First Constraints on the Photon Coupling of Axionlike Particles from Multimessenger Studies of the Neutron Star Merger GW170817.

We use multimessenger observations of the neutron star merger event GW170817 to derive new constraints on axionlike particles (ALPs) coupling to photons. ALPs are produced via Primakoff and photon coalescence processes in the merger, escape the remnant, and decay back into two photons, giving rise to a photon signal approximately along the line of sight to the merger. We analyze the spectral and temporal information of the ALP-induced photon signal and use the Fermi Large Area Telescope (Fermi-LAT) observations of GW170817 to derive our new ALP constraints. We also show the improved prospects with future MeV γ-ray missions, taking the spectral and temporal coverage of Fermi-LAT as an example.

Understanding African American help-seeking for romantic relationships: Advocacy, barriers, and considerations.

African American couples experience greater levels of relationship distress than other racial/ethnic groups, but they are less likely to seek formal couple counseling. Existing literature highlights the importance of community support in the form of church, family, and friends. While the literature suggests that African Americans encounter unique barriers, we do not know how racism and discrimination impact the couple help-seeking process. This study seeks to address this gap and better understand unique barriers in the African American couple help-seeking (AACHS) process via a grounded theory-informed qualitative study. Findings from interviews with 11 African American individuals in committed relationships highlighted mistrust as a significant barrier to AACHS, while community supports are frequently sought out. Our findings add to current understandings about AACHS and highlight important areas for future research. In the clinical implications section, the authors outline tangible steps that clinicians can take based on the findings from this study.

The Use of Hyaluronidase in Aesthetic Practice: A Comparative Study of Practitioner Usage in Elective and Emergency Situations.

BACKGROUND: Hyaluronic acids (HAs) continue to be the fillers of choice worldwide and their popularity is growing. Adverse events (AEs) are able to be resolved through the use of hyaluronidase (HYAL). However, routine HYAL use has been at issue due to perceived safety issues. OBJECTIVES: There are currently no guidelines on the use of HYAL in aesthetic practice, leading to variability in storage, preparation, skin testing, and beliefs concerning AEs. This manuscript interrogated the use of this agent in daily practice. METHODS: A 39-question survey concerning HYAL practice was completed by 264 healthcare practitioners: 244 from interrogated databases and 20 from the consensus panel. Answers from those in the database were compared to those of the consensus panel. RESULTS: Compared to the database group, the consensus group was more confident in the preparation of HYAL, kept reconstituted HYAL for longer, and was less likely to skin test for HYAL sensitivity and more likely to treat with HYAL in an emergency, even in those with a wasp or bee sting anaphylactic history. Ninety-two percent of all respondents had never observed an acute reaction to HYAL. Just over 1% of respondents had ever observed anaphylaxis. Five percent of practitioners reported longer-term adverse effects, including 3 respondents who reported loss of deep tissues. Consent before injecting HA for the possible requirement of HYAL was always obtained by 74% of practitioners. CONCLUSIONS: Hyaluronidase would appear to be an essential agent for anyone injecting hyaluronic acid filler. However, there is an absence of evidence-based recommendations with respect to the concentration, dosing, and treatment intervals of HYAL, and these should ideally be available.

The Trichoptera of Panama XXIV. Fifteen new species and two new country records of the caddisfly genus Neotrichia (Trichoptera, Hydroptilidae), with a key to all known Panamanian species.

In this paper, 15 new species of microcaddisflies in the genus Neotrichia Morton, 1905 (Trichoptera, Hydroptilidae) from Panama are described and illustrated: Neotrichiaabrebotellasp. nov.; Neotrichiacandelasp. nov.; Neotrichiacodazasp. nov.; Neotrichiaemberasp. nov.; Neotrichiaflennikenisp. nov.; Neotrichiahondasp. nov.; Neotrichialandisaesp. nov.; Neotrichialenatisp. nov.; Neotrichiamindyaesp. nov.; Neotrichiapanamensissp. nov.; Neotrichiaparajarochitasp. nov.; Neotrichiaparaxicanasp. nov.; Neotrichiasnixaesp. nov.; Neotrichiaspanglerisp. nov.; Neotrichiaveraguasensissp. nov. In addition, two new country records are presented: Neotrichiaminutisimella (Chambers, 1873) and Neotrichiavibrans Ross, 1944. Finally, the male of N.vibrans is re-illustrated, the female is illustrated and descriptive information given, and a key is provided to the males of all current Neotrichia species in Panama. There are now 45 species of Neotrichia and a total of 525 Trichoptera species recorded from Panama.

