Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy?

Gadolinium-based contrast agents (GBCAs) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect measure of tumor grade, GBCAs are repeatedly used for diagnosis and monitoring. In practice, however, radiologists will encounter situations where GBCA injection is not needed or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging (especially in vulnerable patient groups, such as children), minimize risks of putative side effects, and benefit costs, logistics, and the environmental footprint. On the basis of the current literature, imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors will be reviewed. Early postoperative MRI and fixed-interval imaging of gliomas are examples of GBCA exposure with uncertain survival benefits. Half-dose GBCAs for gliomas and T2-weighted imaging alone for meningiomas are among options to reduce GBCA use. While most imaging guidelines recommend using GBCAs at all stages of diagnosis and treatment, non-contrast-enhanced sequences, such as the arterial spin labeling, have shown a great potential. Artificial intelligence methods to generate synthetic postcontrast images from decreased-dose or non-GBCA scans have shown promise to replace GBCA-dependent approaches. This review is focused on pediatric and adult gliomas and meningiomas. Special attention is paid to the quality and real-life applicability of the reviewed literature.

The Development and Psychometric Evaluation of the Sexual Fantasy Experience Scale.

Clinicians and researchers consider sexual fantasies to be a central aspect of human sexuality. Although these are subjective experiences, most studies have assessed only their frequency and content. A measure that assesses individuals' subjective experience of sexual fantasies is therefore needed. The aim of this study was to evaluate the psychometric properties of a new measure, the Sexual Fantasy Experience Scale (SFES). In Study 1, the SFES was administered to 391 participants (240 defined themselves as women, 149 as men, and 2 as other). In Study 2, the SFES was administered to 426 participants (255 defined themselves as women, 167 as men, and 4 as other), along with a battery of questionnaires including the New Sexual Satisfaction Scale Short Form and the Global Measure of Sexual Satisfaction, both of which measure sexual satisfaction, as well as the Sexual Fantasy Checklist, which evaluates the content of sexual fantasies and their frequency. Five reliable SFES subscales emerged from Study 1: playfulness, limitlessness, functionality, intrusiveness, and shame. In Study 2, a confirmatory factor analysis confirmed the scale's underlying factor structure, which was obtained in Study 1. The subscales of the SFES contributed to the explained variance of the assessments of sexual satisfaction, beyond the contribution of the fantasies' content and frequency, demonstrating the incremental validity of the subscales. The results of the present analyses suggest that the SFES has good psychometric properties, making it useful as an assessment tool for future research, clinical practice, and sex education.

Deepening Sexual Desire and Erotic Fantasies Research in the ACE Spectrum: Comparing the Experiences of Asexual, Demisexual, Gray-Asexual, and Questioning People.

Over the past 30 years, an increasing number of people have identified within the asexual (ACE) spectrum recognizing an absence/low/situational sexual attraction to individuals of any gender. The current study aims to deepen the knowledge of sexual desire, erotic fantasies, and related emotions within the ACE spectrum. A total of 1072 Italian volunteers were recruited to take part to the present study via social media. Data were collected from October 2021 to January 2022 using the Sexual Desire and Erotic Fantasies questionnaire and the Sexual Desire Inventory-2. Participants were divided into four groups: asexual, demisexual, gray-asexual, and questioning. Focusing on sexual desire, asexual people reported significantly lower scores than the other groups in all the dimensions except for "negative feelings to sexual desire," while demisexual participants showed the higher scores in all the domains except for "negative feelings to sexual desire." The questioning group reported the highest scores in the "negative feelings toward sexual desire" compared to the asexual and demisexual ones. The asexual group reported significantly lower scores than the other groups in fantasies frequency, fantasies importance, negative emotions, and sharing and experiencing. The demisexual group showed higher frequency of romantic fantasies than the asexual and gray-asexual ones. The results showed some specific patterns of desire and fantasies among the asexual, gray-asexual, demisexual, and questioning groups. These data may provide relevant material to clinicians working with asexual patients who need greater awareness about the diversity and heterogeneity of the sexual experience within the ACE spectrum.

Erotic Imagination in Latin America: Reflections on Sexual Fantasies and Coloniality.

