There is an increasing burden of neurodevelopmental disorders worldwide, with scarce data in low and middle-income countries, including Nigeria. Little is known about Fragile X disorders (Fragile X syndrome and Fragile X premutation-associated conditions) in developing countries and there is no national data in Nigeria. Advancing Mental Health and Well-being of Nigerian Children Through Public Health Screening for Fragile X Disorders (CHAMP-FX) is a multicentre public health screening initiative designed to estimate the prevalence of Fragile X disorders among children with neurodevelopmental disorders in Nigeria through targeted screening, strengthen diagnostic capacity and provide pathways to targeted treatments. This is a prospective multicentre screening study with longitudinal follow-up recruiting children aged 1-18 years with intellectual disability, autism spectrum disorder, and/or global developmental delay from six tertiary hospitals across Nigeria's six geopolitical zones. Using purposive sampling, 102 participants (17 per zone) will be enrolled. Sociodemographic data and clinical evaluation will be obtained using KoboToolbox. Blood samples will be collected as dried spots on quick-response coded filter cards, stored with desiccant, and transported to the coordinating molecular laboratory. Genetic testing will be performed using a long-range amplification workflow followed by long-read sequencing to determine repeat sizes and classify results using internationally accepted thresholds. The primary outcome is the proportion of participants with Fragile X full mutation and/or premutation in the selected cohort. Secondary outcomes include the distribution of repeat sizes and associations with sociodemographic and clinical variables. Screen-positive participants will receive structured result disclosure, genetic counselling, and referral for appropriate supportive interventions, with targeted therapy using metformin offered to participants diagnosed with Fragile X syndrome. Findings will be disseminated through peer-reviewed publication, conferences and stakeholder engagement.

Safety is the fundamental guarantee of power production. The safety of power operation personnel is closely related to public welfare and the sustained and stable development of the power industry. However, factors endangering the safety of power operation personnel cover multiple dimensions, including personnel operation, equipment status, working environment, and management system, which pose considerable challenges to the comprehensiveness and accuracy of risk identification.

This study integrates scenario construction theory into power operation practice. Based on the grey relational degree and Bayesian network method, a risk assessment method suitable for power operation personnel is constructed and applied in typical power operation scenarios.

In this paper, risk assessment methods are used to identify risk factors, calculate their weights, and conduct logical analysis for the operation of live-line connecting branch leads on 10 kV overhead lines. Through scenario construction, the operation is divided into four key stages with distinct dominant risk factors in each stage. The results show that human factors and environmental factors account for relatively high overall weights, which is consistent with the pattern of actual accidents. Among them, the impact of operators' physical and mental health is unexpected and requires special attention. Meanwhile, there is a significant risk transmission effect among procedures, and the quality of preceding procedures directly determines the safety of subsequent operations.

The calculated results provide direct data support and a reference for decision-making on the precise control of power operation safety, thereby improving the scientific rigor and effectiveness of safety prevention and control measures for power operations.

Healthcare personnel worldwide are exposed to violence and aggression within the workplace. This is despite legislation, policies and guidelines to protect healthcare workers. This violence and aggression also includes healthcare students including nursing and midwifery students. There is limited evidence available regarding the experiences and thoughts of nursing and midwifery students about this phenomenon.

To explore student nurse and midwife experiences of violence when in the placement setting.

A mixed-methods cross-sectional questionnaire survey was conducted involving preregistration nursing and midwifery students in a university in the UK. The research study was planned and reported based on the CROSS checklist. The survey was distributed to 1681 students and 369 responded, giving a response rate of 22%. There were 364 qualitative responses within the survey. This article reports only on the qualitative comments drawn from two open-ended questions, which were thematically analysed based on Braun and Clarke's six-step process.

Two themes emerged, 'Experiences of sustaining and witnessing violence and aggression' and 'Training, education and measures to prevent violence and aggression'.

It is imperative that students receive the most effective and evidence-based education and training to help to prevent and manage violence and aggression while on their programme. It is also imperative that nursing and midwifery students are aware of the importance of reporting episodes of violence and aggression to ensure that students receive the appropriate support and follow up to prevent and help lessen the emotional impact.

Veterans and first responders like firefighters, police officers, paramedics, and military personnel face higher rates of mental health issues and suicide compared to the general population. Implementing and evaluating mental health projects for Veterans and first responders is crucial for enhancing their ability to serve society effectively. Economic evidence is increasingly used to improve the effectiveness and accountability of health and social programs. However, current methods are insufficient for comparing resource efficiency and value for money across different sectors and countries. This study introduces a novel methodology to accommodate heterogeneity across multiple projects within a grant program, enable standardization, and facilitate comparison in real-world implementation research.

