Cluster Design Research Articles

Modeling of scale-dependent perforation geometrical fracture growth in naturally layered media

In this study, the discrete lattice simulation of multi-scale fracture growth in layered media is conducted and validated against fracturing laboratory observation and field micro-seismic monitoring. The results reveal that the perforation can substantially influence hydraulic fracture initiation and extension. The vertically-oriented-perforation induced fracture will effectively initiate with moderate near-wellbore complexity, promoting fracture crossing at bedding interfaces. The interlaced design of perforation cluster can alleviate the stress shadow effect and facilitate uniform fracture propagation. The far-field fracture complexity are related to the bedding interfacial properties: more tensile interfaces tend to arrest induced fractures and restrict their vertical growth, while more fracturing fluid will be diverted into the permeable interfaces of lower shear strength. The complex fracture networks has the potential to trigger fault reactivation or serve as conduits for underground water, thus causing induce seismicity or aquifer contamination. The findings can enrich the understanding of multi-scale fluid-solid coupling mechanisms and further help us prevent geological hazards.

Integrated clustering and routing design and triangle path optimization for UAV-assisted wireless sensor networks

Integrated clustering and routing design and triangle path optimization for UAV-assisted wireless sensor networks

Approximate balancing weights for clustered observational study designs.

In a clustered observational study, a treatment is assigned to groups and all units within the group are exposed to the treatment. We develop a new method for statistical adjustment in clustered observational studies using approximate balancing weights, a generalization of inverse propensity score weights that solve a convex optimization problem to find a set of weights that directly minimize a measure of covariate imbalance, subject to an additional penalty on the variance of the weights. We tailor the approximate balancing weights optimization problem to the clustered observational study setting by deriving an upper bound on the mean square error and finding weights that minimize this upper bound, linking the level of covariate balance to a bound on the bias. We implement the procedure by specializing the bound to a random cluster-level effects model, leading to a variance penalty that incorporates the signal-to-noise ratio and penalizes the weight on individuals and the total weight on groups differently according to the the intra-class correlation.

Acceptability and preliminary impact of a school-based SEL program for rural children in China: A quasi-experimental study

While Social and Emotional Learning (SEL) as school-based mental health preventative interventions have been extensively examined in western contexts, they have not yet been studied much in China. Several SEL programs have been developed or adapted for Chinese contexts, but few studies have examined their intervention effects in resource constrained settings, especially rare in rural schools. This study serves as the first to examine the acceptability and preliminary impact of a school-based SEL intervention in rural Chinese elementary schools. A quasi-experimental pre- and post-intervention study with a two-level cluster design was adopted. The sample consisted of 1247 fifth graders nested within 28 classrooms in Southwest China. Students rated the SEL curriculum as highly satisfactory, interesting, helpful, and practical. Findings demonstrated significant SEL intervention effects on rural children’s overall self-reported social and emotional competencies (ES = 0.213) and three subdomains including self-awareness (ES = 0.342), social awareness (ES = 0.25), and relationship skills (ES = 0.185). However, no intervention effects were found in the subdomains including self-management and responsive decision-making. Additionally, the subgroup analysis revealed that children of work-away parents, as well as boys, obtained greater benefits from the SEL intervention. These findings are interpreted in light of their practice, research, and policy implications to further strengthen school-based SEL efforts for improving rural children’s wellbeing.

Project Based Learning Embedded with Entrepreneurship in Physics Learning to Improve Physics Application Ability

This study aimed to determine the effectiveness and effect size of project-based learning (PjBL) model embedded with entrepreneurship in online physics learning to improve the physics application ability of senior high school students; and to describe students' responses to the entrepreneurship embedded PjBL model. This was a quasi-experimental study. The experimental design used was the clustered pretest-posttest controlled group design, which involved two groups and the sampling was carried out in clusters. This research was conducted at SMA Negeri 1 Mlati Yogyakarta on the subject of Elasticity and Hooke's Law. Data collection techniques in this study used tests and questionnaires. Data analysis utilized descriptive and inferential analysis. The results of the study showed that the application of the entrepreneurship embedded PjBL model was effective for improving students’ physics application ability in the moderate category. The effect size of the entrepreneurship embedded PjBL model towards the physics application ability was in the moderate category. Finally, the student responses toward the entrepreneurship embedded PjBL model were in the very good category.