Latin America comprises 20 countries and 14 dependent territories throughout the Western Hemisphere. It is a diverse and plural region in terms of its geography, cultures, languages, and historical experiences, with fifteenth-century colonialism as a common denominator. Two areas in which the lingering effects of coloniality seem clearly ever-present are the realms of gender and sexuality. The latter encompasses sexual fantasies, a subject of focus in this article. The examination of sexual fantasies remains a ripe area for future research, particularly throughout the Global South, where its linkages to coloniality should be explored in detail. To contribute to this larger and long-term goal, we implemented an online qualitative study designed to document the sexual fantasies of Spanish-speaking individuals living in the Latin American region. We developed a data-gathering form that included open-ended questions to document sexual fantasies. The form was available through the JotForm online platform that was linked to the study webpage entitled "A Calzón Quita'o." We conducted a thematic analysis to identify response patterns. Three main categories emerged from: (1) spatiotemporal references, (2) multiple partners, and (3) power, control, and rough sex. We relied on perspectives linked to ongoing discussions about coloniality to analyze the thematic content in the participants' responses regarding their sexual fantasies. The findings highlight the existing tensions between the reproduction of-and resistance to-the norms associated with gender roles and their embodiment within the framework of the gender binary inherited from coloniality.

Explanations for Gender Differences in Preferences for Submissive Sexual Fantasies.

Women have a stronger preference for sexual submission than men do. In the current studies, we investigated gender differences in fantasies about sexual submission. Replicating previous research, in two studies we found that women expressed a stronger affinity for fantasies about sexual submission than men did. However, controlling for age and several sociocultural factors made the relationship between gender and preference for sexual submission non-significant-that is, we could statistically eliminate the gender difference. These analyses suggest the multiple factors that may influence sexual preferences and the multiple ways that gender differences in preference for submissive sexual fantasies can be eliminated by easily assessed demographic and contextual differences in the experiences of women and men.

Links between Aggressive Sexual Fantasies and Sexual Coercion: A Replication and Extension of a Multifactorial Model.

Current research indicates that aggressive sexual fantasies (ASF) are related to sexual aggression, above and beyond other risk factors for this behavior. There have, however, rarely been explicitly considered in multifactor models aiming to explain sexual aggression. One exception is the multifactorial Revised Confluence Model of Sexual Aggression that was replicated in two samples of male individuals who were convicted of sexual offenses and a small sample of men from the general population and evidenced a high relevance of ASF, respectively. There were, however, no further attempts to replicate the model in larger samples from the general population. We, therefore, used a subsample from the Finnish Genetics of Sexuality and Aggression project including 3269 men (age: M = 26.17 years, SD = 4.76) to do so. Cross-sectional latent structural equation models corroborated previous research and the assumption that ASF are a central component in multifactor models that aim to explain sexual aggression: ASF and antisocial behavior/aggression were equally important associates of sexual coercion when also considering adverse childhood experiences, hypersexuality, and callous-unemotional traits. Additionally, ASF mediated the links between hypersexuality, callous-unemotional traits, as well as childhood sexual abuse and sexual coercion. These links held stable when entering further risk factors, that is, distorted perceptions, rape-supportive attitudes, and violent pornography consumption into the model. Contrasting assumptions, alcohol consumption and antisocial behavior/aggression did not interact. These results illustrate the potential importance of ASF for sexual aggression. They indicate that ASF require consideration by research on sexual aggression as well as in the treatment and risk assessment of sexual perpetrators.

Sexual Norms Across Pornography Use, Sexual Fantasy, and In-Person Sexuality.

Sexual norms define perceptions of who is acceptable to partner with, how many partners are appropriate, and what sexual behaviors are acceptable to engage in. This shapes, in part, who has access to sexual pleasure and who is minoritized based on their sexuality. Though well theorized and researched for "in-person" sexuality, much less is known about sexual norms in other contexts/modalities, such as porn use and sexual fantasy, or how norms connect across these contexts. In the present study, we investigated sexual norms in porn, fantasy, and in-person sexuality, and similarities or differences between these. In an online study, gender/sex and sexually diverse participants (N = 706) manipulated digital circles representing porn use, sexual fantasy, and in-person sexuality. They used circle overlap to represent branchedness (i.e., distinction) and coincidence (i.e., similarity) in norm content, and circle size to indicate perceived norm strength. We found evidence that norm content was perceived to be more branched (i.e., distinct) than coincident (similar) and that norm strength for each context was high. This provides evidence that when people engage in each of these sexual contexts, they tend to do so through distinct normative lenses, rather than a singular lens that represents a universal set of norms applying across all sexual situations. This has implications for how we understand the associations between porn use, fantasy, and in-person sexuality, and highlights the importance of attending to sexuality in context.