Low Tidal Volume Ventilation Is Poorly Implemented for Patients in North American and United Kingdom ICUs Using Electronic Health Records.

BACKGROUND: Low tidal volume ventilation (LTVV; < 8 mL/kg predicted body weight [PBW]) is a well-established standard of care associated with improved outcomes. This study used data collated in multicenter electronic health record ICU databases from the United Kingdom and the United States to analyze the use of LTVV in routine clinical practice. RESEARCH QUESTION: What factors are associated with adherence to LTVV in the United Kingdom and North America? STUDY DESIGN: This was a retrospective, multicenter study across the United Kingdom and United States of patients who were mechanically ventilated. METHODS: Factors associated with adherence to LTVV were assessed in all patients in both databases who were mechanically ventilated for > 48 h. We observed trends over time and investigated whether LTVV was associated with patient outcomes (30-day mortality and duration of ventilation) and identified strategies to improve adherence to LTVV. RESULTS: A total of 5,466 (Critical Care Health Informatics Collaborative [CCHIC]) and 7,384 electronic ICU collaborative research database [eICU-CRD] patients were ventilated for > 48 h and had data of suitable quality for analysis. The median tidal volume (VT) values were 7.48 mL/kg PBW (CCHIC) and 7.91 mL/kg PBW (eICU-CRD). The patients at highest risk of not receiving LTVV were shorter than 160 cm (CCHIC) and 165 cm (eICU-CRD). Those with BMI > 30 kg/m2 (CCHIC OR, 1.9 [95% CI, 1.7-2.13]; eICU-CRD OR, 1.61 [95% CI, 1.49-1.75]) and female patients (CCHIC OR, 2.39 [95% CI, 2.16-2.65]; eICU-CRD OR, 2.29 [95% CI, 2.26-2.31]) were at increased risk of having median VT > 8 mL/kg PBW. Patients with median VT < 8 mL/kg PBW had decreased 30-day mortality in the CCHIC database (CCHIC cause-specific hazard ratio, 0.86 [95% CI, 0.76-0.97]; eICU-CRD cause-specific hazard ratio, 0.9 [95% CI, 0.86-1.00]). There was a significant reduction in VT over time in the CCHIC database. INTERPRETATION: There has been limited implementation of LTVV in routine clinical practice in the United Kingdom and the United States. VT > 8 mL/kg PBW was associated with worse patient outcomes.

Treating facial overfilled syndrome with impaired facial expression-Presenting clinical experience with ultrasound imaging.

BACKGROUND: Facial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods. OBJECTIVE: To showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections. METHODS: Twenty-eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters. RESULTS: The material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra-periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6 I.U. [range: 75-150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with p = 0.578. The position of the oral commissure increased by 0.60 cm in vertical and by 0.30 cm in horizontal directions (both p < 0.001). CONCLUSION: Facial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re-establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity.

Intralabial Lip Compartments and their Potential Clinical Relevance.

BACKGROUND: Aesthetic soft tissue filler injections for lip enhancement are highly popular and are performed throughout the world. When injecting lips with cannulas, as the cannula is advanced, resistance is perceived in consistent locations potentially indicating boundaries between intralabial compartments. OBJECTIVE: To investigate whether intra-labial compartments exist and (if so) to describe their volumes, location, boundaries, and dimensions. METHODS: This cadaveric study investigated a total of n = 20 (13 males, 7 females) human body donors with a mean age at death of 61.9 (23.9) years and a mean body mass index of 24.3 (3.7) kg/m 2. The investigated cohort included n = 11 Caucasian, n = 8 Asian, and n = 1 African American donors. Dye injections simulating minimally invasive lip treatments were conducted. RESULTS: Independent of gender or race, 6 anterior and 6 posterior compartments in the upper and lower lip were identified, for a total of 24 lip compartments. Compartment boundaries were formed by vertically oriented septations that were found in consistent locations. The anterior compartments had volumes ranging from 0.30 - 0.39 cc whereas the posterior compartment volume ranged from 0.44 - 0.52 cc. Centrally, the compartment volumes were larger and decreased gradually towards the oral commissure. CONCLUSION: The volume and the size of each of the 24 compartments contribute to the overall appearance and shape of the lips. To achieve a natural and lip-shape preserving aesthetic outcome it may be preferable to administer the volumizing product using a compartment-respecting injection approach.