The choice of perspective in economic evaluation depends on context, stakeholder viewpoints, resource availability, and intended use. We used a flexible approach, combining various methods to standardize resource utilization, valuation, and outcome assessment. This allowed us to estimate an overall return on investment at the program level by pooling diverse projects together. We evaluated costs from the funder's perspective, using general population valuation for healthcare interventions.

We estimated overall and individual project Return on Investment ratios for the funder's investment in the Mental Health Program, considering both total and in-kind costs. Results show that for every $1 invested in the Veterans and first responders Mental Health Program, the program returns $1.14 in overall health value, slightly exceeding the financial resources invested.

Standard economic evaluation methodologies do not accommodate real-world complexities and the heterogeneity across projects inherent in grant programs. Yet the development of pragmatic economic methods to assess value and return on investment of grant programs is essential given current funding pressures. Our study demonstrates the feasibility of addressing economic evaluations across heterogenous, international projects. Although not strictly adhering to established methods, our pragmatic approach focuses on funder return on investment. This methodology provides a pathway for economic analysis of grant programs.

Individuals around the world report nonordinary experiences that stand out to them compared to their day-to-day or ordinary experiences. Yet, they can be appraised in very different ways, resulting in wellbeing and personal growth, or in marginalization and mental health problems. One challenge is that there are relatively few systematic efforts to explore possible appraisal processes and the overall contextual features of these experiences. In study 1, we report a validation and extension of a previously designed set of appraisal and contextual questions to the Inventory of Nonordinary Experiences, with a sample of Brazilian participants (N = 160). The study successfully validated all original appraisal categories with minor modifications and added nine new context and appraisal categories. In study 2, we conducted a prevalence study by administering these questions in a general population sample (N = 5,117) in which individuals reported on one of 38 nonordinary experiences. Most contextual features and appraisals followed a unimodal distribution approximating a normal distribution. This suggests that nonordinary experiences, however heterogeneous they may be, appear to be interpreted within the same set of beliefs and appraisals, in addition to sharing similar temporal characteristics. Furthermore, although 20% of participants reported an immediate negative impact and 25% reported some degree of suffering or discomfort from experiences, 51% evaluated experiences as promoting overall positive long-term life effects. These findings highlight the potential of human resilience and the complex role of nonordinary experiences vis-a-vis protective factors in promoting health. Our results provide new insights into consciousness states and their mental health and wellbeing implications.

Arithmetic processing is represented in a fronto-parietal network of the brain. However, activation within this network is thought to undergo a developmental shift from domain-general cognitive processing in the frontal cortex towards domain-specific magnitude processing in the parietal cortex. This assumption is primarily based on findings in children and young adults. In this registered report, we set out to replicate the proposed gradual fronto-parietal activation shift in arithmetic processing and, for the first time, to explore how neural development of arithmetic continues during aging. This registered report focuses on the behavioral and neural correlates of arithmetic and arithmetic complexity across the lifespan, i.e., childhood, when arithmetic is first learned; young adulthood, when arithmetic skills are well established already, and old age, when individuals have lifelong arithmetic experience. Therefore, brain activation during mental arithmetic was measured in children, younger adults, and older adults using functional near-infrared spectroscopy (fNIRS). Arithmetic complexity was manipulated via carry and borrow operations in two-digit addition and subtraction. The results provide evidence that increasing arithmetic complexity is associated with increased activation in the fronto-parietal network across all age groups. Even though behavioral carry and borrow effects decrease during development, suggesting improvements in place-value processing, the underlying categorical and continuous processing characteristics and cortical activation remain relatively stable. While frontal activation may decrease from childhood to adulthood, parietal activation does not show a corresponding increase. Thus, the developmental fronto-parietal shift in arithmetic processing might only apply to single-digit arithmetic - but not to two-digit arithmetic across the lifespan. Overall, these results suggest that arithmetic skills acquired in childhood are maintained throughout the lifespan.

In racially and economically segregated communities, structural violence and chronic adversity perpetuate the risk for community violence and related trauma exposure. Despite widespread awareness of community violence, urban youth of color are among those least likely to have access to services that promote trauma recovery. When these youth do encounter the mental health system, the focus is often on behavioral control rather than understanding and addressing the continuous traumatic stress they face. This paper, components of which were first presented at the 41st Annual Meeting of the International Society for Traumatic Stress Studies, describes multipronged, interdisciplinary efforts to provide youth and families affected by community violence with trauma-informed, structurally competent services in both office- and community-based settings within an academic medical center that sees one of the highest volumes of bullet-related injuries in the United States.

