CDC Model Research Articles

Additional Burden Averted in the United States From Use of MF59-Adjuvanted Seasonal Influenza Vaccine Compared With Standard Seasonal Influenza Vaccine Among Adults ≥65 Years.

The MF59-adjuvanted trivalent inactivated influenza vaccine (aIIV3) is designed to overcome immunosenescence and enhance vaccine responses in older adults. We expanded on the Centers for Disease Control and Prevention (CDC) modeling method to estimate the number of additional influenza-related outcomes averted with aIIV3 versus generic quadrivalent inactivated influenza vaccine (IIV4) in adults ≥65 years over 3 influenza seasons (2017-2018 to 2019-2020) in the United States. A static compartmental model was developed based on an existing CDC model with 2 previously recommended calculation methods that increased the accuracy of the model in providing estimates of burden averted. Model inputs included vaccine effectiveness, vaccine coverage, population counts, and disease burden estimates. Additional burden averted (symptomatic cases, outpatient visits, hospitalizations, intensive care unit [ICU] admissions, and deaths) was expressed as total incremental cases averted between the vaccines. Sensitivity analyses tested the resilience of the model results to uncertainties in model inputs. The model estimated that vaccination with aIIV3 versus IIV4 would avert 2.24 times as many symptomatic cases, outpatient visits, hospitalizations, ICU stays, and deaths during 2017-2018; the burden averted in 2018-2019 and 2019-2020 with aIIV3 would be 3.44 and 1.72 times that averted with IIV4, respectively. Disease burden estimates and relative vaccine effectiveness of aIIV3 had the greatest impact on model estimates. Over 3 influenza seasons, the model estimated that aIIV3 was more effective than IIV4 in averting influenza-related outcomes, preventing 1.72 to 3.44 times as many influenza illnesses with proportionate decreases in related healthcare use and complications.

The new Norwegian curriculum and integration of knowledge in textbooks in social studies: a comparative study

The new Norwegian curriculum subject renewal is part of an international trend with a shift towards more knowledge-based curriculum, with greater emphasis on subjects and subject concepts, with the aim of realizing in-depth learning in schools. This paper, which is grounded on social realism and Ratas' CDC model, examines, and compares the design of the curriculum and the new textbooks in social studies. The comparative study reveals a gap between the curriculum and the textbooks, with quite different interpretations of the Norwegian curriculum reform. The paper explains why coherence design, which connects subject concepts, content knowledge and competencies, is a prerequisite for in-depth learning in social studies.

Developing teacher curriculum design expertise: using the CDC Model in the music classroom

AbstractThe purpose of this paper is to discuss the impact of the Curriculum Design Coherence Model (CDC Model – Rata, 2019) on the design practice of two music teachers in a middle school music class in New Zealand. The CDC Model proposes that deep learning first requires deep design coherence. This coherence is generated by three interrelated design dimensions: (i) the ‘surfacing’ of epistemic structure, (ii) the use of subject concepts and (iii) the interrelationship between ‘knowledge-that’ (knowledge of something) and ‘know-how-to’ (knowing how to do something with that knowledge of something). We discuss how the model has been put to use in the design of a song writing unit of work for students aged 10–12 years in a general music class and note the impact of the model on the developing design expertise of the two music teachers involved in a wider research project.

Outbreaks of Acute Gastrointestinal Illness Associated with a Splash Pad in a Wildlife Park - Kansas, June 2021.

In June 2021, Kansas state and county public health officials identified and investigated three cases of shigellosis (a bacterial diarrheal illness caused by Shigella spp.) associated with visiting a wildlife park. The park has animal exhibits and a splash pad. Two affected persons visited animal exhibits, and all three entered the splash pad. Nonhuman primates are the only known animal reservoir of Shigella. The splash pad, which sprays water on users and is designed so that water does not collect in the user area, was closed on June 19. The state and county public health codes do not include regulations for splash pads. Thus, these venues are not typically inspected, and environmental health expertise is limited. A case-control study identified two distinct outbreaks associated with the park (a shigellosis outbreak involving 21 cases and a subsequent norovirus infection outbreak involving six cases). Shigella and norovirus can be transmitted by contaminated water; in both outbreaks, illness was associated with getting splash pad water in the mouth (multiply imputed adjusted odds ratio [aORMI]=6.4, p = 0.036; and 28.6, p = 0.006, respectively). Maintaining adequate water disinfection and environmental health expertise and targeting prevention efforts to caregivers of splash pad users help prevent splash pad-associated outbreaks. Outbreak incidence might be further reduced when U.S. jurisdicitons voluntarily adopt CDC's Model Aquatic Health Code (MAHC) recommendations and through the prevention messages: "Don't get in the water if sick with diarrhea," "Don't stand or sit above the jets," and "Don't swallow the water."†.

