Co-op mode: the emancipatory potential of freelancer co-operatives in the UK videogames industry following the COVID-19 pandemic

With government-imposed lockdowns due to the COVID-19 pandemic, one would expect the videogames industry to experience a windfall as locked-down individuals turn to games to fill the time. Despite successful profit margins for game studios, a multitude of issues have affected videogames freelancers, with this paper displaying how the pandemic has not been plain sailing for the industry. Informed by 31 interviews with freelancers and videogames practitioners, this paper adds to knowledge on the viability of worker co-operatives and how they offer hope to those workers looking for more emotional and financial security post-pandemic. The paper concludes by suggesting that although co-operatives provide alleviation for workers against a multitude of concerns, there needs to be more education, promotion and funding for co-ops to make them an accessible corporate structure. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Diagnostic Test Kinetics, Infectivity, and Immunological Responses Among Unvaccinated Adults During Acute SARS-CoV-2 Infection

Background. Appropriate diagnostic testing can be used to inform infection control measures and reduce SARS-CoV-2 transmission, yet the test kinetics, infectivity, and immunological responses during acute, non-severe SARS-CoV-2 infection need clarity. Methods. We conducted a prospective cohort study between Nov 2020-July 2021 in Seattle, Washington of 95 unvaccinated, immunocompetent adults with no prior SARS-CoV-2 infection. Nasal swabs (nasopharyngeal and anterior) and blood serum samples were serially collected at six visits over two months. Viral RNA, N and S antigen concentrations, and viral growth/infectivity were measured from nasal samples. Anti-S total antibody and IgG assays were performed on serum. We fit loess curves to quantitative data corresponding to each testing modality by days since symptom onset (DSSO) and compared qualitative test results across time points to demonstrate timedependent agreement of PCR, N antigen, and culture results. Generalized estimating equations were used to approximate relative risk of culture positivity (a proxy for infectiousness) for positive vs. negative test results (antigen and PCR), stratified by presence/ absence of symptoms and DSSO. Sampling Schema Nasal swabs and venous blood were collected at visits 1-4;venous blood only at visits 5-6. All participants were enrolled within 14 days of symptom onset (median: 6) and 7 days of a positive test (median: 4). Results. Infections in this cohort (median age: 29y) were mild (no hospitalization). Median (IQR) time to negative result was 11 (4), 13 (6), and 20 (7) DSSO for culture growth, N antigen, and PCR tests, respectively. Viral RNA quantities declined more slowly than antigen and culturable virus;antibody titers rose rapidly 5-15 DSSO and plateaued 20-30 DSSO. All culture-positive samples collected 0-5 DSSO were positive by PCR, but relative risk of culture positivity (infectiousness) for positive vs. negative PCR results declined 6-10 DSSO. Relative risk of culture positivity for positive vs. negative antigen results was consistently high 0-10 DSSO, with similar results when stratified by presence of symptoms. Diagnostic test kinetics and immunological responses Diagnostic test kinetics and immunological responses measured in adults with non-severe, symptomatic SARS-CoV-2 infection: loess trendlines and 95% confidence intervals are given for SARS-CoV-2 viral load (calculated from PCR Ct value using a calibration curve), TCID50 from viral culture, mean concentrations of nucleocapsid and spike antigen proteins, and anti-S total and IgG antibody concentrations. Conclusion. The results reinforce the importance of molecular PCR testing as a highly sensitive diagnostic tool but with limited utility as an indicator of viral culturability and likely infectiousness. N antigen testing may be a preferable diagnostic test within two weeks of symptom onset, especially 6-10 DSSO, because it more closely correlates with culture growth over the course of infection.

Utility of Virtual New-Patient Clinics in Women Under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which are considered a low-risk subgroup. Method: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusions: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

Extreme Angiographic-Physiologic Mismatch With Elevated Left Ventricular End-Diastolic Pressure.

