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Transfer RNAs (tRNAs) are transcribed and then processed through a series of post-transcriptional steps to produce mature forms that are charged with amino acids for translation. A CCA sequence is added at their 3' ends as the site of aminoacylation. Although a single enzyme typically adds the CCA tail without a nucleic acid template, Schizosaccharomyces pombe encodes two enzymes: CCA1 that adds the two cytosines and CCA2 that adds the adenosine. Here we explore how these two S. pombe enzymes evolved specificity to generate the 3' CCA tails. Enzymology (activity and kinetic assays) indicates distinct nucleotide addition specificity. CCA1 adds the sequential cytosines with a slower first addition followed by a quicker second addition. CCA2 then rapidly adds the terminal adenosine. Moreover, structural biology (crystal structures and molecular dynamics simulations) explains how the active site configuration and distances between active site and tRNA elbow binding residues of CCA1 and CCA2 restrict their tRNA substrate specificity. Together the data presented here describe how S. pombe CCA1 and CCA2 interrogate complete reaction complexes of tRNA and nucleotide substrates that arrange the particular components for active site catalysis and therefore specificity.

Traditional face-to-face postgraduate psychology practicums are associated with a range of challenges, such as poor availability and accessibility of supervised placements, difficulty accumulating adequate client contact and supervision hours, and lack of consistency and standardisation between placements. While the use of simulated practicums in health-related fields is becoming increasingly acknowledged, the efficacy is less well understood. Building on a previous pilot evaluation, this study aimed to quantitatively evaluate the effectiveness of a fully online and simulated practicum for professional psychology trainees in developing initial professional competencies. The results indicated that trainee competencies, as assessed by board approved supervisors, significantly improved across all domains from mid-to-end-of-practicum. Furthermore, the study found that completion rates for the online, simulated practicum were significantly higher, and rates of extensions to complete the practicum were significantly lower, compared to previously offered face-to-face practicums. These findings provide some empirical support for the use of simulated practicum experiences for postgraduate psychology students. Simulated practicum can provide standardised training for psychologists to develop core competencies and overcome barriers to traditional face-to-face practicum experiences and has the potential to increase the level of competency for trainees prior to commencement of face-to-face practicum or internships. What is already known about this topic: (1) The availability and accessibility of supervised practicums can be a bottleneck in professional psychology training. (2) Simulation-based learning is increasingly utilised in psychology training, including practicum experiences. (3) Psychometric evaluation of simulated practicums is needed. What this topic adds: (1) This study evaluated the effectiveness of a fully online and simulated practicum for professional psychology trainees. (2) Results indicated that trainee competencies, as assessed by board-approved supervisors, significantly improved across all domains of competence from mid-to-end-of-practicum. (3) Implications for professional psychology training are discussed.

Dextrocardia with complete atrioventricular septal defect (AVSD) is an exceptionally rare congenital cardiac anomaly. Mirror-image cardiac orientation adds substantial surgical complexity and requires detailed preoperative planning in accordance with national congenital heart disease management guidelines. We report the case of a 1.4-year-old male infant who presented with poor weight gain, recurrent respiratory infections, and intermittent cyanosis. Imaging studies confirmed dextrocardia with situs inversus totalis, complete AVSD with a common atrium, severe pulmonary stenosis, and mirror-image systemic and pulmonary venous anatomy. Surgical correction was successfully performed using the single-patch technique, with careful orientation to preserve physiological venous drainage without the need for venous rerouting. Complete AVSD repair in the setting of dextrocardia is rarely reported. The single-patch technique, commonly used in standard AVSD repair, can be safely adapted to mirror-image anatomy when detailed anatomical mapping and interdisciplinary planning are undertaken. Preservation of normal physiological venous pathways is essential to achieving favorable outcomes. Single-patch repair of complete AVSD in children with dextrocardia is feasible and effective when meticulous planning and experienced surgical execution are employed. This case contributes valuable evidence to the limited literature on managing complex congenital heart defects in mirror-image anatomy.

