Current dual base editors and hypermutators exhibit limited types of base conversion and constrained mutational diversity. To address this challenge, we engineer a compact dual base editor "A&GBE" by fusing a deaminase and glycosylase with nickase Cas9 (nCas9) to enable concurrent adenine and cytosine editing. Furthermore, we develop quadruple base mutating modules (QBMM) by fusing nickase or dead Cas9 with engineered thymine-DNA glycosylase (TDG), N-methylpurine DNA glycosylase (MPG) and TadA8e, together with MS2-MCP system recruited activation-induced cytidine deaminase (AID). This QBMM enables simultaneous mutation of all four types of nucleotide bases (A, T, G, C) within an approximately 100 base pair (bp) sequence surrounding the gRNA target site. This platform generates hyper diverse multi-nucleotide variants, establishing a powerful tool for accelerated protein evolution, functional genomics, and disease modeling.

Vision impairment affects approximately 1 in 4 school-aged children in the United States, and yet challenges in connecting to care exist. Poor vision has been linked to diminished academic performance, social development challenges, and poor mental health. School-based vision programs (SBVPs), which typically provide vision screenings, eye exams, and eyeglasses directly in schools, are one promising avenue to improve access to care, especially in underserved communities.

Vision is a foundational component of both health and educational equity, and SBVPs are interventions that address gaps in access to care for disadvantaged populations.

SBVPs would benefit from better integration with school health services and more robust systems to coordinate referrals to eye care providers. States should monitor the impact of SBVPs on access to care. Implementation and expansion of SBVPs should prioritize under-resourced schools and students who face the greatest access barriers.

Evidence for the impact of SBVPs in addressing unmet eye care needs among our most vulnerable students is robust. Evidence-based policy, financing, data infrastructure, and community partnerships are needed to embed vision care in school health to advance both health and educational equity.

Given the importance of oral health to overall health, inclusive evidence-based interventions to improve health care access, quality of life, and learning and development through school-based delivery of oral health care are needed for all children, including those with special needs.

Integrated delivery of school- and community-based health care holds the potential to improve the health and lives of children and adolescents. Team-based approaches are effective in ensuring continuity of care on-site in schools.

Greater attention to ensuring socioeconomically disadvantaged students gain access to school-based delivery of dental services and adolescent priorities (periodontal disease, dental erosion, and misalignment of the upper and lower teeth) may enhance oral health care for these underserved groups. Long-term tracking of oral health outcomes (caries-free rate, oral health-related quality of life) and educational success (attendance/graduation rates, grade point averages) would bolster the case for school-based delivery of integrated health care.

School-based oral health programs provide comprehensive on-site care, including topical fluoride application and sealant placement to prevent dental caries. Involving parents and teachers in program activities emphasizes the importance of oral health to overall health both at home and in school.

Trauma and violence exposure are critical barriers to educational equity, affecting student mental health and academic achievement. Despite growing attention to trauma-informed practices in schools, implementation remains uneven and often overlooks the complexity of trauma experiences or their systemic roots.

Grounded in and extending Basch's (2011) framework for prioritizing health conditions to reduce educational disparities, this paper synthesizes lessons learned and proposes a path forward for school-based trauma prevention and intervention. We identify three key opportunities: (1) expanding school-based trauma definitions to include chronic and identity-based stressors such as racialized trauma and immigration-related adversity; (2) leveraging comprehensive, school-wide frameworks to support infrastructure development, cross-sector partnerships, and sustainable implementation; and (3) elevating secondary traumatic stress as a core concern within trauma-informed systems.

Schools can use public health-oriented frameworks to align trauma-informed practices with equity goals. Key actions include conducting inclusive needs assessments, providing culturally responsive professional development, fostering cross-sector partnerships, and embedding policies that support educator wellness and prevent secondary traumatic stress.

By broadening definitions, centering equity, and supporting staff well-being, schools can create trauma-informed systems that are sustainable, responsive, and healing-centered.

Adolescent substance use remains a significant concern for student health, well-being, and academic outcomes, yet fewer than 4% of youth who need treatment receive it. Schools are a critical, but underutilized setting, for adolescent substance use prevention and intervention. While Multi-Tiered Systems of Support (MTSS) provide a useful framework, meaningful engagement of youth, families, schools, and communities is crucial for effective and equitable systems.

This paper asserts that youth-family-school-community partnerships should serve as the core foundation of effective school-based substance use programming. Drawing on Ecological System Theory and bridging school mental health and substance use literature, this paper proposes a framework that centers partnership, equity, and engagement within MTSS.

School policy should prioritize funding and infrastructure that promotes genuine youth, family, school, and community collaboration, including telehealth options, flexible scheduling, and hiring school-based mental health staff. These efforts can help to improve equitable access to multi-tiered school substance use services for youth and families.

Partnerships among youth, families, schools, and communities should be central to school-based substance use programming to support the development of effective and equitable school mental health systems.

To examine Sense of Coherence over a 3-year period and investigate whether baseline levels and changes in Sense of Coherence are associated with rehabilitation outcomes.

Longitudinal cohort study.

Patients accepted for specialized rehabilitation (n = 601).

