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This article reports on a unique collaboration between principal and teacher preparation programs within one college of education at a rural university in southeastern United States. The collaborative project worked to meet both the need of teacher candidates to receive instructional feedback and coaching on their teaching and the need of principal candidates to gain experience giving instructional coaching to novice teachers. Feedback and coaching were provided through video capture and annotation technology (VCAT) allowing the principal candidate to provide specific feedback using evidence from the teaching candidate's teaching video to support their instructional coaching. Researchers explored quantitative and qualitative data of principal candidates' coaching experience to determine the change in their self-efficacy in providing instructional coaching over the course of a semester and their perceptions of their experience using VCAT to facilitate the coaching. [ABSTRACT FROM AUTHOR]

As cultural, social, political and economic changes take place, the secondary or high school curriculum should reflect and respond to changing needs and aspirations of students. Technology Education has been proactive in this arena as it has transformed over the decades to meet ever-changing societal needs. The most recent change to the discipline has been to add engineering and, as a result, adopting a new name and curriculum-Engineering and Technology Education. The added component and name change in Technology Education is causing discussions about what the new direction means, what professional preparation changes will be incurred, and what work graduating students will be prepared to do. In light of these changes, this study investigated perceptions of high school students in the United States of America about engineering and technology courses they take. To investigate whether students' perceptions are in accord with current changes in Engineering and Technology Education, 316 students enrolled in engineering and technology courses in Georgia schools that have an affiliation with the Georgia Engineering and Technology Education Association (GETEA) were surveyed. According to data analyses, students' perceptions can be divided into two factors. Educational Value of Course (factor 1) was extracted from statements measuring the degree to which the courses prepare students for employment and provide them with information regarding future employment. Personal Relevance of Course (factor 2) was derived from statements measuring students' perceptions about links between engineering and technology education and their personal lives. Such findings suggest these students valued their engineering and technology courses, planned to continue their education, made good grades, and had varied types of career expectations for jobs such as design engineers and architects. [ABSTRACT FROM AUTHOR]

The article discusses the role of women hunters in the 19th-century American West. Particular focus is given to depictions of frontierswomen Martha Jane Canary, better known as Calamity Jane, Grace Gallatin Thompson Seton, and Evelyn Cameron. It is suggested that while the frontier provided an opportunity for these women to pursue traditionally masculine occupations, they were depicted as unusual and non-threatening exceptions to established gender roles. Details on tourism in the West by upper-class women and the role of hunting in the homestead economy are also presented. Other topics include performativity and the women's adoption of male costume.

Early linkage and retention in HIV clinical care is essential for optimal disease management, promotion of health, and receipt of secondary prevention messages to decrease onward transmission of HIV. Youth, specifically racial/ethnic minority young men who have sex with men (YMSM), continue to acquire new HIV infections and have been shown to be less likely to engage in regular HIV care and adhere to scheduled medical visits. The goal of the current study was to evaluate the characteristics of participants and program delivery that were associated with early linkage and retention in HIV care among HIV-infected YMSM of color enrolled in an outreach, linkage, and retention study. Of the 334 patients included in the linkage analysis, 72% were linked to care within 30 days of diagnosis, 81% within 60 days, and 87% within 90 days. While no patient-level characteristics were associated with early linkage, having the person who provided the positive HIV test result refer the patient to HIV care ( p=0.048), specifically calling to make the appointment ( p=0.009), was associated with earlier linkage. Retention of Latino participants (96.2%) was significantly higher than for the African-American (79.9%) youth ( p=0.006). Overall, 221 participants had at least 1 year of possible follow-up and 82.8% of these participants were retained at 1 year. While unique challenges exist in the care of adolescents infected with HIV from identification to engagement and retention in clinical care, programs that are responsive and dedicated to the needs of these youth can be successful in retaining them in care. [ABSTRACT FROM AUTHOR]

