Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment.

BACKGROUND: Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes of patients with and without significant neurological manifestations during initial COVID-19 hospitalization. METHODS AND FINDINGS: Patients hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection between 03/01/2020 and 4/16/2020 in the Montefiore Health System in the Bronx, an epicenter of the early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). This cohort consisted of 414 patients with COVID-19 with significant neurological manifestations and 1,199 propensity-matched patients (for age and COVID-19 severity score) with COVID-19 without neurological manifestations. Neurological involvement during the acute phase included acute stroke, new or recrudescent seizures, anatomic brain lesions, presence of altered mentation with evidence for impaired cognition or arousal, and neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, and skeletal muscle injury with normal orientation and arousal signs). There were no significant group differences in female sex composition (44.93% versus 48.21%, p = 0.249), ICU and IMV status, white, not Hispanic (6.52% versus 7.84%, p = 0.380), and Hispanic (33.57% versus 38.20%, p = 0.093), except black non-Hispanic (42.51% versus 36.03%, p = 0.019). Primary outcomes were mortality, stroke, heart attack, major adverse cardiovascular events (MACE), reinfection, and hospital readmission post-discharge. Secondary outcomes were neuroimaging findings (hemorrhage, active and prior stroke, mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), and volume loss). More patients in the neurological cohort were discharged to acute rehabilitation (10.39% versus 3.34%, p < 0.001) or skilled nursing facilities (35.75% versus 25.35%, p < 0.001) and fewer to home (50.24% versus 66.64%, p < 0.001) than matched controls. Incidence of readmission for any reason (65.70% versus 60.72%, p = 0.036), stroke (6.28% versus 2.34%, p < 0.001), and MACE (20.53% versus 16.51%, p = 0.032) was higher in the neurological cohort post-discharge. Per Kaplan-Meier univariate survival curve analysis, such patients in the neurological cohort were more likely to die post-discharge compared to controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; p < 0.001)). Across both cohorts, the major causes of death post-discharge were heart disease (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza and pneumonia (13.79%, 9.89%), COVID-19 (10.34%, 7.69%), and acute respiratory distress syndrome (ARDS) (10.34%, 6.59%). Factors associated with mortality after leaving the hospital involved the neurological cohort (odds ratio (OR): 1.802 (95% CI [1.237, 2.608]; p = 0.002)), discharge disposition (OR: 1.508 (95% CI [1.276, 1.775]; p < 0.001)), congestive heart failure (OR: 2.281 (95% CI [1.429, 3.593]; p < 0.001)), higher COVID-19 severity score (OR: 1.177 (95% CI [1.062, 1.304]; p = 0.002)), and older age (OR: 1.027 (95% CI [1.010, 1.044]; p = 0.002)). There were no group differences in radiological findings, except that the neurological cohort showed significantly more age-adjusted brain volume loss (p = 0.045) than controls. The study's patient cohort was limited to patients infected with COVID-19 during the first wave of the pandemic, when hospitals were overburdened, vaccines were not yet available, and treatments were limited. Patient profiles might differ when interrogating subsequent waves. CONCLUSIONS: Patients with COVID-19 with neurological manifestations had worse long-term outcomes compared to matched controls. These findings raise awareness and the need for closer monitoring and timely interventions for patients with COVID-19 with neurological manifestations, as their disease course involving initial neurological manifestations is associated with enhanced morbidity and mortality.

Improvement of Emergency Department Chest Pain Evaluation Using Hs-cTnT and a Risk Stratification Pathway.