Cardiomyopathy is universally penetrant in young adults with Duchenne muscular dystrophy (DMD), and is increasingly the preponderant cause of death. We describe the ECG, echocardiography and cardiac MRI (CMR) findings associated with this disease, and the level of agreement between imaging modalities, highlighting the obstacles encountered in high rates of failed diagnostic cardiac imaging in our DMD multidisciplinary care centre. We followed all patients attending a Comprehensive Multidisciplinary Adult DMD clinic over 4 years. All attendees underwent transthoracic echocardiography (TTE) and were offered referral for cardiac MRI (CMR). We recorded baseline demographics, ECG characteristics and imaging findings, comparing TTE and CMR derived LVEF. A total of 33 patients enrolled, median age 20, with mean follow-up of 3 years and 3 months. Common ECG abnormalities were dominant R in V1, pathological Q waves and right axis deviation. Mean LVEF was 51 % at enrollment and 45 % at follow-up by TTE. Presence of any degree of mitral regurgitation correlated strongly to left ventricular systolic dysfunction. CMR was completed in just 25 % of patients, all of whom had extensive midwall fibrosis. Of those in whom CMR failed, 52 % were unable to lie flat or position correctly for scanning, predominantly due to muscle contractures. Despite suboptimal TTE imaging in 75 %, there was good agreement in LVEF between CMR and TTE. We found a high rate of failure to complete diagnostic cardiac imaging in this group of patients with impaired mobility predominantly due to fixed flexion deformities, inability to lay flat or to tolerate the scan. Our study highlights the critical need to provided specially trained Echo and CMR sonographers who understand the challenges to optimal quality imaging in these patients, and who are appropriately supported by Health Care Assistants (HCA) who are familiar with careful positioning to facilitate optimal imaging. Never the less, the study highlights the importance of multimodality imaging, and practical strategies to overcome environmental obstacles to diagnostic imaging, to better guide aggressiveness of treatment for DMD and its inherent cardiomyopathy.Key Learning Points.What is already known:•In addition to significant mobility impairment, Duchenne muscular dystrophy (DMD) is associated with development of severe cardiomyopathy in childhood / early adulthood. Due to relatively recent improvements in survival, the evolution of ECG and imaging correlates in adulthood are poorly described.•The accuracy and degree of correlation between transthoracic echocardiography (TTE) and cardiac MRI (CMR) in this cohort is not known. Myocardial fibrosis, not evaluated on TTE, can be seen on cardiac CMR, and is thought to be predictive of earlier and more severe cardiomyopathy phenotype. Its prevalence in this form of cardiomyopathy is unknown.•Patients with DMD are likely to encounter difficulty in achieving diagnostic cardiac imaging due to factors inherent to the condition as well as environmental obstacles, and an optimal strategy for imaging is not well defined in this particular patient group with unique practical challenges and imaging findings.What the study adds:•We describe the typical and common ECG, TTE and CMR findings in an adult cohort of patients with DMD cardiomyopathy, and the barriers to completing these investigations.•Extensive midwall fibrosis was seen on CMR in 100% of patients scanned, supporting the hypothesis of a universally penetrant cardiomyopathy, and a strategy of early pharmacotherapy in all patients, prior to symptom onset.•We report a good degree of correlation between TTE and CMR -derived LVEF, and therefore highlight the importance of multimodality imaging, with an individually tailored approach in this cohort, in order to guide decisions around escalation of treatment, ICD implantation and prognostication.

Objective This study examines whether mode of birth is associated with postpartum psychological distress among women who experienced high-risk versus low-risk pregnancies. It adds an ethical perspective to the literature by considering how medicalization of birth may differentially affect women's autonomy and well-being across pregnancy risk contexts. Method In a cohort of 138 women who gave birth at a northern Israeli hospital (January to September 2023), psychological outcomes were measured eight weeks postpartum using the DASS-21 and PTSD Checklist (PCL-5). Birth mode and pregnancy risk status were extracted from medical records. Pearson correlations were computed separately for high-risk (n = 20) and low-risk (n = 118) groups. Results Among women with high-risk pregnancies, more medicalized birth modes were significantly correlated with higher levels of stress (rp = 0.655), anxiety (rp = 0.863), depression (rp = 0.726), and PTSD symptoms (rp = 0.789). No significant associations were found in the low-risk group. Conclusions Birth mode plays a critical role in postpartum mental health for women with high-risk pregnancies. These findings underscore the ethical duty to prevent psychological harm and to respect women's relational autonomy, making trauma-informed, autonomy-supportive care a moral imperative in medically complex births.

