequitable infrastructure access and adverse health impacts. Over 80% rely on on-site sanitation infrastructure and most are failing. A community assessment of exposure to untreated sewage was conducted using samples from residential drinking water, surface swabs, and soil combined with environmental water and soil samples using culture-based and quantitative polymerase chain reaction (qPCR) methods. Testing varied slightly across samples, due to difficulty of access or availability. Of 43 households, 68% and 55% of houses had detectable presence of human fecal matter indicator in their soils and on their doorsteps, respectively, and 0% had detectable amounts of culturable Escherichia coli in their drinking water. Of 40 houses sampled, 88% tested positive for E. coli in soil samples. Of 39 residences, 31% had positive presence of environmental and zoonotic parasites in soil, but none for Necator americanus , Cryptosporidium species , or Giardia intestinalis . Of the 18 sampled environmental surface waters, 100% tested positive for culturable E. coli , 50% had detectable human fecal matter indicator present, and 27% tested positive for anthropogenic parasites. This work sheds light that there is presence of culturable E. coli, human fecal matter, and anthropogenic parasites in residential soil samples of all sanitation types (municipal, septic tank, and straight piping) and in environmental surface waters throughout the sampled areas. Our findings support the narrative that sanitation infrastructure of all types in Lowndes County, Alabama are compromised and highlights residential and environmental exposure to raw wastewater. Graphical Abstract

Pediatric medical devices lag behind adult devices due to economic barriers, smaller patient populations, changing anatomy and physiology of patients, regulatory hurdles, and especially difficulties in executing clinical trials. We investigated the requirements, challenges, associated timeline, and costs of conducting a multi-site pivotal clinical trial for a Class II pediatric physiologic monitoring device. This case study focused on the negotiation of clinical trial agreements (CTAs), budgets, and Institutional Review Board (IRB) processing times for a pediatric device trial. We identified key factors contributing to delays in clinical trial execution and potential best practices to expedite the process while maintaining safety, ethics, and efficacy. The total time from site contact to first patient enrollment averaged 14 months. CTA and budget negotiations were the most time-consuming processes, averaging nearly 10 and 9 months, respectively. Reliance and local IRB processing also contributed significantly to the timeline, overall adding an average of 6.5 months across institutions. Nearly half of all costs were devoted to regulatory oversight. The COVID-19 pandemic caused significant slowdowns and delays at multiple institutions during study enrollment. Despite these pandemic-induced delays, it is important to note that the issues and themes highlighted remain relevant and have post-pandemic applicability. Our case study results underscore the importance of establishing efficient and standardized processing of CTAs, budget negotiations, and use of reliance IRBs to expedite clinical trial execution for pediatric devices. The findings also highlight the need for a national clinical trials network to streamline the clinical trial process.

In 2017, the Beats Per Minute (BPM) electronic music festival was banned from Playa del Carmen following a horrific shooting that left five dead and fifteen injured. The city’s response was to crack down on electronic music, arguing the scene posed a unique danger to the safety of the city and that electronic music was not part of Playa’s cultural identity. Those in the scene argued something else was underway, suggesting that the scene was being pushed out of the city to make room for higher end, luxury tourism development. The ousting of electronic music from the city raised important questions about the city’s cultural identity and the direction of tourism development the city would take. This essay takes a critical look at these events, tracing the way Playa’s particular electronic music scene grew to global notoriety as both a cause and consequence of the Maya Riviera’s impressive tourism expansion over the last two decades and how those in the scene believed themselves to be an essential part of the city’s heritage. The city government’s decision to oust BPM reveals how struggles over cultural heritage are at the very heart of how urban space is organized in tourism zones. Using the concept of “contestation”, this ethnographic account demonstrates how disputes over heritage and culture frame important questions of neoliberal, political-economy and can lead to counterintuitive outcomes.