BACKGROUND: Chest pain is among the most common reasons for presentation to the emergency department (ED) worldwide. Additional studies on most cost-effective ways of differentiating serious vs. benign causes of chest pain are needed. OBJECTIVES: Our study aimed to evaluate the effectiveness of a novel risk stratification pathway utilizing 5th generation high-sensitivity cardiac troponin T assay (Hs-cTnT) and HEART score (History, Electrocardiogram, Age, Risk factors, Troponin) in assessing nontraumatic chest pain patients in reducing ED resource utilization. METHODS: A retrospective chart review was performed 6 months prior to and after the implementation of a novel risk stratification pathway that combined hs-cTnT with HEART score to guide evaluation of adult patients presenting with nontraumatic chest pain at a large academic quaternary care ED. Primary outcome was ED length of stay (LOS); secondary outcomes included cardiology consult rates, admission rates, number of ED boarders, and number of eloped patients. RESULTS: A total of 1707 patients and 1529 patients were included pre- and postimplementation, respectively. Median overall ED LOS decreased from 317 to 286 min, an absolute reduction of 31 min (95% confidence interval 22-41 min), after pathway implementation (p < 0.001). Furthermore, cardiology consult rate decreased from 26.9% to 16.0% (p < 0.0001), rate of admission decreased from 30.1% to 22.7% (p < 0.0001), and number of ED boarders as a proportion of all nontraumatic chest pain patients decreased from 25.13% preimplementation to 18.63% postimplementation (p < 0.0001). CONCLUSIONS: Implementation of our novel chest pain pathway improved numerous ED throughput metrics in the evaluation of nontraumatic chest pain patients.

Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia.

BACKGROUND: Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which has significant risks. Flow artifact, intrinsic to magnetic resonance angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol for patients with SCA. METHODS: A standardized MRA scanning protocol with an echo time of less than 5 ms was implemented at Montefiore Medical Center (MMC), NY in May 2016. Retrospective chart review identified 21 pediatric patients with SCA, with an MRA head both pre- and post-May 2016. Arterial stenosis on MRA, machine parameters, and treatment plans were compared pre- and post-implementation. RESULTS: Ten of the 21 patients met inclusion criteria. Previously seen stenosis was re-classified to a lower degree in six of the 10 patients, leading to discontinuation of transfusions in five patients. No patients required escalation of therapy to chronic transfusions. CONCLUSION: Optimizing flow artifact by decreasing echo time to less than 5 ms can improve accurate interpretation of cerebrovascular disease, and ensure appropriate treatment plans are in place for stroke prevention. This is especially important for implementing "TCD With Transfusions Changing to Hydroxyurea (TWiTCH)" clinical trial results in the real-world setting.

Imaging score for differentiation of meningioma grade.

PURPOSE: We sought to establish a comprehensive imaging score indicating the likelihood of higher WHO grade meningiomas pre-operatively. METHODS: All surgical intracranial meningioma patients at our institution between 2014 and 2018 underwent retrospective chart review. Preoperative MRI sequences were reviewed, and imaging features were included in the score based on statistical and clinical significance. Point values for each significant feature were assigned based on the beta coefficients obtained from multivariate analysis. The imaging score was calculated by adding up the points, for a total score of 0 to 5. The predictive ability of the score to identify higher-grade meningiomas was evaluated. RESULTS: Ninety patients, 50% of whom had a postoperative diagnosis of WHO grade II meningioma, were included. The mean age for the population was 59.9 years and 70% were female. Tumor volume ≥ 36.0 cc was assigned 2 points, presence of irregular tumor borders was assigned 2 points, and presence of peritumoral edema was assigned 1 point. The probability of having a WHO grade II meningioma was 0% with a score of 0, 25.0% with a score of 1, 38.5% with a score of 2, 65.4% with a score of 3, and 83.3% with a score of 4 or greater. A threshold of ≥ 3 points achieved a recall of 0.80, precision of 0.73, F1-score of 0.77, accuracy of 0.76, and AUC of 0.82. CONCLUSION: The proposed imaging scoring system had good predictive capability for WHO grade II meningiomas with good discrimination and calibration. External validation is needed.

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.

Elaborating and Testing Erotic Target Identity Inversion Theory in Three Paraphilic Samples.

Some men sexually attracted to types of persons (e.g., women) or things (e.g., animals) also have internalized sexual attractions: sexual arousal by the idea of being the type of person or thing to whom they are attracted. Consequently, some of these men develop erotic target identity inversions, in which they imitate, yearn to be, or identify as an instance of their erotic target. Erotic Target Identity Inversion Theory predicts that for every external erotic target to which men are attracted, a subset of men will develop an internalized sexual attraction, which may cause an erotic target identity inversion. We examined these predictions in Internet surveys of three samples of men with paraphilic sexual interests: 322 men attracted to amputees, 1501 men attracted to animals, and 402 men attracted to severely obese persons. All samples included substantial minorities of men reporting internalized sexual attractions and erotic target identity inversions specific to their external sexual attractions (e.g., men attracted to amputees who are also aroused by the fantasy of being amputees and wish to become amputees). The correlation between degree of each internalized sexual attraction and degree of its corresponding erotic target identity inversion was approximately 1.0 after correction for attenuation. In each sample, participants' specific internalized sexual attraction was positively correlated with autogynephilia, likely the most common internalized sexual attraction in men. Erotic Target Identity Inversion Theory can potentially explain a variety of otherwise puzzling phenomena, including transgender identity among female-attracted natal males and men seeking amputations of healthy limbs.