Teacher Becoming Curriculum Designer: Professional Teaching and Learning in China's Early Childhood Education.

The Curriculum Design Coherence Model (CDC Model) was created as a universal curriculum design method to connect disciplinary knowledge to teachers’ expertise in a bid to promote professional teaching and learning. However, research into how the CDC Model has been adopted and localized in the Chinese educational context is scarce. This article focuses on the application and impact of the CDC Model on the resulting teaching practices in China’s Early Childhood Education (ECE) settings. The data collected through a focus group discussion with 21 teachers from a model kindergarten at the municipal level in China reveals that the CDC Model has increased the teachers’ professionalism by promoting their curriculum initiative, forging curriculum knowledge orientation, strengthening the conceptual structure within the kindergarten-developed curriculum, and enhancing the coordination between the curricula of the different courses offered by the kindergarten. This positive influence has also helped the teachers bridge their disagreement on curriculum content and pedagogy and overcome some difficulties in using the CDC Model. The study has implications for revitalizing the value of disciplinary knowledge and for viewing ECE teachers as active professional agents in ECE curriculum design and teaching.

The Often-Overlooked Applicant: The Medical Technologist as a Qualified Candidate for Novice Infection Prevention Positions

BackgroundThe current shortage of healthcare workers (HCW) across the country has been exacerbated by the COVID-19 pandemic, and the role of infection preventionist (IP) is no exception. As a result, a shift to broaden the scope of HCWs entering IP has gained attention. This study sought to compare competency expectations between medical technologists (MT) and IPs to better understand the bridge between the two professions, with the intent of highlighting MTs as qualified candidates for novice IP positions.MethodsThis study evaluated available competency guidelines for MTs and compared them to the 2019 Association for Professionals in Infection Control and Epidemiology (APIC) competency model for the IP. The primary source used for this study was the Competency Guidelines for Laboratory Professionals resource made available through the Centers for Disease Control and Prevention (CDC). Supplemental competency data was drawn from a research article focused on MTs with 3-5 years of experience. Domains within the CDC's model were determined to either be completely, partially, or not addressed within APIC's model. The 6 primary domains and 32 subdomains of the APIC model were then compared to the CDC model, both with and without the supplemental article data, and results evaluated.ResultsResults showed a 74% complete and partial match between the APIC 2019 competency model and domains within the CDC MT competency model, or 28 of 38 domains. When supplemental competency data was included for MTs with 3-5 years of experience with additional education, there was an 82% complete and partial match between sources, or 31 of 38 domains.ConclusionsThis study demonstrates that MTs, particularly with 3-5 years of experience with additional education, possess a strong foundational knowledge set for novice IP positions. Hiring managers should strongly consider MT applicants for open IP positions moving forward.

Evaluation of the Pathogenic-Mixed Biofilm Formation of Pseudomonas aeruginosa/Staphylococcus aureus and Treatment with Limonene on Three Different Materials by a Dynamic Model.