Given the continued high incidence of HIV infection in the United States among racial/ethnic minority young men who have sex with men (YMSM), and an appreciation that antiretroviral therapy (ART) can provide personal and public health benefits, attention is needed to enhance the detection of HIV-infected youth and engage them in medical care and support services that encourage sustained HIV treatment and suppression of viremia. Poor retention in clinical care has been associated with higher mortality, an increase in HIV RNA, and decreased CD4 cell count. The goal of the current study was to evaluate the health care utilization and health outcomes of HIV-infected racial/ethnic minority YMSM enrolled in an outreach, linkage, and retention study funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB). We hypothesized that among racial/ethnic minority YMSM, baseline CD4 counts and usage of ART are influenced by age, race, drug and alcohol use, and mental health symptoms. Overall, 155 subjects had at least a baseline CD4 count recorded at study entry. There was a low rate of ART use in this population with only one-half of the cohort with CD4 counts ≤350 cells/mm3 being prescribed ART to treat their infection. However, of those youth who were started on ART, the majority (74%) did achieve undetectable viral loads (<400 copies). Given the continued increase in cases of HIV infection among racial/ethnic minority YMSM, efforts to increase both the provision of ART and support services that encourage adherence in this population are warranted. [ABSTRACT FROM AUTHOR]

We assessed changes in sexual behaviors from baseline to 12-month follow-up among a multisite cohort of HIV-positive racial/ethnic minority young men who have sex with men enrolled in an outreach, linkage, and retention study. In the 3 months prior to their baseline interview, more than three-quarters of participants (78.5%) reported sex with at least one man (mean: 2.3 partners). Among sexually active participants, 44.2% had one partner; 50.5% had 2-9 partners; and 5.3% had 10 or more partners. Over three-quarters (77.5%) reported engaging in sex with at least one steady partner, 43.5% with at least one casual partner, and 29.5% with both casual and steady partners. Exchanging sex for money, drugs, or other needs was reported by 13.2%. Use of condoms during oral and anal sex increased significantly from baseline to 12-month follow-up (oral sex: 29.1-42.5%, p=0.02; anal sex: 67.8-76.2%, p=0.05). While unprotected anal sex significantly decreased among individuals who were new to care (34.8-18.3%, p<0.0001), it significantly increased among individuals who were previously in care (26.7-37.5%, p=0.03). Overall, exchange sex decreased from 13.3% at baseline to 5.0% at 12 months ( p=0.001). Despite reductions in unprotected sexual encounters and exchange sex through one year of follow-up, many participants continued to engage in high-risk sexual behaviors. Retention within this study appeared to be associated with decreases in high-risk sexual behaviors, especially among participants who were new to care, although more research is needed. Future studies should investigate sexual network characteristics and the prevalence of behaviors such as serosorting. [ABSTRACT FROM AUTHOR]

Young men of color who have sex with men (YMSM of color) have been disproportionately affected by the HIV/AIDS epidemic in the United States. Between 2001 and 2006, HIV/AIDS diagnoses increased 93.1% among African-American MSM aged 13-24 and 45.8% among Latino MSM aged 13-24. Many multisite studies have yielded valuable information on the behaviors associated with HIV infection in adolescents, MSM, African-Americans, and Latinos. Studies among adolescents found a high prevalence of risky sexual behaviors, including having multiple partners and unprotected intercourse and frequent substance use. Multisite studies of MSM also found frequent reports of alcohol and drug abuse, and one study found that nearly one-half (48%) of HIV-positive MSM were unaware of their infection. Similarly, two multisite studies of YMSM found high rates of unprotected sex, substance use, and HIV-infection among YMSM of color. Recognizing these challenges, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) funded the first multisite study to improve engagement, linkage to HIV care, and retention in care for HIV-positive YMSM of color. The objective of this article is to review the epidemiologic data on HIV-positive YMSM of color from surveillance and multisite studies in order to identify the needs of this population and the gaps in the literature. [ABSTRACT FROM AUTHOR]

Las Vegas is customarily seen as a postmodern city of fantasy and simulation, a place where history and geography scarcely matter. In this article I argue instead that Las Vegas might be usefully described as a frontier city. When civic boosters sought to first sell their town as a tourist paradise it was the iconography of the American West that captivated public interest. In a place that invented theming, the frontier represented the original blueprint. Even when Las Vegas moved away from a western aesthetic, it continued to subscribe to a frontier mantra. Its culture of gambling resonated with ideas of individualism, risk, freedom and adventuring, while the constant reinvention of the city pointed towards a vertical frontier to match Frederick Jackson Turner's horizontal rubric. [ABSTRACT FROM AUTHOR]

