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Aim: To compare three-dimensional (3D) facial morphology of various unilateral cleft subphenotypes at 9-years of age to normative data using a general face template and automatic landmarking. The secondary objective is to compare facial morphology of 9-year-old children with unilateral fusion to differentiation defects., Methods: 3D facial stereophotogrammetric images of 9-year-old unilateral cleft patients were imported into 3DMedX® for processing. All images of patients with a right sided cleft were mirrored. A regionalized general facial template was used for standardization. This template was pre-aligned to each face using five automatically determined landmarks and fitted using MeshMonk. All cleft patients were compared to an age-and gender matched normative face using distance maps and inter-surface distances (mm). Average faces were created for five groups (unilateral cleft lip, alveolus, and/or palate (UCL/A/P), fusion and differentiation defects). The selected regions for the evaluation of facial morphology were: complete face, nose, upper lip, lower lip, chin, forehead, and cheeks., Results: A total of 86 consecutive 3D-stereophotogrammetry images were acquired for examination. No statistically significant differences were observed among the UCL, UCLA, and UCLP groups for the complete face, cheeks, chin, forehead, lower lip, and nose. However, in the upper lip region a significant difference was observed between the UCLP and UCL groups ( P = 0.004, CI [-2.93 to -0.48]). Further visual examination of the distance maps indicated that more severe clefts corresponded to increased retrusion in the midface and the tip of the nose, though these differences were not statistically significant across groups. For fusion vs differentiation defects, no statistically significant differences were observed, neither for the complete face nor for any of the individual regions., Conclusion: The findings demonstrate statistically significant differences in the upper lip region between children with UCL and those with UCLP, particularly with greater upper lip retrusion in the UCLP group. The use of color-coded distance maps revealed local variations and a trend of asymmetry in the nasal region, with increasing retrusion of the nose tip, upper lip, and cheeks correlating with the severity of the cleft. Although these trends were not statistically significant, they suggest a progressive facial retrusion pattern as cleft severity increases. For the secondary objective, no statistical differences were found between the facial morphology of children with fusion and differentiation defects, although a similar progression of maxillary retrusion was observed in the distance maps., Competing Interests: Robin Bruggink is a developer for 3DMedX® which is a commercial research package used in this study., (© 2025 Crins-de Koning et al.)

Background: The Compulsory Mental Health Care Act in the Netherlands (CMHCA) came into effect in 2020. Mental health nurse practitioners have since been allowed to be ‘responsible clinician’ However, there seems to be diversity in the implementation of the role in practice., Aim: To investigate the state of affairs regarding the role of the mental health nurse practitioners as ‘responsible clinician’ within the CMHCA and reflecting on this topic., Method: Legislative texts, guidelines and professional associations have been consulted. The quality and professional statutes of eighteen large mental health institutions in the Netherlands were also studied, using the search terms ‘responsible clinician’, ‘Compulsory Mental Health Care Act’, ‘nurse practitioner’, ‘CMHCA’., Results: The CMHCA leaves room for precise interpretation of the role of responsible clinician. In more than half of the quality and professional statutes examined (N=10), the role of responsible clinician is not specified. The other statutes (N = 8) include various frameworks for the role of a mental health nurse practitioner as responsible clinician., Conclusion: The role of the nurse practitioner as responsible clinician is not clearly described in the statutes and guidelines reviewed. The CMHCA leaves room for how to fulfill this. We recommend a broad field consultation to arrive at clearer advice about which discipline is responsible clinician in which situation.

Background and Hypothesis: Recovering from a first psychosis is a highly individual process and requires the person to make sense of their experiences. Clinicians, in turn, need to comprehend these first-person perspectives, creating a mutual sense-making dynamic. Antipsychotic medication is a substantial part of psychosis treatment. Providing insight in the lived experience of recovery with antipsychotics could improve the mutual understanding and help bridge the gap between the perspective of the clinician and that of the person recovering from psychosis., Study Design: 14 persons in recovery from a first psychosis with the use of antipsychotics were interviewed. Their narratives were analyzed using Interpretative Phenomenological Analysis (IPA)., Study Results: Five overarching themes were found, representing important and meaningful experiences in recovering with antipsychotic medication. Theme 1: antipsychotics as external dampening (4 subthemes); Theme 2: shifting of realities; Theme 3: pace of recovery; Theme 4: antipsychotics' influence on identity; and Theme 5: is it truly the antipsychotics?, Conclusions: Our findings show that recovery from psychosis with antipsychotics is an all-encompassing, multi-faceted, and ambivalent experience. The themes found in this research could inspire clinicians to discuss less obvious aspects of the experience of recovering with antipsychotics. Even more so, paying attention to the first-person perspective could lead to a more thorough understanding and benefit therapeutic relationships., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)