Translesional coronary pressure measures the hemodynamic significance of epicardial coronary artery disease. Angiographic-physiologic mismatching is attributed mainly to imaging limitations. We present a patient with extreme visual-physiologic functional mismatch and a markedly elevated left ventricular end diastolic pressure (LVEDP) as a potential contributory mechanism.

Utility of virtual new-patient clinics in women under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which is considered a low-risk subgroup. Methods: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusion: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

Risk factor modeled microenvironment effects lymphatics activity and IBC invasiveness and progression

Background. Lymphovascular invasion (LVI) and breast tumor emboli within dermal and breast lymphatic vessels are prognostic for metastatic spread and poor outcomes, and are abundant in Inflammatory breast cancer (IBC). IBC is an aggressive breast cancer that presents suddenly with breast swelling and redness due to tumor emboli in lymphatics. Lack of breast-feeding and obesity are IBC risk factors. We sought to demonstrate the combinatorial effects of a high-fat diet and nursing on lymphatic function and compare these to IBC tumor induced changes in lymphatic function. We hypothesize that risk factors for aggressive breast cancer may alter lymphatic function in the normal gland prior to tumor initiation. Methods. Following two rounds of pregnancy in 20 multiparous SCID Beige immunocompromised mice, half of the mice were force weaned while half nursed pups. Prior to forced weaning, half of each of these groups were fed a high fat diet (HFD: 60 Kcal %, N = 10) while the other half received a low-fat diet (LFD: 10 Kcal %, N = 10). Consecutive dynamic near-infrared fluorescence (NIRF) lymphatic imaging was performed at 6-7 months (covid interruption) and 14 months after initiating the diet by injecting a near-IR fluorophore into the mammary fatpad and recording lymphatic pulsing over 8 minutes using V++. Matlab and ImageJ were used to quantify pulsing rates on the ventral lymphatics in each animal. Fatpads were Ssubsequently inoculated with SUM149 IBC cells and imaging was repeated 16 months post diet initiation. Lymphatic imaging over time by HFD vs LFD was further studied in nulliparous animals. Tissues were collected for further analyses. ResultsData analysis prior to tumor injection, demonstrated lymphatic pulsing (pulses/4 minutes) increased over time in HFD force weaned (HFFW) and HFD nursing (HFN) animals only (65.5 vs 72.6, P=0.059;60.1 vs 76.6, P=0.0099, respectively). Comparing HFFW and HFN to matched LFD groups (LFFW and LFN), at 14 weeks HFD was associated with increased pumping after forced weaning (62.3 vs. 72.6, P=0.074), and nursing (62.5 vs 76.6, P=0.0023). There was an increase in pulsing after tumor initiation (16 months after initiation of diet) in all groups (80.1, 84.1, 83.2, 82.4, P > 0.05 all comparisons to initial timepoint). In a separate experiment examining HFD (N=5) vs LFD (N=5) in nulliparous mice, lymphatic contractile activity increased in all animals over. time, average ventral lymphatic contractile frequency for LFD and HFD at week 8, 11 and 14 weeks after diet initiation were 5, 8.64, 15.9 pumps/4 mins vs 11.8, 18.5, 28.2 pumps/4 mins, (P = 0.01, 0.05, and 0.0005 respectively). ConclusionsHFD increased lymphatic pulsing rate over time to a significantly greater extent than LFD continuing over 14 months independent of reproductive and nursing status. Tumor initiation prompted further increased pulsing rates beyond that observed after HFD across all groups. The magnitude of the effect of HFD on lymphatic pulsing approached the rate after tumor initiation, while reproductive variables did not impact lymphatic pulsing. Further studies are warranted to demonstrate the relationship if any between lymphatic pumping pre-initiation and LVI after tumor initiation and examine the role of intervention on reducing LVI.

School's out: Parenting stress and screen time use in school-age children during the COVID-19 pandemic.