This article considers the construction of the Northern Rockies as a hunter's paradise in the latter years of the nineteenth century. It explores the crafting of the region as a game utopia by a cadre of hunter-tourists, whose writings of what I term “fictionalized reality” celebrated the Rockies as an American Serengeti for sports and a realm of pioneer exoticism. Significantly, it argues that hunting became far more than an exercise in imperial tourism, instead representing a regenerative mechanism through which the sportsman emerged from the game trail, firstly as an exemplar of American masculinity, and secondly, as a fully-fledged westerner. Stories of nature red in tooth and the “hunter-hero” thus effectively obscured the political and economic realities of frontier assimilation to present the West as one vast playground for entertainment, adventuring and honorable violence. The article discusses the engagement between hunter and hunted, taking in themes of western tourism, codes of manhood, nature appreciation, gun-play, and the gaze, before concluding with an analysis of how the “storied past” of hunting literature, photography, and taxidermy broadcast a strident identity for the Northern Rockies that persists to this day. [ABSTRACT FROM AUTHOR]

This chapter provides a glimpse of student affairs assessment at Isothermal Community College including a specific example of assessment, tips to implementing assessment at your institution, and barriers encountered when implementing the process at Isothermal Community College. [ABSTRACT FROM AUTHOR]

The article focuses on the Denver Health & Hospital Authority's project in conjunction with the Colorado Clinical Guidelines Collaborative to improve adult immunization rates in U.S.. To measure improvement efforts the percentage of adults aged 65 years and above who leave clinic visits with up-to-date pneumococcal vaccination was calculated each month.This was done by covering three key aspects: standing orders, an immunization registry, and an algorithm to recommend vaccinations.

In 1997 Congress established the State Child Health Insurance Program (SCHIP) to address the problem of the nation's low-income uninsured children. To help children become eligible for SCHIP and to tap into the potential revenue stream for previously uninsured children, community health centers have taken differing approaches. This study examines the lessons learned from enrolling children at 14 health centers in six states. The lessons can be valuable for primary care centers and other safety-net providers. [ABSTRACT FROM AUTHOR]

The article discusses a study which determines the perceptions of parents, professionals and vocational administrators regarding the National Standards for Family and Consumer Sciences (FCS) curriculum in Georgia. The study was conducted on the parents of FCS students, members of the Georgia Association of Family and Consumer Sciences (GAFCS) and vocational administrators for the FCS education programs. It is concluded that all three groups supported the inclusion of the standards in all seven FCS curricular areas including family, nutrition and wellness, human development, interpersonal relationships, connections of career, community and family, parenting, and family and community services.

Describes a collaboration between the faculty in an urban elementary school and the faculty in a nearby education college for the purposes of enhancing the learning of mathematics and science by the schoolchildren and of providing quality urban field experience sites in mathematics and science for preservice elementary teachers. History of the partnership; Specific activities.

Examines every aspect of textbooks in trade and industrial education as used in secondary and postsecondary levels in the 1980s to the 1990s. Value of readability; Methods, procedures and results of the study.

The author comments on the challenge faced by U.S. states concerning the need for securing primary care for expanded Medicaid populations. It says that eight states including Georgia, Oklahoma and Texas might have large Medicaid expansions despite having weak primary care capacity. According to the author, the health care reform initiated by U.S. President Barack Obama has caused the problems with the health insurance of Americans.

The article presents a study on students perceptions towards family and consumer sciences (FCS) education programs in the U.S. It aims inform and help educators tailor relevant and meaningful programs that will enhance school experiences for adolescents. It shows a discrepancy between the importance students place on skills taught in FCS education and its importance in relation to other major subjects. It appears that elective subjects are thought to be less important by students. Students also stated that they could learn the content of FCS education in outside the classroom at home, church, and other classes.

