Don’t You Know That You’re Toxic: Normalization of Toxicity in Online Gaming

Peer ReviewedVideo game toxicity, endemic to online play, represents a pervasive and complex problem. Antisocial behaviours in online play directly harm player wellbeing, enjoyment, and retention—but research has also revealed that some players normalize toxicity as an inextricable and acceptable element of the competitive video game experience. In this work, we explore perceptions of toxicity and how they are predicted by player traits, demonstrating that participants reporting a higher tendency towards Conduct Reconstrual, Distorting Consequences, Dehumanization, and Toxic Online Disinhibition perceive online game interactions as less toxic. Through a thematic analysis on willingness to report, we also demonstrate that players abstain from reporting toxic content because they view it as acceptable, typical of games, as banter, or as not their concern. We propose that these traits and themes represent contributing factors to the cyclical normalization of toxicity. These findings further highlight the multifaceted nature of toxicity in online video games

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Paralysis by Analysis: Choking, Clutching, and Reinvestment in Competitive Gameplay

Video games frequently invoke high-pressure circumstances in which player performance is crucial. These high-pressure circumstances are incubators for ‘choking’ and ‘clutching’—phenomena that broadly address critical failures and successes in performance, respectively. The eruption of esports into the mainstream has vitalized the need to understand performance in video games, and particularly in competitive games spaces. In this short workshop paper, we present a selection of findings and insights from a full paper (submitted for review) exploring potential mechanisms behind choking and clutching. We find that propensity to choke is positively predicted by trait reinvestment—a predisposition to ‘focus inwards’ in high pressure contexts, reverting to slower ‘declarative’ processing in lieu of more automated ‘procedural’ processing. We also find that propensity to clutch is positively predicted by player experience with competitive gaming. We propose that such findings can be utilized to scaffold and support performance in high-pressure gaming spaces, such as esports

Routine chest X-rays after pigtail chest tube removal rarely change management in children.

BackgroundThe need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management.MethodsPatients &lt; 18&nbsp;years old with pigtail chest tubes placed 2014-2019 at a tertiary children's hospital were reviewed. Exclusion criteria were age &lt; 1&nbsp;month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion.Results111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8&nbsp;years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax.ConclusionsPost-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax

“Bad Vibrations”: Sensing Toxicity From In-Game Audio Features

Toxicity in online gaming is a problem that causes harm to players, developers, and gaming communities. Toxic behaviours persist in online multiplayer games for a number of reasons, and continue to go unchecked due in large part to a lack of reliable methods to accurately detect toxicity online, in real-time, and at scale. In this paper, we present a modeling approach that uses features derived from in-game verbal communication and game metadata to predict if Overwatch games are toxic. With logistic regression models, we achieve accuracy scores of 86.3% for binary (high vs low toxicity) predictions. We discuss which features were most salient, potential application of our predictive model, and implications for toxicity detection in games. Our approach is a low-cost, low-effort, and non-invasive detection approach that contributes to holistic efforts in combating toxicity in games

Don't you know that you're toxic: Normalization of toxicity in online gaming

Video game toxicity, endemic to online play, represents a pervasive and complex problem. Antisocial behaviours in online play directly harm player wellbeing, enjoyment, and retention-but research has also revealed that some players normalize toxicity as an inextricable and acceptable element of the competitive video game experience. In this work, we explore perceptions of toxicity and how they are predicted by player traits, demonstrating that participants reporting a higher tendency towards Conduct Reconstrual, Distorting Consequences, Dehumanization, and Toxic Online Disinhibition perceive online game interactions as less toxic. Through a thematic analysis on willingness to report, we also demonstrate that players abstain from reporting toxic content because they view it as acceptable, typical of games, as banter, or as not their concern. We propose that these traits and themes represent contributing factors to the cyclical normalization of toxicity. These fndings further highlight the multifaceted nature of toxicity in online video games

Feeling Good and In Control: In-game Tools to Support Targets of Toxicity

Game developers, researchers, and players recognize the harm of toxic behaviour in online games-yet toxicity persists. Players' coping strategies are limited to tools that focus on punishing toxic players (e.g., muting, blocking, reporting), which are inadequate and often misused. To address the needs of players experiencing toxicity, we took inspiration from research in other online spaces that provide support tools for targets of harassment. We iteratively designed and evaluated in-game tools to support targets of toxicity. While we found that most players prefer tools that explicitly address toxicity and increase feelings of control, we also found that tools that solely provide social or emotional support also decrease stress, increase feelings of control, and increase positive affect. Our findings suggest that players may benefit from variety in toxicity support tools that both explicitly address toxicity in the moment and help players cope after it has occurred

Feeling Good and In Control: In-game Tools to Support Targets of Toxicity

Game developers, researchers, and players recognize the harm of toxic behaviour in online games-yet toxicity persists. Players' coping strategies are limited to tools that focus on punishing toxic players (e.g., muting, blocking, reporting), which are inadequate and often misused. To address the needs of players experiencing toxicity, we took inspiration from research in other online spaces that provide support tools for targets of harassment. We iteratively designed and evaluated in-game tools to support targets of toxicity. While we found that most players prefer tools that explicitly address toxicity and increase feelings of control, we also found that tools that solely provide social or emotional support also decrease stress, increase feelings of control, and increase positive affect. Our findings suggest that players may benefit from variety in toxicity support tools that both explicitly address toxicity in the moment and help players cope after it has occurred

Don't you know that you're toxic: Normalization of toxicity in online gaming

Video game toxicity, endemic to online play, represents a pervasive and complex problem. Antisocial behaviours in online play directly harm player wellbeing, enjoyment, and retention-but research has also revealed that some players normalize toxicity as an inextricable and acceptable element of the competitive video game experience. In this work, we explore perceptions of toxicity and how they are predicted by player traits, demonstrating that participants reporting a higher tendency towards Conduct Reconstrual, Distorting Consequences, Dehumanization, and Toxic Online Disinhibition perceive online game interactions as less toxic. Through a thematic analysis on willingness to report, we also demonstrate that players abstain from reporting toxic content because they view it as acceptable, typical of games, as banter, or as not their concern. We propose that these traits and themes represent contributing factors to the cyclical normalization of toxicity. These fndings further highlight the multifaceted nature of toxicity in online video games

“Bad Vibrations”: Sensing Toxicity From In-Game Audio Features

Toxicity in online gaming is a problem that causes harm to players, developers, and gaming communities. Toxic behaviours persist in online multiplayer games for a number of reasons, and continue to go unchecked due in large part to a lack of reliable methods to accurately detect toxicity online, in real-time, and at scale. In this paper, we present a modeling approach that uses features derived from in-game verbal communication and game metadata to predict if Overwatch games are toxic. With logistic regression models, we achieve accuracy scores of 86.3% for binary (high vs low toxicity) predictions. We discuss which features were most salient, potential application of our predictive model, and implications for toxicity detection in games. Our approach is a low-cost, low-effort, and non-invasive detection approach that contributes to holistic efforts in combating toxicity in games