Background: Biofilms have been found growing on implantable medical devices. This can lead to persistent clinical infections. The highly antibiotic-resistant property of biofilms necessitates the search for both potent antimicrobial agents and novel antibiofilm strategies. Natural product-based anti-biofilm agents were found to be as efficient as chemically synthesized counterparts with fewer side effects. In the present study, the effects of limonene as an antibiofilm agent were evaluated on Pseudomonas aeruginosa and Staphylococcus aureus biofilm formed on different surfaces using the CDC model system in continuous flow. The flgK gene and the pilA gene expression in P. aeruginosa, and the icaA gene and eno gene in S. aureus, which could be considered as efficient resistance markers, were studied. Methods: Mono- and dual-species biofilms were grown on polycarbonate, polypropylene, and stainless-steel coupons in a CDC biofilm reactor (Biosurface Technologies, Bozeman, MT, USA). To evaluate the ability of limonene to inhibit and eradicate biofilm, a sub-MIC concentration (10 mL/L) was tested. The gene expression of P. aeruginosa and S. aureus was detected by SYBR Green quantitative Real-Time PCR assay (Meridiana Bioline, Brisbane, Australia). Results: The limonene added during the formation of biofilms at sub-MIC concentrations works very well in inhibiting biofilms on all three materials, reducing their growth by about 2 logs. Of the same order of magnitude is the ability of limonene to eradicate both mono- and polymicrobial mature biofilms on all three materials. Greater efficacy was observed in the polymicrobial biofilm on steel coupons. The expression of some genes related to the virulence of the two microorganisms was differently detected in mono- and polymicrobial biofilm. Conclusions: These data showed that the limonene treatment expressed different levels of biofilm-forming genes, especially when both types of strains alone and together grew on different surfaces. Our findings showed that limonene treatment is also very efficient when biofilm has been grown under shear stress causing significant and irreversible damage to the biofilm structure. The effectiveness of the sanitation procedures can be optimized by applying antimicrobial combinations with natural compounds (e.g., limonene).

Sự thăng tiến của cựu người học thạc sĩ Y tế công cộng tại khu vực Tây Nam Bộ tốt nghiệp Trường Đại học Y tế công cộng giai đoạn 2010 – 2019

Objective: Describe the employment position and advancement of the former Master of Public Health (MSc) student in the Southwestern area of the University of Public Health, 2010-2019 Research methodology: Using cross-sectional research methods, collecting quantitative data by self-filling questionnaires. Data are collected in 2020 by sending online ballots in the form of google forms to all former learners. Results: Interview results obtained from 110 former learners showed that after graduating from the MSC program, 16.4% of former learners changed positions, 30.9% of former learners changed positions. go on bussiness. In which, at present, 64.5% of former trainees work at the provincial level and 43.6% work in preventive medicine. Conclusion: The mobilization, appointment / prompting agency and the implementation of the CDC model at the provincial level and the 2-function district health center are the reasons for the advancement of former students of the area South West region after graduation. Keywords: Promotion, job placement, training, master of public health.

What is a knowledge-rich curriculum?

A well-designed curriculum creates a knowledge-rich one. The application of the Curriculum Design Coherence Model (CDC Model) in the international Knowledge-Rich School Project is discussed to demonstrate the effectiveness of the Model as a design tool. It achieves coherence by connecting the three forms of subject knowledge: generalising concepts, materialised content and applied competencies. Concepts’ generalisability creates knowledge’s internal logic – the source of understanding (learning). Students only develop deep understanding when they work with generalising concepts. Thinking (learning) doesn’t occur in a vacuum – one must think with something (concepts). And students also need to think about something (content). The article explains why it is essential to connect concepts and content. Such connection overcomes the limitations of both a ‘big ideas’ or concepts-only approach and a content-list approach. The CDC Model’s connection of generalising concepts, materialised content and applied competencies also reveals why New Zealand’s current competency-centred curriculum is inadequate. Two examples show how the CDC Model is used – a Physical Education topic ‘Exercise’ and a Social Studies topic, ‘The History of Ngati Kuri.’ Topics designed in the Knowledge-Rich School Project are mentioned.

Outbreaks Associated with Treated Recreational Water - United States, 2015-2019.