Особенности проектирования кластеров как больших организационно-экономических систем

The need for accelerated reindustrialization of industry highlights the task of modernization based on modern principles of the procedure for designing new enterprises, holdings, clusters and other complex economic structures, united by a category of large organizational and economic systems. The problem is that if the development of a promising image of an industrial enterprise is carried out using an established technology (analysis of the initial data – development strategy development – building a business model – development of projects of production and social subsystems, as well as management subsystems – preparation of a business plan), then the procedure for designing an industrial cluster is not yet clearly regulated. Only the requirements for industrial clusters applying for state support for their development have been identified. The absence of such regulations leads to a situation in which some of the already created industrial clusters cease to exist due to miscalculations made during their formation and the organization of the initial stage of operation. The features of organizational design of industrial clusters – a promising form of regional concentration of production are consiered. The article discloses the features of industrial clusters and their differences from industrial enterprises from the point of view of design, and also proposes a procedure for performing this work, which includes an original set of actions that ensures the achievement of the goals of the participants in this association. Its specificity is associated with the cooperation of legally independent economic entities from various spheres of the economy, interested in obtaining an additional effect from the coordination of their activities in the region, on the terms of informal unification without losing the freedom to choose their areas of activity, but within the framework of coordinating the joint achievement of common goals.

Serum S100B Level in the Management of Pediatric Minor Head Trauma

Minor head trauma (HT) is one of the most common causes of hospitalization in children. A diagnostic test could prevent unnecessary hospitalizations and cranial computed tomographic (CCT) scans. To evaluate the effectiveness of serum S100B values in reducing exposure to CCT scans and in-hospital observation in children with minor HT. This multicenter, unblinded, prospective, interventional randomized clinical trial used a stepped-wedge cluster design to compare S100B biomonitoring and control groups at 11 centers in France. Participants included children and adolescents 16 years or younger (hereinafter referred to as children) admitted to the emergency department with minor HT. The enrollment period was November 1, 2016, to October 31, 2021, with a follow-up period of 1 month for each patient. Data were analyzed from March 7 to May 29, 2023, based on the modified intention-to-treat and per protocol populations. Children in the control group had CCT scans or were hospitalized according to current recommendations. In the S100B biomonitoring group, blood sampling took place within 3 hours after minor HT, and management depended on serum S100B protein levels. If the S100B level was within the reference range according to age, the children were discharged from the emergency department. Otherwise, children were treated as in the control group. Proportion of CCT scans performed (absence or presence of CCT scan for each patient) in the 48 hours following minor HT. A total of 2078 children were included: 926 in the control group and 1152 in the S100B biomonitoring group (1235 [59.4%] boys; median age, 3.2 [IQR, 1.0-8.5] years). Cranial CT scans were performed in 299 children (32.3%) in the control group and 112 (9.7%) in the S100B biomonitoring group. This difference of 23% (95% CI, 19%-26%) was not statistically significant (P = .44) due to an intraclass correlation coefficient of 0.32. A statistically significant 50% reduction in hospitalizations (95% CI, 47%-53%) was observed in the S100B biomonitoring group (479 [41.6%] vs 849 [91.7%]; P < .001). In this randomized clinical trial of effectiveness of the serum S100B level in the management of pediatric minor HT, S100B biomonitoring yielded a reduction in the number of CCT scans and in-hospital observation when measured in accordance with the conditions defined by a clinical decision algorithm. ClinicalTrials.gov Identifier: NCT02819778.

Power Analyses for Estimation of Complier Average Causal Effects Under Random Encouragement Designs in Education Research: Theory and Guidance

Random encouragement designs evaluate treatments that aim to increase participation in a program or activity. These randomized controlled trials (RCTs) can also assess the mediated effects of participation itself on longer term outcomes using a complier average causal effect (CACE) estimation framework. This article considers power analysis methods for such CACE analyses for a range of RCT designs, including nonclustered, clustered, and random block designs. The focus is on behavioral encouragements to promote action, such as text messaging, that are increasingly being tested in education trials. We derive asymptotic distributions of the CACE estimators using generalized estimating equations theory, which underlie the power formulas. We incorporate noncompliance from both the actual receipt of the encouragement and participation itself. An illustrative power analysis provides sample size guidance using an available Shiny R dashboard.

Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey

In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. US President's Emergency Plan for AIDS Relief.

The importance of community resources for breastfeeding

BackgroundBreastfeeding has long-lasting effects on children’s cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g., education, race/ethnicity, income level) are associated with breastfeeding initiation and duration. Further, research shows significant variation in access to community resources by race/ethnicity. It is unclear how community resources may impact breastfeeding practices and how this might intersect with maternal race/ethnicity.MethodsThis study combined nationally-representative data from the Study of Attitudes and Factors Effecting Infant Care (SAFE), which surveyed US mothers immediately after the infant’s birth and at two to six months of infant age, with the Child Opportunity Index (COI) 2.0, a census tract measure of community resources associated with child development, to explore the association between community resources and breastfeeding initiation and whether this varies based on maternal race/ethnicity and country of birth. The SAFE Study used a stratified, two-stage, clustered design to obtain a nationally representative sample of mothers of infants, while oversampling Hispanic and non-Hispanic (NH) Black mothers. The SAFE study enrolled mothers who spoke English or Spanish across 32 US birth hospitals between January 2011 and March 2014.ResultsAfter accounting for individual characteristics, mothers residing in the highest-resourced communities (compared to the lowest) had significantly greater likelihood of breastfeeding. Representation in higher-resourced communities differed by race/ethnicity. Race/ethnicity did not significantly moderate the association between community resources and breastfeeding. In examining within race/ethnic groups, however, community resources were not associated with non-US born Black and Hispanic mothers’ rates of breastfeeding, while they were with US born Black and Hispanic mothers.ConclusionsFindings suggest that even health behaviors like breastfeeding, which we often associate with individual choice, are connected to the community resources within which they are made. Study implications point to the importance of considering the impact of the contextual factors that shape health and as a potential contributor to understanding the observed race/ethnicity gap.

Pseudotetrahedral Organotin-Capped Chalcogenidometalate Supermolecules with Optical Limiting Performance.

The rational design of crystalline clusters with adjustable compositions and dimensions is highly sought after but quite challenging as it is important to understand their structural evolution processes and to systematically establish structure-property relationships. Herein, a family of organotin-based sulfidometalate supertetrahedral clusters has been prepared via mixed metal and organotin strategies at low temperatures (60-120 °C). By engineering the metal composition, we can effectively control the size of the clusters, which ranges from 8 to 35, accompanied by variable configurations: P1-[(RSn)4M4S13], T3-[(RSn)4In4M2S16] (R = nbutyl-Bu and phenyl-Ph; M = Cd, Zn, and Mn), T4-[(BuSn)4In13Cu3S31], truncated P2, viz. TP2-[(BuSn)6In10Cu6S31], and even T5-[(BuSn)4In22Zn6Cu3S52], all of which are the largest organometallic supertetrahedral clusters known to date. Of note, the arylstannane approach plays a critical role in regulating the peripheral ligands and further enriching geometric structures of the supertetrahedral clusters. This is demonstrated by the formation of tin-oxysulfide clusters, such as T3-[(RSn)4Sn6O4S16] (R = Bu, Ph, and benzyl = Be) and its variants, truncated T3, viz., TT3-[(BuSn)6Sn3O4S13] and augmented T3, viz., T3-[(Bu3SnS)4Sn6O4S16]. Especially, two extraordinary truncated clusters break the tetrahedral symmetry observed in typical supertetrahedral clusters, further substantiating the advantages offered by the arylstannane approach in expanding cluster chemistry. These organometallic supertetrahedral clusters are highly soluble and stable in common solvents. Additionally, they have tunable third-order nonlinear optical behaviors by controlling the size, heterometallic combination, organic modification, and intercluster interaction.