A nine-month-old boy with regression of milestones and severe constipation: an unusual case of a large spinal NTRK1 fusion pilocytic astrocytoma.

INTRODUCTION: Pilocytic astrocytoma, a World Health Organization grade 1 tumor, is the most common brain tumor in children between 5 and 14 years of age and the second most common in children younger than 5 and older than 14. Although classical to the cerebellum and hypothalamic regions, it can also arise in the spinal cord. Larotrectinib, a selective inhibitor of tropomyosin receptor kinase, has been effective in pediatric tumors with NTRK fusion mutations in children as young as 1-month-old. CASE: We share the case of a 9-month-old boy who presented with a 4-month history of regression of his milestones and severe constipation who was found to have a large spinal pilocytic astrocytoma with multiple intracranial periventricular lesions.

Robust evidence for bisexual orientation among men.

The question whether some men have a bisexual orientation-that is, whether they are substantially sexually aroused and attracted to both sexes-has remained controversial among both scientists and laypersons. Skeptics believe that male sexual orientation can only be homosexual or heterosexual, and that bisexual identification reflects nonsexual concerns, such as a desire to deemphasize homosexuality. Although most bisexual-identified men report that they are attracted to both men and women, self-report data cannot refute these claims. Patterns of physiological (genital) arousal to male and female erotic stimuli can provide compelling evidence for male sexual orientation. (In contrast, most women provide similar physiological responses to male and female stimuli.) We investigated whether men who self-report bisexual feelings tend to produce bisexual arousal patterns. Prior studies of this issue have been small, used potentially invalid statistical tests, and produced inconsistent findings. We combined nearly all previously published data (from eight previous studies in the United States, United Kingdom, and Canada), yielding a sample of 474 to 588 men (depending on analysis). All participants were cisgender males. Highly robust results showed that bisexual-identified men's genital and subjective arousal patterns were more bisexual than were those who identified as exclusively heterosexual or homosexual. These findings support the view that male sexual orientation contains a range, from heterosexuality, to bisexuality, to homosexuality.

How Autogynephilic Are Natal Females?

Blanchard proposed that autogynephilia is a natal male's paraphilic sexual arousal in response to the thought or fantasy of being a woman. Furthermore, based on evidence collected from natal males with gender dysphoria, Blanchard argued that autogynephilia is the fundamental motivation among nonhomosexual males (i.e., those not exclusively attracted to men) who pursue sex reassignment surgery or live as transgender women. These ideas have been challenged by several writers who have asserted, or offered evidence, that autogynephilia is common among women. However, their evidence was weakened by problematic measures and limited comparison groups. We compared four samples of autogynephilic natal males (N = 1549), four samples of non-autogynephilic natal males (N = 1339), and two samples of natal females (N = 500), using Blanchard's original measure: the Core Autogynephilia Scale. The autogynephilic samples had much higher mean scores compared with non-autogynephilic natal males and natal females, who were similar. Our findings refute the contention that autogynephilia is common among natal females.

Lyme Neuroborreliosis Presenting as Multiple Cranial Neuropathies.

Neuroborreliosis can manifest with cranial nerve (CN) palsies, commonly CN VII. Rarely have isolated or multiple palsies been reported. We describe a case of a young female from a Lyme endemic region who presented with bilateral CN VI palsies and a dilated right pupil, possibly a partial CN III palsy. She later developed CN VII palsy and bilateral enhancement of multiple cranial nerves on neuroimaging. She was diagnosed with Lyme disease by serological testing, with gradual improvement on antibiotics. Our case illustrates that neuroborreliosis can present as any or multiple CN palsies, and should be considered particularly in endemic areas.

