"How do we do that?" An analysis of TikToks by lesbians over age 30 representing sexual identity, lived experience over time, and solidarity.

Lesbians have long turned to digital media and technologies for information, support, and to self-represent sexual identity in ways that have the capacity for building communities and gathering publics and counterpublics. TikTok is a short video platform popular with young people, which has increasingly seen the participation of comparatively older users. This paper investigates the self-representation of lesbians over age 30 on TikTok to understand the themes in their content and how the platform shapes their communication with others. Through sampling tailored to TikTok's algorithmic curation, ten lesbians' accounts are examined alongside qualitative coding and analysis of 50 of these creators' videos. Findings reveal key themes regarding the expression of identity and age, lived experience over time, and bids for connection and community. TikTokers expressed lesbian identity in continuity with longstanding stereotypes to enhance visibility but also incorporated humor and youthful trends to give rise to novel identity expressions. Videos showcasing the passage of time and sociopolitical change demonstrated the resilience of lesbian lives and conveyed hope while advice and statements of solidarity expressed support for young people's present struggles with homophobia and transphobia. Contrasting with studies of TikTok's generational wars, this article shows how older lesbians are building generational bridges through their uptake of youth-driven platform practices, sharing of past challenges to support youth in overcoming present hurdles, and by modeling lesbian futures.

Efficacy of supervised immersive virtual reality-based training for the treatment of chronic fatigue in post-COVID syndrome: study protocol for a double-blind randomized controlled trial (IFATICO Trial).

BACKGROUND: The treatment of persistent fatigue after COVID-19 infection is complex. On the one hand, it involves maintaining a sufficient level of physical and mental activity to counteract possible degenerative processes of the body and nervous system. On the other hand, physical and mental activities can also lead to worsening of symptoms. Therefore, the challenge in treating Post-COVID fatigue is to stimulate the body and central nervous system in a way that stimulates growth and improvement, but does not overtax individual physical and mental limits. Special training programs try to take these characteristics into account, but often reach their limits. A promising approach is offered by new fitness technologies based on immersive virtual realities that stimulate both body and brain while minimizing physical and psychological stress. The aim of this study is to investigate the efficacy of supervised immersive Virtual Reality (VR)-based activity training compared to conventional activity training for patients with Post-COVID-associated fatigue. METHODS: In a single centre, individually randomised, prospective, double-blind two-arm exploratory superiority trial with parallel group design, N = 100 patients with persistent fatigue after COVID-19 infection will be recruited. The intervention includes a supervised immersive neuromuscular training (12 sessions of 30 min over 6 weeks) based on a novel VR-exercise device. We will systematically compare the effects of this intervention on Post-COVID-associated fatigue with a supervised conventional activation program of comparable scope without an immersive environment. The primary outcome is the difference between groups in absolute change in the mean fatigue symptom severity measured on the Fatigue Severity Scale (FSS) from baseline to posttreatment assessment. Posttreatment assessment in both groups will be conducted by blinded outcome assessors. At three and six months afterwards, patients are sent self-report questionnaires for follow up. The main analysis will be based on the intention-to-treat principle. DISCUSSION: To the best of our knowledge, this is the first exploratory study on a supervised immersive neuromuscular training for the treatment of persistent fatigue after COVID-19 infection. TRIAL REGISTRATION: German register for clinical studies (ID: DRKS00032059) Prospectively registered on June 16th 2023. URL of trial registration.

Angular Momentum Transfer via Relativistic Spin-Lattice Coupling from First Principles.

The transfer and control of angular momentum is a key aspect for spintronic applications. Only recently, it was shown that it is possible to transfer angular momentum from the spin system to the lattice on ultrashort timescales. To contribute to the understanding of angular momentum transfer between spin and lattice degrees of freedom we present a scheme to calculate fully relativistic spin-lattice coupling parameters from first principles. In addition to the dipole-dipole interactions often discussed in the literature, these parameters give, in particular, access to the spin-lattice effects controlled by spin-orbit coupling. By treating changes in the spin configuration and atomic positions at the same level, closed expressions for the atomic spin-lattice coupling parameters can be derived in a coherent manner up to any order. Analyzing the properties of these parameters, in particular their dependence on spin-orbit coupling, we find that even in bcc Fe the leading term for the angular momentum exchange between the spin system and the lattice is a Dzyaloshiskii-Moriya-type interaction, which is due to the symmetry breaking distortion of the lattice.