Testing the Factor Structure and Construct Validity of the German Version of Gray et al.'s (2003) Sexual Fantasy Questionnaire.

Gray et al.'s (2003) Sexual Fantasy Questionnaire (SFQ) is becoming an increasingly used self-report measure of sexual fantasy use. The current study analyzed the factorial structure and construct validity of the behavioral items of the SFQ using a nomological network of other sexuality-related measures in a large German-speaking sample (N = 846). Participants' (27.7% females) mean age was 30.8 years (SD = 11.0). Exploratory factor analysis revealed a 65-item scale comprising five-factors, which were termed: normophilic sexual fantasies, sexualized aggression, sexualized submission, submissive courtship, and bodily functions. This German version of the SFQ was found to have high construct validity indicated by its association with other related constructs. Based on these results, we argue that the SFQ is a valid self-report measure that can be used in both research and clinical practice (foremost the factors sexualized aggression and sexualized submission). Suggestions for future research are discussed in light of the results and the study's limitations.

Preschoolers negatively evaluate conventional norm violations in pretend play.

A growing body of research demonstrates that children's pretend play is largely influenced by their understanding of reality. The current work took a novel approach to testing children's understanding of pretense by investigating whether children apply and uphold their knowledge of conventional norms in pretend play. In this study, 3- to 5-year-old children (N = 200) were introduced to a series of pretend play scenarios (e.g., pretending to eat breakfast) in which a puppet pretended to follow a norm (e.g., pretended to eat cereal for breakfast) or violate a norm (e.g., pretended to eat a hamburger for breakfast). These pretend play scenarios were presented as either fantastical or realistic in nature. Consistent with our hypotheses, children evaluated pretend norm violation more negatively than pretend norm adherence and reported liking norm violators less than norm followers. Contrary to our hypothesis, the manipulation of play context (fantastical vs. realistic) did not affect children's evaluations. That is, children were just as negative about pretend norm violations (relative to pretend norm adherence) in fantastical pretend play scenarios as they were in realistic pretend play scenarios. Furthermore, individual differences in children's fantasy orientation did not predict their evaluations. This study is the first to establish that children maintain their real-world understanding of conventional norms in pretend play, providing further evidence that children's pretense is largely realistic in nature.

Immediate and delayed effects of fantastical content on children's executive functions and mental transformation.

Watching fantastical content has been shown to negatively affect young children's executive function (EF) skills. No study has investigated how long these negative effects persist and whether they extend to other cognitive skills. The current experimental study aimed to (1) detect how long fantastical content affects children's EF performance and (2) examine whether watching fantastical content negatively affects children's other (non-EF) cognitive task performance, namely mental transformation. A total of 120 5- and 6-year-old children (M = 66 months, SD = 5.52) were randomly assigned to one of the four following conditions: (a) immediate testing after watching an 8-min non-fantastical cartoon, (b) immediate testing after watching an 8-min fantastical cartoon, (c) 10-min delayed testing after watching a fantastical cartoon, and (d) immediate testing after an 8-min free play (control condition). After exposure to each condition, children were tested on EF and mental transformation measures. Results showed that children watching a fantastical cartoon performed worse on working memory and inhibitory control tasks than children watching a non-fantastical cartoon or playing. However, the 10-min delay between the watching and testing sessions eliminated the negative impact observed on inhibitory control. Groups did not differ on cognitive flexibility and mental transformation. As in previous studies, watching fantastical content negatively affected children's EFs, but this negative impact disappeared in a few minutes and seems unique to EFs. These results suggest that fantastical content may temporarily affect attentional and information processing systems related to EFs.

A Content Analysis of Problematic Gambling Prevention Interventions in the United States.

Gambling revenue in the United States is at all-time highs while recent and forthcoming legislation relaxes constraints on casino gaming, sports betting, and fantasy sports betting. Increased gambling will result in increased problematic gambling, highlighting the need to study the impact of our problematic gambling prevention interventions. To address this, we conducted a content analysis of problematic gambling prevention messages in the U.S. Results reveal that although there is overlap between theoretically-based messaging appeals recommended by research and those used in actual prevention interventions, health behavior theory is inconsistently applied and there are numerous examples of potential backfire effects. Results are discussed in terms of their impact on theory development and their noteworthy practical application.

Daydreaming and grandiose delusions: development of the Qualities of Daydreaming Scale.

BACKGROUND: Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content. AIMS: We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity. METHOD: 798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling. RESULTS: The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test-retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group. CONCLUSIONS: The process of daydreaming may be one target in psychological interventions for grandiose delusions.