Nausea and vomiting in pregnancy is a common affliction, especially in the early trimesters. This is typically managed at home with doxylamine-pralidoxime or other home remedies. Many women, however, require additional adjuncts to control their symptoms. In this case we present a G2P0 female at 7 weeks gestation who arrived in the emergency department with persistent vomiting for several days. This patient already had a home medication regimen of multiple antiemetics. Additional treatment with ondansetron, prochlorperazine, and metoclopramide via IV administration as well as fluid administration resulted in minimal improvement in her symptoms in the emergency department. After stepwise escalation of antiemetic therapy and fluid resuscitation failed to provide relief, droperidol administration resulted in the rapid and complete resolution of her symptoms. This allowed for a safe discharge rather than admission for hyperemesis gravidarum. This case highlights the utility of droperidol as a rescue antiemetic in pregnancy when conventional therapies prove to be ineffective. This adds to the evidence supporting consideration of droperidol for refractory cases of nausea and vomiting and hyperemesis gravidarum in pregnancy. The purpose of this case report is to describe the safety and efficacy of droperidol in the treatment in refractory nausea and vomiting in pregnancy.

Considerable diversity in cardiology training and credentialing pathways exist within the Asia-Pacific. We aimed to map these variations and report similarities and disparities with a view to understanding needs in cardiology curricula development in the region. A 42-item online questionnaire was distributed to credentialed cardiologists serving as representatives from various regions within the Asia-Pacific, allowing obtainment of region-specific data as of December 2023. Responses were derived from a total of 23 regions. All regions required specialist qualification to practise cardiology. Overall, 69.6% have a single training pathway, while 21.7% and 8.7% have two or three pathways, respectively. Majority (91.3%) had structured cardiology training curricula with assigned supervisor and regular assessments. The majority (91.3%) required mandatory training in internal medicine prior to cardiology. The total training duration inclusive of medicine and cardiology varied across regions (range 3-8 years) with 26.1% lasting 5 years and 43.5% lasting 6 years. All programmes had mandatory clinical cardiology training; 82.6% had interventional cardiology, 73.9% had electrophysiology, 73.9% had cardiac imaging training. However, 47.8% of regions had no training in cardiac computerized tomography (CT) and 56.5% had no cardiac magnetic resonance (CMR) imaging. 73.9% required mandatory research for board certification. In addition, 95.1% had an exit exam at completion of training (local in 95% cases). Board certification was mandatory for general cardiology practise in 69.6% of regions. Separate subspeciality fellowships were mandatory in 73.9% of regions. Significant regional variations in cardiology training and credentialing pathways exist, presenting opportunities to harmonize and improve training metrics regionally. Key message What is already known on the topic? Cardiology training within the Asia-Pacific region has considerable variation in terms of duration, curriculum, training, and exit requirements. What this study adds? This study outlines the similarities and differences of cardiology training between different countries within the Asia-Pacific region. How this study might affect research, practise or policy? Results from this study provide insights that may inform the development of harmonized and contextually appropriate cardiology curricula in the Asia-Pacific region. Establishing common standards for cardiology training could facilitate a more uniform and coherent curriculum across Asia, ensuring consistency in trainee competencies and clinical practise.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency impairs NADPH generation through the pentose phosphate pathway, resulting in reduced glutathione regeneration and increased vulnerability to oxidative stress. While its clinical significance is well described in hemolytic disorders, its impact on tumor biology and chemosensitivity remains poorly characterized. Cisplatin, a backbone agent in the management of nasopharyngeal carcinoma (NPC), exerts its cytotoxicity through the formation of DNA adducts and the robust induction of reactive oxygen species (ROS) activity. We report a patient with non-keratinizing NPC and a G6PD variant, a (class III) deficiency, who demonstrated a rapid and pronounced objective response to cisplatin-based induction and concurrent chemoradiotherapy. Unfortunately, the patient also exhibited signs of rapid and persistent hematologic (platelets and white cells) toxicity. Notably, no hemolytic events occurred. A narrative review of the available literature indicates that G6PD-deficient cells exhibit a reduced antioxidant reserve, increased cisplatin-induced DNA damage, and impaired activation of ROS-detoxifying pathways. A few clinical observations similarly report enhanced tumor responsiveness in G6PD-deficient individuals, although the evidence is sparse and heterogeneous. Preclinical data support the notion that diminished NADPH availability amplifies cisplatin-triggered oxidative injury, thereby increasing tumor susceptibility. This case adds to emerging evidence that G6PD deficiency may potentiate cisplatin efficacy in NPC by exploiting intrinsic redox vulnerabilities. While preliminary, these findings suggest the potential utility of metabolic phenotyping in treatment stratification. Prospective studies are needed to define the predictive value, safety, and therapeutic implications of G6PD status in cisplatin-based regimens.