Changes to medication abortion clinical practices in response to the COVID-19 pandemic.

OBJECTIVES: To document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic. STUDY DESIGN: Longitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations. RESULTS: Seventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits. CONCLUSIONS: Sites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research. IMPLICATIONS STATEMENT: Medication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.

Primary care provider adherence to reproductive healthcare guidelines in adolescents and young adults with disabilities: A retrospective matched cohort study1.

PURPOSE: Assessing provider adherence to preventative sexual and reproductive healthcare guidelines in adolescents and young adults (AYA) patients with physical and intellectual disabilities (PWD). METHODS: Records of PWD (N= 42) age 12-26 receiving health maintenance between 01/01/11-12/31/16 were reviewed for: (1) initiation and completion of human papilloma virus (HPV) vaccination series, (2) initiation and completion of meningococcal vaccination, (3) screening for human immunodeficiency virus (HIV), and documentation of (4) sexual, (5) menstrual, and (6) pregnancy histories. Unaffected age and gender-matched patients provided comparison data (Comparison Cohort, CC). RESULTS: The mean age of both groups was 17.3 years ± 3.8 and 40.5% were female. There was no significant difference between groups regarding the completion of HPV or meningococcal vaccine series. Among those 15+ years of age, 7.1% of PWD and 28.6% of CC were screened for HIV (p= 0.04). Sexual history was documented in 19.0% of PWD versus 73.8% of CC (p< 0.001). Among females, menstrual regularity was recorded in 11.8% of PWD versus 47.1% of CC (p= 0.02) and pregnancy history in 0.0% of PWD versus 29.4% of CC (p= 0.04). CONCLUSIONS: Adherence to sexual health guidelines was suboptimal, and lower among PWD. Vaccination rates did not differ between the two groups.

A pilot randomized controlled trial of omega-3 fatty acid supplementation for the treatment of anxiety in adolescents with anorexia nervosa.

OBJECTIVE: To evaluate the effectiveness and tolerability of omega-3 polyunsaturated fatty acid (PUFA) supplementation for treatment of trait anxiety among adolescent females with restrictive anorexia nervosa (AN). METHOD: A pilot double-blind, placebo-controlled randomized trial of adolescent females with AN (N = 24) entering Partial Hospitalization Program (PHP) from January 2015 to February 2016. Participants were randomized to four daily PUFA (2,120 mg eicosapentaenoic acid/600 mg docosohexaenoic acid) or placebo capsules for 12 weeks. A 9-item questionnaire of side effect frequency assessed medication tolerability. The Beck Anxiety Inventory-Trait measured anxiety at baseline, 6, and 12 weeks. Linear mixed models evaluated associations between randomization group and study outcomes. Twenty-two and 18 participants completed 6 and 12 weeks of data collection, respectively. RESULTS: Medication side effect scores were low and were not significantly different between randomization groups at Week 6 (p = .20) or 12 (p = .41). Mean trait anxiety score significantly (p < .01) decreased from baseline to 12 weeks in both groups, and the rate of change over the course of time did not differ between omega-3 PUFA and placebo groups (p = .55). CONCLUSION: Omega-3 PUFA supplementation was well tolerated in adolescent females with AN. Although power to detect differences was limited, we found no evidence that omega-3 PUFA benefited anxiety beyond nutritional restoration.

A Retrospective Chart Review of Contraceptive Use among Adolescents with Opioid Use Disorder.

STUDY OBJECTIVE: To describe contraceptive use among female adolescents initiating outpatient treatment for opioid use disorder. DESIGN: Retrospective chart review. SETTING: Outpatient clinic providing medication-assisted treatment for substance use disorders to adolescents and young adults. PARTICIPANTS: Nonpregnant female adolescents who presented for treatment from January 1, 2013 to January 31, 2016 (N = 123). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prescription contraceptive use at baseline and initiation of a new method within 90 days. RESULTS: Of 123 female adolescents who presented for treatment of opioid use disorder, 113 (91.9%) reported sexual activity and 80 (65.0%) were not using prescription contraception at intake. Previous pregnancy was reported by 43 (35.0%) and 20 (16.3%) were positive for a sexually transmitted infection. Contraceptive counseling was not documented for 73 (59.3%) patients. Among patients with no prescription contraception at baseline, 56 of 80 (70.0%) initiated a method within the study window. Significant predictors (odds ratio [OR]; 95% confidence interval) of contraceptive initiation included previous pregnancy (8.6; 1.39-52.99), education of less than a high school diploma/general equivalency diploma (7.4; 1.63-33.41), and return for follow-up visit (9.8; 2.18-43.69). CONCLUSION: Young women who presented for opioid use disorder treatment were at high risk of adverse reproductive health outcomes. Most were sexually active and not using prescription contraception. Findings underscore the need for contraceptive counseling in this patient population. Optimally, these services would be provided in conjunction with substance use treatment. Improved contraceptive counseling documentation will allow evaluation of effective contraceptive counseling strategies for adolescents with opioid use disorders and might serve to inform future interventions.

