Michael E. Schoeny

In this single-center, retrospective cohort study of 1169 patients requiring outpatient parenteral antimicrobial therapy, complications (i.e., bloodstream infections or venous thrombosis) occurred more frequently in patients with midlines (6.4 per 1,000 line-days) than peripherally inserted central catheters (1.1 per 1,000 line-days), adjusted hazard ratio 3.60 (95% confidence interval 1.66–7.81).

Background: Black adolescent females are disproportionately affected by obesity and its associated adverse health outcomes. Though racial disparities in obesity and related health outcomes are often attributed to differences in socioeconomic status, growing evidence suggests that structural racism is a contributing factor. To prevent the numerous comorbidities associated with obesity in black females, interventionists must confront the tripartite impact of structural racism, racial discrimination, and intersectionality on physical activity and dietary behaviors. The purpose of this paper was to describe Public Health Critical Race Praxis (PHCRP) as a race-conscious approach to intervention development, refinement, and evaluation. Approach: PHCRP can be applied to behavioral intervention research to provide a lens to develop, refine, deliver, and/or evaluate culturally tailored interventions. We present a description of the 4 PHCRP foci for interventionists with examples of the 10 affiliated principles. PHCRP Application: The intervention team led with the overarching principle, race consciousness, to guide their refinement efforts, including acknowledgment of personal biases, identification of the mechanisms in which bias perpetuates racism, and development of counteractivities to combat these biases. The intervention team operationalized PHCRP by critically evaluating decisions through a race-conscious lens, ensuring that the 4 foci remained foundational throughout the refinement process. Discussion: Interventionists have unintentionally reinforced racism with complicit silence by not directly addressing the profound influence of racism on health behaviors. We urge interventionists to regard the inclusion of a race-conscious framework, such as PHCRP, as a necessary requirement for designing interventions with marginalized populations.

Background: Sequential physical activity interventions hold promise in developing effective interventions when adapted to participants’ physical activity. Adaptive interventions can be further strengthened by understanding the moderators of their effects on physical activity outcomes. Purpose: To determine whether baseline personal characteristics moderated the impact of adaptive interventions on physical activity in the Working Women Walking trial. Methods: This study analyzed data from a sequential multiple assignment randomized trial (SMART) targeting 18- to 70-year-old women employed at an urban medical center who self-reported low physical activity (N = 301). Four adaptive interventions included combinations of Initial Treatments (Fitbit or Fitbit + Text Messages) and Augmented Treatments for nonresponders (Motivational Calls or Group Meetings). Personal characteristics, including demographics, health status, self-reported physical activity, and neighborhood walkability, were measured at baseline. Moderation of intervention effects was tested across ActiGraph-assessed physical activity at baseline, 9-10 weeks (end of Initial Phase), 35-36 weeks (end of Augmented Phase), and 49-50 weeks (end of Maintenance). Results: There was no evidence that personal characteristics moderated the differential impact of the Initial or Augmented Treatments on device-assessed steps or moderate-to-vigorous physical activity. Independent of the Initial Treatment, Black race, higher baseline body mass index, and higher baseline self-reported moderate-to-vigorous physical activity were associated with lower increases in physical activity (P < .05) during the Initial Phase. Lower neighborhood walkability was associated with relative decreases in physical activity during the Maintenance Phase. Conclusions: Although personal characteristics may have altered the degree to which participants increased their physical activity, they did not alter the differential impact of the adaptive interventions. Clinical Trial Registration Number: ClinicalTrials.gov identifier: NCT03558828.

Background: Digital interventions offer scalable solutions for program accessibility but face challenges with engagement and adherence. Hybrid delivery models integrating human support through coaching may enhance engagement outcomes, which can improve intervention or clinical outcomes. Purpose: This study describes a structured, intervention-agnostic coaching model and associated training procedures designed to reinforce digital intervention content without requiring specialist expertise. It evaluates the feasibility, fidelity, and acceptability of the coaching model, including participant satisfaction. Methods: Parents of toddlers born very preterm (n = 113) received digital parent training or health education paired with weekly coaching calls. Eleven coaches from diverse educational backgrounds completed a standardized training protocol. Feasibility was assessed via observations and coach self-report of adherence and competence. Acceptability was evaluated through parent satisfaction surveys. Descriptive analyses summarized fidelity, engagement, and program completion. Results: Coaches demonstrated high adherence (M = 94.9%) and competence (M = 88.9%) across 266 observed calls, with minimal variance. Parent call engagement was rated high (M = 2.70; 3-point scale). Most parents (75%) attended ≥6 of 11 coaching calls, and 64% completed all 6 digital program modules. Satisfaction was strong, with 93.6% of parents reporting being satisfied or very satisfied, and over 70% felt connected to their coach. Calls were brief (M = 12.9 minutes), supporting feasibility for busy families. Conclusions: An intervention-agnostic coaching model delivered by non-specialists was feasible and acceptable for parent participants. Development of a standardized coaching manual and testing across additional digital interventions are planned to enhance scalability and replication. Clinical trial identification number: NCT05217615; ClinicalTrials.gov.