Bilateral cranial nerve 6 palsy in a patient with multiple sclerosis and vitamin D-dependent rickets.

The development of multiple sclerosis (MS) is multifactorial. Elevated levels of vitamin D may lower the risk and reduce relapses by immunomodulatory mechanisms. Conversely, vitamin D-dependent rickets (VDDR), an inheritable form of rickets secondary to impairment in vitamin D synthesis or action, may increase MS risk. This has been described in three patients with VDDR type 1A. Here, we present a patient with VDDR type 2 - unclear if type 2A or 2B based on historical genetic testing - who subsequently developed MS. She presented with 8 weeks of binocular horizontal diplopia and was found to have 8 prism dioptres of esotropia in primary gaze and a mild limitation of abduction in both eyes. Radiological workup was consistent with MS demyelination. She was started on solumedrol infusions, with full resolution of the esotropia and abduction deficits. She has since been transitioned to ocrelizumab with vitamin D supplementation and has not had a relapse to date. It is important to consider MS in patients genetically predisposed to low vitamin D levels or functional impairment, as with VDDR. Vitamin D supplementation can achieve remission in some forms of VDDR, and its role in MS prevention in these patients should be considered. In patients with type 2A or 2B VDDR, who have impairment in receptor function, additional treatment modalities require investigation. Lastly, demyelination is a rare cause of bilateral cranial nerve 6 palsy. This case illustrates the importance of considering MS in cranial nerve palsies, particularly in patients with vitamin D deficiencies or functional impairment.

A map of desire: multidimensional scaling of men's sexual interest in male and female children and adults.

BACKGROUND: Men sexually interested in children of a specific combination of maturity and sex tend to show some lesser interest in other categories of persons. Patterns of men's sexual interest across erotic targets' categories of maturity and sex have both clinical and basic scientific implications. METHOD: We examined the structure of men's sexual interest in adult, pubescent, and prepubescent males and females using multidimensional scaling (MDS) across four datasets, using three large samples and three indicators of sexual interest: phallometric response to erotic stimuli, sexual offense history, and self-reported sexual attraction. The samples were highly enriched for men sexually interested in children and men accused of sexual offenses. RESULTS: Results supported a two-dimensional MDS solution, with one dimension representing erotic targets' biological sex and the other dimension representing their sexual maturity. The dimension of sexual maturity placed adults and prepubescent children on opposite ends, and pubescent children intermediate. Differences between men's sexual interest in adults and prepubescent children of the same sex were similar in magnitude to the differences between their sexual interest in adult men and women. Sexual interest in adult men was no more associated with sexual interest in boys than sexual interest in adult women was associated with sexual interest in girls. CONCLUSIONS: Erotic targets' sexual maturity and biological sex play important roles in men's preferences, which are predictive of sexual offending. The magnitude of men's preferences for prepubescent children v. adults of their preferred sex is large.

NFκB (Nuclear Factor κ-Light-Chain Enhancer of Activated B Cells) Activity Regulates Cell-Type-Specific and Context-Specific Susceptibility to Calcification in the Aortic Valve.

OBJECTIVE: Although often studied independently, little is known about how aortic valve endothelial cells and valve interstitial cells interact collaborate to maintain tissue homeostasis or drive valve calcific pathogenesis. Inflammatory signaling is a recognized initiator of valve calcification, but the cell-type-specific downstream mechanisms have not been elucidated. In this study, we test how inflammatory signaling via NFκB (nuclear factor κ-light-chain enhancer of activated B cells) activity coordinates unique and shared mechanisms of valve endothelial cells and valve interstitial cells differentiation during calcific progression. Approach and Results: Activated NFκB was present throughout the calcific aortic valve disease (CAVD) process in both endothelial and interstitial cell populations in an established mouse model of hypercholesterolemia-induced CAVD and in human CAVD. NFκB activity induces endothelial to mesenchymal transformation in 3-dimensional cultured aortic valve endothelial cells and subsequent osteogenic calcification of transformed cells. Similarly, 3-dimensional cultured valve interstitial cells calcified via NFκB-mediated osteogenic differentiation. NFκB-mediated endothelial to mesenchymal transformation was directly demonstrated in vivo during CAVD via genetic lineage tracking. Genetic deletion of NFκB in either whole valves or valve endothelium only was sufficient to prevent valve-specific molecular and cellular mechanisms of CAVD in vivo despite the persistence of a CAVD inducing environment. CONCLUSIONS: Our results identify NFκB signaling as an essential molecular regulator for both valve endothelial and interstitial participation in CAVD pathogenesis. Direct demonstration of valve endothelial cell endothelial to mesenchymal transformation transmigration in vivo during CAVD highlights a new cellular population for further investigation in CAVD morbidity. The efficacy of valve-specific NFκB modulation in inhibiting hypercholesterolemic CAVD suggests potential benefits of multicell type integrated investigation for biological therapeutic development and evaluation for CAVD.

Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke.

BACKGROUND AND PURPOSE: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). METHODS: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19-specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. RESULTS: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. CONCLUSIONS: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

Sexual Arousal Patterns of Mostly Heterosexual Men.

Mostly heterosexual men describe themselves as slightly bisexual, with predominant sexual attraction to women but occasional attraction to men. After "completely heterosexual," "mostly heterosexual" is the most common male sexual orientation, by self-report. However, self-reported bisexual feelings among men can diverge from patterns of genital arousal, an objective measure of sexual interest with high validity. We compared 49 mostly heterosexual and 50 completely heterosexual men's patterns of genital and subjective sexual arousal to male and female erotic stimuli. In addition, we compared these groups on relevant self-report measures pertaining to sexual feelings, identity, and behavior. Results supported increased bisexual arousal with respect to self-report and genital arousal pattern among the mostly heterosexual men, compared with the completely heterosexual men. Furthermore, mostly heterosexual men reported more childhood gender nonconformity, greater male sex partners, and less self-reported disgust or aversion to sex acts with men. "Mostly heterosexual" appears to be a gradation of male sexual orientation associated with unique genital arousal patterns, among other correlates.

Comparing the Real-World Effectiveness of Competing Colonoscopy Preparations: Results of a Prospective Trial.

OBJECTIVES: National societies provide little guidance regarding which colonoscopy bowel preps are best tolerated and most effective; this reflects a lack of comparative effectiveness studies that directly evaluate the available preps in a "real-world" setting. To address this gap, we conducted a prospective, commercially unfunded comparative effectiveness study of currently available bowel preps and measured their impact on bowel cleansing. METHODS: We included patients aged ≥18 years, who presented for an outpatient colonoscopy at a large medical center serving more than 70 academic and community-based endoscopists who are free to prescribe the bowel prep of their choice. The primary outcome was bowel cleansing quality as measured by the Boston Bowel Preparation Scale. We performed regression models with random effects on the outcomes to adjust for confounding. RESULTS: Approximately 4,339 colonoscopies were performed by 75 endoscopists. Magnesium citrate, MiraLAX with Gatorade, MoviPrep, OsmoPrep, Prepopik/Clenpiq, and Suprep all had significantly higher prep tolerability compared with GoLYTELY (all P < 0.05). For bowel cleansing, Suprep (7.28 ± 1.66; P < 0.001), MoviPrep (7.11 ± 1.62; P = 0.004), and MiraLAX with Gatorade (7.09 ± 1.64; P < 0.001) had higher total Boston Bowel Preparation Scale scores compared with GoLYTELY (6.67 ± 1.87); there were no significant differences among the remaining preps. Split-prep dosing was associated with better cleansing; however, men, opioid and tricyclic antidepressent users, and patients with diabetes and cirrhosis had worse cleansing (all P < 0.05). CONCLUSIONS: In this prospective, real-world comparative effectiveness study of available bowel preps, we found that MiraLAX with Gatorade, MoviPrep, and Suprep were prospectively associated with superior tolerability and bowel cleansing.

Effect of shoulder and elbow position on ulnar nerve conduction.