Growing up in a rural setting is a strong predictor of future rural practice for physicians. This study reports on the fifteen-year decline in the number of rural medical students, culminating in rural students' representing less than 5 percent of all incoming medical students in 2017. Furthermore, students from underrepresented racial/ethnic minority groups in medicine (URM) with rural backgrounds made up less than 0.5 percent of new medical students in 2017. Both URM and non-URM students with rural backgrounds are substantially and increasingly underrepresented in medical school. If the number of rural students entering medical school were to become proportional to the share of rural residents in the US population, the number would have to quadruple. To date, medical schools' efforts to recognize and value a rural background have been insufficient to stem the decline in the number of rural medical students. Policy makers and other stakeholders should recognize the exacerbated risk to rural access created by this trend. Efforts to reinforce the rural pipeline into medicine warrant further investment and ongoing evaluation. [ABSTRACT FROM AUTHOR]

Evaluates the use of textbooks in secondary and post-secondary technology education programs, using readability, human interest and writing style. Findings. INSET: Reading levels and means for technology education texts..

Focuses on a study which examined the factor structure of symptom ratings in early-onset psychotic illnesses in children in Washington State. Subjects and data analysis; Factor analysis of psycholopathology symptoms; Limitations and clinical implications.

There are more than 300,000 estimated cases of spinal cord injury (SCI) in the United States, and approximately 27,000 of these are Veterans. Immobilization from SCI results in adverse secondary medical conditions and reduced quality of life. Veterans with SCI who have completed rehabilitation after injury and are unable to ambulate receive a wheelchair as standard of care. Powered exoskeletons are a technology that offers an alternative form of limited mobility by enabling over-ground walking through an external framework for support and computer-controlled motorized hip and knee joints. Few studies have reported the safety and efficacy for use of these devices in the home and community environments, and none evaluated their impact on patient-centered outcomes through a randomized clinical trial (RCT). Absence of reported RCTs for powered exoskeletons may be due to a range of challenges, including designing, statistically powering, and conducting such a trial within an appropriate experimental framework. An RCT for the study of exoskeletal-assisted walking in the home and community environments also requires the need to address key factors such as: avoiding selection bias, participant recruitment and retention, training, and safety concerns, particularly in the home environment. These points are described here in the context of a national, multisite Department of Veterans Affairs Cooperative Studies Program-sponsored trial. The rationale and methods for the study design were focused on providing a template for future studies that use powered exoskeletons or other strategies for walking and mobility in people with immobilization due to SCI. [ABSTRACT FROM AUTHOR]

Importance: Robotic exoskeletons leverage technology that assists people with spinal cord injury (SCI) to walk. The efficacy of home and community exoskeletal use has not been studied in a randomized clinical trial (RCT)., Objective: To examine whether use of a wheelchair plus an exoskeleton compared with use of only a wheelchair led to clinically meaningful net improvements in patient-reported outcomes for mental and physical health., Design, Setting, and Participants: This RCT of veterans with SCI was conducted at 15 Veterans Affairs medical centers in the US from September 6, 2016, to September 27, 2021. Data analysis was performed from March 10, 2022, to June 20, 2024., Interventions: Participants were randomized (1:1) to standard of care (SOC) wheelchair use or SOC plus at-will use of a US Food and Drug Administration (FDA)-cleared exoskeletal-assisted walking (EAW) device for 4 months in the home and community., Main Outcomes and Measures: Two primary outcomes were studied: 4.0-point or greater improvement in the mental component summary score on the Veterans RAND 36-Item Health Survey (MCS/VR-36) and 10% improvement in the total T score of the Spinal Cord Injury-Quality of Life (SCI-QOL) physical and medical health domain and reported as the proportion who achieved clinically meaningful changes. The primary outcomes were measured at baseline, post randomization after advanced EAW training sessions, and at 2 months and 4 months (primary end point) in the intervention period. Device usage, reasons for not using, and adverse events were collected., Results: A total of 161 veterans with SCI were randomized to the EAW (n = 78) or SOC (n = 83) group; 151 (94%) were male, the median age was 47 (IQR, 35-56) years, and median time since SCI was 7.3 (IQR, 0.5 to 46.5) years. The difference in proportion of successes between the EAW and SOC groups on the MCS/VR-36 (12 of 78 [15.4%] vs 14 of 83 [16.9%]; relative risk, 0.91; 95% CI, 0.45-1.85) and SCI-QOL physical and medical health domain (10 of 78 [12.8%] vs 11 of 83 [13.3%]; relative risk, 0.97; 95% CI, 0.44-2.15) was not statistically different. Device use was lower than expected (mean [SD] distance, 1.53 [0.02] miles per month), primarily due to the FDA-mandated companion being unavailable 43.9% of the time (177 of 403 instances). Two EAW-related foot fractures and 9 unrelated fractures (mostly during wheelchair transfers) were reported., Conclusions and Relevance: In this RCT of veterans with SCI, the lack of improved outcomes with EAW device use may have been related to the relatively low device usage. Solutions for companion requirements and user-friendly technological adaptations should be considered for improved personal use of these devices., Trial Registration: ClinicalTrials.gov Identifier: NCT02658656.