Background During the COVID-19 pandemic, millions of children abruptly moved to online schooling, which required high levels of parental involvement. Family routines were disrupted, potentially increasing parental stress, and may be reflected in greater media screen time use in children. Objectives To determine whether (1) parenting styles and (2) parenting stress were associated with children's screen time use during the pandemic compared to the pre-pandemic period. Methods Parents (> 18 years of age) were recruited to complete an online survey regarding changes in their children's (6-12 years) screen time use and daily activities before and during the pandemic. Stress and parental involvement were assessed using the Perceived Stress Scale (PSS) and Alabama Parenting Questionnaires respectively. General linear models assessed whether parenting style and parent stress were associated with children's screen time during the pandemic, adjusting for demographic variables and daily activities. Results 104 parents were enrolled, and 73 (70.2%) parents completed the surveys. Children's screen time (e.g., watching television and playing video games) increased significantly, from 2.6 to 5.9h a day (p = .001) during pandemic-related school closures. Fewer changes in children's screen time use were significantly associated with greater parental involvement (p = .017). Parent stress (p = .018) significantly predicted children's screen time use. Lower household income was associated with increased hours of screen time in both models (both, p < .05). Conclusions: Children's screen time increased significantly during the initial months of the pandemic. Parent stress and parenting styles may be modifiable risk factors to promote children's well-being during the ongoing pandemic.

Assessing patient satisfaction with the cystic fibrosis telehealth service

Objectives: Telehealth (via videocall) was rapidly implemented by the South Australian Adult Cystic Fibrosis (CF) Service in March 2020 due to the Novel Coronavirus 2019 pandemic. Home spirometers were distributed as part of objective patient assessment. Our aim was to assess patient satisfaction with the telehealth service in CF multidisciplinary clinic via online survey. Methods: All patients of the CF service were invited to complete an online survey designed to assess satisfaction with telehealth, which was undertaken through the consumer organisation Cystic Fibrosis South Australia. A quantitatively driven concurrent mixed-methods design was chosen, with statistical analysis of symmetrical five-point Likert responses using IBM SPSS Statistics for Windows v.26 and coding of unstructured responses for thematic analysis. Results: To date 57/160 patients (35.6%) completed the survey, with some item non-responses. 37/57 (64.9%) participants were aged ≤35 years of age, 42/53 (79.2%) had ≥2 telehealth appointments, and 46/53 (86.7%) found it easy/very easy to access. 18/48 (37.5%) of participants had technical issues. Despite this 48/52 (92.3%) felt satisfied/very satisfied with engagement of CF team via telehealth. 38/50 (76%) found telehealth more convenient with significant time saved. The thematic analysis added depth to quantitative analysis by identification of six key themes: convenience, ease of access, maintaining the therapeutic relationship, comprehensive care, safety, and patient centred care. Conclusion: Most patients reported high satisfaction with telehealth and would like a hybrid clinic with the option of telehealth or in person review for clinics into the future.

Assessing patient satisfaction with the cystic fibrosis telehealth service

Introduction/Aim: Telehealth (via videocall) was rapidly implemented by the South Australian Adult Cystic Fibrosis (CF) Service in March 2020 due to the Novel Coronavirus 2019 pandemic (COVID-19). Home spirometers were distributed as part of objective patient assessment. Our aim was to assess patient satisfaction with the telehealth service in CF multidisciplinary clinic via online survey. Methods: All patients of the CF service were invited to complete an online survey designed to assess satisfaction with telehealth, which was undertaken through the consumer organization Cystic Fibrosis South Australia. A quantitatively driven concurrent mixed-methods design was chosen, with statistical analysis using IBM SPSS Statistics for Windows v.26 and coding of unstructured responses to generate themes for thematic analysis. Results: To date 57 from a cohort of 160 patients (35.6%) completed the survey, with some item non-responses. 37/57 (64.9%) of participants were aged ≤35yo, 42/53 (80.7%) had 2 telehealth appointments, and 46/53 (86.7%) found it easy/very easy to access. 18/48 (37.5%) of participants had problems with audio/visual dropout. Despite this 48/52 (92.3%) felt satisfied or very satisfied that the CF team were engaged in their care via telehealth, with just under half utilizing a home spirometer at the time of the survey. 38/50 (76%) found that telehealth was more convenient than an in-person appointment with significant time saved. The thematic analysis added context and depth to analysis of the quantitative data by identification of six key themes of convenience, ease of access, maintaining the therapeutic relationship, comprehensive care, safety, and patient centred care. Conclusion: Most patients reported high satisfaction with telehealth and would like a hybrid clinic with the option of telehealth or in person review for clinics into the future.