The use of commercial milk formula (CMF) in facilities providing maternity and newborn services disrupts establishment of breastfeeding and adds to greenhouse gas (GHG) emissions. We identified evidence on GHG emissions in these services and explored implications for a gender-just transition to GHG emissions reductions by scaling-up the Baby-Friendly Hospital Initiative (BFHI) to reduce CMF use. We performed a scoping review and narrative synthesis on three interrelated topics: 1) GHG emissions impact of CMF use in maternity services, 2) gender-just transitions in agrifood systems away from dairy production, and 3) BFHI's influence on CMF use at hospital discharge. Searches retrieved 280 articles across three topics, with 51 meeting inclusion criteria. For topic 1, there was limited focus on GHG impacts or CMF use, with just one study primarily addressing the impacts of CMF use for food waste. Topic 2 included 14 studies showing that gender disparities and structural inequalities hinder effective gender mainstreaming and climate change adaptation in agriculture such as dairying, while none cited gendered effects on producers of reducing dairy use from transitioning to more sustainable health services. For topic 3, 36 studies indicated that BFHI reduced CMF supplementation, and increased breastfeeding. This study highlights a significant evidence gap regarding carbon footprints of facilities providing maternity and newborn services. Given the GHG emissions associated with CMF, absence of evidence of harmful impacts on female dairy farmers, and under-investment in women's competencies as maternity care professionals, facilities seeking to reduce their carbon footprint should implement gender-just strategies such as BFHI which minimize unnecessary CMF use and increase investments in breastfeeding support and training of mostly female maternity services staff.

Background: The photopic negative response (PhNR) of the full-field electroretinogram is a retinal ganglion cell-weighted functional signal increasingly proposed as a clinical biomarker. Despite extensive study across ocular and systemic diseases, its precise clinical role and incremental value remain incompletely established. Methods: This narrative review synthesizes key human studies of the photopic negative response, with emphasis on physiological basis, recording methodology, and clinical contexts in which PhNR may provide added functional insight. Results: In glaucoma, PhNR provides an objective measure of retinal ganglion cell dysfunction that correlates moderately with optical coherence tomography (OCT)-derived structural loss and visual field indices, but with substantial inter-individual variability. Its greatest clinical utility lies in early disease detection, cross-sectional functional assessment, and documenting short-term functional changes following intraocular pressure reduction, rather than longitudinal progression monitoring. Beyond glaucoma, PhNR reveals inner retinal dysfunction in systemic and genetic conditions, particularly idiopathic intracranial hypertension and diabetes, where retinal ganglion cells may reflect broader neurological or metabolic stress. Conclusions: PhNR is best viewed not as a standalone diagnostic or progression tool, but as a complementary functional biomarker that adds objective insight when structural imaging or psychophysical testing is limited or discordant. Its role aligns closely with the retina's emerging function as a mirror of systemic and genetic disease, provided recordings are standardized and results interpreted cautiously.