Competing Interests: Competing interests: None declared.

Background/objectives: Almost half of deaths related to COVID-19 in the United States are linked to nursing homes (NHs). We describe among short-term and long-term residents at three NHs in Michigan the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges., Design: Outbreak investigation., Setting: Three NHs in southeast Michigan., Participants: All residents (N = 215) at three NHs (total beds = 356) affiliated with a large academic healthcare system., Methods: Upon detection of confirmed cases within the facility, each NH in collaboration and consultation with local hospital, public health officials, and parent corporation implemented immediate facility-wide testing and the following intervention measures: cohorting of COVID-19 positive residents; communication regarding testing and results with residents, healthcare professionals, and families; personal protective equipment reeducation and use throughout facilities; and dedicated staffing for infected patients cohorted in a dedicated COVID-19 wing. We collected patient data regarding demographics, symptoms, comorbidities, hospitalization, and 14-day outcomes., Results: A total of 29 cases of COVID-19 were identified at three participating NHs. Nineteen cases of COVID-19 were identified through symptom-triggered testing from March 23 to April 23, 2020; 10 (4.7%) additional cases were identified through universal testing of 215 residents conducted from April 7 to 15, 2020. The hospitalization rate was 37.9%. The case fatality rate was 20.7% (6/29); these patients had multiple comorbidities. No residents who tested positive through the point-prevalence survey required hospitalization, and five were discharged home within 14 days., Conclusion: Proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials are necessary to rapidly respond to an outbreak and limit the transmission of COVID-19. This coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs., (© 2020 The American Geriatrics Society.)

Background: Perinatal exposure to air pollution and immune system dysregulation are two factors consistently associated with autism spectrum disorders (ASD) and other neurodevelopmental outcomes. However, little is known about how air pollution may influence maternal immune function during pregnancy., Objectives: To assess the relationship between mid-gestational circulating levels of maternal cytokines/chemokines and previous month air pollution exposure across neurodevelopmental groups, and to assess whether cytokines/chemokines mediate the relationship between air pollution exposures and risk of ASD and/or intellectual disability (ID) in the Early Markers for Autism (EMA) study., Methods: EMA is a population-based, nested case-control study which linked archived maternal serum samples collected during weeks 15-19 of gestation for routine prenatal screening, birth records, and Department of Developmental Services (DDS) records. Children receiving DDS services for ASD without intellectual disability (ASD without ID; n = 199), ASD with ID (ASD with ID; n = 180), ID without ASD (ID; n = 164), and children from the general population (GP; n = 414) with no DDS services were included in this analysis. Serum samples were quantified for 22 cytokines/chemokines using Luminex multiplex analysis technology. Air pollution exposure for the month prior to maternal serum collection was assigned based on the Environmental Protection Agency's Air Quality System data using the maternal residential address reported during the prenatal screening visit., Results: Previous month air pollution exposure and mid-gestational maternal cytokine and chemokine levels were significantly correlated, though weak in magnitude (ranging from - 0.16 to 0.13). Ten pairs of mid-pregnancy immune markers and previous month air pollutants were significantly associated within one of the child neurodevelopmental groups, adjusted for covariates (p < 0.001). Mid-pregnancy air pollution was not associated with any neurodevelopmental outcome. IL-6 remained associated with ASD with ID even after adjusting for air pollution exposure., Conclusion: This study suggests that maternal immune activation is associated with risk for neurodevelopmental disorders. Furthermore, that prenatal air pollution exposure is associated with small, but perhaps biologically relevant, effects on maternal immune system function during pregnancy. Additional studies are needed to better evaluate how prenatal exposure to air pollution affects the trajectory of maternal immune activation during pregnancy, if windows of heightened susceptibility can be identified, and how these factors influence neurodevelopment of the offspring.

