bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protracted (&gt;100 m.y.) deep crustal orogenesis revealed by in situ monazite petrochronology in the Shuswap Metamorphic Complex, British Columbia, Canada
Authors: Bowie Sarah , Gibson H. Daniel , Dyck Brendan , Godin Laurent , Larson Kyle 
Published: November 2024

Abstract
The Shuswap Metamorphic Complex in southeastern British Columbia, Canada, exposes penetratively deformed rocks exhumed from deep crustal levels (~25–30 km depth) of the Canadian Cordillera. Existing models describing its tectonometamorphic evolution are not directly linked to absolute age constraints acquired through modern petrochronological methods and, therefore, remain ambiguous. To differentiate between proposed models, here we apply U-Th-Pb monazite petrochronology, petrological modeling, and microstructural analysis to quantify conditions and timing of deformation across a transect of the Shuswap Metamorphic Complex. Our results demonstrate that metamorphism decreases in age with increased structural depth associated with progressive localization of NE-directed shearing toward the base of the Shuswap Metamorphic Complex. Monazite U-Th-Pb age data from the structural level exposed in the study area are consistent with protracted northeast-directed compression from ca. 167 Ma to ca. 59 Ma, after which west-directed ductile extension continued until at least ca. 49 Ma and was progressively localized along the Okanagan Valley fault system. New data presented are consistent with a model of basal accretion in front of a foreland-propagating ductile thrust system, followed by exhumation of the Shuswap Metamorphic Complex facilitated in large part by crustal-scale extension.
Economic evaluation of computerised interpretation of fetal heart rate during labour: a cost-consequence analysis alongside the INFANT study
Authors: Schroeder Elizabeth , Yang Miaoqing , Brocklehurst Peter , Linsell Louise , Rivero-Arias Oliver 
Published: November 2024

ObjectiveEconomic evaluation of computerised decision-support software intended to assist in the interpretation of a cardiotocography (CTG) during birth.DesignIndividual patient level data from the INFANT study (an unmasked randomised controlled trial).SettingMaternity units in the UK and Ireland.PopulationSingleton or twin pregnancy women of 35 weeks’ gestation or more and receiving continuous electronic fetal monitoring during labour.InterventionComputerised decision-support software.MethodsCost-consequence analysis presenting costs and outcomes with a time horizon of 2 years from a government healthcare perspective. Unit cost data collected from a combination of primary and secondary sources.Main outcome measuresPrimary clinical outcomes were (i) composite ‘poor neonatal outcome’ and (ii) developmental assessment at age 2 years in a subset of surviving children. Mean cost per mother and infant dyad from birth to hospital discharge, and from hospital discharge to 24 months follow-up. Maternal health-related quality of life was assessed at 12 and 24 months follow-up using the EuroQol three-level health-related quality of life instrument (EQ-5D-3L).ResultsData were analysed for 46 042 women and 46 614 infants. No statistically significant differences were detected between trial arms in any of the primary clinical outcomes or maternal quality of life. No statistically significant differences in costs were detected in maternal or infant costs from trial entry to hospital discharge or overall from hospital discharge to 2-year follow-up.ConclusionsDecision-support software during labour is not associated with additional maternal or infant benefits and over a 2-year period the software did not lead to additional costs or savings to the National Health Service.Trial registration numberISRCTN98680152.
Benefit equity of social health insurance in China and its provinces (2014–2020): implications for universal health coverage
Authors: Zhang Yaoyun , Mills Anne , Xu Jin 
Published: November 2024

IntroductionChina has increased fiscal input into social health insurance (SHI) schemes to achieve universal health coverage. Our study aimed to examine the equity of SHI benefits in the country and five representative provinces over the period of 2014–2020.MethodsWe analysed nationally and subnationally representative data from four waves (2014, 2016, 2018 and 2020) of the China Family Panel Studies. Benefit relative to consumption was assessed using concentration indices and concentration curves. We compared benefit distribution against health need across consumption quintiles. We further decomposed the change in the concentration index from 2014 to 2020.ResultsThe national concentration index for SHI benefit was pro-rich but became substantially less so over time, falling from 0.262 in 2014 to 0.133 in 2020. Poorer quintiles suffered more ill health but received a smaller share of SHI benefits compared with the richer quintiles. All five provinces improved in benefit equity to varying degrees. Reduced disparity between employee and resident schemes, and use of hospitals as the usual source of care, accounted for 44.47% and 14.70%, respectively, of the national improvement in SHI benefit equity.ConclusionThe benefit equity of SHI in China has improved, likely influenced by the narrowing funding gap between resident and employee scheme benefits. However, benefits remained skewed towards the richer groups with lower health need, revealing the resilience of an ‘Inverse Benefit Law’. We suggest risk-equalisation of SHI funds and coordinated reform in health financing and service delivery towards a greater focus on primary care.
From curriculum to clinic: a qualitative study of junior doctors’ perceptions of global health and sustainable development
Authors: Agardh Charlotte , Bielik Julia , Ekman Anna-Theresia , Velin Lotta , Herzig van Wees Sibylle 
Published: November 2024