Severe Sepsis and Acute Myocardial Dysfunction in an Adolescent with Chlamydia Trachomatis Pelvic Inflammatory Disease: A Case Report.

BACKGROUND: Although generally asymptomatic, severe Chlamydia trachomatis (C. trachomatis) infections have been documented. C. trachomatis has been associated with myocarditis as well as sepsis. CASE: A 19-year-old girl with type 1 diabetes mellitus developed sudden-onset mental status change and shock after resolution of diabetic ketoacidosis. Abdominal and pelvic imaging showed uterine and adnexal inflammation, and pelvic examination confirmed a diagnosis of pelvic inflammatory disease. The patient was intubated, required vasopressor support, and developed severe biventricular myocardial dysfunction. Infectious myocarditis workup was negative. Nucleic acid amplification testing from vaginal discharge was positive for C. trachomatis and Trichomonas vaginalis and negative for Neisseria gonorrhoeae. SUMMARY AND CONCLUSION: C. trachomatis should be considered in the workup of septic shock, particularly in populations at high risk for sexually transmitted infections.

Inpatient medical stabilization for adolescents with eating disorders: patient and parent perspectives.

PURPOSE: The serious physical complications of eating disorders in adolescents may necessitate inpatient medical stabilization, yet little is known about how patients and their parents perceive the hospitalization experience. METHODS: We identified 82 patients admitted to a large urban hospital for medical stabilization between January 1, 2010 and June 30, 2013. Twenty-three patients and 32 parents completed directed telephone interviews. Respondents rated components of the inpatient protocol using five-point Likert scales and answered open-ended questions regarding hospitalization. Quantitative and qualitative analyses were performed. RESULTS: The mean age of patients at admission was 14.9 years (range 9-21) and the average stay was 8.4 days (range 2-25). Patients rated "massage therapy" most helpful and "cell phone limits" least helpful. Parents rated "nursing staff" most helpful and "seeing other patients in the hospital" least helpful. Protocol components viewed differently by parents and patients included parents more strongly endorsing "staff supervision of meals" (4.34 vs 2.82, p < 0.001) and "limits on physical activity" (4.34 vs 3.23, p = 0.001). The two most common themes identified in open-ended questions were need for hospitalization as a signifier of eating disorder severity and desire for mental health services on the medical unit. Parents emphasized the value of dietician-directed meal planning. CONCLUSIONS: Inpatient medical stabilization for adolescent eating disorders may play an important role not only in addressing acute medical complications, but also in activating the patient and family regarding the need for ongoing treatment. Parents particularly appreciate staff supervision of meals and having a respite from meal planning.

Statewide opioid prescriptions and the prevalence of adolescent opioid misuse in Ohio.

BACKGROUND: Little is known about the relationship between opioid prescribing practices and the prevalence of adolescent opioid misuse. OBJECTIVE: To examine the relationships between both opioid prescriptions filled by adolescents and adults and adolescents seeking treatment for opioid misuse in Ohio. METHODS: Analyses of large statewide databases from 2008 to 2012, including all 88 counties in Ohio. The Ohio Board of Pharmacy provided data regarding prescription opioids filled by adolescents (12-20 years, N = 50,030,820 doses) and adults (>20 years, N = 3,811,288,395 doses) by county of residence. The Ohio Department of Mental Health and Drug Addiction Services provided annual treatment admissions for adolescent opioid misuse by county of residence (N = 6446). RESULTS: Adults filled prescriptions for nearly 100 oral opioid doses per capita annually, while adolescents filled prescriptions for approximately 7 oral opioid doses per capita annually. In Bayesian Poisson modeling examining the effect of annual adult per capita dose on adolescent treatment admissions, adjusted for annual adolescent per capita dose and year, an increase of one in the annual adult per capita opioid dose resulted in an increase of 1.3% (RR = 1.013, 95% HPD CI = [1.008, 1.017]) in the rate of adolescent treatment admissions. This association corresponds to a 99.99% chance that the adolescent treatment rate increases when the annual per capita adult dose is increased by one unit. CONCLUSION: The amount of opioids filled by adults in Ohio, although relatively stable from 2008 to 2012, is approximately 13 times that filled by adolescents and is significantly associated with adolescents seeking treatment for opioid misuse. Efforts to decrease adolescent opioid misuse should also focus on reducing adult opioid prescriptions.

Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.

Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.

Bone Mineral Density and Weight Changes in Adolescents Randomized to 3 Doses of Depot Medroxyprogesterone Acetate.

STUDY OBJECTIVE: To assess the association between medroxyprogesterone acetate exposure and bone mineral density (BMD) loss and weight change in adolescents. DESIGN: Forty-eight-week prospective, randomized trial conducted May 2012-April 2014. SETTING: Recruitment occurred in the general community and outpatient clinics in central Ohio. PARTICIPANTS: Self-referred sample of 34 female adolescents aged 12-21 years initiating depot medroxyprogesterone acetate (DMPA). INTERVENTIONS: Randomization to 1 of 3 DMPA doses (150, 104, or 75 mg) given intramuscularly every 12 weeks for 48 weeks. MAIN OUTCOME MEASURES: Absolute and percent change in BMD from 0-48 weeks at the L1-L4 lumbar spine, total hip, and femoral neck; absolute and percent change in weight at 48 weeks. RESULTS: DMPA dose was associated with medroxyprogesterone acetate exposure as evidenced by a direct relationship (P < .001) between dose group and area under the concentration time curve. At 48 weeks, no significant BMD decreases were seen in the 75 mg dose group. The 104 and 150 mg dose groups experienced significant (P < .01) decreases in L1-L4 lumbar spine BMD (3.1% and 4.0%, respectively). The 150 mg group also had significant (P < .05) decreases in total hip (3.0%) and femoral neck (4.0%) BMD. No group differences in weight change were observed. No pregnancies occurred in any DMPA dose group. CONCLUSIONS: Our data provide evidence of a dose-response relationship between DMPA and BMD loss. Intramuscular DMPA doses less than 150 mg can decrease risk of BMD loss in adolescents. The risk/benefit ratio of lower-dose DMPA should be further investigated in larger and more diverse adolescent populations.

Accident Proneness in Children and Adolescents Affected by ADHD and the Impact of Medication.

OBJECTIVE: This study aims to ascertain once and for all whether children and adolescents affected by ADHD show a higher risk for accidents, as well as investigating a possible association between the administration of ADHD-specific medication and the occurrence of accidents. METHOD: Two exceptionally large sets of data were implemented in this analysis. Participants included children and adolescents representative of the entire German population. Data for Survey 1 was collected through extensive administration of questionnaires. Data for Survey 2 stemmed from the records of a leading German health insurance company. In terms of statistical analysis, chi-square tests as well as logistic regression analyses were applied and odds ratios (ORs) were determined. RESULTS: Innovative results are presented showing a significantly higher likelihood for ADHD-affected youngsters to be involved in accidents compared with their nonaffected counterparts (Survey 1: OR = 1.60; Survey 2: OR = 1.89) but lacking an overall significant influence of medication regarding the occurrence of accidents (Survey 1: OR = 1.28; Survey 2: OR = 0.97). Frequency of accidents could be predicted by ADHD, gender, and age in both samples. Medication intake served as a weak predictor only in Survey 2. CONCLUSION: It has been determined in two representative and independent German samples that youngsters with ADHD are at a significantly higher risk of being involved in accidents. In the future, this should always be considered when setting up a treatment plan to ensure a safer and healthier coming of age without relying solely on specific effects of medication. (J. of Att. Dis. 2016; 20(6) 501-509).

Delayed Ego Strength Development in Opioid Dependent Adolescents and Young Adults.