The effects of COVID-19 on telestroke care delivery

Background: Telestroke is increasingly being utilized to deliver acute stroke care to patients without in-person access to stroke expertise. After the U.S. emergence of the COVID-19 pandemic in March of 2020, reports of its effects on acute stroke care surfaced. This review examines the effect of the COVID-19 pandemic on telestroke care delivery in a large telestroke network, spanning 36 states and 340 hospitals throughout the nation. Methods: For this retrospective observational study, data was reported from the internal medical record platform from three separate time periods - a year before the pandemic (March 2019 - May 2019), the three months immediately prior to the pandemic (December 2019 - February 2020), and the height of the COVID-19 pandemic in the U.S. (March 2020 - May 2020). Two groups were studied, those seen in the emergency department (ED) with a suspected stroke diagnosis, and those who received alteplase in the ED. Results: The analysis revealed a decrease in patient volumes in both groups during the pandemic. The presentation time did not significantly vary between any of the stroke or alteplase groups. There was no significant difference in door-to-consult request times in the pandemic vs prior to the pandemic. The door-to-video time was shorter in the pandemic in alteplase patients compared to immediately prior (P=0.04), but not compared to 2019 (P=0.35). There was no significant difference in door-to-decision times or door-to-needle times in all of the groups. There was no difference in stroke severity in the alteplase group during the pandemic, but in the stroke group, stroke severity was higher during the pandemic (P<0.01). Rates of thrombolysis did not decrease during the pandemic. Conclusion: COVID-19 has strained the U.S. emergency medical system and created unique challenges to treating patients with acute ischemic stroke. Likely due to the size and heterogeneity of the patient population, minimal adverse effects on telestroke process metrics were seen in this particular large teleneurology practice during the COVID-19 pandemic. This review highlights the resilience of our nation's stroke system of care to withstand the stressor of a worldwide pandemic.

Sex differences in the delivery of acute telestroke care

Background: Sex differences are encountered in many aspects of ischemic stroke, including risk factors, presenting symptoms, stroke mechanism, acute interventions and functional outcomes. As telestroke services continue to expand, many patients utilize telestroke for the evaluation and treatment of suspected stroke symptoms. To date, the existence of such differences between sexes has not been identified in the patient population having utilized telestroke for acute stroke care. Methods: A retrospective observational study of the experience of a single teleneurology practice serving 340 hospitals from April 2018 to June 2020 was performed. Patients seen in the emergency department (ED) with a diagnosis of suspected stroke were included. Data from the acute stroke encounter was reported through the current medical record platform. Results: Within the queried period, there were 11,454 male and 11,794 female patients identified as having received ED telestroke evaluation for suspected acute stroke. Males were younger than females (67 vs 70, P<0.01). Males had higher rates of prior stroke, hypertension, diabetes, hyperlipidemia, and coronary disease than females (P<0.01), while females had higher rates of atrial fibrillation (P=0.03) and TIA (P<0.01). Rates of antiplatelet and anticoagulants were higher in males (P<0.01) than females. There were no differences in time to ED presentation, time to request consult or make a thrombolysis decision, or length of consult. Females had higher stroke severity (P<0.01) and door-to-needle times (P<0.01), but lower alteplase rates (P=0.02) compared to males. Conclusion: This review of a national heterogeneous telestroke patient population is indicative of sex differences in multiple aspects of acute ischemic stroke, most notably in thrombolysis delivered via telestroke. Further investigation into the etiology of such differences is warranted, as well as a survey of functional outcomes. As telemedicine continues to expand in the era of the COVID-19pandemic, it is imperative that the reasons behind this disparity are investigated.