[...]the way that broadcast crews seem to understand their mission to capture and relay live action from the theatre is right in line with how television promotes its coverage of live events generally: by promising not the artifice of cinema, but a transmission of actual events—a record of what happens. [...]despite various strategies aimed toward preserving liveness (or at least its “residue”), whatever success such translations have in “captur[ing] the theatrical medium” via digital media simultaneously suggests liveness as a marginal or even dispensable quality when it comes to theatre, since such an achievement implies a mediatization that does not endanger the ontological “core” of theatrical experience. [...]while the Nesta case study recounts “that 84% of audiences . . . felt real excitement” at knowing that the broadcast was simultaneous with the action onstage, it also found that time-delayed and encore screenings “appear to work just as well, suggesting that the atmosphere of the screening, and the brand, are as important as the instant relay” (14). Rather than standing as a testament to digital media’s ability to, in the proper hands and with the right strategies, maintain theatre’s liveness or a passable semblance of it, products like NT Live and the RSC’s Live from Stratford do much to suggest theatre’s independence from liveness. [...]despite the innovation apparent in the broadcast process developed by the NT, it does so for the most part using conventional and even relatively conservative theatrical productions with a blue-ribbon pedigree. [...]audiences of digital translations have no seat that anyone in the house could possibly occupy; instead, they enjoy meticulously assigned points of view designed to highlight and showcase theatrical moments and practices to (often intimate) advantage and in some cases to amplify them—a form of distortion and emphasis masquerading as immediacy, or at least as benign enhancement.

Higher education institutions have long played a key role in solving society's most pressing problems. However, as the scale and complexity of socio‐environmental problems has grown, there has been a renewed debate about the role that academic institutions should play in developing solutions and how institutional structures should be redesigned to encourage greater interdisciplinarity. In the following pages, we present a graduate student perspective on this debate. Specifically, we identify challenges facing interdisciplinary graduate student researchers and present a series of recommendations for how institutions can better prepare them to become the next generation of leaders in interdisciplinary, action‐oriented research focused on solving socio‐environmental problems. Higher education institutions have long played a key role in solving society's most pressing problems. However, as the scale and complexity of socio‐environmental problems has grown, there has been a renewed debate about the role that academic institutions should play in developing solutions and how institutional structures should be redesigned to encourage greater interdisciplinarity. In the following pages, we present a series of recommendations for how institutions can better prepare them to become the next generation of leaders in interdisciplinary, action‐oriented research focused on solving socio‐environmental problems.

Set in the town of Playa del Carmen, Mexico, my dissertation traces the expansion of organized labor in the Maya Riviera’s quickly growing tourism sector. My findings challenge well-established accounts of tourism development in Mexico which emphasize the sector’s relationship to neoliberal forms of capitalist development premised on the flexibilization of labor markets and the weakening of unions. Based on nearly two years of ethnographic fieldwork split evenly between the Sindicato de Taxistas (taxi driver union) and the Confederación Revolucionario de Obreros y Campesinos (CROC, resort and hotel worker union), I uncover a surprisingly robust labor movement underway. In this context, I examine the important political-economic and sociocultural roles each union plays in local community dynamics while also carefully documenting the different and contested meanings workers attach to their union membership. In doing so, I uncover the wide-ranging effects each union has on life in the Maya Riviera. These effects include efforts to improve workplace conditions, strengthen gender and kin relations, unions’ complicated relationships to organized crime and the local vice economy, and their impact on the environment. Organized labor in the tourism sector, I show, has led to upward mobility and job stability for workers, but at the cost of generating new inequalities across class, ethnic, and gender lines, implicating workers in organized crime, and cementing a reliance on ecologically unsustainable tourism development. To make sense of these tensions, my project engages with and builds upon the enduring social science concept of solidarity, which I examine as both a social process and as an ethical bond linking different people together. Each union, I argue, indexes a different and imperfect form of solidarity reflective of the sociocultural and political-economic contradictions of tourism and capitalist development in Mexico. My study concludes by retheorizing solidarity as a continuous and laborious process premised on the collective struggle to reduce inequality and harmonize, rather than erase, difference. In this view, solidarity is treated as a form of social labor that necessitates attending to the conditions and ethics under which it is performed.