Outbreaks associated with treated recreational water can be caused by pathogens or chemicals in aquatic venues such as pools, hot tubs, water playgrounds, or other artificially constructed structures that are intended for recreational or therapeutic purposes. For the pseriod 2015-2019, public health officials from 36 states and the District of Columbia (DC) voluntarily reported 208 outbreaks associated with treated recreational water. Almost all (199; 96%) of the outbreaks were associated with public (nonbackyard) pools, hot tubs, or water playgrounds. These outbreaks resulted in at least 3,646 cases of illness, 286 hospitalizations, and 13 deaths. Among the 155 (75%) outbreaks with a confirmed infectious etiology, 76 (49%) were caused by Cryptosporidium (which causes cryptosporidiosis, a gastrointestinal illness) and 65 (42%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms). Cryptosporidium accounted for 2,492 (84%) of 2,953 cases resulting from the 155 outbreaks with a confirmed etiology. All 13 deaths occurred in persons affected by a Legionnaires' disease outbreak. Among the 208 outbreaks, 71 (34%) were associated with a hotel (i.e., hotel, motel, lodge, or inn) or a resort, and 107 (51%) started during June-August. Implementing recommendations in CDC's Model Aquatic Health Code (MAHC) (1) can help prevent outbreaks associated with treated recreational water in public aquatic venues.

89590 A multi-theoretical analysis of the design, implementation and outcomes of The Greater Rochester LARC Initiative to prevent unintended teen pregnancy

ABSTRACT IMPACT: This study provides insights on how to replicate a successful initiative for preventing unintended teen pregnancy. OBJECTIVES/GOALS: Reducing unintended teen pregnancy is a national health priority, and a recommended strategy is to increase awareness and availability of long-acting reversible contraception (LARC). The Rochester LARC Initiative did this, and teen LARC use rose from 4% to 24%. The goal of this study is to determine key elements for replicating the intervention. METHODS/STUDY POPULATION: Our initiative used an innovative approach we call ‘community detailing’ to deliver education about LARC to adults working with teens. We analyzed the intervention goals, design components, implementation strategies, and public health outcomes. Our analysis was informed by the CDC model for Promoting Science-Based Approaches to Teen Pregnancy Prevention Using Getting to Outcomes (PSBA-GTO), Diffusion of Innovations, and RE-AIM framework for implementation outcomes. We compared our model with characteristics of LARC-promotion efforts, as well as successful health education campaigns. We tabulated the components of our intervention across theoretical domains, aiming to determine essential elements of effective design, adaptation, and dissemination & implementation. RESULTS/ANTICIPATED RESULTS: The initiative incorporated multiple components common to successful health education programs: measurable behavior-change outcomes; formative research before roll-out; tailored communications for different audiences; speakers who were credible, knowledgeable and skilled communicators; content that was new to recipients and essential for decreasing barriers to desired behaviors. It included elements of successful LARC promotion/teen pregnancy prevention programs, such as organizing information by effectiveness of methods and using youth-empowering messaging. It differed from other successful programs by offering discussions to adults who work with teens in both medical and community settings. This analysis also highlights unintended positive ripple effects. DISCUSSION/SIGNIFICANCE OF FINDINGS: These results establish how community detailing is effective for disseminating actionable information about the safety, efficacy and availability of LARC. These insights could inform other prevention initiatives. An anticipated practical product of this study will be a user-friendly manual for replicating the LARC Initiative in other locations.

793. Expert Panel Consensus Ranking of Comorbid Conditions Causally Related to Clostridioides difficile Infection

BackgroundNumerous studies have identified comorbidities that are associated with Clostridioides difficile infection (CDI), but current CDC and CMS models for risk adjusting hospital CDI rates do not include patient comorbid conditions. Incorporating patient-level data could improve CDI risk adjustment, but comorbidities would need to be easily electronically available for widescale implementation. Ideally, they would also be causally related to CDI — i.e., true risk factors, not confounders — to facilitate more unbiased inter-hospital comparisons. The current study aimed to determine which comorbid conditions are causally related to CDI based upon expert consensus.MethodsWe used Delphi methodology to administer an iterative, two-round survey with an intervening teleconference, to eight infectious disease experts. Experts evaluated 40 comorbid conditions included in Charlson and Elixhauser comorbidity indices (and thus validated for electronic capture through administrative data), as well as other comorbidities commonly associated with CDI. Experts rated comorbid conditions from 1 (not at all related) to 5 (strongly related), based upon perceived relatedness with CDI. To assign causal relatedness, the following criteria had to be met at the end of round two: 1) majority (> 50%) of experts rating the condition at 3 (somewhat related) or higher; 2) inter-quartile range (IQR) < = 1; and 3) standard deviation (SD) < = 1.Results8/40 (20%) comorbid conditions were ranked as causally related to CDI, including patient age, three malignancy comorbidities, two transplant-related comorbidities, HIV/AIDS, and inflammatory bowel disease. A further 18/40 (45%) qualified as indeterminately related, and 14/40 (35%) were ranked as not causally related to CDI (Table). Three of the eight causally related factors were not components of Elixhauser or Charlson indices.Table ConclusionWe identified comorbid conditions that may be appropriate candidates to consider for inclusion in patient-level risk adjustment models. Some causal factors did not originate from established comorbidity indices. Thus, future work to validate electronic capture of these conditions could further reduce barriers to risk-adjustment implementation.Disclosures All Authors: No reported disclosures