Sense of Coherence and rehabilitation outcomes, defined by health and functioning were assessed before rehabilitation and after 3 years after using the 13-item Sense of Coherence questionnaire, the EuroQol visual analogue scale, and the Medical Outcomes Study Short Form 36. Sense of Coherence was analysed descriptively, and associations with rehabilitation outcomes were examined using analysis of covariance, adjusted for age, sex, level of education, referral diagnosis, and multimorbidity.

Participants reported lower Sense of Coherence, health, and functioning compared with reference populations. Mean change in Sense of Coherence over 3 years was small at the group level, at 0.7 (SD 9.7) points. Substantial variation was observed in both baseline Sense of Coherence and individual change over time. Both baseline Sense of Coherence and change in Sense of Coherence were independently associated with rehabilitation outcomes, with stronger associations observed for overall health and mental functioning than for physical functioning.

These findings suggest that interventions aimed at strengthening Sense of Coherence may improve rehabilitation outcomes across patient groups.

School nurses frequently encounter student mental health concerns, but little is known about how they prioritize mental health responsibilities relative to other nursing duties and local team structures.

This Q methodology study examined shared viewpoints about school nurse duties that most support positive student and school outcomes. Seventy nurses from six rural, high-poverty US school districts ranked 25 duties aligned with the National Association of School Nurses framework. Q sorts were analyzed using centroid extraction and Varimax rotation; post-sort comments informed viewpoint interpretation.

A three-viewpoint solution explained 71% of the variance, with 52 nurses loading significantly. Viewpoint 1 prioritized suicide-risk response and mental health work as safety responsibilities. Viewpoint 2 emphasized medical expertise and crisis-oriented mental health involvement. Viewpoint 3 prioritized planning and care coordination while ranking direct mental health duties lower.

Findings support clear role expectations, aligned referral and crisis protocols, appropriate staffing, and targeted professional learning for school nurse participation in mental health teams.

Nurses agreed on core safety duties but differed in how mental health responsibilities fit within routine school nursing practice.

This scoping review examined and synthesised existing literature on models of care involving Mental Health Nurse Practitioners (MHNPs) practising or consulting within Emergency Department (ED)-based Emergency Mental Health (EMH) services. EDs are a key access point for mental health care and often provide first contact or after-hours support for people experiencing crisis, reinforcing their central role within the mental health system. The review highlights the need for timely, safe and specialised mental health care within EDs to strengthen the quality, safety and responsiveness of EMH services. Given the limited ED-specific MHNP literature, studies involving related advanced mental health nursing roles were also included where functions overlapped with MHNP practice, although these roles were not considered equivalent. Using Arksey and O'Malley's framework, 13 ED-specific studies were included: two quantitative, two qualitative, five mixed-methods, three realist or realist-informed evaluations and one descriptive or pilot service evaluation. Three themes were identified: consumer outcomes and timely access to care; MHNP roles within ED service models; and stakeholder perspectives and systemic challenges. Across studies, MHNPs and related advanced mental health nursing roles were associated with improved access to specialist assessment, enhanced care coordination, reduced psychological distress and high consumer and staff satisfaction. However, evidence was largely derived from early-stage, single-site evaluations. Barriers relating to role visibility and organisational support also limited sustainability. Overall, MHNP roles remain under-researched, highlighting the need to identify system-level enablers supporting effective integration and impact.

This study explores the complexities and challenges Australian judges face when making decisions in Family Court cases involving parents with a mental illness under the Family Law Act 1975 (Cth). Within an Interpretative Phenomenological Analysis framework, interviews were conducted with six Australian family court judges. Findings highlight the primary focus on child safety, the intricate interplay of mental illness, substance abuse and family violence, and the critical role of evidence from mental health professionals. The results underscore the need for accessible mental health treatment, robust support systems and evidence-based assessments, as well as efforts to address barriers such as stigma and affordability that hinder parents' access to care. The findings of this study suggest that further research on parental mental illness in family law cases would be beneficial for both professionals and users of the family law system.

Social media is increasingly used as a source of mental health information for young people, with influencers playing a key role in public health communication. However, little is known about how young people engage with influencer mental health content and the media literacy skills they use to evaluate it. The objective of this study is to explore and evaluate the self-reported media literacy skills and beliefs that young people use when they encounter mental health content on TikTok.

The study uses qualitative, thematic analysis to provide an empirical account of how young people interpret mental health content from influencers on TikTok. Research was conducted via eighteen group (n = 73 participants) and individual interviews (n = 13) with eighty-six participants in the United Kingdom. The analysis focused on self-reported media literacy skills and strategies for navigating influencer-led mental health content.

The study identifies three contextual challenges in young people's responses to mental health content on TikTok: (I) reliability and relatability act as distinct but complementary criteria used to assess influencers and their mental health content; (II) platform beliefs influence willingness to engage with mental health content; and (III) algorithmically driven platform design hinders critical thinking about mental health content.

These findings highlight the sophistication of young people's media literacy skills alongside the significant, contextual barriers, which hinder the use of social media as a channel for mental health support from influencers. Our results suggest that public health campaigns may need to take a more platform-sensitive approach to online communication, acknowledging the ways platform-driven beliefs and design shape how and why young people engage with mental health content.