Individuals with subthreshold posttraumatic stress disorder (PTSD) often experience significant impairment yet face barriers to care (e.g., insurance denials and exclusion from clinical trials) due to strict Diagnostic and Statistical Manual of Mental Disorders (DSM)-based diagnostic criteria that rely entirely on symptom counts. Symptom counts assume all symptoms contribute equally to underlying (within-criterion) severity. Recently, item response theory and nonlinear factor analysis models have been used to estimate PTSD severity, accounting for differences in the relative weight of symptoms. We examined a subset of treatment-seeking adults with comorbid PTSD and substance use disorders in Project Harmony who met the criteria for full PTSD based on weighted severity scores regardless of whether they met the full DSM-defined criteria. Latent class analysis was then used to identify differences in symptom endorsement patterns in this empirically estimated full-threshold PTSD group. Three distinct classes were identified: (a) participants with full-threshold PTSD based on both DSM and weighted classification, (b) underdiagnosed participants who did not endorse either DSM Criterion C (avoidance) symptom, or (c) underdiagnosed participants who only endorsed one DSM Criterion E (alterations in arousal/reactivity) symptom. Endorsement of two DSM Criterion D symptoms (negative alterations in cognitions and mood) did not differ across classes, suggesting that they could be "priority symptoms" indicating high distress and impairment, regardless of DSM diagnostic status or severity level. Accounting for symptom weighting and prioritizing these symptoms in assessment and diagnosis could increase precision in PTSD assessment and ensure equitable access to care.

Objective: Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are often comorbid. While exposure-based treatments can be effective for each, given that comorbid OCD and PTSD symptoms often interact dynamically, concurrent treatment may be most beneficial. The aim of the current analysis was to examine the naturalistic effectiveness of concurrently delivered exposure and response prevention (ERP) and prolonged exposure (PE) therapy among individuals with comorbid OCD and PTSD. Methods: This retrospective, observational analysis examined clinical data from adults (N=181) diagnosed with comorbid OCD and PTSD who were treated with concurrent ERP and PE through an online specialty therapy platform. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) and OCD symptoms using the Dimensional Obsessive-Compulsive Scale (DOCS). Linear mixed models examined symptom change from baseline to three timepoints: (1) session 20, (2) session 40, and (3) the final assessment timepoint completed by each patient. Results: PTSD symptoms decreased from mean=43.5 (SD=14.2) at baseline to mean=26.4 (SD=17.6) at final session (Hedges g=1.03, 95% CI: 0.85-1.21). OCD symptoms decreased from mean=35.2 (SD=13.7) to mean=19.5 (SD=13.9) (Hedges g=1.16, 95% CI: 0.97-1.35). By the final session, median percent improvement was 40.9% (interquartile range [IQR]: 11.5%-70.7%) for PTSD and 50.0% (IQR: 25%-67.6%) for OCD. A total of 67.4% of patients achieved a clinically significant PTSD response (≥10-point PCL-5 reduction), 64.1% achieved a clinically significant OCD response (≥35% DOCS reduction), and 49.2% achieved a clinically significant PTSD and OCD response. Analyses of secondary treatment outcomes showed significant reductions in depressive and anxiety symptoms and disability, along with improvements in quality of life. Conclusion: Findings suggest that concurrent ERP and PE, delivered remotely via video therapy in a real-world setting, may be a clinically effective treatment approach for individuals with comorbid OCD and PTSD.

The Circle of Security-Parenting program (COS-P) is a widely disseminated attachment and mentalization-informed parenting intervention. Outcome studies, however, have yielded mixed results and its effectiveness for parents from different demographic groups is largely unknown. This study examined the outcomes of COS-P and explored parent demographics (mother/father status and education). Participants were 117 parents who attended COS-P at an Australian Early Parenting Center. The Composite Caregiving Questionnaire (CCQ) assessed caregiving representations (self-efficacy regarding emotion/affection and empathy/understanding, hostility, caregiving helplessness, and parental reflective functioning). Outcomes were analyzed using a mixed model repeated measures design. Results revealed significant post-intervention improvement on all CCQ domains, with some demographic differences. Fathers reported a greater rate of improvement in parental self-efficacy regarding empathy and understanding compared to mothers, after starting from a lower level. There were no differences in any outcomes between parents who were university-educated and those who were not. Findings provide further evidence that COS-P improves caregiving representations, but there may be some differences for mothers and fathers.