INTRODUCTION: The aims of this study were to determine the effect of shoulder and elbow position on ulnar nerve conduction studies (NCS), and the length of reserve that asymptomatic individuals have in their ulnar nerves. METHODS: Healthy subjects (n = 22) underwent ulnar NCS in 4 positions of shoulder abduction and elbow flexion. RESULTS: The mean increase in nerve conduction velocity (NCV) from the slack position of shoulder adducted and elbow extended to the stretch position of shoulder abducted and elbow flexed was 2.9 m/s (P < 0.01). Using this difference, the mean length of reserve in the ulnar nerve along the limb was found to be 28.3 (SD=13.8) mm. Shoulder abduction increased the mean NCV 0.8 m/s (P = 0.03) independent of elbow flexion. CONCLUSIONS: This study demonstrates an ulnar nerve reserve in healthy patients that is taken up with shoulder abduction and elbow flexion and suggests shoulder position should be standardized during ulnar NCS. Muscle Nerve, 2019.

The "Furry" Phenomenon: Characterizing Sexual Orientation, Sexual Motivation, and Erotic Target Identity Inversions in Male Furries.

Furries are individuals who are especially interested in anthropomorphic or cartoon animals (e.g., Bugs Bunny). They often strongly identify with anthropomorphic animals and create fursonas, identities of themselves as those anthropomorphic animals. Some practice fursuiting, or wearing costumes that resemble anthropomorphic animals. Furries have been portrayed as sexually motivated in the media and popular culture, although little empirical research has addressed this issue. If some furries are sexually motivated, they may be motivated by an erotic target identity inversion (ETII): sexual arousal by the fantasy of being the same kinds of individuals to whom they are sexually attracted. Furries with ETIIs would experience both sexual attraction to anthropomorphic animals and sexual arousal by fantasizing about being anthropomorphic animals, because they often change their appearance and behavior to become more like anthropomorphic animals. We surveyed 334 male furries recruited from the Internet about their sexual orientation, sexual motivation, and sexual interests. A large majority of our sample reported non-heterosexual identities (84%) and some degree of sexual motivation for being furries (99%). Male furries also tended to report a pattern of sexual interests consistent with an ETII involving anthropomorphic animals. Both sexual attraction to anthropomorphic animals and sexual arousal by fantasizing about being anthropomorphic animals were nearly universal. Furthermore, male furries tended to be sexually aroused by fantasizing about being the same kinds of anthropomorphic animals to whom they were sexually attracted, with respect to gender and species. This sexual motivation and these unusual sexual interests do not justify discrimination or stigmatization.

Visual Attention to Sexual Stimuli in Mostly Heterosexuals.

Individuals who report mostly heterosexual orientations (i.e., mostly sexually attracted to the opposite sex, but occasionally attracted to the same sex) outnumber all other non-heterosexual individuals combined. The present study examined whether mostly heterosexual men and women view same- and other-sex sexual stimuli differently than exclusively heterosexual men and women. A novel eye-tracking paradigm was used with 162 mostly and exclusively heterosexual men and women. Compared to exclusively heterosexual men, mostly heterosexual men demonstrated greater attention to sexually explicit features (i.e., genital regions and genital contact regions) of solo male and male-male erotic stimuli, while demonstrating equivalent attention to sexually explicit features of solo female and female-female erotic stimuli. Mediation analyses suggested that differences between mostly and exclusively heterosexual profiles in men could be explained by mostly heterosexual men's increased sexual attraction to solo male erotica, and their increased sexual attraction and reduced disgust to the male-male erotica. No comparable differences in attention were observed between mostly and exclusively heterosexual women-although mostly heterosexual women did demonstrate greater fixation on visual erotica overall-a pattern of response that was found to be mediated by reduced disgust.

Autopedophilia.

The most salient dimension of men's sexual orientation is gender: attraction to males versus females. A second dimension is sexual maturity: attraction to children versus adults. A less appreciated dimension is location: attraction to other individuals versus the sexual fantasy of being one of those individuals. Men sexually aroused by the idea or fantasy of being the kinds of individuals to whom they are sexually attracted have an erotic-target identity inversion (ETII). We conducted an online survey to investigate the prevalence and phenomenology of ETIIs among 475 men sexually attracted to children. Autopedophilia, or sexual arousal by the idea of being a child, was common. Furthermore, autopedophilic men tended to be sexually aroused by imagining themselves as the kinds of children (with respect to gender and age) to whom they are sexually attracted. Results support the concept of ETIIs and exemplify the simultaneous importance of three dimensions of male sexual orientation.