Background: Surveillance of wastewater from healthcare facilities has the potential to identify the emergence of multidrug-resistance (MDR) genes of public health importance. Specifically, wastewater surveillance (WWS) can provide sentinel surveillance of novel MDR genes or organisms in healthcare facilities, helping to direct targeted prevention efforts and monitor longitudinal effects. Several knowledge gaps need to be addressed before WWS can be used routinely for MDR surveillance, including determining optimal approaches to sampling, processing, and testing wastewater. Methods: To this end, we evaluated multiple methods for wastewater collection (passive, composite, and grab), concentration (nanoparticles, filtration, and centrifugation), and PCR quantification (real-time quantitative PCR vs. digital PCR) for Candida auris and 5 carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48-like) twice weekly for 6 months at a long-term acute care hospital in Chicago, IL. We also tested the effects of different transport and sample storage conditions on PCR quantification. Results: All genes were detected in facility wastewater, with blaKPC being the most consistently abundant. Experiments were done in triplicate with gene copy, variance, and number of detections between triplicates used to determine method efficacy. We found that passive samples processed immediately by centrifugation followed by bead-beating and dPCR provided the most reliable results for detecting MDR genes and C. auris. We also present the tradeoffs of different approaches and use culture and metagenomics to elucidate clinical relevance. Conclusions: This study establishes a practical approach for WWS as a potential tool for public health monitoring of MDR burden in healthcare facilities.

Background: Different interventions have shown efficacy in improving physical activity in women. This study aimed to determine the most effective adaptive intervention combining 4 efficacious treatments (Fitbit, text messages, personal calls, and group meetings) for improving physical activity. Methods: The Working Women Walking program used a Sequential Multiple Assignment Randomized Trial (SMART) design with 3 phases: initial (weeks 1–8), augmented (weeks 9–34), and maintenance (weeks 35–50). Low-active women aged 18–70 working at an academic medical center were recruited. In the initial phase, participants were randomized to Fitbit or Fitbit + text messages. After 8 weeks, nonresponders were rerandomized to an augmented treatment (personal calls or group meetings). The primary outcomes (steps/day and minutes of moderate/vigorous physical activity [MVPA]/day via ActiGraph) were assessed at baseline and 8, 34, and 50 weeks. Results: The study had 301 women (age: 45.1 [11.6] y). During the initial phase, there were no differences by initial treatment for change in steps (P = .78) or MVPA (P = .60). During the augmented phase, there were no differences by augmented treatment among nonresponders for change in steps (P = .95) or MVPA (P = .78). A significant overall increase was seen in steps (752/d; P < .001, d = 0.56) and MVPA at 8 weeks (4.1 min/d; P < .001, d = 0.48), and this was sustained at 34 and 50 weeks. Conclusions: Text messages, personal calls, and group meetings did not lead to increased physical activity. Using Fitbit and goal setting (a constant) appeared to have some benefit for many of the women in improving physical activity.

Background: Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain.Methods: We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events.Results: Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment.Conclusion: A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Background: Young Arab American women are at risk for cardiovascular disease, but there is limited data on their physical activity (PA) engagement. Objectives: The aim of this study was to examine the relationship between PA and its correlates in young Arab American women. The objectives of this study were to: (1) describe self-reported lifestyle PA behaviors of young Arab American women and (2) examine the relationship between their self-reported lifestyle PA, device-measured lifestyle PA (combined moderate /vigorous and steps), and potentially associated factors (demographics, physical measures, individual factors, and behavior cognition factors). Methods: This cross-sectional study was conducted with women 18 to 35 years of age and Arab American (n = 50) in the Midwest Region of the United States. Participants wore ActiGraph GT3X-BT monitors for 7 days; self-report measures included the International Physical Activity Questionnaire, demographics, acculturation, discrimination, religiosity, self-efficacy, and social support. Results: The mean age of participants was 25.5 years ( SD: 5.5; range: 18-35). Per ActiGraph, the average daily steps were 5946 ( SD: 2783); only 24% met the moderate-intensity PA guidelines. Self-efficacy was significantly associated with increased moderate-to-vigorous PA ( B = 0.37; P = .012). Conclusion: The average daily steps for the young Arab American women in this study were of low active classification. More than 75% of the women failed to meet the recommended weekly moderate /vigorous PA guidelines. Our study supports the importance of targeting and tailoring PA interventions on young Arab American women who have low self-efficacy for overcoming barriers to lifestyle PA.

Objective: To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization.Design: Serial cross-sectional study.Setting/participants: Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU.Methods: Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models.Results: We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80–0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89–0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91–1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84–1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed.Conclusions: On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.

High engagement in lifestyle health behaviors appears to be protective against cognitive decline in aging. We investigated the association between patterns of modifiable lifestyle health behaviors and common brain neuropathologies of dementia as a possible mechanism. We examined 555 decedents from the Rush Memory and Aging Project, free of dementia at their initial concurrent report of lifestyle health behaviors of interest (physical, social, and cognitive activities, and healthy diet), and who underwent a postmortem neuropathology evaluation. First, we used latent profile analysis to group participants based on baseline behavior patterns. Second, we assessed the associations of profile membership with each neurodegenerative (global Alzheimer’s disease [AD] pathology, amyloid-beta load, density of neurofibrillary tangles, and presence of cortical Lewy bodies and TAR DNA-binding protein 43 cytoplasmic inclusions) and neurovascular pathologies (presence of chronic gross or microscopic infarcts, arteriolosclerosis, atherosclerosis, and cerebral amyloid angiopathy), using separate linear or logistic regression models, adjusted for age at death, sex (core model), vascular disease risk factors, and vascular conditions (fully adjusted model). Participants had either consistently lower (N = 224) or consistently higher (N = 331) engagement across 4 lifestyle health behaviors. We generally found no differences in neuropathologies between higher and lower engagement groups in core or fully adjusted models; for example, higher engagement in lifestyle health behaviors was not associated with global AD pathology after core or full adjustment (both p > .8). In conclusion, we found no evidence of associations between patterns of lifestyle health behaviors and neuropathology. Other mechanisms may underlie protective effects of health behaviors against dementia.