Objective. To evaluate ego strengths, in the context of Erikson's framework, among adolescents and young adults diagnosed with opioid dependence as compared to non-drug using youth. Methods. Opioid dependent (n = 51) and non-drug using control (n = 31) youth completed the self-administered Psychosocial Inventory of Ego Strengths (PIES). The PIES assesses development in the framework of Erikson's ego strength stages. Multivariate linear regression modeling assessed the independent association of the primary covariate (opioid dependent versus control) as well as potential confounding variables (e.g., psychiatric comorbidities, intelligence) with total PIES score. Results. Mean total PIES score was significantly lower in opioid dependent youth (231.65 ± 30.39 opioid dependent versus 270.67 ± 30.06 control; p < 0.01). Evaluation of the PIES subscores found significant (p < 0.05) delays in all ego strength areas (hope, will, purpose, competence, fidelity, love, care, and wisdom). When adjusting for potential confounders, opioid dependence remained a significant (p < 0.001) independent predictor of total PIES score. Conclusion. Adolescents with opioid dependence demonstrated significant delays in ego strength development. A treatment approach acknowledging this delay may be needed in the counseling and treatment of adolescents with opioid dependence.

Serum adipocytokines and adipose weight gain: a pilot study in adolescent females initiating depot medroxyprogesterone acetate.

OBJECTIVE: To evaluate whether serum adipocytokine concentrations, controlling for baseline adiposity, are predictive of adipose weight gain in adolescents initiating depot medroxyprogesterone acetate (DMPA). METHODS: Percent body fat was measured at baseline and 6 months. Baseline serum adipocytokine concentrations were quantified. RESULTS: Mean percent body fat was 31.6% (±7.6) at baseline and 33.5% (±7.6) at 6 months. In multivariable linear regression modeling (adjusted for baseline percent body fat), Hispanic ethnicity and baseline serum adiponectin concentration were inversely associated (p≤.05) with absolute change in percent body fat at 6 months. CONCLUSIONS: Serum adiponectin concentration may be useful for assessing risk of DMPA-associated adipose gains.

Dietary Intake and Weight Gain Among Adolescents on Depot Medroxyprogesterone Acetate.

STUDY OBJECTIVE: To examine the relationship between dietary intake and weight gain among adolescent females initiating depot medroxyprogesterone acetate (DMPA). DESIGN: Prospective observational study. SETTING: Two urban Adolescent Medicine clinics. PARTICIPANTS: 45 postmenarchal females, age 12 to 21, enrolled after self-selecting to initiate DMPA. INTERVENTION: Participants received 150 mg DMPA intramuscularly every 12 weeks. Height, weight, and 24-hour dietary recall were collected at baseline, 3, 6, and 12 months. MAIN OUTCOME MEASURE: Body mass index (BMI) over time calculated as weight (kg)/height (m(2)). Associations between dietary variables and BMI were evaluated with repeated measures analysis of variance modeling. RESULTS: Mean chronological and gynecologic ages were 16.2 ± 1.5 and 4.2 ± 1.8 years, respectively. Mean BMI increased from 23.7 ± 5.3 to 25.3 ± 5.7 over 12 months. Average dietary intake included: 1781.4 ± 554.1 total kilocalories, 228.5 g ± 69.8 carbohydrates, 71.0 g ± 27.3 fat, and 61.0 g ± 20.2 protein. These diet measures were not associated with BMI over time. Dietary fiber, magnesium, and linoleic acid were inversely associated with increased BMI over time (P < .05) CONCLUSION: We found no evidence that general measures of diet (energy, carbohydrates, fat, and protein), as assessed by 24-hour recall, were predictive of weight gain on DMPA. Several nutrients abundant in foods that benefit overall health were inversely associated with increased BMI over time, suggesting that diet quality, rather than quantity, is a more important predictor of DMPA-associated weight gain.

Harmonic expectancy violations elicit not-just-right-experiences: a paradigm for investigating obsessive-compulsive characteristics?

Obsessive-compulsive disorder (OCD)-like symptoms are commonly associated with sensations of incompleteness and not-just-right experiences (NJRE). Although NJRE have gained much attention in recent years, most studies have not gone beyond a description of their phenomenology and prevalence also in healthy adults. We applied a validated harmonic expectancy violation paradigm to experimentally investigate NJRE evoked by deviant auditory perceptions. We assessed reaction times (RT) to harmonic and disharmonic chord sequences as well as their emotional appraisal in 64 healthy young adults. The participants clearly indicated disharmonic chord sequences as sounding not-just-right and incomplete and rated them as unpleasant, arousing, and irritating. The RT to disharmonic chord sequences was significantly shorter than the RT to harmonic chord sequences. This effect tended to be greater in those participants who reported stronger general experiences of incompleteness as an underlying core dimension of OCD-like symptoms. In addition, general experience of incompleteness was correlated to the difference between RT to harmonic and that to disharmonic chord sequences, indicating that the intensity of general experience of incompleteness was associated with a more readily activated processing of the deviant auditory perceptions.