An Exploratory Study of Incels' Dating App Experiences, Mental Health, and Relational Well-Being.

Incel refers to an online group of young males who feel frustration and despair at being repeatedly neglected on the dating market. Despite gaining notoriety for a number of public attacks, the majority of incel research is comprised of analyses of their forums rather than of individuals themselves. This provides a good contextual overview of the incel community but does not capture the experiences of incels or identify how and why this group responds so strongly to rejection. A total of 38 incel and 107 non-incel males (MAGE = 23.60, SD = 4.90) were recruited through Reddit and two institutional forums to participate in the present online study, completing questionnaires pertaining to their dating app experiences and their mental and relational well-being. Large differences between incels and non-incels were found, with the former reporting greater depressive symptoms, rejection sensitivity, relationship status influence, and insecure attachment. These were all associated with perceived popularity, which incels scored lower on. Incels also adopted more liberal dating app strategies, yet reported fewer matches, conversations, and in-person outcomes. The pattern of results reported sheds new light on the role that dating apps may play in incels' efforts to attract mates and how these frustrations manifest. This is integral both to understanding the broader incel discourse as well as any efforts to develop treatment strategies with self-identified incels who seek counseling.

A Clinician's Guide to Gluten Challenge.

Gluten challenge is an essential clinical tool that involves reintroducing or increasing the amount of gluten in the diet to facilitate diagnostic testing in celiac disease (CD). Nevertheless, there is no consensus regarding the applications of gluten timing, dosing, and duration in children. This review aims to summarize the current evidence, discuss practical considerations, and proposes a clinical algorithm to help guide testing in pediatric patients. Childhood development, social circumstances, and long-term health concerns must be considered when identifying a candidate for gluten challenge. Based on previous studies, the authors suggest baseline serology followed by a minimum of 3-6 grams of gluten per day for over 12 weeks to optimize diagnostic accuracy for evaluation of CD. A formal provider check-in at 4-6 weeks is essential so the provider and family can adjust dosing or duration as needed. Increasing the dose of gluten further may improve diagnostic yield if tolerated, although in select cases a lower dose and shorter course (6-12 weeks) may be sufficient. There is consensus that mild elevations in celiac serology (<10 times the upper limit of normal) or symptoms, while supportive are not diagnostic for CD. Current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend histologic findings of intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy as the accurate and most appropriate endpoint for gluten challenge.

One is the loneliest number: Involuntary celibacy (incel), mental health, and loneliness.

Incels-a ragtag collection of young males who have rallied around their shared experience of romantic rejection-have slowly emerged as an online group of interest to researchers, no doubt as a result of several high-profile attacks. Much of this work has centered around incels' dating experiences, sexual attitudes, and online forums. However, it is possible that their moniker, short for involuntary celibate, has resulted in an overemphasis on their sexual exclusion and frustration. Recent work has identified social isolation as a key aspect of inceldom, which may help explain why incels have responded negatively to romantic rejection. The present study thus sought to examine the role of social support and loneliness in experiences of rejection in a sample of incel (n = 67) and non-incel (n = 103) men. Results indicated that incels experience more feelings of loneliness and less social supports than non-incel men. Both of these variables were associated with multiple mental and relational health issues that incels also scored more highly on. Further, incels reported using more solitary and problematic coping mechanisms. These results suggest that incels may be missing a key buffer in sheltering them from the adverse effects of romantic rejection. It also extends previous findings highlighting the importance of attachment styles in differentiating incels from non-incels, which may perpetuate feelings of isolation. Implications for how this may relate to incel discourse and clinical interventions are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04275-z.

Involuntary Celibacy: A Review of Incel Ideology and Experiences with Dating, Rejection, and Associated Mental Health and Emotional Sequelae.

PURPOSE OF REVIEW: Incels (involuntary celibates) have recently garnered media attention for seemingly random attacks of violence. Much attention has centered around the misogynistic and violent discourse that has taken place in online incel forums as well as manifestos written by incels who have perpetrated deadly attacks. Such work overlooks the experiences and issues faced by incels themselves, the majority of which have not engaged in any violent behavior. RECENT FINDINGS: A small number of studies have recruited incels. Results from these studies highlight the nuanced nature of the incel identity. It is also apparent that incels suffer from high levels of romantic rejection and a greater degree of depressive and anxious symptoms, insecure attachment, fear of being single, and loneliness. Incels report significant issues pertaining to their mental, social, and relational well-being and may seek support from forums that often feature misogynistic and violent content.

A Survey of Veterinary Medical Professionals' Knowledge, Attitudes, and Experiences with Animal Sexual Abuse.