Importance: Increasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease., Objectives: To assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population., Design, Setting, and Participants: This secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau., Main Outcomes and Measures: The study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity., Results: From 1980 to 2018, the absolute number of full-time IM faculty increased from 10 964 to 42 547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n = 17 165 [40.3%]) compared with all other clinical departments (n = 48 936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017)., Conclusions and Relevance: This cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.

Purpose: To understand the predictive value of medical student application characteristics on rural practice intent., Method: The authors constructed a linked database of 2012-2017 medical school matriculants from American Medical College Application Service applications and Association of American Medical Colleges Matriculating Student Questionnaire (MSQ, 2012-2017) and Graduation Questionnaire (GQ, 2016-2018). Using logistic regression, they compared application variables (birth, high school, childhood county, and self-declared geographical origin) to students' MSQ and GQ intent to practice rurally. Rural practice intent from matriculation to graduation was compared using the McNemar test for paired nominal data., Results: The number of students meeting inclusion criteria was 115,027. More students self-declared rural origin (18,662; 16.4%) than were identified using geographically coded variables (6,097-8,784; 6.1%-8.1%). Geographically coded rural variables were all strongly and similarly associated with rural practice intent, with rural high school being the most predictive on both MSQ (odds ratio [OR], 6.51; CI, 6.1-7.0) and GQ (OR, 5.4; CI, 4.9-6.0). Self-declared geographical origin was associated with a similar rural practice intent on both MSQ (OR, 6.93; CI, 6.5-7.3) and GQ (OR, 5.69; CI, 5.2-6.2). Rural practice intent declined for all groups from matriculation to graduation., Conclusions: Considering students who self-declare as rural identifies a larger group of rural medical school applicants than more "objective" geographic variables, without negatively impacting students' predicted interest in eventual rural practice. Further research should track actual practice location and explore strategies to mitigate declining rural career interest.

Background: Clostridioides difficile infection (CDI) is on the rise., Objective: To evaluate the effect of a tiered, evidence-based intervention to prevent CDI., Design: Pre-post observational evaluation of a prospective, 12-month, national, nonrandomized, clustered quality improvement project to reduce hospital health care-associated infection., Setting: Acute care, long-term acute care, and critical access hospitals working with state partner organizations (state hospital associations and state health departments) to improve health care-associated infection prevention practices., Participants: Targeted hospitals had a high burden of CDI and another health care-associated infection. Other hospitals that did not meet these criteria volunteered to participate., Intervention: Multimodal intervention that consisted of 1) on-demand educational modules and webinars, 2) in-person meetings facilitated by state-level partners, 3) feedback and recommendations for implementation of evidence-based recommendations (including a CDI-specific guide on which interventions to implement), and 4) guided facilitation through infection prevention resources and site visits., Measurements: Pre- and postintervention CDI rates., Results: Between November 2016 and May 2018, 387 hospitals (366 of which reported CDI data) in 23 states and the District of Columbia participated in the intervention. There was a statistically significant decrease in CDI incidence over the study period, from 7.0 cases per 10 000 patient-days in the preintervention period to 5.7 cases per 10 000 patient-days in the postintervention period. However, this decrease appeared to be part of a temporal trend rather than due to the study intervention., Limitations: Commitment to and adherence with recommended infection prevention practices before and after the intervention were not assessed. The intervention period was relatively brief, and patient-level data were not available., Conclusion: Although a statistically significant decline in hospital-onset CDI was observed, this trend appears to be unrelated to the study intervention., Primary Funding Source: Centers for Disease Control and Prevention.