IntroductionThe role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors’ views on the application of their global health knowledge in the clinical setting remains scarce. This study aimed to explore junior doctors’ perceptions of global health and sustainable development, the education they have received on these issues and the relevance of this knowledge in their current and future work.MethodsThis was a qualitative study based on individual interviews conducted between May and June 2022. 16 junior doctors, in mandatory clinical training after completing medical school, were purposively sampled from five Swedish hospitals. Transcripts were analysed using qualitative content analysis.ResultsThree themes were identified. The first theme (1) ‘medical doctors have a role in the transition to a sustainable society’, shows that sustainable development is increasingly perceived as relevant for junior doctors’ clinical work. The second theme (2) ‘global health and sustainable development teaching is inconsistent and somewhat outdated’, highlights that there is an assumption that global health and sustainable development can be self-taught. A discrepancy between what is being taught in medical school and the clinical reality is also recognised. This causes challenges in applying global health interest and knowledge in the clinical setting, which is described in the third theme (3) ‘application of global health and sustainable development is difficult’. This theme also highlights opportunities for continued engagement, with the perceived benefit of becoming a more versatile doctor.ConclusionThis study emphasises the need for conceptual clarity regarding global health in medical education and raises the need for clarification regarding the level of responsibility for integrating sustainable practices in Swedish healthcare settings.
Delivering an innovative multi-infection and female genital mutilation screening to high-risk migrant populations (ISMiHealth): study protocol of a cluster randomised controlled trial with embedded process evaluation
Authors: Cruz Angeline , Cuxart-Graell Alba , Gonçalves Alessandra Queiroga , Vázquez-Villegas José , Vallejo-Godoy Silvia , Salas-Coronas Joaquín , Piqueras Nicolás , Martínez-Torres Sara , Artigues-Barberà Eva , Rando-Matos Yolanda , Margalejo Ana Aguilar , Vizcaíno Jesús , Requena Pilar , Martínez-Pérez Ángela , Ferrer Elisabet , Méndez-Boo Leonardo , Coma Ermengol , Luzón-García María Pilar , Sequeira-Aymar Ethel , Casellas Aina , Vázquez-Montiel Marta , Jacques-Aviñó Constanza , Medina-Perucha Laura , Sicuri Elisa , Evangelidou Stella , Aguilar Martín Carina , Requena-Mendez Ana 
Published: November 2024

IntroductionISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysisThis study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and disseminationThe study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration numberNCT05868005.
Detection, linkage to care, treatment and monitoring of hypertension in coastal communities in Accra, Ghana: protocol for a quasi-experimental study (The Ghana Heart Initiative Hypertension Study)
Authors: Boima Vincent , Hayfron-Benjamin Charles , Doku Alfred , Twumasi Afua A A , Ottie-Boakye Doris , Selom Juliette Edzeame , Agyemang Charles 
Published: November 2024