A Qualitative Review on Halal Cluster Studies

Halal has become one of the fastest-growing consumer sectors in the world. Muslims seek halal integrity in food, non-food products, and services worldwide. It was found that Halal Cluster Design influences customers to buy quality Halal food by moderating services, health standards, and organizational views. In addition, clusters can boost industrial productivity, increase cluster participants' ability for innovation and product development, and drive the establishment of new enterprises that support innovation and extend clusters, may produce new and better employment, new enterprises, diversify the local economy, and have a financial effect. This study was made to determine the development map on the topic of Halal Cluster research. This study provides a systematic review using bibliometric mapping of the development of keyword trends, authors, and journals about the Halal Cluster from several reputable Scopus indexed papers published between 2007 and 2021. Furthermore, this study was conducted to review what can be done and become the literature for future research related to Halal Clusters. The results of the study show that papers published with the theme of the Halal Cluster continue to develop, especially in 2019-2021.

Issues of financing economic entities of the cluster for the production of flower products in the Kaluga region using the potential of state support

In the flower industry at the regional level and in the country as a whole, problems related to the geopolitical situation have worsened, and accordingly, with the organization of production, sales, logistics supply chains, and financing of activities. Effective functioning and development of floriculture in difficult modern conditions is impossible without appropriate sources of financing and optimization of their structure. The main directions, levels, and structure of funding sources are an important component of the strategy for the creation, operation and development of a cluster for the production of floral products in the Kaluga Region.Based on a critical analysis of the state and prospects for the development of the floriculture industry in the region in a cluster design, the article substantiates approaches to the formation of an optimal structure of sources in two main areas of financing based on the types of activities of economic entities. The emphasis is placed on the levels of potential financing when planning business processes and the possibility of using government support. The provisions of the article were used in the development of a strategy for the creation and development of a cluster for the production of floral products in the Kaluga region.

Predictors of perinatal mortality in Liberia’s post-civil unrest: A comparative analysis of the 2013 and 2019–2020 Liberia Demographic and Health Surveys

IntroductionPerinatal mortality remains a pressing concern, especially in lower and middle-income nations. Globally, 1 in 72 babies are stillborn. Despite advancements, the 2030 targets are challenging, notably in sub-Saharan Africa....

Analytical tools of the risk assessment mechanism for the establishment and development of a cluster for the production of flower products in the Kaluga Region

state of the geopolitical situation, the disruption of well-established logistics supply chains, sanctions trade restrictions have led to an aggravation of problems in the flower industry of the regions, the country as a whole, and at the same time have identified new opportunities and prospects for its development. At the same time, the relevance of cluster design of the functioning of the industry increases. The functioning and development of the flower industry in modern conditions is associated with numerous threats and risks, which requires their identification, assessment, monitoring, followed by the adoption of adequate measures to neutralize. In these conditions, a reasonable, timely assessment of the risks of the current and investment activities of the cluster for the production of flower products in the whole region, taking into account the characteristics of its participants, is of decisive importance. Without an optimal selection of analytical tools and their effective use, it is impossible to ensure the reality of risk assessment, which certainly affects the effectiveness of producers of floriculture products and the industry as a whole. Based on a general analysis of the state of the floriculture industry in the region, the prospects for development in a cluster format, the article substantiates approaches to the optimal selection and use of analytical tools for a real assessment of numerous threats and risks in order to stop and level them in a timely manner. Based on expert estimates obtained using a specially developed PEST analysis methodology, the authors identified the main external risks and threats to the development of a flower cluster in the Kaluga region, summarized the results of SWOT analysis and identified measures that can reduce the negative impact of the identified threats and risks. The provisions of the article were used in the development of a strategy for the creation and development of a cluster for the production of flower products in the Kaluga region.