Characterization of a novel polyextremotolerant fungus, Exophiala viscosa, with insights into its melanin regulation and ecological niche.

Black yeasts are polyextremotolerant fungi that contain high amounts of melanin in their cell wall and maintain a primar yeast form. These fungi grow in xeric, nutrient depletes environments which implies that they require highly flexible metabolisms and have been suggested to contain the ability to form lichen-like mutualisms with nearby algae and bacteria. However, the exact ecological niche and interactions between these fungi and their surrounding community are not well understood. We have isolated 2 novel black yeasts from the genus Exophiala that were recovered from dryland biological soil crusts. Despite notable differences in colony and cellular morphology, both fungi appear to be members of the same species, which has been named Exophiala viscosa (i.e. E. viscosa JF 03-3 Goopy and E. viscosa JF 03-4F Slimy). A combination of whole genome sequencing, phenotypic experiments, and melanin regulation experiments have been performed on these isolates to fully characterize these fungi and help decipher their fundamental niche within the biological soil crust consortium. Our results reveal that E. viscosa is capable of utilizing a wide variety of carbon and nitrogen sources potentially derived from symbiotic microbes, can withstand many forms of abiotic stresses, and excretes melanin which can potentially provide ultraviolet resistance to the biological soil crust community. Besides the identification of a novel species within the genus Exophiala, our study also provides new insight into the regulation of melanin production in polyextremotolerant fungi.

Redefining Beauty: A Qualitative Study Exploring Adult Women's Motivations for Lip Filler Resulting in Anatomical Distortion.

BACKGROUND: Lip filler enhancement has fast become one of the most popular minimally invasive cosmetic procedures. Motivations for "overtreatment" with lip fillers are poorly understood. OBJECTIVES: The aim of this study was to explore female motivations for and experiences of procedures that achieve an aesthetic of distorted lip anatomy. METHODS: Twenty-four females who had undergone lip filler procedures resulting in strikingly distorted lip anatomy, determined by the Harris classification of filler spread, took part in semistructured interviews about their motivations, experiences, and perceptions related to lip fillers. A qualitative thematic analysis was carried out. RESULTS: Four major themes are discussed: (1) the normalization of lip fillers, (2) perceptual drift which is mediated by exposure to repetitive images of larger lips on social media, (3) perceived financial and social benefits of larger lips, and (4) the relation between mental health and seeking repeated lip filler procedures. CONCLUSIONS: Motivations for seeking lip fillers vary, but most subjects described social media impacting perceived aesthetic norms. A process of perceptual drift occurs whereby mental schema encoding expectations of "natural" facial anatomy can adapt through repeated exposure to enhanced images. The results can inform aesthetic practitioners and policymakers seeking to understand and support those seeking minimally invasive cosmetic procedures.

Introduction of the Lip Classification of Tubercles: A Novel Approach to Minimally Invasive Aesthetic Lip Treatments.

Background: Lip enhancement procedures involving dermal fillers are one of the most sought after nonsurgical aesthetic treatments. However, current trends are associated with unnatural results and involve increased risks of complications and compromise to normal function. It appears that lips may be classified according to the presentation of their tubercles and this may be used to guide minimally invasive techniques which aim to preserve individual lip shapes and normal function. Objectives: To test the reliability of a classification system based on lip tubercle morphology, named the Lip Classification of Tubercles (LCT). Methods: To test the reliability of the LCT, a total of 214 high-definition photographs of patients' lips with no previous histories of lip treatments were classified independently by 4 experienced aesthetic practitioners on 2 separate occasions 3 months apart; the second followed a more detailed explanation of the classification. Results: When inter-rater reliability was calculated for the first attempt, the results were 36% and 43% for upper and lower lips, respectively. The second attempt following an education process resulted in 79% for both lips. When 1 practitioner was considered the standard, the average score for the remaining 3 showed some individual variation but improved significantly from 58% to 85%. Conclusions: The LCT is a reliable way to classify lip types based on the morphology of tubercles.

Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance.

An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.

University students' sleep during the COVID-19 pandemic in the State of Hawai'i.

Objectives: This study assessed undergraduates' sleep in Hawai'i during the COVID-19 pandemic and whether demographic characteristics, health locus of control, substance use and campus features related to sleep outcomes. Implications are considered for programs to support students' sleep and health during pandemic conditions. Participants: About 1,288 undergraduate students from six universities in Hawai'i. Methods: Surveys assessing sleep, emotional wellbeing, ethnicity, body mass index, locus of health control, and substance use. Results: Students' reported increased sleep time but decreased sleep quality during the pandemic. Sleep disruption related to anxiety, depression, ethnicity, substance use, BMI, health locus of control, class rank, and whether students lived at home. All campuses were associated with disrupted sleep, regardless of size, location, religious affiliation, term structure, or method of instruction. Conclusions: In response to public health crises, such as the COVID-19 pandemic, all Hawai'i universities should screen students for sleep disruption, emotional adjustment, social isolation and substance misuse. Programs to promote sleep and behavioral health appear particularly warranted for graduating seniors, Pacific Islanders, students with high BMI, and students who commute to college.

Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples' Prevention, Service, and Care.

Background: American Indian and Alaska Native (AI/AN) peoples are disproportionately impacted by substance use disorders (SUDs) and health consequences in contrast to all racial/ethnic groups in the United States. This is alarming that AI/AN peoples experience significant health disparities and disease burden that are exacerbated by settler-colonial traumas expressed through prejudice, stigma, discrimination, and systemic and structural inequities. One such compounding disease for AI/AN peoples that is expected to increase but little is known is Alzheimer's disease and related dementias (ADRD). AI/AN approaches for understanding and treating disease have long been rooted in culture, context, and worldview. Thus, culturally based prevention, service, and caregiving are critical to optimal outcomes, and investigating cultural beliefs regarding ADRD can provide insights into linkages of chronic stressors, disease, prevention and treatment, and the role of substance misuse. Method: To understand the cultural practices and values that compose AI/AN Elder beliefs and perceptions of ADRD, a grounded theory, qualitative study was conducted. Twelve semistructured interviews with AI/AN Elders (M age = 73; female = 8, male = 4) assessed the etiology, course, treatment, caregiving, and the culturally derived meanings of ADRD, which provides a frame of understanding social determinants of health (SDH; eg, healthcare equity, community context) and impacts (eg, historical trauma, substance misuse) across the lifespan. Results: Qualitative analyses specific to disease etiology, barriers to treatment, and SDH revealed 6 interrelated and nested subthemes elucidating both the resilience and the chronic stressors and barriers faced by AI/AN peoples that directly impact prevention, disease progression, and related services: (1) postcolonial distress; (2) substance misuse; (3) distrust of Western medicine; (4) structural inequities; (5) walking in two worlds; and (6) decolonizing and indigenizing medicine. Conclusion: Barriers to optimal wellbeing and SDH for AI/AN peoples are understood through SUDs, ADRD, and compounding symptoms upheld by colonial traumas and postcolonial distress. En masse historical and contemporary discrimination and stress, particularly within Western medicine, both contextualizes the present and points to the ways in which the strengths, wisdom, and balance inherent in AI/AN culture are imperative to the holistic health and healing of AI/AN peoples, families, and communities.

State of research in MFT: Thoughts from the Editor's Chair: This article is a modified transcript of the keynote address given by Dr. Steven M. Harris, Editor of the Journal of Marital and Family Therapy, at the inaugural annual meeting of the Intervention Research Topical Interest Network of the American Association for Marriage and Family Therapy. The meeting was held on October 5, 2022 at the Kellogg Center on the campus of Michigan State University.

The Editor of JMFT discusses the state of research in systemic family therapy.

The Trichoptera of Panama XXII. Sixteen new microcaddisfly species (Trichoptera, Hydroptilidae).