IntroductionOver the past few decades, the prevalence of hypertension in Ghana has increased significantly. Insufficient diagnosis and suboptimal management of diagnosed cases result in increased mortality and morbidity due to poor blood pressure control and attendant complications. This highlights the need for new models of hypertension control in highly burdened, urban poor communities. This study aims to identify patients with hypertension in the coastal communities of the Greater Accra region, link patients newly diagnosed with hypertension to appropriate medical care and monitor treatment outcomes using task-shifting strategies.Methods and analysisIn this quasi-experimental study, participants with a mean blood pressure of ≥140/90 mm Hg will be recruited from seven coastal communities of Ghana’s Greater Accra region. Based on proportion to the size of these communities, we will screen and recruit 10 000 and 3000 participants, respectively, from all study sites. We will link the recruited individuals to designated health facilities and follow them for a year to assess treatment outcomes, blood pressure control, adherence to treatment, anthropometric measurements, funduscopic assessment, urinalysis, blood urea nitrogen and creatinine level, ECG and echocardiograms. In addition, we will use mobile health technology to support community screening, blood pressure checks and remote monitoring of patients diagnosed with hypertension, as well as send messages on medication adherence and lifestyle changes. Furthermore, we will conduct focus group discussions among community members and indepth interviews with persons considered to be newly diagnosed with hypertension, community health workers and religious leaders/representatives to assess the knowledge and perceptions of different study participants regarding hypertension diagnosis, management, control, experiences and treatment.Ethics and disseminationThe study was approved by the Ghana Health Service Ethics Review Committee (protocol identification number GHS-ERC 028/08/22). We will obtain written informed consent from each participant. In addition to journal publication, dissemination activities will include a report to the Ghana Health Service on the outcome of the project.Trial registration numberISRCTN76503336.
Expansion and evaluation of level II and III recovery residences for people taking medications for an opioid use disorder: project HOMES (Housing for MAR Expanded Services) study protocol
Authors: Wilkerson J M , Gallardo Kathryn R , Rodriguez Serena , Brown Henry Shelton , Ganduglia Cazaban Cecilia M , Yang James J , Herrera Estevan R , Zoschke Isaiah Niles , Stewart Hannah L N , McCurdy Sheryl A 
Published: November 2024

IntroductionAs the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced by people who live in recovery residences, little is known about the experience of people who live in these residences while taking medications for an opioid use disorder (MOUD) as part of their recovery. Thus, this study has three aims: (1) expand the availability of recovery residences that meet the National Alliance for Recovery Residences standards in Texas and serve individuals taking medications for an opioid use disorder as part of their recovery; (2) evaluate recovery residences for people taking MOUD as part of their recovery; and (3) compare the cost-effectiveness of recovery residences to treatment-as-usual.Methods and analysisIn collaboration with community partners, we opened 15 recovery residences in the State of Texas to house people taking MOUD as part of their recovery. We are collecting quantitative and qualitative data to evaluate outcomes at the intrapersonal, interpersonal, organisational and community levels. At the intrapersonal level, we are assessing changes in behavioural and psychosocial constructs using a longitudinal survey, objectively measuring current substance use with a point-of-interview breathalyser and urinalysis, and examining changes in healthcare utilisation using data obtained from a healthcare information exchange. We are collecting interpersonal data using in-depth individual interviews with residents and staff. We are collecting organisational data using field observation and a cost-effectiveness study, and we are collecting community data using neighbourhood mapping.Ethics and disseminationThe UTHealth institutional review board approved all protocols. We will disseminate study findings via conference presentations, peer-reviewed publications and brief community reports.
Achieving and sustaining reduction in hospital-acquired complications in an Australian local health service
Authors: Li Qun Catherine , Codde Jim , Karnon Jonathan , Hince Dana 
Published: November 2024

BackgroundReducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient’s recovery and health service delivery by diverting resources away from other core patient care activities. While numerous reports are available in the literature for projects that successfully reduce specific HAC, questions remain about the sustainability of this isolated approach and there may be benefits for more wholistic programmes that aim to align prevention strategies across a hospital. This study describes such a programme that uses evidence and theories in the literature to achieve and sustain a reduction in HACs in an Australian local health service between 2019 and 2022.MethodsAn organisation-wide HACs Reduction Programme underpinned by a 3-pillar strategic framework (complete documentation, accurate coding, clinical effectiveness) and a 5-year roadmap to clinical excellence was developed. Priorities were identified through Pareto analysis and aligned at organisational, service and specialty levels. The Institute for Healthcare Improvement (IHI) 90-day cycle was modified to implement contextualised evidence-based interventions supported by the application of the Awareness, Desire, Knowledge, Ability and Reinforcement change management model. Under this wholistic umbrella, specific projects were data-driven, evidence-based and outcome-oriented to promote clinical engagement and a continuous improvement culture.ResultsOverall mean HAC rate per 10 000 episodes of care decreased from a baseline of 459.5 across 2017 and 2018 to 363.1 in 2019 and remained lower through to the end of 2022 indicating sustained improvement in performance.ConclusionA wholistic approach to reduce HACs increased the likelihood of multidisciplinary integration for contextualised strategies and interventions. Improvement work, particularly in relation to patient outcomes, is a dynamic process that needs to be intentionally cultivated, targeted and coordinated. The modified IHI 90-day cycle proved to be an effective tool for implementation that contributed to sustained change.
Depressive symptom trajectories among general population during the COVID-19 pandemic in Iceland: a prospective cohort study (2020–2023)
Authors: Wang Yue , Hauksdóttir Arna , Thordardottir Edda Bjork , Ge Fenfen , Gísladóttir Elísabet Unnur , Jakobsdóttir Jóhanna , Ásbjörnsdóttir Kristjana Hrönn , Rúnarsdóttir Harpa , Unnarsdóttir Anna Bára , Magnúsdóttir Ingibjörg , Love Thorvardur Jon , Kristinsson Sigurdur Yngvi , Palsson Runolfur , Zoega Helga , Fang Fang , Tómasson Gunnar , Song Huan , Aspelund Thor , Valdimarsdottir Unnur 
Published: November 2024