PLUS-IS-LESS project: Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments: study protocol for a pragmatic stepped-wedge cluster-randomized trial

BackgroundLower respiratory tract infections (LRTIs) are among the most frequent infections and a significant contributor to inappropriate antibiotic prescription. Currently, no single diagnostic tool can reliably identify bacterial pneumonia. We thus evaluate a multimodal approach based on a clinical score, lung ultrasound (LUS), and the inflammatory biomarker, procalcitonin (PCT) to guide prescription of antibiotics. LUS outperforms chest X-ray in the identification of pneumonia, while PCT is known to be elevated in bacterial and/or severe infections. We propose a trial to test their synergistic potential in reducing antibiotic prescription while preserving patient safety in emergency departments (ED).MethodsThe PLUS-IS-LESS study is a pragmatic, stepped-wedge cluster-randomized, clinical trial conducted in 10 Swiss EDs. It assesses the PLUS algorithm, which combines a clinical prediction score, LUS, PCT, and a clinical severity score to guide antibiotics among adults with LRTIs, compared with usual care. The co-primary endpoints are the proportion of patients prescribed antibiotics and the proportion of patients with clinical failure by day 28. Secondary endpoints include measurement of change in quality of life, length of hospital stay, antibiotic-related side effects, barriers and facilitators to the implementation of the algorithm, cost-effectiveness of the intervention, and identification of patterns of pneumonia in LUS using machine learning.DiscussionThe PLUS algorithm aims to optimize prescription of antibiotics through improved diagnostic performance and maximization of physician adherence, while ensuring safety. It is based on previously validated tests and does therefore not expose participants to unforeseeable risks. Cluster randomization prevents cross-contamination between study groups, as physicians are not exposed to the intervention during or before the control period. The stepped-wedge implementation of the intervention allows effect calculation from both between- and within-cluster comparisons, which enhances statistical power and allows smaller sample size than a parallel cluster design. Moreover, it enables the training of all centers for the intervention, simplifying implementation if the results prove successful.The PLUS algorithm has the potential to improve the identification of LRTIs that would benefit from antibiotics. When scaled, the expected reduction in the proportion of antibiotics prescribed has the potential to not only decrease side effects and costs but also mitigate antibiotic resistance.Trial registrationThis study was registered on July 19, 2022, on the ClinicalTrials.gov registry using reference number: NCT05463406.Trial statusRecruitment started on December 5, 2022, and will be completed on November 3, 2024. Current protocol version is version 3.0, dated April 3, 2023.

The symbolic two-step method applied to cancer care delivery research: Safeguarding against designing an underpowered cluster randomized trial with a continuous outcome by accounting for the imprecision in the within- and between-center variation.

Knowing the predictive factors of the variation in a center-level continuous outcome of interest is valuable in the design and analysis of parallel-arm cluster randomized trials. The symbolic two-step method for sample size planning that we present incorporates this knowledge while simultaneously accounting for patient-level characteristics. Our approach is illustrated through application to cluster randomized trials in cancer care delivery research. The required number of centers (clusters) depends on the between- and within-center variance; the within-center variance is a function of estimates obtained by regressing the log within-center variance on predictive factors. Obtaining accurate estimates of the components needed to characterize the within-center variation is challenging. Using our previously derived sample size formula, our objective in the current research is to directly account for the imprecision in these estimates, using a Bayesian approach, to safeguard against designing an underpowered study when using the symbolic two-step method. Using estimates of the required components, including the number of centers that contribute to those estimates, we make formal allowance for the imprecision in these estimates on which a sample size will be based. The mean of the distribution for power is consistently smaller than the single point estimate that the sample size formula yields. The reduction in power is more pronounced in the presence of increased uncertainty about the estimates with the reduction becoming more attenuated with increased numbers of centers that contribute to the estimates. Accounting for imprecision in the estimates of the components required for sample size estimation using the symbolic two-step method in the design of a cluster randomized trial yields conservative estimates of power.

Femicide, intimate partner femicide, and non-intimate partner femicide in South Africa: An analysis of 3 national surveys, 1999-2017.