Is time-lapse monitoring (TLM) with or without a machine learning selection algorithm for embryo selection cost-effective when compared with conventional culture and selection? Neither TLM with or without the use of machine learning for embryo selection is likely to be cost-effective when compared with the conventional approach. TLM adds cost to IVF treatments without improving clinical results. Recent randomized controlled trials (RCTs) provide evidence that TLM is unlikely to increase pregnancy or live birth rates (LBRs) relative to conventional embryo culture and selection. To date no cost-effectiveness analysis of TLM has been published. A cost-effectiveness analysis (CEA) from a healthcare perspective was performed based on data from our multicentre RCT on TLM, which was conducted from 2017 to 2020. Women scheduled for Day 3 single embryo transfer during their first, second, or third oocyte retrieval were included. The trial included three strategies: (i) TLE: embryo selection based on a machine learning algorithm and uninterrupted culture; (ii) TLR: routine morphological embryo selection and uninterrupted culture; and (iii) CON (Control): routine morphological embryo selection and interrupted culture. In total, 1731 couples were included. The difference in mean costs between treatment groups was calculated with the following cost items: laboratory procedures, laboratory facilities (incubator, disposables, service), embryo transfers, pregnancies, miscarriages, and deliveries. We did not consider costs of stimulation, oocyte retrieval, and IVF/ICSI procedures as these were identical in each group. The effectiveness measure for the CEA was the cumulative LBR. Incremental cost-effectiveness ratios were calculated for direct comparisons between strategies. The 12-month cumulative LBR rate was similar in the three treatment groups: TLE 48.7%, TLR 48.4%, CON 48.2%. The mean difference in costs was €237 (95% CI: -35 to 508) between TLE and CON, and €55 (95% CI: -203 to 313) between TLR and CON. The incremental cost-effectiveness ratio between TLE and CON for one additional live born was €45 950; for TLR versus CON, it was €26 905. The probability that TLE or TLR are cost-effective was low for all willingness-to-pay level, with several scenarios resulting in comparable findings. This study reports the cost-effectiveness for one time-lapse incubator; however, more systems are currently available. While our cost-effectiveness analysis provides evidence that TLM is unlikely to be cost-effective, its use is not inferior to conventional methods in terms of clinical results and can offer certain advantages for IVF laboratories. The authors received a grant from the Netherlands Organization for Health Research and Development (ZonMw) for the execution of the SelecTIMO study (Health Care Efficiency Research programme grant 843001602). Merck (Germany and the Netherlands) supplied the six time-lapse incubators, funded the laboratory adjustments, and provided technical support and training to laboratory personnel before and during the study. The following declarations of competing interests are outside the submitted work: J.M.J.S. reports research grants from Ferring BV and Merck BV, speakers' fees from Merck BV and travel support for attending meetings from Merck BV and Goodlife BV. C.B.L. reports speaker's honoraria from Merck and Organon (The Netherlands), travel support from Merck and Organon, and was Editor-in-Chief of Human Reproduction. M.v.W. is Editor-in-Chief of Human Reproduction Update. The remaining authors have no conflicts of interest to declare. NTR5423: ICTRP Search Portal (who.int).

During the peak of the coronavirus disease 2019 (COVID-19) pandemic, radiographers in Zambia faced heavy workloads as chest X-ray referrals outpaced staffing and the capacity of X-ray imaging equipment, and protective gear was limited. The pandemic disrupted the daily work routines of radiographers, yet little is known about how radiographers in Zambia experienced and thrived through this public health crisis. This study aimed to determine the work experiences and practices of radiographers during the COVID-19 pandemic for future reference. Two tertiary hospitals are designated as COVID-19 treatment centres in the Eastern province of Zambia. A qualitative approach with exploratory and descriptive designs was employed. A purposive sample of 11 radiographers was used for interviews to reach data saturation. The time frame for data collection was from 01 November 2023 to 30 November 2023. Data were collected through semi-structured face-to-face interviews and were analysed thematically using Braun and Clarke's method. Four themes were developed, namely: (1) personal and work-related challenges, (2) adapting to abrupt changes, (3) wellness and information support and (4) preparation for future pandemics. Radiographers adapted and demonstrated resilience to the high occupational pressures of patient referrals for chest X-ray imaging during the pandemic, although they were fearful of contracting the COVID-19 infection. This article adds strategies to improve emergency X-ray imaging response and strengthen preparedness for future health emergencies, informed by radiographers' COVID-19 experiences.

