To sample or not to sample: A governance-focused decision tree for wastewater service providers considering participation in wastewater-based epidemiology (WBE) in support of public health programs.

Wastewater-based epidemiology (WBE) provides value to public health monitoring and protection. Participation of public and private wastewater system operators in WBE efforts is critical to public health surveillance program success and sustainability. However, given the number of WBE solicitations wastewater service providers receive, the limitation of service provider resources, the concerns around privacy, ethics, and equity, and the fatigue associated with responding to COVID-19, operators are becoming more hesitant to participate in WBE efforts. While various ethical concerns and sustainability challenges associated with WBE have been documented, no efforts to date have investigated what factors should systematically influence the decision to provide samples to a WBE effort. Therefore, this study develops a decision-making tool for WBE teams to proactively monitor, manage, and avoid wastewater system operators' operational risks and potential liabilities. Ultimately, using this tool allows WBE program partners in academia, government, and industry to better understand wastewater system operators' needs and challenges surrounding data quality and use, public health ethics, and daily wastewater infrastructure operation.

Monitoring coliphages to reduce waterborne infectious disease transmission in the One Water framework.

Coastal waters, surface waters, and groundwater are impacted by wastewater and stormwater discharges, as well as agricultural flows containing animal waste and nutrients. A One Water approach posits that components of the water system have overlapping and interactive impacts on other aspects of the system, for which a comprehensive approach to water management is needed to further inform public health decisions. Current frameworks for monitoring wastewater effluent and recreational surface waters include the measurement of fecal indicator bacteria. Although viral pathogens are likely to be transported further and can survive longer than bacterial pathogens, virus monitoring is not required for recreational waters. A scientific consensus is emerging that the use of bacterial indicators alone does not account for nor represent the health risks associated with viral pathogens due to the differences in the fate and transport of bacterial versus viral pathogens in wastewater treatment, surface water, and groundwater. Furthermore, it is likely that the public health risk associated with these waterborne pathogens is variable and diverse. For example, under drought conditions, effluents of urban water systems can comprise most of the dry weather flow in downstream waters, which are often used as sources of drinking water. This de facto reuse could increase viral risk for the end users of this water. A One Water approach will aid in protecting the health of the public from waterborne pathogens, regardless of where those pathogens entered the water system. In this review, we assert that monitoring for fecal indicator viruses can complement the monitoring of bacterial indicators, thereby improving public health protections. Bacteriophages have the strongest research foundation and correlation with viral pathogens along with some prediction power for risk to human health. Methods for detecting and quantifying coliphages are briefly summarized, as are challenges in the implementation of testing. Key knowledge gaps and research priorities are discussed so that the potential value and limitations of coliphage monitoring can be better addressed and understood.

Assessing and managing SARS-CoV-2 occupational health risk to workers handling residuals and biosolids.

Current wastewater worker guidance from the United States Environmental Protection Agency (USEPA) aligns with the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) recommendations and states that no additional specific protections against SARS-CoV-2, the virus that causes COVID-19 infections, are recommended for employees involved in wastewater management operations with residuals, sludge, and biosolids at water resource recovery facilities. The USEPA guidance references a document from 2002 that summarizes practices required for protection of workers handling class B biosolids to minimize exposure to pathogens including viruses. While there is no documented evidence that residuals or biosolids of any treatment level contain infectious SARS-CoV-2 or are a source of transmission of this current pandemic strain of coronavirus, this review summarizes and examines whether the provided federal guidance is sufficient to protect workers in view of currently available data on SARS-CoV-2 persistence and transmission. No currently available epidemiological data establishes a direct link between wastewater sludge or biosolids and risk of infection from the SARS-CoV-2. Despite shedding of the RNA of the virus in feces, there is no evidence supporting the presence or transmission of infectious SARS-CoV-2 through the wastewater system or in biosolids. In addition, this review presents previous epidemiologic data related to other non-enveloped viruses. Overall, the risk for exposure to SARS-CoV-2, or any pathogen, decreases with increasing treatment measures. As a result, the highest risk of exposure is related to spreading and handling untreated feces or stool, followed by untreated municipal sludge, the class B biosolids, while lowest risk is associated with spreading or handling Class A biosolids. This review reinforces federal recommendations and the importance of vigilance in applying occupational risk mitigation measures to protect public and occupational health.