In most countries, reliable national statistics on femicide, intimate partner femicide (IPF), and non-intimate partner femicide (NIPF) are not available. Surveys are required to collect robust data on this most extreme consequence of intimate partner violence (IPV). We analysed 3 national surveys to compare femicide, IPF, and NIPF from 1999 to 2017 using age-standardised rates (ASRs) and incidence rate ratios (IRRs). We conducted 3 national mortuary-based retrospective surveys using weighted cluster designs from proportionate random samples of medicolegal laboratories. We included females 14 years and older who were identified as having been murdered in South Africa in 1999 (n = 3,793), 2009 (n = 2,363), and 2017 (n = 2,407). Further information on the murdered cases were collected from crime dockets during interviews with police investigating officers. Our findings show that South Africa had an IPF rate of 4.9/100,000 female population in 2017. All forms of femicide among women 14 years and older declined from 1999 to 2017. For IPF, the ASR was 9.5/100,000 in 1999. Between 1999 and 2009, the decline for NIPF was greater than for IPF (IRR for NIPF 0.47 (95% confidence interval (CI) 0.42 to 0.53) compared to IRR for IPF 0.69 (95% CI 0.63 to 0.77). Rates declined from 2009 to 2017 and did not differ by femicide type. The decline in IPF was initially larger for women aged 14 to 29, and after 2009, it was more pronounced for those aged 30 to 44 years. Study limitations include missing data from the police and having to use imputation to account for missing perpetrator data. In this study, we observed a reduction in femicide overall and different patterns of change in IPF compared to NIPF. The explanation for the reductions may be due to social and policy interventions aimed at reducing IPV overall, coupled with increased social and economic stability. Our study shows that gender-based violence is preventable even in high-prevalence settings, and evidence-based prevention efforts must be intensified globally. We also show the value of dedicated surveys in the absence of functional information systems.

Characterizing the Digital Twin in Structural Mechanics

The Digital Twin is one of the major technology trends of the last decade. During the course of its rapid expansion into various fields of application, many definitions of the Digital Twin emerged, tailored to its respective applications. Taxonomies can cluster the diversity and define application-specific archetypes. This paper presents a systematic characterization of the Digital Twin in the context of structural mechanics and lightweight design. While the importance of a shared understanding and the development of holistic solutions for implementing Digital Twins in various application areas is widely recognized, a general framework for implementing Digital Twins in structural mechanics has not yet been established. In this paper, we systematically characterize Digital Twins and develop a framework for their application in structural mechanics, enabling the digital design and monitoring of structures for improved performance and maintenance strategies. The key contributions include collecting and clustering design and operational requirements and deriving two central archetypes: structure-designing and structure-monitoring Digital Twins. The primary goal is to reduce the complexity of conceptualizing Digital Twins of structures by providing a preliminary framework and reconsidering the Digital Twins of structures as a holistic system throughout the product life cycle. Overall, in this paper, we take a systematic approach to enhancing the conceptualization and implementation of Digital Twins in structural mechanics.

Design of a hybrid implementation effectiveness cluster randomized controlled trial of delivering written exposure therapy for PTSD in underserved primary care settings

IntroductionPosttraumatic stress disorder (PTSD) results in substantial costs to society. Prevalence of PTSD among adults is high, especially among those presenting to primary care settings. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination and implementation within primary care settings is challenging. Building Experience for Treating Trauma and Enhancing Resilience (BETTER) examines the effectiveness of integrating Written Exposure Therapy (WET) within primary care collaborative care management (CoCM). WET is a brief exposure-based treatment that has the potential to address many challenges of delivering PTSD EBPs within primary care settings. MethodsThe study is a hybrid implementation effectiveness cluster-randomized controlled trial in which 12 Federally Qualified Health Centers (FQHCs) will be randomized to either CoCM plus WET (CoCM+WET) or CoCM only with 60 patients within each FQHC. The primary aim is to evaluate the effectiveness of CoCM+WET to improve PTSD and depression symptom severity. Secondary treatment outcomes are mental and physical health functioning. The second study aim is to examine implementation of WET within FQHCs using FQHC process data and staff interviews pre- and post-intervention. Exploratory aims are to examine potential moderators and mediators of the intervention. Assessments occur at baseline, and 3- and 12-month follow-up. ConclusionThe study has the potential to impact practice and improve clinical and public health outcomes. By establishing the effectiveness and feasibility of delivering a brief trauma-focused EBP embedded within CoCM in primary care, the study aims to improve PTSD outcomes for underserved patients.Trial registration: (Clinicaltrials.govNCT05330442).