The Multi-Specialty Recruitment Assessment (MSRA) is a proctored assessment, comprising a clinical problem-solving (CPS) test and a situational judgement test (SJT), often combined with selection interviews, for admission to multiple postgraduate medical specialty training programmes in the UK. The study examined the predictive validity of these selection assessments (i.e. the extent to which they effectively predicted later performance outcomes). Data were obtained from the UKMED dataset and analyzed for ten UK medical specialties (~13 000 unique applications) to explore relationships between selection data (CPS, SJT, and selection interview) and subsequent performance outcomes; Annual Review of Competence Progression (ARCP) and national professional examination scores, comprising Applied Knowledge Tests (AKTs) and Objective Structured Clinical Examinations (OSCEs). Results supported the predictive validity of the MSRA and interview scores with some evident trends across different criteria. For example, the CPS tended to be most predictive of the AKT performance, and the SJT (which assesses non-academic skills) tended to be more strongly predictive of OSCE than AKT performance. The predictive validity of the selection interviews beyond the MSRA varied by specialty. Results provide evidence of the predictive validity for both the MSRA and interviews across a range of specialties, providing insights into how best to design and combine different selection methods to balance key considerations such as reliability, validity, efficiency, and positive candidate feedback. The findings of this research also have implications for other healthcare selection settings. Key messages • What is already known on this topic - Previous research has already demonstrated that the MSRA shows predictive validity in the context of General Practice and Psychiatry selection, and has begun to explore the validity of the MSRA and interviews in further specialties. However, there is a lack of recent research exploring the predictive validity of MSRA in selection processes across other specialties, using a range of criterion measures and longitudinal performance outcomes, such as exam data. • What this study adds - The MSRA demonstrates validity with Annual Review of Competence Progression (ARCP) and national professional examination scores in postgraduate medical specialty training, across a range of different medical specialties. • How this study might affect research, practice, or policy - The results of this study can be used to inform future policy and decision making regarding the use of the MSRA alongside selection interviews and to enhance the reliability, validity, efficiency, and candidate experience for selection in future. Further, results provide valuable insights about the validity of such methods which may be informative to other settings internationally.

Augmentative and alternative communication (AAC) requires speech-language pathologists (SLPs) to have unique skills that may not be easily transferred from other practice areas. The introduction of the National Disability Insurance Scheme (NDIS) also created a distinctive work context for Australian SLPs within the disability sector. Therefore, this study aimed to investigate the self-perceived competence of Australian SLPs in AAC. This study followed a sequential explanatory mixed methods approach. First, 203 SLPs completed a quantitative online survey. Next, 16 SLPs of those surveyed, participated in a one-on-one, semi-structured interview over Zoom. Competency ratings were higher for those SLPs who received pre-professional training in AAC, worked in a metropolitan area, had spent more time in the workforce and had a higher proportion of AAC users on their caseload. Competency ratings also differed by service delivery task; delivering therapy received the highest rating, while conducting assessments received the lowest. When asked about barriers and facilitators to clinical competence in AAC, four themes were identified (1) access to training and information, (2) AAC is a quickly evolving and changing field, (3) the impact of workplace context and (4) the attitudes of key stakeholders regarding AAC. SLPs in Australia report mixed levels of competence in AAC and experience many barriers to further developing their competence. Considerations should be made for how to reduce these barriers at a national level to ensure AAC users are accessing high quality supports. What is already known on the subject Previous literature has highlighted that speech-language pathologists (SLPs) internationally have varied levels of self-perceived competence in augmentative and alternative communication (AAC). Most of this research has been conducted in the United States and has been quantitative. What this paper adds to the existing knowledge This mixed methods study highlights that the self-perceived competence of Australian SLPs is impacted by university training, geographical location, time in the workforce, caseload and service delivery task. SLPs also feel that workplace context, attitudes of key stakeholders, technological advances and access to post-professional training impacts their ability to further develop competence in AAC. What are the potential or actual clinical implications of this work? This study highlights the critical role of key stakeholders such as university staff, funding bodies and employers in the development of clinical competence in AAC for SLPs.

Embedded cryptography stands or falls on entropy quality, yet small devices have few trustworthy sources and little tolerance for heavyweight protocols. We build a Quantum Entropy as a Service (QEaaS) system that moves QRNG-derived entropy from a Quantis device to ESP32-class clients over post-quantum-secured channels. On the server side, the design exposes two paths: direct quantum entropy through a custom OpenSSL provider and mixed entropy through the Linux system pool. On the client side, we extend libcoap's Zephyr support, integrate wolfSSL-based DTLS 1.3 into the CoAP stack, and add a BLAKE2s entropy pool that preserves the standard Zephyr extraction interface while introducing an injection API for server-provided entropy. Benchmarks on ESP32 hardware, targeting 100 iterations per configuration, show that ML-KEM-512 completes a DTLS 1.3 handshake in 313 ms on average without certificate verification, 35% faster than ECDHE P-256. Pairing ML-KEM-512 with ML-DSA-44 lowers the mean to 225 ms. Certificate verification adds roughly 194 ms for ECDSA but only 17 ms for ML-DSA-44, so the fully post-quantum configuration remains 63% faster than classical ECDHE P-256 with ECDSA even under full verification. Local BLAKE2s pool operations stay below 0.1 ms combined. On this platform, post-quantum key exchange and authentication are not only feasible; they are faster than the classical baseline.

