This paper explores the lives and careers of video game live broadcasters, especially those who gain their primary real-world income through this practice. We introduce the dominant market leader - ...the platform Twitch.tv - and outline its immensely rapid growth and the communities of millions of broadcasters, and tens of millions of viewers, it now boasts. Drawing on original interview data with professional and aspiring-professional game broadcasters ('streamers'), we examine the pasts, presents, and anticipated futures of streamers: how professional streamers began streaming, the everyday labour practices of streaming, and their concerns and hopes about the future of their chosen career. Through these examinations we explore the sociotechnical entanglements - digital intimacy, celebrity, content creation, and video games - that exemplify this new media form. Live streaming is an online practice expanding in both production and consumption at immense speed, and Twitch and its streamers appear to be at the forefront of that revolution.
This article considers the nature and functions of humour in digital game live streaming on Twitch. Most streamers and viewers seem uncomfortable with ‘serious’ in-game narrative content, resulting ...in weighty or emotional moments in games becoming sources of comedy and humour. Many also subvert the platform’s power dynamics by mocking community standards or the possibility of being banned, while some go even further and treat streamers themselves as fair game for mockery. This article thus examines how the humour of play, games and the Internet combine and evolve in an emerging and distinctive ‘stream-humour’, which can be sometimes playful and supportive yet sometimes shade into antagonism, rule-bending and hostility. Examining these dynamics on Twitch, in turn, provides a valuable window into how platform infrastructures and cultures generate norms and cultures of humour and amusement, and strengthens our understanding of online communities and platform power in this and similar contexts.
In this paper I explore economic and inclusion opportunities for people with disabilities and mental health issues afforded by 'live streaming' ‒ the live broadcast of one's activities over the ...internet to a globally dispersed audience. In both 2016 and 2017, the leading live streaming platform Twitch.tv broadcast over 500,000 years of video, which were produced by over two million regular broadcasters ('streamers'), and consumed by an audience of several hundred million viewers. Streamers can profit, up to and including a full-time living 'wage' for those at the highest levels. Numerous successful streamers with chronic health issues have discussed the personal and professional benefits streaming brings them. Utilising data from a research project with 100 interviews, alongside approximately 500 hours of ethnographic observation, this paper examines the experiences of live streaming for broadcasters with disabilities, mental health issues, or physical health issues. Firstly, I explore the positive elements of streaming for these broadcasters, focusing on the many conditions represented in this demographic, and the benefits streaming gives for inclusion and community. Secondly, I consider the negative experiences of these streamers, focused on entanglements of health and technology that make their streaming lives potentially more challenging than their colleagues. Thirdly, I focus on the economic opportunities, and the potential for entrepreneurial activity, the platform affords. I conclude the analysis by exploring how these aspects make live streaming a potentially exemplary emancipatory and entrepreneurial space for these individuals, but not one without challenges.
This article explores the growing importance of live streaming, specifically on website and platform Twitch.tv, to the games industry. We focus not on live streaming as a form of media production and ...consumption, but instead explore its newly central role in the contemporary political economy of the whole video games ecosystem. We explore three cases: streaming newly released games and the attendant role of streaming in informing consumer choice; the visibility and added lifespan that streaming is affording to independent and niche games and older games; and the live streaming of the creation of games, shedding light on the games industry and subverting ordinarily expensive or highly competitive game-design courses, training and employment paths. To do so, we draw on empirical data from offline and online fieldwork, including 100 qualitative interviews with professional live-streamers, offline ethnography at live-streaming events, and online ethnography and observation of Twitch streams. The article concludes that live streaming is a major new force in the games industry, creating new links between developers and influencers and shifting our expectations of game play and game design, and is consequently a platform whose major structural effects are only now beginning to be understood.
Peripartum cardiomyopathy (PPCM) is a potentially life‐threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the ...months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre‐existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline‐directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress‐mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease‐specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter‐defibrillators, cardiac resynchronization therapy and implanted long‐term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.
‘Gamification’ is understood as the application of game systems – competition, rewards, quantifying player/user behaviour – into non-game domains, such as work, productivity and fitness. Such ...practices are deeply problematic as they represent the capture of ‘play’ in the pursuit of neoliberal rationalization and the managerial optimization of working life and labour. However, applying games and play to social life is also central to the Situationist International, as a form of resistance against the regularity and standardization of everyday behaviour. In this article, the authors distinguish between two types of gamification: first, ‘gamification-from-above’, involving the optimization and rationalizing of work practices by management; and second, ‘gamification-from-below’, a form of active resistance against control at work. Drawing on Autonomism and Situationism, the authors argue that it is possible to transform non-games into games as resistance, rather than transferring game elements out of playful contexts and into managerial ones. Since the original ‘gamification’ term is now lost, the authors develop the alternative conception as a practice that supports workers, rather than one used to adapt behaviour to capital. The article concludes with a renewed call for this ‘gamification-from-below’, which is an ideal form of resistance against gamification-from-above and its capture of play in pursuit of work.