Evaluation of Preparedness and Recovery Needs of Private Well Users After the Great Louisiana Flood of 2016.

CONTEXT: The August 2016 Louisiana flood marked the second 500-year flood in the state in 1 year. OBJECTIVE: The aim of this study was to identify private well user needs in the aftermath of the flood and to develop disaster planning and recovery recommendations for flood-prone well-reliant communities. DESIGN: A descriptive cross-sectional study was conducted to collect information from a convenience sample of flood-impacted well users via surveys and water sampling kits, which were distributed to well users 9 to 11 weeks after floodwaters receded (n = 106). SETTING: Surveys and kits were distributed at roadside flood response and recovery stations set up by local churches in French Settlement, Livingston Parish, Louisiana, an area at the epicenter of the flood-impacted area. PARTICIPANTS: Subjects were included if they self-reported having a flood-impacted well. MAIN OUTCOME MEASURES: Surveys collected information to characterize knowledge gaps, risk perceptions, flood impacts, resource accessibility, and well maintenance barriers. Well water tests evaluated total coliform and Escherichia coli. RESULTS: Among those in low-risk flood zones (n = 22), 27% were in areas designated as having flooded. Among flood-impacted wells that were shock chlorinated after the flood (n = 16), 31.3% tested positive for total coliform and 12.5% for E coli. Only 26% of respondents received well-related information after the disaster. CONCLUSIONS: Results highlight critical needs for disaster planning and well user education in flood-prone areas, changes to flood risk maps, and concerns with the efficacy of disinfection strategies. Information and resources needs for flood-impacted well users are presented and recommendations on how to improve flood preparedness and recovery are made.

Improving stereotypes: The impact of interprofessional education in pre-health students.

Research within interprofessional education (IPE) indicates health professional students hold stereotypes of other health professions at all stages within their academic journey. IPE can minimize negative stereotypes and influence a student's willingness and readiness to collaborate with others. This article explores undergraduate pre-health student stereotypes of various health professionals at the beginning and end of a six-week summer academic enrichment program, which included IPE. Convenience sampling was used to request participation in a survey, which included the Student Stereotypes Ratings Questionnaire (SSRQ). The SSRQ asks students to rate their perception of health professions on multiple traits. One hundred pre-health students across three institutions completed the SSRQ. The mean scores across all professions and all traits increased post-survey. Lowest pre-mean scores were for nursing (the ability to work independently and the ability to lead a team) and registered dietitian (the ability to lead a team). The highest pre-mean score was for the physician profession for academic ability. Results from this study indicate varying levels of stereotypes have already developed in pre-health students. After the six-week program, pre-health students' perceptions of health professions were positively affected. Data from this study indicates there are benefits to exposing pre-health students to IPE.

Implications of SARS-CoV-2 on current and future operation and management of wastewater systems.

While researchers have acknowledged the potential role of environmental scientists, engineers, and industrial hygienists during this pandemic, the role of the water utility professional is often overlooked. The wastewater sector is critical to public health protection and employs collection and treatment system workers who perform tasks with high potential for exposures to biological agents. While various technical guidances and reports have initially provided direction to the water sector, the rapidly growing body of research publications necessitates the constant review of these papers and data synthesis. This paper presents the latest findings and highlights their implications from a water and wastewater utility operation and management perspective. PRACTITIONER POINTS: Extrapolation from SARS-CoV-1 and MERS-CoV, as well as other surrogates, has helped predicting SARS-CoV-2 behavior and risk management. Data from treated wastewater effluent suggest that current processes are sufficient for SARS-CoV-2 control. Scientific evidence supports the possibility of fecal-oral transmission for SARS-CoV-2. Limited evidence supports the potential survival of infective SARS-CoV-2 on surfaces and in aerosols and the efficacy of control measures at reducing transmission. Protective practices and PPE can protect workers from SARS-CoV-2 and other pathogens found in wastewater.