Aggressive sexual fantasy frequency outperforms other characteristics in cross-sectionally predicting self-reported sexual aggression in 4 samples.

BACKGROUND: Aggressive sexual fantasies (ASFs) have consistently been associated with sexual aggression measures. ASF frequency has mostly been used to indicate ASF, but other ASF characteristics may be important to explain the apparent gap between alleged high lifetime prevalence rates of ASF and lower sexual aggression rates-that is, why ASFs are only sometimes put into action. AIM: The present study therefore examined whether additional ASF characteristics show associations with sexual aggression measures above and beyond ASF frequency to identify the most relevant ASF characteristics. METHODS: The present study is based on cross-sectional survey data from 4 independent mostly community samples with 448, 131, 758, and 415 participants to examine whether ASF elaboration, intrusion, preoccupation, context, and consent were associated with self-reported sexual aggression measures beyond ASF frequency. OUTCOMES: Self-reported sexual aggression measures included presumably consensual and nonconsensual sexual sadism, self-reports on acting on ASF, sexual harassment, use of coercive strategies, and rape proclivity. RESULTS: The results showed positive correlations among all ASF characteristics. ASF frequency was the most consistent and often strongest predictor of sexual aggression across samples and outcome measures. ASF elaboration and/or its interaction with ASF frequency added to this prediction in study 1 but not in study 2. All other ASF characteristics in studies 1 to 4 either did not add to the predictions or yielded results contrary to expectations, mostly suggesting suppressor effects. CLINICAL IMPLICATIONS: Sexual medicine and forensic sexology researchers may want to consider ASF frequency in diagnostics and develop and refine interventions to reduce it in cases of clearly elevated levels. STRENGTHS AND LIMITATIONS: The strengths of the present study include considering 4 independent samples as well as a large number of ASF characteristics and sexual aggression measures. Its limitations include the reliance on cross-sectional data and not being able to examine the potential influences of all ASF characteristics in a single model. CONCLUSION: ASF frequency seems the most valid and reliable indicator of ASF and the most important associate of sexual aggression. It should be considered the main indicator of ASF by future research and in prevention efforts and risk assessment.

Fantasy Sexual Material Use by People with Attractions to Children.

PURPOSE OF REVIEW: With the Internet allowing consumers easy access to fantasy and fictional sexual materials (FSM), it is becoming increasingly important to understand the context of their use among specific populations. Of particular, social, clinical, and legal interest is FSM use by people who are attracted to children and whether this may have a risk-enhancing or protective impact on their likelihood of committing a contact or non-contact sexual offence. RECENT FINDINGS: There is a lack of data currently available in relation to the use of FSM by those with sexual attractions to children. Evidence from allied areas appears to show no meaningful associations between FSM use and sexual aggression. We propose a novel research program and some initial research questions that provide a theoretical framework for more evidence-based inquiry on FSM use by people who experience attractions to children.

Sexual Orientation, Sexual Motivation, and Erotic Target Identity Inversions in Male Adult Baby/Diaper Lovers.

Adult baby/diaper lovers (AB/DLs) enjoy role-playing as babies and/or wearing diapers. They also engage in other related activities, such as urinating or defecating themselves and having an adult care for them. Previous surveys have revealed that AB/DLs commonly report sexual motivation, a finding that is corroborated by case reports in the psychiatric literature and some media interviews. The fact that AB/DLs change their appearance and behavior to become more like babies raises the possibility that they have an erotic target identity inversion (ETII). In ETIIs, a person's external erotic target is inverted into the self, resulting in sexual arousal by the fantasy of being a member of the target class or by imitating one. If AB/DLs are sexually motivated by an ETII, they should experience both sexual attraction to babies and sexual arousal by the fantasy of being a baby. We surveyed 207 male AB/DLs recruited from the Internet about their sexual orientation, sexual motivation, and sexual interests for a primarily quantitative analysis. Consistent with past research, a substantial minority of participants reported non-heterosexual identities (42%), and a large majority reported some degree of sexual motivation for being AB/DLs (93%). Wearing diapers and urinating or defecating oneself were rated as especially sexual. Even though 40% of participants reported sexual arousal by the fantasy of being a baby, only 4% reported sexual attraction to babies. This pattern of results is contrary to predictions from the concept of ETIIs. Instead, participants indicated that physical or mental pain, humiliation, and an adult woman were important to their sexual fantasies of being a baby. Masochism appears to be a promising alternative to an ETII for explaining the sexual motivation of AB/DLs.