We examine an algorithm for the creation of proton-disordered ice cells based on a simulated-annealing (SA) scheme for molecular orientations. Application to defect-free ice Ih, a clathrate-hydrate structure, and a random polycrystalline ice Ih sample demonstrates the SA technique to be effective, attaining maximum HB connectivity using relatively short cooling simulations, thus serving as an alternative method for those cases in which the application of topology-based methods is inhibited., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

Background: In recent years, active surveillance has been introduced as an alternative to excisional treatment in younger women with cervical intraepithelial neoplasia grade 2 because regression rates are high and excisional treatment is associated with increased risk of preterm birth. However, early identification of women at increased risk of persistence/progression is important to ensure timely treatment. Evidence is limited on biomarkers that may be used to identify women at increased risk of persistence/progression., Objective: This study aimed to describe human papillomavirus HPV type-specific persistence/progression in women undergoing active surveillance for cervical intraepithelial neoplasia grade 2., Study Design: We conducted a historical cohort study of women aged 23 to 40 years diagnosed with cervical intraepithelial neoplasia grade 2 at Aarhus University Hospital from 2000 to 2010. Women were identified through the Danish Pathology Data Bank (DPDB) and were considered as undergoing active surveillance if they had a first record of a cervical biopsy within 2 years after index diagnosis and no loop electrosurgical excision procedure before this. Human papillomavirus genotyping was performed on archived tissue samples using the HPV SPF 10 -DEIA-LiPA 25 system (DNA ELISA [enzyme-linked immunosorbent assay] HPV SPF10 kit and RHA HPV SPF10-LiPA25 kit). Persistence/progression was defined as having a record of cervical intraepithelial neoplasia grade ≥2 in the DPDB determined on the last and worst diagnosis on a biopsy or loop electrosurgical excision procedure specimen during follow-up. We estimated the relative risk (95% confidence interval) of persistence/progression using a modified Poisson model., Results: A total of 455 women were included. Two-thirds were aged ≤30 years (73.8%) at index diagnosis, and nearly half had a high-grade index cytology (48.8%). Overall, 52.2% of all women had cervical intraepithelial neoplasia grade ≥2 during follow-up; 70.5% were human papillomavirus-16-positive and 29.5% were positive for other human papillomavirus types. Human papillomavirus-16 was associated with a significantly higher risk of persistence/progression (relative risk, 1.64; 95% confidence interval, 1.37-1.95) compared with non-human papillomavirus-16. The risk of persistence/progression was highest in human papillomavirus-16-positive women with a high-grade index cytology compared with human papillomavirus-16-positive women with a low-grade cytology (relative risk, 1.29; 95% confidence interval, 1.03-1.61), whereas no differences were observed across age groups., Conclusion: The highest risk of persistence/progression was observed among human papillomavirus-16-positive women, particularly those with associated high-grade cytology. These findings suggest that early excisional treatment should be considered in this group of women., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this qualitative study is to explore patients' perspectives on Acceptance and Commitment Therapy for early stages of psychosis. Therefore, we interviewed participants of the INTERACT study, that quantitatively investigated Acceptance and Commitment Therapy in Daily Life (ACT-DL) in combination with treatment as usual, for early stages of psychosis, comparing it to treatment as usual., Methods: Within 6 months after finishing ACT-DL, we conducted semi-structured, individual interviews with 19 participants. All interviews were audio-recorded and transcribed. Thematic analysis was used for coding and analysis., Results: Two overarching themes were formed: 'the meaning of ACT' and 'what to improve'. Considering the first, participants generally understood and connected with the meaning of ACT, noticing more awareness and acceptance of their thoughts and feelings, and living more in line with their personal values. The second theme included comments on the protocol not being personal or psychosis specific enough and some elements of ACT being too difficult to understand when having active psychotic symptoms., Conclusions: This study suggests that ACT is an acceptable and promising new form of treatment for early stages of psychosis, and it provides relevant information to further develop ACT for this group., (© 2023 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: A subgroup of patients with severe mental illness (SMI) is underrepresented in scientific research, in part due to barriers around giving informed consent. This may lead to response bias and lack of knowledge about this group. Retrospective research with existing patient data is the only way to increase our knowledge for some patient groups., Aim: To make recommendations to exploit the possibility of retrospective research with existing patient data, taking into account applicable laws and regulations., Method: After a review of relevant laws and regulations, recommendations are made., Results: Factors that determine the possibilities for retrospective research are 1) whether the researcher works with directly traceable, pseudonymized or anonymized data; 2) whether there is a high risk of response bias when asking for informed consent; 3) whether information is collected within the treatment relationship. Depending on the situation, there are several alternatives to an informed consent procedure., Conclusion: Knowledge of the relevant regulations and collaboration with specialists in the field often makes retrospective research with existing data in those patients with SMI who cannot give informed consent possible.