Electronically Available Patient Claims Data Improve Models for Comparing Antibiotic Use Across Hospitals: Results From 576 US Facilities.

BackgroundThe Centers for Disease Control and Prevention (CDC) uses standardized antimicrobial administration ratios (SAARs)—that is, observed-to-predicted ratios—to compare antibiotic use across facilities. CDC models adjust for facility characteristics when predicting antibiotic use but do not include patient diagnoses and comorbidities that may also affect utilization. This study aimed to identify comorbidities causally related to appropriate antibiotic use and to compare models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization.MethodsThe study included adults discharged from Premier Database hospitals in 2016–2017. For each admission, we extracted facility, claims, and antibiotic data. We evaluated 7 models to predict an admission’s antibiotic days of therapy (DOTs): a CDC facility model, models that added patient clinical constructs in varying layers of complexity, and an external validation of a published patient-variable model. We calculated hospital-specific SAARs to quantify effects on hospital rankings. Separately, we used Delphi Consensus methodology to identify Elixhauser comorbidities associated with appropriate antibiotic use.ResultsThe study included 11 701 326 admissions across 576 hospitals. Compared to a CDC-facility model, a model that added Delphi-selected comorbidities and a bacterial infection indicator was more accurate for all antibiotic outcomes. For total antibiotic use, it was 24% more accurate (respective mean absolute errors: 3.11 vs 2.35 DOTs), resulting in 31–33% more hospitals moving into bottom or top usage quartiles postadjustment.ConclusionsAdding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals’ utilization rankings.

A mathematical model to estimate the state-specific impact of the Health Resources and Services Administration's Ryan White HIV/AIDS Program.

BackgroundAccess to and engagement in high-quality HIV medical care and treatment is essential for ending the HIV epidemic. The Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) plays a critical role in ensuring that people living with diagnosed HIV (PLWH) are linked to and consistently engaged in high quality care and receive HIV medication in a timely manner. State variation in HIV prevalence, the proportion of PLWH served by the RWHAP, and local health care environments could influence the state-specific impact of the RWHAP. This analysis sought to measure the state-specific impact of the RWHAP on the HIV service delivery system and health outcomes for PLWH, and presents template language to communicate this impact for state planning and stakeholder engagement.Methods and findingsThe HRSA’s HIV/AIDS Bureau (HAB) and the Centers for Disease Control and Prevention‘s Division of HIV/AIDS Prevention (CDC DHAP) have developed a mathematical model to estimate the state-specific impact of the RWHAP. This model was parameterized using RWHAP data, HIV surveillance data, an existing CDC model of HIV transmission and disease progression, and parameters from the literature. In this study, the model was used to analyze the hypothetical scenario of an absence of the RWHAP and to calculate the projected impact of this scenario on RWHAP clients, RWHAP-funded providers, mortality, new HIV cases, and costs compared with the current state inclusive of the RWHAP. To demonstrate the results of the model, we selected two states, representing high HIV prevalence and low HIV prevalence areas. These states serve to demonstrate the functionality of the model and how state-specific results can be translated into a state-specific impact statement using template language.ConclusionsIn the example states presented, the RWHAP provides HIV care, treatment, and support services to a large proportion of PLWH in each state. The absence of the RWHAP in these states could result in substantially more deaths and HIV cases than currently observed, resulting in considerable lifetime HIV care and treatment costs associated with additional HIV cases. State-specific impact statements may be valuable in the development of state-level HIV prevention and care plans or for communications with planning bodies, state health department leadership, and other stakeholders. State-specific impact statements will be available to RWHAP Part B recipients upon request from HRSA’s HIV/AIDS Bureau.

Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners' Perspectives.

Introduction:Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners’ experiences of care provision.Methods:The study used a qualitative design in two phases: 1) semi-structured interviews, 2) one focus group. The setting comprised one public health network and five community services in urban Australia. In Phase 1, health practitioners across settings were interviewed about their experience of transitional care. Phase 2 sought feedback about the Phase 1 findings from different practitioners. All data were thematically analysed.Findings:In Phase 1), 48 healthcare practitioners were interviewed across multiple settings. Few participants were aware of the introduction of consumer-directed care in community aged care. Four main themes were identified: ‘Rapid and safe care transition’, ‘Discussing as a team’, ‘Questioning the discharge’, and ‘Engaging patients and carers’. In Phase 2), seven participants from different settings reviewed and endorsed the findings from Phase 1.Discussion and conclusions:Findings indicate that healthcare practitioners use a range of communication and coordination processes in optimising integrated transitional care. Although participants involved their patients in transitional care planning, most participants were unaware of the recent implementation of consumer-directed care. In contexts of community-based care shaped by multidisciplinary, sub-acute and CDC models, care integration must focus on improved communication with patients and carers to ascertain their needs and to support their increased responsibility in their care transitions.

Deep conceptual learning opportunities in business studies classrooms

Initial tests of the curriculum design coherence model (McPhail, 2020) indicate that teachers face challenges in relation to engaging deeply with the epistemic structure of their subject. In this study, we discuss the additional difficulty that teachers have in identifying appropriate content and examples that will provide opportunities for students' concept formation. The key question guiding this study was: "What opportunities for deep conceptual learning and cognitive advance are provided in business studies classrooms?" This analysis of the pedagogic practices of teachers is framed by the curriculum design coherence model (CDC) that is informed by deep learning from the cognitivist theory perspective. This article gives an account of observations of grade 11 business studies lessons in two schools. The lessons were observed, recorded, transcribed, and deductively analysed according to an analytical framework based on the CDC model. While there was evidence of concepts that were taught, appropriate subject content necessary for understanding the concept was not evident in most of the lessons. The dominant pedagogy of direct instruction, reading definitions, and copying notes amounted to giving students the definition of concepts and their basic components in a skeletal way. Content that requires students to analyse and infer meanings and make generalisations was lacking. The absence of appropriate content and examples, such as case studies in the textbook, curtailed opportunities for deep conceptual learning and cognitive advance. These practices deny learners access to the formal academic knowledge of the discipline.

Is tuberculosis patients management improved in the integrated TB control model in West China? A survey in Guizhou Province, China

BackgroundTuberculosis (TB) patient management (TPM) is crucial to improve patient compliance to treatment. The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention (CDC) was not high under the previous CDC model of TB control in China. In the integrated TB control model in China, TB patient management (TPM) was mainly delivered by lay health workers (LHWs) in primary health care (PHC) sectors. This study aims to investigate TPM delivery in resource-limited western China and to identify factors affecting TPM delivery by LHWs under the integrated TB control model.MethodsA stratified random sampling was used to select study sites. Pulmonary TB (PTB) patients ≥15 years old from selected counties/districts in Guizhou Province were surveyed from August 2015 to May 2016. Structured questionnaires were used to collect data. A χ2 test and logistic regression were used to identify factors associated with self-administered treatment (non-TPM).ResultsIn total, 638 PTB patients were included in the final analysis. Close to 30% of patients were ethnic minorities. More than 30% of patients were from counties with high TB burden, and 24.9% of patients had poor compliance to treatment. Only 37.1% of patients received TPM delivered by LHWs under the integrated TB control model throughout the treatment period. The main reasons for unwillingness to manage reported by patients included social stigma and no perceived need. Being ethnic minorities (OR = 3.35) was a main factor associated with lower likelihood of receiving TPM, while living in areas with middle or high TB burden may increase the likelihood of receiving TPM (OR = 0.17 and 0.25, respectively). Among current management approaches, more than 85% of patients chose phone reminder as their preferred TPM by LHWs.ConclusionsTPM under the integrated model in West China is still low and need further improvement, and the impeding factors of TPM need to be addressed. Strengthening patient-centered and community-based TPM and developing more feasible approaches of TPM delivery should be explored in future research in this region.