Sixteen new species of microcaddisflies (Trichoptera, Hydroptilidae) from Panama are herein described and illustrated. The majority of these were collected during surveys of Panama's national parks and protected areas during 2017 and 2018, employing both UV and Malaise traps. The new species include: Alisotrichiaeisbergaesp. nov., Angrisanoiabokotasp. nov., Brediniaparaespinosasp. nov., Cerasmatrichiagarfiozasp. nov., Cerasmatrichiaveraguasensissp. nov., Costatrichiacaloveborasp. nov., Metrichiacaloveborasp. nov., Metrichiacascadasp. nov., Metrichiachiriquiensissp. nov., Metrichiaescobillasp. nov., Metrichialeahaesp. nov., Metrichiatatianaesp. nov., Ochrotrichiaconejorejasp. nov., Ochrotrichiaparaflagellatasp. nov., Oxyethirapehrssonaesp. nov., and Zumatrichiaculebrasp. nov. In total, 506 Trichoptera species are now recorded for the Republic of Panama, distributed among 15 families and 56 genera.

Autologous Minimally Manipulated Homologous Adipose Tissue (AMHAT) for Treatment of Nonhealing Diabetic Foot Ulcers.

Diabetic foot complications are increasingly burdensome for patients, clinicians, and society. Development of innovative therapies to support good quality basic care is a priority among those with an interest in this area. One of these involves scanning and printing tissues to match and conform to a defect (so-called 3D printing). Methods: A single-arm pilot study of ten consecutive patients with a history of a chronic diabetic foot ulcer (DFU), treated with autologous minimally manipulated homologous adipose tissue (AMHAT), dispensed by a specialized 3D bioprinter, Dr. INVIVO, was performed. Patients with nonhealing DFUs present for more than 4 weeks and refractory to standard-of-care therapies were included. Wounds were treated with a single application of AMHAT, and then followed up weekly for up to 12 weeks, or until the wounds healed. The primary outcome measure was complete epithelialization of the wound up to 12 weeks after the treatment. Secondary outcome measures included wound size and/or volume reduction, assessment of ulcer grade, and time to closure. Results: Five wounds were healed by 5 weeks and one at 8 weeks. The mean percent area reduction at 12 weeks was 78.3% (SD: 33.23). Complete closure was achieved in 60% of wounds. The mean time to closure in these wounds was 49.1 days (95% CI, 29.9-68.3). No adverse events were reported. Conclusions: Single treatment of bioprinted AMHAT appears to be a safe and potentially effective treatment modality for patients with chronic DFUs. Further studies are warranted to explore the full potential of 3D bioprinting for tissue repair in this high-risk population.

Evolutionary Significance of Fungal Hypermutators: Lessons Learned from Clinical Strains and Implications for Fungal Plant Pathogens.

Rapid evolution of fungal pathogens poses a serious threat to medicine and agriculture. The mutation rate determines the pace of evolution of a fungal pathogen. Hypermutator fungal strains have an elevated mutation rate owing to certain defects such as those in the DNA mismatch repair system. Studies in Saccharomyces cerevisiae show that hypermutators expedite evolution by generating beneficial alleles at a faster pace than the wild-type strains. However, an accumulation of deleterious alleles in a hypermutator may reduce its fitness. The balance between fitness cost and mutation benefit determines the prevalence of hypermutators in a population. This balance is affected by a complex interaction of ploidy, mode of reproduction, population size, and recent population history. Studies in human fungal pathogens like Aspergillus fumigatus, Candida albicans, Candida glabrata, Cryptococcus deuterogattii, and Cryptococcus neoformans have highlighted the importance of hypermutators in host adaptation and development of antifungal resistance. However, a critical examination of hypermutator biology, experimental evolution studies, and epidemiological studies suggests that hypermutators may impact evolutionary investigations. This review aims to integrate the knowledge about biology, experimental evolution, and dynamics of fungal hypermutators to critically examine the evolutionary role of hypermutators in fungal pathogen populations and project implications of hypermutators in the evolution of fungal plant pathogen populations. Understanding the factors determining the emergence and evolution of fungal hypermutators can open a novel avenue of managing rapidly evolving fungal pathogens in medicine and agriculture.