Panic in the Streets-Pandemic and Protests: A Manifestation of a Failure to Achieve Democratic Ideals.

America is at a critical crossroads in history as the COVID-19 pandemic expands. We argue that the failure to respond effectively to the pandemic stems from the nation's protracted divergence from the democratic ideals, we purport to value. Structural racism and class-based political and economic inequity are sustained through the failings of the nation's democratic institutions and processes. The situation has, in turn, fostered further inequity and undermined science, facts, and evidence in the name of economic and political interests, which in turn has encouraged the spread of the pandemic, exacerbated health disparities, and escalated citizen tensions. We present a broad vision of reforms needed to achieve democratic ideals which we believe is the most important first step to achieving true political representation, achieving a resilient and sustainable economy, and fostering the health of vulnerable communities, workers, and the planet.

The Environmental Health Impact of Hurricane Katrina on New Orleans.

Hurricane Katrina caused unprecedented flood damage to New Orleans, Louisiana, and has been the costliest hurricane in US history. We analyzed the environmental and public health outcomes of Hurricane Katrina by using Internet searches to identify epidemiological, sociodemographic, and toxicological measurements provided by regulatory agencies.Atmospheric scientists have now warned that global warming will increase the proportion of stronger hurricanes (categories 4-5) by 25% to 30% compared with weaker hurricanes (categories 1-2).With the new $14.6 billion Hurricane Storm Damage Risk Reduction System providing a 100-year storm surge-defensive wall across the Southeast Louisiana coast, New Orleans will be ready for stronger storms in the future.

Preparing Students for a More Public Health-Aware Market in Response to COVID-19.

The COVID-19 pandemic has made the public more aware of public health and the role its professionals play in addressing the pandemic. Schools and programs in public health have a new opportunity to recruit, train, and sustain the public health workforce. Academic public health can further educate the public and prepare students for meaningful careers through interprofessional education and practice-based learning.

Residuals, sludge, and biosolids: Advancements in the field.

Advancements in the field of residuals, sludge, and biosolids have been made in 2019. This review outlines the major contributions of researchers that have been published in peer-reviewed journals and conference proceedings throughout 2019 and includes brief summaries from over 125 articles. The review is organized in sections including life cycle and risk assessments; characteristics, quality, and measurement including micropollutants, nanoparticles, pathogens, and metals; sludge treatment technologies including dewatering, digestion, composting, and wetlands; disposal and reuse including adsorbents, land application and agricultural uses, nutrient recovery, and innovative uses; odor and air emissions; and energy issues.

Biosolids and sludge management.

The advancements in the field of sludge and biosolids have been made over the past year. This review outlines the major contributions of researchers that have been published in peer-reviewed journals and conference proceedings throughout 2018. The review is organized in sections including regulatory developments and market analysis; analysis and quantification of characteristics including microconstituents and metals; treatment advances for the conversion of sludge to biosolids including pretreatment and sludge minimization, conditioning and dewatering, digestion, composting, and innovative technologies; product development and reuse including adsorbents and thermal products, agricultural and other uses, and innovative uses; odor and air emissions; and energy factors. PRACTITIONER POINTS: Summary of advances in the field of residuals and biosolids research in 2018. This review outlines the major contributions of researchers that have been published in peer-reviewed journals and conference proceedings. Topics covered range from regulation to innovation.

Supporting Health System Transformation: The development of an integrated interprofessional curriculum inclusive of public health students.

Under pressures to support health system transformation, many health professional accreditation organizations have incorporated standards requiring interprofessional education. However, the inclusion of population health topics and public health or health administration students into IPE experiences is limited. With the belief that understanding and cooperation among the health professions will be important to support health system transformation, The Louisiana State University Health Sciences Center-New Orleans has created several IPE experiences focused on population health, programs that are examined in this article along with insights that could prove useful for other programs seeking to build IPE into their regular curricula.

Supporting health system transformation through an interprofessional education experience focused on population health.