There has been little study of animal sexual abuse (ASA). Subsequently, little is known about veterinary medical professionals' (e.g., Veterinarians, Veterinary Technicians, Veterinary Nurses) knowledge of ASA and how they may contribute to the prevention of ASA. Thus, the objective of this paper is to comprehensively study ASA in a sample of veterinary medical professionals. Eighty-eight professionals were recruited through professional associations and posts on social media to take part in a survey examining non-sexual animal abuse, ASA, and criminal justice perceptions. Results indicated that, levels of knowledge and training were much lower for ASA than non-sexual abuse. Professionals also responded punitively toward individuals who have committed sexual abuse against animals and supported long prison sentences and registries for offenders. Veterinary medical professionals were supportive of mandatory reporting of all types of abuse but did not feel prepared to testify in these cases should they go to court. These results have implications for practice as they indicate that veterinary medical professionals are not receiving enough training on abuse - particularly ASA - which could put their patients at risk of continued harm.

A Snapshot of Image-Based Sexual Abuse (IBSA): Narrating a Way Forward.

Introduction: The rise of technology has ushered in a new means of sexual expression, commonly referred to as sexting, which involves the sending of sexual messages or images of oneself to another person. Growing in popularity particularly among youth and young adults, the sending of images to current or potential romantic or sexual partners is increasingly becoming part of courting and relationship maintenance rituals. Yet this new domain of sexual agency has been met with a rise in the non-consensual dissemination of intimate or nude photographs to third parties, in some cases to humiliate or shame the creator of the image. Methods: This paper uses a socio-narratological approach to understand the complex consequences that (largely female) victims of image-based sexual abuse (IBSA) experience. Results: Individuals who experience IBSA may undergo perpetuated suffering due to an interwoven constellation of internal and external forces, much of which is rooted in the sexual regulation (if not subjugation) of women. Suffering is presented as originating from three domains: the self, the perpetrator, and society, which interact as a "Dark Triad." Conclusions: The use of socio-narratology to disentangle the suffering may provide victims and mental health professionals with experiential clarity. Further, it offers a way forward for individuals who have experienced this unique form of sexual violence.

Attitudes toward the Punishment of Juvenile and Adult Sexual Offenders in Canada: The Roles of Sentencing Goals and Criminal Justice Motivations.

There has long been concern among academics and those in criminal justice professions regarding the public's seemingly enthusiastic support for punitive responses to sexual offenders, such as long sentences, residency restrictions, registration, and community notification. Yet there has been little research to date on what motives may be driving the endorsement of these policies, particularly registration. Our understanding is further muddled by conflicting research on punitive attitudes in general, with some suggesting that retributive motives are behind such attitudes while others report the efficacy of utilitarian motives. Using a sample of 376 university students, the current study sought to determine whether retributive, utilitarian, or other motives drove support for longer sentences and registration for juvenile and adult sexual offenders. Results indicated that motives largely differed between the two sanctions as well as the two age groups of offenders. Both retributive and utilitarian motives contributed to support for policies, suggesting that these motives work in congruence with one another. This has clear implications for policy discussions, as advocates for criminal justice reform should be appealing to both motives to change societal attitudes.

Accurately Assessing Gay Men's Erectile Functioning: A Critique of the International Index of Erectile Function (IIEF) Use with Gay Men.

The International Index of Erectile Functioning (IIEF) has been widely used to measure gay men's erectile functioning. However, the IIEF was initially developed using a sample of men whose sexual orientation was unspecified. Using scales not validated for specific populations can result in inaccurate assessments. The purpose of the current study was to evaluate the dimensionality, reliability, and validity of the IIEF with a large sample of gay men. One thousand and eighteen men self-identifying as "exclusively gay" completed an online survey consisting of demographics, the IIEF, the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale 4 (PSS4), and the Gay Male Sexual Difficulties (GMSD) erectile difficulties sub-scale. The replicability of the IIEF factor structure with a gay male sample was determined using exploratory and confirmatory factor analyses. Additionally, the HADS, PSS4, and GMSD were used to determine the validity of the IIEF. The current study was unable to replicate the IIEF factor structure. Four items required deletion and the factor solution differed from the original. Thus, reinterpretation of the latent variables was deemed necessary. Although the resultant 12-item IIEF evidenced model fit, validity, and reliability, it is not recommended for use with gay men. The revised IIEF is unable to accurately measure gay men's erectile functioning as the content of the items fail to capture their sexual behaviors (i.e., insertive and receptive anal sex).

Tipping the Scales: Effects of Gender, Rape Myth Acceptance, and Anti-Fat Attitudes on Judgments of Sexual Coercion Scenarios.