IntroductionWhile changes in the prevalence of depressive symptoms during the COVID-19 pandemic have been described across populations, few studies have incorporated multidimensional variables to characterise the varying effects of the pandemic on the population’s mental health.MethodsThis cohort study included 6423 participants aged ≥18 years from the Icelandic COVID-19 National Resilience Cohort. Data on depressive symptoms and pandemic-related and non-pandemic-related factors were obtained during three pandemic assessment periods (baseline, follow-up wave 1 and follow-up wave 2; April 2020–December 2021), while health outcomes were obtained during the post-pandemic assessment period (follow-up wave 3; September 2022–February 2023). We used latent growth mixture models to identify variation in depressive symptom trajectories during the pandemic. We then used XGBoost models with 37 pandemic-related and non-pandemic-related factors to characterise these trajectories. Moreover, we performed linear regression to assess the association between the identified trajectories and post-pandemic health outcomes.ResultsOf the included participants, we identified four depressive symptom trajectories, including consistently low (83.7%), consistently high (5.3%), initially high (5.1%) and late-onset high (5.9%) symptom trajectories. Individuals who exercised frequently (≥3 days/week) and enjoyed social and family support were more likely to experience a consistently low symptom trajectory. In contrast, individuals with a history of psychiatric disorders, women and young adults (18–39 years) were less likely to follow the consistently low symptom trajectory. Moreover, compared with the consistently low symptom trajectory, the other trajectories were associated with significantly higher levels of depressive, anxiety and somatic symptoms and cognitive problems during the post-pandemic period.ConclusionsOur results underscore the long-lasting impact of the COVID-19 pandemic on population mental health. Interventions focusing on exercise, social support and family support may mitigate the adverse mental health effects of future pandemics.
Well-being interventions for emergency department staff: ‘necessary’ but ‘inadequate’ – a phenomenographic study
Authors: Beckham Andrew , Cooper Nicola 
Published: November 2024

IntroductionStress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being. This study therefore aimed to understand their experiences of these interventions.MethodsSemi-structured interviews were carried out with nine members of staff from different professional backgrounds at a tertiary trauma centre in the UK between June and July 2023. The inclusion criteria were staff who had worked in a National Health Service ED setting in the UK for more than 12 months. Participants were asked about their experience and perceptions of well-being interventions delivered in the workplace. A phenomenographical approach was applied to analyse the narrative data.ResultsThe findings resulted in seven qualitatively different but related categories. Participants experienced interventions to be: (1) necessary due to their stressful working environment; (2) beneficial in supporting their well-being; (3) feasible in an ED setting; (4) inadequate due to lack of quality and accessibility; (5) improving with increased acceptability and support; (6) restricted by clinical and organisational factors; and (7) ambiguous in definition, measurement and individual interpretation. Space for facilitated reflection and role modelling by leaders were felt to be important.ConclusionsJob demands simultaneously necessitate and restrict the provision of adequate interventions to support well-being in the ED. These demands need to be addressed as part of wider organisational change including the provision of self-care facilities and opportunities, protected time for facilitated reflection, high-quality and accessible learning opportunities for personal and professional development, training for staff delivering well-being interventions and positive role modelling by leaders.