The purpose of the study was to determine the impact of an interprofessional education (IPE) experience on first year students across all schools of a health sciences center on the topic of pediatric immunizations. The authors conducted a pre-/post-test at Louisiana State University Health Sciences Center-New Orleans with 731 first year students from 25 academic programs encompassing all six schools (Allied Health, Dentistry, Graduate Studies, Medicine, Nursing and Public Health). In the four questions related to the Interprofessional Education Collaborative (IPEC) sub-competencies and the three questions related to professional role regarding immunizations, there was a statistically significant difference in the pre-/post-test survey results (P < 0.0001). Student learning related to the collaboration needed to make a larger impact on patient outcomes was demonstrated through assessment of an open-ended question. IPE experiences can improve first-year students' perceptions of IPEC sub-competencies regarding the importance of population health and teamwork. By utilizing a population health focus with IPE activities, novice learners are equipped to learn and apply collaborative practice skills along with recognizing the importance of promoting overall health and well-being instead of just health care.

Biosolids and Sludge Management.

The field of biosolids and sludge has progressed significantly over the past year. This review includes summations of the leading research published in journals and conference proceedings in 2017. The following sections are presented: biosolids regulations and management issues; biosolids characteristics, quality and measurement including microconstituents, pathogens, nanoparticles, and metals; sludge treatment technologies including pretreatment and sludge minimization, conditioning and dewatering, digestion, composting, and innovative technologies; disposal and reuse including combustion/incineration, agricultural uses, and innovative uses; odor and air emissions; and energy issues.

Biosolids and Sludge Management.

This review covers journal articles and conference papers related to biosolids and sludge management that were published in 2016. The literature review has been divided into the following sections: •Biosolids regulations and management issues; • Biosolids characteristics, quality and measurement including microconstituents, pathogens, nanoparticles, and metals; • Sludge treatment technologies including pretreatment and sludge minimization, conditioning and dewatering, digestion, composting, and innovative technologies; • Disposal and reuse including combustion/ incineration, agricultural uses, and innovative uses; • Odor and air emissions; and • Energy issues.

Aligning interprofessional education collaborative sub-competencies to a progression of learning.

In the United States, the Interprofessional Education Collaborative (IPEC) developed four core competencies for interprofessional collaborative practice. Even though the IPEC competencies and respective sub-competencies were not created in a hierarchal manner, one might reflect upon a logical progression of learning as well as learners accruing skills allowing them to master one level of learning and building on the aggregate of skills before advancing to the next level. The Louisiana State University Health-New Orleans Center for Interprofessional Education and Collaborative Practice (CIPECP) determined the need to align the sub-competencies with the level of behavioural expectations in order to simplify the process of developing an interprofessional education experience targeted to specific learning levels. In order to determine the most effective alignment, CIPECP discussions revolved around current programmatic expectations across the institution. Faculty recognised the need to align sub-competencies with student learning objectives. Simultaneously, a progression of learning existing within each of the four IPEC domains was noted. Ultimately, the faculty and staff team agreed upon categorising the sub-competencies in a hierarchical manner for the four domains into either a "basic, intermediate, or advanced" level of competency.

Biosolids and Sludge Management.

This review section covers journal articles and conference papers related to biosolids and sludge management that were published in 2015. The literature review has been divided into the following sections: • Biosolids regulations and management issues; • Biosolids characteristics, quality and measurement including microconstituents, pathogens, nanoparticles and metals; • Sludge treatment technologies including pretreatment and sludge minimization, conditioning and dewatering, digestion, composting and innovative technologies; • Disposal and reuse including combustion/incineration, agricultural uses and innovative uses; • Odor and air emissions; and • Energy issues.

Biosolids and Sludge Management.

This review section covers journal articles and conference papers related to biosolids and sludge management that were published in 2014. The literature review has been divided into the following sections: • Biosolids regulations and management issues; • ;Biosolids characteristics, quality and measurement including microconstituents and pathogens; • Sludge treatment technologies including pretreatment and sludge minimization, conditioning and dewatering, digestion, composting and innovative technologies; • Disposal and reuse including combustion/ incineration, land application and non- agricultural use; • Odor and air emissions; and • Energy issues.