Pregnancy involves a complex interplay between maternal neuroendocrine and immunological systems in order to establish and sustain a growing fetus. It is thought that the uterus at pregnancy ...transitions from quiescent to laboring state in response to interactions between maternal and fetal systems at least partly
altered neuroendocrine signaling. Progesterone (P4) is a vital hormone in maternal reproductive tissues and immune cells during pregnancy. As such, P4 is widely used in clinical interventions to improve the chance of embryo implantation, as well as reduce the risk of miscarriage and premature labor. Here we review research to date that focus on the pathways through which P4 mediates its actions on both the maternal reproductive and immune system. We will dissect the role of P4 as a modulator of inflammation, both systemic and intrinsic to the uterus, during human pregnancy and labor.
The rise of machine learning in healthcare has significant implications for paediatrics. Long-term conditions with significant disease heterogeneity comprise large portions of the routine work ...performed by paediatricians. Improving outcomes through discovery of disease and treatment prediction models, alongside novel subgroup clustering of patients, are some of the areas in which machine learning holds significant promise. While artificial intelligence has percolated into routine use in our day to day lives through advertising algorithms, song or movie selections and sifting of spam emails, the ability of machine learning to utilise highly complex and dimensional data has not yet reached its full potential in healthcare. In this review article, we discuss some of the foundations of machine learning, including some of the basic algorithms. We emphasise the importance of correct utilisation of machine learning, including adequate data preparation and external validation. Using nutrition in preterm infants and paediatric inflammatory bowel disease as examples, we discuss the evidence and potential utility of machine learning in paediatrics. Finally, we review some of the future applications, alongside challenges and ethical considerations related to application of artificial intelligence. IMPACT: Machine learning is a widely used term; however, understanding of the process and application to healthcare is lacking. This article uses clinical examples to explore complex machine learning terms and algorithms. We discuss limitations and potential future applications within paediatrics and neonatal medicine.
The process of parturition involves the transformation of the quiescent myometrium (uterine smooth muscle) to the highly contractile laboring state. This is thought to be driven by changes in gene ...expression in myometrial cells. Despite the existence of multiple myometrial gene expression studies, the transcriptional programs that initiate labor are not known. Here, we integrated three transcriptome datasets, one novel (NCBI Gene Expression Ominibus: GSE80172) and two existing, to characterize the gene expression changes in myometrium associated with the onset of labor at term. Computational analyses including classification, singular value decomposition, pathway enrichment, and network inference were applied to individual and combined datasets. Outcomes across studies were integrated with multiple protein and pathway databases to build a myometrial parturition signaling network. A high-confidence (significant across all studies) set of 126 labor genes were identified and machine learning models exhibited high reproducibility between studies. Labor signatures included both known (interleukins, cytokines) and unknown (apoptosis,
, cell proliferation/differentiation) pathways while cyclic AMP signaling and muscle relaxation were associated with non-labor. These signatures accurately classified and characterized the stages of labor. The data-derived parturition signaling networks provide new genes/signaling interactions to understand phenotype-specific processes and aid in future studies of parturition.
An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to ASCO's membership following publication or presentation of potentially ...practice-changing data from major studies. This PCO addresses the clinical utility of using epidermal growth factor receptor (EGFR) mutation testing for patients with advanced non-small-cell lung cancer (NSCLC) to predict the benefit of taking a first-line EGFR tyrosine kinase inhibitor (TKI).
Patients with EGFR-mutated NSCLC have a significantly higher rate of partial responses to the EGFR TKIs gefitinib and erlotinib. In the United States, approximately 15% of patients with adenocarcinoma of the lung harbor activating EGFR mutations. EGFR mutation testing is widespread at academic medical centers and in some locales in community practice. As of yet, there is no evidence of an overall survival (OS) benefit from selecting treatment based on performing this testing.
One large phase III trial (the Iressa Pan-Asia Study IPASS trial), three smaller phase III randomized controlled trials using progression-free survival as the primary end point, and one small phase III trial with OS as the primary end point, all involving first-line EGFR TKIs and chemotherapy doublets, form the basis of this PCO.
On the basis of the results of five phase III randomized controlled trials, patients with NSCLC who are being considered for first-line therapy with an EGFR TKI (patients who have not previously received chemotherapy or an EGFR TKI) should have their tumor tested for EGFR mutations to determine whether an EGFR TKI or chemotherapy is the appropriate first-line therapy. NOTE. ASCO's provisional clinical opinions (PCOs) reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO's PCOs, or for any errors or omissions.
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