A damaging belief exists that to become a victim of sexual violence, victims must be deemed sexually desirable. As a result, sexual violations where the victims are individuals whom society may deem as less attractive-such as overweight women-may elicit less empathy for the victim or minimize the likelihood they are believed. Yet, there is some evidence that overweight women actually report higher rates of sexual violence than women of other weight categories. Although there has been some research implicating weight biases in sexual assault cases, this has not been extended to cases of sexual coercion despite their growing share of police reports. A sample of 168 participants were recruited from Canada via social media (n = 82) and through a midsized university in Ontario, Canada (n = 86). Using a mock jury paradigm, participants responded to a vignette depicting the sexual coercion of a thin or overweight woman. Participants reported their opinions on the sexual coercion scenario, and prejudicial attitudes, using two standardized scales. Men reported greater rape myth acceptance, anti-fat attitudes, and victim responsibility and endorsed significantly more perpetrator mitigating factors and expressed more negative affect toward the victim. Participants in the overweight condition also expressed greater perpetrator sympathy, greater perpetrator mitigation, and less negative affect toward the perpetrator. These results suggest that overweight women may face additional barriers when reporting their experiences of sexual coercion, particularly to men.

The Utility of IgA-Based Serologic Markers in Diagnosing Celiac Disease in Children 24 Months of Age or Younger.

Current screening guidelines in North America for celiac disease recommend additional IgG based testing for younger children. Our multicenter retrospective study showed that the anti-tissue transglutaminase IgA antibody test should be the recommended initial test in all children, including those ≤24 months of age.

A Celiac Care Index Improves Care of Pediatric Patients Newly Diagnosed with Celiac Disease.

OBJECTIVES: To describe quality improvement efforts to reduce variability in the care of children diagnosed with celiac disease through use of an institutional patient registry and a chronic care index. STUDY DESIGN: An institutional patient registry tracked rates of follow-up visits and repeat serologic testing. A Celiac Care Index that included anthropometrics, biopsy expectations, dietician consultation, and baseline laboratory evaluation was developed to standardize evaluation at diagnosis. Provider education sessions communicated expectations for this standard of care and order sets within the electronic medical record simplified test collection. Data was recorded and reviewed weekly and structured communications with providers were provided biweekly. RESULTS: Adherence with follow-up expectations (77%-89% P = .03) and repeat serologic testing (50%-90% P < .0001) significantly increased during the study period. Adherence with completion of the Celiac Care Index resulted in significant improvement in obtaining complete blood count (80%-98% P < .0001), iron (25%-78% P < .0001), ferritin (34%-80% P < .0001), alanine aminotransferase/aspartate aminotransferase (74%-96% P < .0001), thyroid-stimulating hormone (64%-90% P < .0001), vitamin D (36%-83% P < .0001), and hepatitis B immune status (30%-80% P < .0001). Iron deficiency demonstrated by low ferritin levels was common (41%) and a high rate of nonimmunity to hepatitis B (70%) was detected. CONCLUSIONS: The Celiac Care Index improved adherence with published care recommendations and reduced variability in baseline evaluation at diagnosis. Laboratory test results indicate further studies are needed to evaluate these recommendations.

Constipation in Children with Autism Spectrum Disorder Associated with Increased Emergency Department Visits and Inpatient Admissions.

OBJECTIVE: To evaluate whether constipation in children with autism spectrum disorder (ASD) is associated with increased emergency department (ED) visits and inpatient admissions compared with constipation in children without ASD. STUDY DESIGN: The Nationwide Emergency Department Sample was used to retrospectively examine demographic data, clinical characteristics, and outcomes of children with ASD and children without ASD who visited the ED for constipation between 2006 and 2014. RESULTS: ED visits by children with ASD were more likely to be constipation-related compared with visits by children with other chronic conditions or children with no chronic conditions (1.9% vs 0.6% vs 0.9%; P < .001). Children with ASD were more likely than children with other chronic conditions or no chronic conditions to be admitted to the hospital after an ED visit for constipation (15.0% vs 10.6% vs 1.2%; P < .001). Hospital charges were higher in children with ASD than in those without chronic conditions. CONCLUSIONS: Constipation is responsible for a large proportion of ED visits and more inpatient admissions resulting from these ED visits. These findings suggest a need for developing more effective outpatient therapies for constipation in children with ASD.

Treatment of a gastric lactobezoar with N-acetylcysteine.

Lactobezoars are a rare finding with potentially serious sequelae in pediatric patients with feeding intolerance. Aggressive treatment may be preferred to traditional treatments to avoid complications in medically complex patients. In our patient, N-acetylcysteine lavage was a safe and effective alternative that resulted in rapid resolution of his feeding intolerance.

Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study.