To describe oral hygiene behavior and oral health literacy in the general adult German population (also stratified by migration background) and to identify the association of migration background with such outcomes. Data from the general adult German population aged 18-74 years was used (quota-based sample representative in terms of age, gender, and federal state). The analytic sample equaled 5,000 individuals, with mean age of 47 years, 51% being female, and 11% had a migration background. Common questions were employed to measure oral hygiene behavior, oral health literacy and migration background. Multiple logistic regressions were used to explore the association of migration background with oral hygiene behavior and oral health literacy. A significant proportion reported not using oral hygiene products, with 35.5% not using an electric toothbrush (not using manual toothbrush: 28.1%), 59.4% not using fluoride gel, and 27.7% not using interdental cleaning aids. Additionally, 14.1% brushed their teeth for less than two minutes and 76.4% reported having at least good oral health literacy. Depending on migration background, some outcomes significantly varied. Adjusted multiple logistic regressions showed that having a migration background (compared to not having a migration background) was significantly associated with lower odds of using an electric toothbrush (OR = 0.79, 95% CI:0.66-0.95) and duration of tooth brushing (OR = 0.54, 95% CI:0.43-0.69). Data on oral health, use of different oral hygiene products, and oral health literacy among adults with migration background is limited. Our analysis adds to this knowledge and helps identify gaps and needs in this population to improve preventive measures.

Maturity-onset diabetes of the young (MODY) KCNJ11 is caused by pathogenic variants in the KATP channel of the pancreatic β-cell leading to altered insulin secretion. Bi-allelic loss-of-function variants lead to neonatal diabetes mellitus (DM) whereas heterozygous gain-of-function variants lead to congenital hyperinsulinism. Heterozygous loss-of-function variants, however, are suggested to cause a bimodal pattern with hyperinsulinaemic hypoglycaemia in early life (with an often-mild presentation) and progressing to glucose intolerance in early adulthood. We describe three family members with early-onset DM (or glucose intolerance) without clear features of type 1 or type 2 DM. A heterozygous likely pathogenic missense variant c.119G>A (p.(Gly40Asp)) was found in an autosomal dominant pattern. This variant was previously only linked to cases of congenital hyperinsulinism and had been described as likely pathogenic or pathogenic in patients with type 2 DM. To our knowledge, this is the first report linking the c.119G>A KCNJ11 variant to a clinical context of MODY. We have no evidence in our patients of clinically significant hypoglycaemia at young age. However, we still hypothesise - congruent with the latest evidence - that there might be a bimodal pattern in individuals with this variant. This report adds to the clinical and genetic heterogenicity of MODY and illustrates the complexity of early diagnosis of MODY. We describe another clinical phenotype, namely diabetes mellitus, associated with a pathogenic variant in the KCNJ11 gene that was previously only linked to congenital hyperinsulinism.An initial non-specific genetic variant for MODY always warrants an extensive clinical work-up, a thorough family history and segregation of the variant in family members.This case highlights the heterogeneous presentation of pathogenic variants in MODY genes.

Imperforate hymen is the most common congenital obstructive anomaly of the female genital tract and an important cause of primary amenorrhea; however, delayed diagnosis may occur in low-resource and culturally sensitive settings, especially when coexisting genital findings such as type II female genital mutilation (FGM) complicate clinical assessment. A 17-year-old nulliparous adolescent from a rural area, married for two months, presented with primary amenorrhea since puberty, severe cyclic lower abdominal pain, and avoidance of sexual intercourse because of discomfort. She had normal secondary sexual characteristics, and genital examination demonstrated a tense, bluish bulging hymenal membrane, with coexisting type II FGM noted on examination. Pelvic ultrasonography confirmed hematocolpos and hematometra. The patient underwent hymenectomy using a cruciate incision, with evacuation of approximately 700 mL of retained menstrual blood. Her postoperative course was uneventful, and her symptoms resolved on follow-up. This case highlights that imperforate hymen should be suspected in adolescents presenting with primary amenorrhea and cyclic pelvic pain, particularly when diagnosis is delayed in rural or culturally complex settings. The coexistence of type II FGM adds clinical relevance to the case and should prompt careful genital examination and thoughtful surgical planning. Early recognition and timely hymenectomy are curative and help prevent avoidable physical and psychosocial complications.