Individual differences in autobiographical memory predict the tendency to engage in spontaneous thoughts.

Individual differences in autobiographical memory have become a research area of interest, but little is known about its associations with other individual differences dimensions, such as the tendency to engage in spontaneous cognition. We report two studies examining individual differences in autobiographical memory, as measured by the Autobiographical Recollection Test (ART), in relation to eight trait-like measures of spontaneous thought and, in Study 2, also a measure of fantasy proneness. In Study 1, the ART correlated positively and systematically with six out of eight measures of spontaneous thought, even when controlling for age, gender, and trait positive and negative affect. The two exceptions concerned spontaneous thoughts specifically related to attentional deficits. Study 2 replicated these findings and extended them to a measure of fantasy proneness. The findings demonstrate that people who generally consider their autobiographical memories to be vivid, detailed, relevant, and coherent, report a higher tendency to engage in various forms of spontaneous cognition, including positive constructive daydreaming, spontaneous mind wandering, involuntary mental time travel, and vivid and immersive fantasy. We discuss these findings in terms of the role autobiographical memory plays in spontaneous thoughts.

A Qualitative Exploration of Sleep-Related Sexual Interests: Somnophilia and Dormaphilia.

Somnophilia is an under-researched paraphilia. Consequently, there are discrepancies in its definition and conceptual understanding. Also, literature regarding the sexual interest in being asleep during sexual activity (dormaphilia) is even more limited. As such, there is a need to understand these paraphilias more deeply. This study recruited 232 participants online to discuss the content, origin, sexual appeal, emotional appraisal, and behavioural enactment of their somnophilic and dormaphilic interests and fantasies. A Thematic Analysis led to the identification of four main themes: (1) Relevance of Sleep State; (2) Roles within Sleep Sex; (3) Enactment of Sleep Paraphilia and (4) Lack of Consent and Awareness. These four themes spanned across both those reporting somnophilic and dormaphilic fantasies. The Discussion explores the multi-faceted nature of the interests, and implications for the understanding of somnophilia and dormaphilia. This study provides the first qualitative exploration of sleep-related paraphilias, opening avenues for future research and practice.

Validity and reliability of the Polish Maladaptive Daydreaming Scale (PMDS-16) and its short form (PMDS-5).

Maladaptive daydreaming (MD) defines excessive use of fantasy, which replaces human interaction and/or interferes with academic, interpersonal, or vocational functioning. This study tests psychometric properties of the Polish version of the Maladaptive Daydreaming Scale (PMDS-16) and a short 5-item version derived from it (PMDS-5), and their capacity to screen for MD. The relationship between MD, resilience and the quality of life was also explored. Validity and reliability were examined in a sample of 491 participants in nonclinical (n = 315) and mixed-clinical (n = 176) groups who completed the tests online. The exploratory factor analysis with principal component analysis method of parameter estimation without rotation confirmed a one-factor solution of both instruments. Reliability of both versions was corroborated by Cronbach's alpha coefficient (PMDS-16: >.941; PMDS-5: >.931). The cutoff score maximizing sensitivity and specificity for MD was 42 in both instruments, but the short version had better discriminating properties. People who identified themselves as maladaptive daydreamers in comparison to those who did not had significantly higher scores in both instruments. Maladaptive daydreamers also had lower quality of life in the psychological and social relationships domains and poorer resilience. Both PMDS-16 and PMDS-5 proved to have satisfactory psychometric properties. They have similar psychometric properties, although PMDS-5 has better discriminating power and can be used effectively for the screening of MD.

Fetal Fantasy and the Perfect Child: How Certain Challenges of Adolescence may Inform Aspects of the Abortion Debate.

This article explores psychic aspects of abortion, from the fixity of beliefs over its legalization, to conscious and unconscious fantasies related to the fetus, children, parenting, fertility, and so on. Generally speaking, the field has shown less direct interest in abortion per se than might be surmised, particularly given the centrality of sexuality and procreation in psychoanalysis. The recent legal changes may initiate more psychoanalytic interest in the topic. The current writing studies a possible strand of fantasy in which conscious and unconscious wishes for an unending, idealized, and blameless child-object are displaced onto a fetus or fetal imago. Speculations and suggestions are drawn from casework with an individual which points to a possible channeling or avoidance of unprocessed grief when the seeming perfection of childhood ends abruptly, almost without transition, with the imposition of adolescent personality development.