Informed consent is a requirement for medical research. Obtaining consent can be complex in patients with severe psychiatric disorders, often leading to their exclusion from study participation. Here, we discuss a case involving a patient with clozapine-resistant schizophrenia, highlighting the different perspectives of caregivers and physician-researchers, with an emphasis on decision-making capacity. The case illustrates the complexity of informed consent in this population, including the challenges in assessing decision-making capacity, ethical dilemmas, and potential improvements., We conclude that improving existing standardized assessment tools, promoting inclusive approaches to research participation, and supporting patient representation in decision-making processes can contribute to the quality and integrity of medical research involving individuals with the most severe forms of psychiatric disorders.

Background: Medical confidentiality is a foundation under every treatment relationship. Medical confidentiality is not immutable and has undergone a number of developments in recent decades., Aim: Reflection on the developments that medical confidentiality went through in the Netherlands and Belgium in recent decades and on the connection between medical confidentiality and the General Data Protection Regulation (GDPR)., Method: Exploration of differences and similarities in legislation and practice regarding medical confidentiality and the GDPR in the Netherlands and Belgium, and consideration of the consequences of the implementation of the GDPR., Results: Medical confidentiality went through a relativization, a privatization and a materialization. There are two views on the relationship between GDPR and medical confidentiality: that the GDPR can be an exception to medical confidentiality, and that medical confidentiality always ranks higher than the GDPR., Conclusion: Medical confidentiality and the GDPR are substantially different. There is a risk that the focus on the GDPR, both at the societal level and within organizations, may diminish the focus on medical confidentiality.

Superionic (SI) water ices-high-temperature, high-pressure phases of water in which oxygen ions occupy a regular crystal lattice whereas the protons flow in a liquid-like manner-have attracted a growing amount of attention over the past few years, in particular due to their possible role in the magnetic anomalies of the ice giants Neptune and Uranus. In this paper, we consider the calculation of the free energies of such phases, exploring hybrid reference systems consisting of a combination of an Einstein solid for the oxygen ions occupying a crystal lattice and a Uhlenbeck-Ford potential for the protonic fluid that avoids irregularities associated with possible particle overlaps. Applying this approach to a recent neural-network potential-energy landscape for SI water ice, we compute Gibbs free energies as a function of temperature for the SI fcc and liquid phases to determine the melting temperature T m at 340 GPa. The results are consistent with previous estimates and indicate that the entropy difference between both phases is comparatively small, in particular due to the large amplitude of vibration of the oxygen ions in the fcc phase at the melting temperature.

The mass transport properties along dislocation cores in hcp ^{4}He are revisited by considering two types of edge dislocations as well as a screw dislocation, using a fully correlated quantum simulation approach. Specifically, we employ the zero-temperature path-integral ground state (PIGS) method together with ergodic sampling of the permutation space to investigate the fundamental dislocation core structures and their off-diagonal long-range order properties. It is found that the Bose-Einstein condensate fraction of such defective ^{4}He systems is practically null (≤10^{-6}), just as in the bulk defect-free crystal. These results provide compelling evidence for the absence of intrinsic superfluidity in dislocation cores in hcp ^{4}He and challenge the superfluid dislocation-network interpretation of the mass-flux-experiment observations, calling for further experimental investigation.

Due to their potential role in the peculiar geophysical properties of the ice giants Neptune and Uranus, there has been a growing interest in superionic (SI) phases of water ice. So far, however, little attention has been given to their mechanical properties, even though plastic deformation processes in the interiors of planets are known to affect long-term processes, such as plate tectonics and mantle convection. Here, using density functional theory calculations and machine learning techniques, we assess the mechanical response of high-pressure/temperature solid phases of water in terms of their ideal shear strength (ISS) and dislocation behavior. The ISS results are well described by the renormalized Frenkel model of ideal strength and indicate that the SI ices are expected to be highly ductile. This is further supported by deep neural network molecular dynamics simulations for the behavior of lattice dislocations for the SI face-centered cubic (fcc) phase. Dislocation velocity data indicate effective shear viscosities that are orders of magnitude smaller than that of Earth's lower mantle, suggesting that the plastic flow of the internal icy layers in Neptune and Uranus may be significantly faster than previously foreseen.