The United States Environmental Protection Agency (EPA) defines environmental justice (EJ) as “The fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.” Environmental injustices are not just a symptom of environmental conditions themselves, but are a manifestation of legal, economic, political, and social structures of oppression.Globally, there are over 4.5 billion people who lack access to safely managed sanitation, with the largest burden of inadequate infrastructure being most greatly felt by communities which are marginalized based on income, indigeneity, and race. The work herein explores three different case studies of engagement with environmental injustices, leveraging academic environmental science and engineering, with three different theories of change: philanthropy-led research, academic-led research, and community-led research, respectively.Case 1: The Philippines has poor access to improved sanitation, declining national food security, and water scarcity during the dry seasons. Although the country does not contribute as much to man-induced climate change, the Philippines is considered to be one of the most vulnerable countries to be disproportionately affected by climate change, further exacerbating lack of access to sanitation. Through the Gates Foundation’s Reinvent the Toilet Challenge theory of change to privatize innovative technologies to develop for-profit businesses around innovative sanitation systems, a novel modular laboratory anaerobic digestate nitrification and denitrification post-treatment bioreactor system was is developed and operated for 200 days. The system achieved a combined removal of chemical oxygen demand (COD), total nitrogen (TN), and phosphorus (PO4-P) up to 84%, 69%, and 89%, respectively, and have successfully recovered vital nutrients for agricultural development by precipitating ammonium magnesium phosphate hydrate, a documented valuable slow-release solid fertilizer.Case 2: A predominately African American community in Wake County, North Carolina which, despite being surrounded by White neighborhoods with municipal water distribution lines, relies on private wells for their water supply and relies on on-site septic tanks for sanitation needs. Residents have reason to believe that both on-site water and sanitation infrastructure are compromised, and contamination is of concern. An academic-led community assessment was conducted to determine exposure to standard pathogens and chemical contaminants using culture-based and qPCR methods. Cross contamination septic tanks and wells were evaluated by comparing antibiotic resistance gene profiles, microbial source tracking, and geostatistical models. From samples of 14 household wells, 6 tested positive for total coliforms, 4 for E.coli, 10 for sucralose, and 80% and 20% of total E.coli isolates tested positive for antibiotic resistance to amoxicillin and ceftriaxone, respectively.Case 3: Lowndes County is a predominantly Black rural county in Alabama which has a rich history and present climate of racial discrimination, economic oppression, and social activism. Over 80 % of the county relies on on-site sanitation infrastructure and most of them are failing, exposing many to raw wastewater. Under the Center of Rural Enterprise and Environmental Justice’s ownership and management, a community assessment of exposure to untreated sewage was conducted using samples from residential drinking water, surface swabs, public surface waters, and both residential and public soil samples using culture-based and qPCR methods. From samples of 43 households, 68% and 55% of houses had detectable presence of human fecal matter in their residential soils and on their doorsteps, respectively. Of the 18 publicly accessible surface waters which were sampled, 50% had detectable amounts of human fecal matter present.To assess justice and equity components of the theories of change, each case study was contextualized within an equity framework and recommendations are presented regarding the execution of these strategies. Although different theories of change have various broader implications and limitations, the work herein supports the notion that environmental science and engineering can be utilized to address environmental injustices if inclusive and equitable frameworks are used in the research processes.

Background Institutional antibiograms play a key role in antimicrobial stewardship and may provide a venue for clinical decision support. Our institution recently transitioned our paper antibiogram to an enhanced digital antibiogram with antibiotic recommendations for common pediatric infections. The objectives of this study were (1) to improve the accessibility of our institutional antibiogram through a digital platform and (2) to improve trainee confidence when selecting empiric antibiotics by integrating clinical decision support. Methods The digital antibiogram was developed and evaluated at a tertiary children’s hospital. The tool was developed iteratively over one year by our innovation and digital health accelerator with recommendations for empiric antibiotic selection provided by experts in pediatric infectious diseases (see Figure 1 for example). Usability pilot testing was performed with a group of ordering providers and the tool was released internally in October 2018. A paired pre- and post- implementation survey evaluated residents’ perceptions of the accessibility of the paper vs. digital antibiogram and their confidence when selecting empiric antibiotics. Data were analyzed by Fisher exact test. Results During the 3 months after release, the digital antibiogram was accessed 1014 times with similar proportions of views for susceptibility data, dosing, and empiric antibiotic recommendations. Of the 31 pediatric residents who responded to both pre- and post- implementation surveys, only 59% had access to a copy of the paper antibiogram. Following release of the digital antibiogram, residents referred to antibiotic susceptibilities more frequently (P < 0.05, Figure 2) and were more frequently more confident when selecting the correct antibiotic dose (P < 0.01, Figure 3). See Figure 4 for dosing recommendation example. Conclusion Providing antibiotic susceptibility and dosing recommendations digitally improved accessibility and resident confidence during antibiotic prescribing. Our digital tool provides a successful platform for displaying the antibiotic data and recommendations that enable appropriate antibiotic use. Disclosures All authors: No reported disclosures.