OBJECTIVES: The purpose of this study was to determine whether a heart failure (HF) management strategy using continuous intracardiac pressure monitoring could decrease HF morbidity. BACKGROUND: Patients with HF may experience frequent decompensations that require hospitalization despite intensive treatment and follow-up. METHODS: The COMPASS-HF (Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure) study was a prospective, multicenter, randomized, single-blind, parallel-controlled trial of 274 New York Heart Association functional class III or IV HF patients who received an implantable continuous hemodynamic monitor. Patients were randomized to a Chronicle (Medtronic Inc., Minneapolis, Minnesota) (n = 134) or control (n = 140) group. All patients received optimal medical therapy, but the hemodynamic information from the monitor was used to guide patient management only in the Chronicle group. Primary end points included freedom from system-related complications, freedom from pressure-sensor failure, and reduction in the rate of HF-related events (hospitalizations and emergency or urgent care visits requiring intravenous therapy). RESULTS: The 2 safety end points were met with no pressure-sensor failures and system-related complications in only 8% of the 277 patients who underwent implantation (all but 4 complications were successfully resolved). The primary efficacy end point was not met because the Chronicle group had a nonsignificant 21% lower rate of all HF-related events compared with the control group (p = 0.33). A retrospective analysis of the time to first HF hospitalization showed a 36% reduction (p = 0.03) in the relative risk of a HF-related hospitalization in the Chronicle group. CONCLUSIONS: The implantable continuous hemodynamic monitor-guided care did not significantly reduce total HF-related events compared with optimal medical management. Additional trials will be necessary to establish the clinical benefit of implantable continuous hemodynamic monitor-guided care in patients with advanced HF.

Reducing events in patients with chronic heart failure (REDUCEhf ) study design: continuous hemodynamic monitoring with an implantable defibrillator.

BACKGROUND: The use of implantable cardioverter defibrillators (ICDs) has been proven effective in the prevention of sudden cardiac death (SCD) and constitutes standard of care in appropriate populations. Combining a pressure sensing system with ICD therapy represents the first attempt to provide continuous hemodynamic monitoring using a device previously designed exclusively for SCD protection. METHODS: REDUCE is a prospective, multicenter, randomized, single-blind, parallel-controlled trial designed to assess the safety of the Chronicle ICD system (single chamber ICD with a hemodynamic monitoring system) and the effectiveness of a management strategy guided by intracardiac pressure information among ICD-indicated New York Heart Association (NYHA) Class II or III heart failure (HF) patients. Those successfully implanted with a Chronicle ICD will be randomized to the Chronicle group or Control group. All patients will receive optimal medical therapy, but the hemodynamic information from the device will be used to guide patient management only in the Chronicle group. Primary endpoints include freedom from system-related complications and relative risk reduction of one or more HF-related events (hospitalizations, and emergency department and urgent care visits requiring intravenous therapy for HF). Approximately 850 patients will be enrolled in at least 75 centers in the United States to accrue the 419 events needed to test the primary effectiveness endpoint. Enrollment began in April 2006, and is expected to end during 2009. CONCLUSION: REDUCE will assess the safety of the Chronicle ICD system and the effectiveness of a patient management strategy based on remote access to continuous intracardiac pressures in reducing HF-related events.

Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic heart failure.

BACKGROUND: We describe the performance of an implantable hemodynamic monitor (IHM) that allows continuous recording of heart rate, patient activity levels, and right ventricular systolic, right ventricular diastolic, and estimated pulmonary artery diastolic pressures. Pressure parameters derived from the implantable monitor were correlated to measurements made with a balloon-tipped catheter to establish accuracy and reproducibility over time in patients with chronic heart failure (CHF). METHODS AND RESULTS: IHM devices were implanted in 32 patients with CHF (left ventricular ejection fraction, 29% +/- 11%; range, 14%-62%) and were tested with right heart catheterization at implantation and 3, 6, and 12 months later. Hemodynamic variables were digitally recorded simultaneously from the IHM and catheter. Values were recorded during supine rest, peak response of Valsalva maneuver, sitting, peak of a 2-stage (25-50 W) bicycle exercise test, and final rest period. The median of 21 paired beat-to-beat cardiac cycles was analyzed for each intervention. A total of 217 paired data values from all maneuvers were analyzed for 32 patients at implantation and 129 paired data values for 20 patients at 1 year. The IHM and catheter values were not different at baseline or at 1 year (P >.05). Combining all interventions, correlation coefficients were 0.96 and 0.94 for right ventricular systolic pressure, 0.96 and 0.83 for right ventricular diastolic pressure, and 0.87 and 0.87 for estimated pulmonary artery diastolic pressure at implantation and 1 year, respectively. CONCLUSIONS: The IHM and a standard reference pressure system recorded comparable right heart pressure values in patients with CHF. This implantable pressure transducer is accurate over time and provides a means to precisely monitor the hemodynamic condition of patients with CHF in a continuous fashion.