Knowledge‐rich teaching: A model of curriculum design coherence

A theoretical model called ‘Curriculum Design Coherence’ (CDC) is described and justified. The model's purpose is to assist teachers in the compulsory and higher education sectors to design courses that can accommodate the complex and interdependent relationship between concepts and content and between knowledge and skills. Its intended usefulness as a curriculum design tool may also contribute to teachers’ pedagogical decision‐making. The model was initially developed in a New Zealand university Engineering study and is now being trialled in a study in the compulsory schooling sector with the ‘Knowledge‐Rich School Project’. The CDC model integrates concepts, content and competencies in a coherent way, thereby avoiding several tendencies which have affected curriculum studies in recent decades. These are: a ‘skills’ versus ‘concepts’ bifurcation; an over‐emphasis on fragmented content without conceptual integration; and a similar over‐emphasis on pedagogy (the ‘how’) at the expense of what is taught. The first sections of the article discuss the theories used to justify the model's connections between the elements of concepts, content and competencies. The theories concern (1) knowledge types (disciplinary and socio‐cultural) and (2) knowledge forms (propositional/conceptual and procedural/competencies). The justification is followed by a description of the CDC model itself.

Pool Chemical Injuries in Public and Residential Settings - United States, 2008-2017, and New York, 2018.

Pool chemicals are added to water in treated recreational water venues (e.g., pools, hot tubs/spas, and water playgrounds) primarily to protect public health. Pool chemicals inactivate pathogens (e.g., chlorine or bromine), optimize pH (e.g., muriatic acid), and increase water clarity, which helps prevent drowning by enabling detection of distressed swimmers underwater. However, pool chemicals can cause injuries if mishandled. To estimate the annual number of U.S. emergency department (ED) visits for pool chemical injuries, CDC analyzed 2008-2017 data from the National Electronic Injury Surveillance System (NEISS), operated by the U.S. Consumer Product Safety Commission (CPSC). During 2015-2017, pool chemical injuries led to an estimated 13,508 (95% confidence interval [CI]=9,087-17,929) U.S. ED visits; 36.4% (estimated 4,917 [95% CI=3,022-6,811]) of patients were aged <18 years. At least 56.3% (estimated 7,601 [95% CI=4,587-10,615]) of injuries occurred at a residence. Two thirds of the injuries occurred during the period from Memorial Day weekend through Labor Day. This report also describes a toxic chlorine gas incident that occurred at a public pool in New York in 2018. Pool chemical injuries are preventable. CDC's Model Aquatic Health Code (MAHC) is an important resource that operators of public treated recreational water venues (e.g., at hotels, apartment complexes, and waterparks) can use to prevent pool chemical injuries.

Consumer directed care in residential aged care: an evaluation of a staff training program

Objectives: The advent of Consumer-Directed Care (CDC, or individualized care) in Residential Aged Care Facilities (RACFs, or residential care) will require a paradigm shift in service delivery. This article evaluated the six-session Resident at the Centre of Care (RCC) staff training program designed to equip staff to implement a CDC model of care among residents.Method: There were two experimental conditions: RCC training program alone, RCC training program plus support, and a ‘care as usual’ condition. Outcome measures were resident quality of life (QoL) and resident working relationships with staff at 3-month follow-up. At Time 1, 92 residents from RACFs participated in the program. The RCC is six sessions that focus on the development of staff skills in communicating with residents, as well as the organizational change and transformational leadership that is needed for the implementation of CDC.Results: There were significant improvements in resident QoL. There was no major difference between the RCC Program plus support condition compared to the RCC Program alone condition, but both were associated with more positive changes in resident QoL than the ‘care as usual’ condition.Conclusion: This study demonstrates that training staff in strategies to implement CDC in RACFs can lead to an improvement in the wellbeing of many residents, and that additional support to assist staff to implement the strategies may not be required to produce such improvements. Longer term follow-up is necessary to determine if the improvements in resident QoL are sustained.