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Background Orbital exenteration is a disfiguring procedure reserved for life-threatening malignancies. This study examines the clinical course and outcomes of a large series of patients who underwent orbital exenteration for malignant periocular neoplasms. Methods This is a retrospective review of patients who underwent orbital exenteration from 1 July 2005 to 30 June 2015 at four tertiary referral centres in the USA, Australia and Canada. Demographics, indication for surgery, pathology, surgical technique, reconstruction type and outcomes were reviewed. Results Orbital exenteration was performed on 102 patients. The mean age at surgery was 67.5 years. The most common malignant tumours encountered were squamous cell carcinoma, melanoma and basal cell carcinoma. Seventy-six patients (75%) underwent reconstruction with a local myocutaneous flap, twelve with partial-thickness skin grafts (PTSG), or split skin graft, two had a free flap, and one had a dermis fat graft. Sixteen patients had combined procedures of two of the above. Complete removal of the tumour was achieved with clear margins in 81 cases. Of all patients, 72% were alive at 48 months or more. Conclusion The majority of orbital exenterations performed in this series were secondary to periocular malignancies with unsuccessful/insufficient previous treatments. Regional myocutaneous flaps, PTSG, full-thickness skin grafts and dermis fat grafts were all highly effective and durable reconstructive options, and were able to withstand radiation therapy without complications. [ABSTRACT FROM AUTHOR]

Purpose: The curation of images using human resources is time intensive but an essential step for developing artificial intelligence (AI) algorithms. Our goal was to develop and implement an AI algorithm for image curation in a high-volume setting. We also explored AI tools that will assist in deploying a tiered approach, in which the AI model labels images and flags potential mislabels for human review., Design: Implementation of an AI algorithm., Participants: Seven-field stereoscopic images from multiple clinical trials., Methods: The 7-field stereoscopic image protocol includes 7 pairs of images from various parts of the central retina along with images of the anterior part of the eye. All images were labeled for field number by reading center graders. The model output included classification of the retinal images into 8 field numbers. Probability scores (0-1) were generated to identify misclassified images, with 1 indicating a high probability of a correct label., Main Outcome Measures: Agreement of AI prediction with grader classification of field number and the use of probability scores to identify mislabeled images., Results: The AI model was trained and validated on 17 529 images and tested on 3004 images. The pooled agreement of field numbers between grader classification and the AI model was 88.3% (kappa, 0.87). The pooled mean probability score was 0.97 (standard deviation [SD], 0.08) for images for which the graders agreed with the AI-generated labels and 0.77 (SD, 0.19) for images for which the graders disagreed with the AI-generated labels ( P  < 0.0001). Using receiver operating characteristic curves, a probability score of 0.99 was identified as a cutoff for distinguishing mislabeled images. A tiered workflow using a probability score of < 0.99 as a cutoff would include 27.6% of the 3004 images for human review and reduce the error rate from 11.7% to 1.5%., Conclusions: The implementation of AI algorithms requires measures in addition to model validation. Tools to flag potential errors in the labels generated by AI models will reduce inaccuracies, increase trust in the system, and provide data for continuous model development., (© 2022 by the American Academy of Ophthalmology.)

In this paper we ask how to best allocate a given time-varying supply of vaccines during the second phase of the Covid-19 pandemic across individuals of different ages. Building on our previous heterogeneous household model of optimal economic mitigation and redistribution (Glover et al., 2021) we contrast the actual vaccine deployment path that prioritized older, retired individuals with one that first vaccinates younger workers. Vaccinating the old first saves more lives but slows the economic recovery, relative to inoculating the young first. Vaccines deliver large welfare benefits in both scenarios (relative to a world without vaccines), but the old-first policy is optimal under a utilitarian social welfare function. The welfare gains from having vaccinated the old first are especially significant once the economy is hit by a more infectious Delta variant in the summer of 2021., (© 2022 Elsevier B.V. All rights reserved.)

Background: Psychoeducation delivered face-to-face is effective in alleviating mental health morbidities in family carers of individuals with psychosis. However, research in such interventions delivered online is scarce. We evaluated the effectiveness of a digital multicomponent intervention-COPe-support-in improving carers' mental wellbeing and caregiving-related outcomes., Methods: In this two-arm, individually randomised, superiority trial, people aged 18 years or older who provided at least weekly support in any format for a relative or close friend affected by psychosis across England were randomly assigned (1:1) to either COPe-support or a passive online information resource using an independent online system. Participants were recruited through 30 mental health UK National Health Service trusts. The study team were masked to allocation and assessment of outcomes as all data collection took place online. Participants had access to either condition for 40 weeks and were advised to spend at least half an hour per week over the initial 20 weeks to go through materials at their own pace and to allow time to integrate knowledge and skills learned into practice. It was not feasible to mask participants or the online facilitator to intervention allocation. COPe-support provided psychoeducation on psychosis-related caregiving strategies and forums with professionals and other carers, and the control intervention comprised a passive online information resource. The primary outcome at 20 weeks was mental wellbeing measured by the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; minimally clinically important difference [MCID] 3). This trial is registered with ISRCTN, 89563420., Findings: Between March 1, 2018, and Feb 14, 2020, 407 participants were randomly assigned, with 204 allocated to COPe-support and 203 allocated to control. The participants (mean age 53·1 years, SD 13·2) were mostly female (330 [81%] of 407 participants) and White (359 [88%] of 407 participants). 346 (85%) of 407 participants provided primary endpoint data, 174 (85%) of 204 participants in the COPe-support group and 172 (85%) of 203 participants in the control group. The mean WEMWBS score at 20 weeks was 44·5 (SD 8·31) for the COPe-support group and 43·3 (9·19) for the control group. We found no evidence of a difference in wellbeing between the two groups (adjusted mean difference 0·37, 95% CI -1·14 to 1·88; p=0·63). In the COPe-support group, 106 (52%) of 204 participants met the complier definition of a minimum of two logins in separate weeks. The complier average causal effect analysis increased the difference in WEMWBS scores (adjusted difference 0·83, 95% CI -1·45 to 3·11; p=0·47), but this was lower than the MCID. There were no adverse events., Interpretation: Our findings did not support the use of COPe-support over a passive online information resource. However, further research to optimise digital interventions adjunctive to face-to-face support for carers remains important., Funding: National Institute for Health Research., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction and Hypothesis: The synthetic mid-urethral sling (MUS) has been the pre-eminent surgical treatment option for stress urinary incontinence (SUI) in women in recent times. However, increasing numbers of patients are now requesting mesh removal, secondary to persisting symptoms attributed to their sling. We present a video demonstrating a combined vaginal and laparoscopic approach to this procedure; along with supporting information outlining essential pre-operative assessment, counselling, and governance considerations., Methods: A 60-year-old woman presented with a 4-year history of pelvic pain. She ascribed this to her retropubic MUS (a tension-free vaginal tape). Following extensive work-up, the mesh was removed using the technique described., Results: On review, 3 months post-operatively, the patient reported improvement in the vaginal discomfort she had experienced prior to the procedure-albeit with concomitant deterioration in her SUI., Conclusions: An open or laparoscopic approach can be employed to dissect out the retropubic arms of an MUS. The latter provides a superior view of the retropubic space and confers potential advantages regarding recovery and cosmesis. The surgical technique detailed is safe and effective, especially when augmented by thorough preparation and patient counselling., (© 2021. The International Urogynecological Association.)

Introduction: A community-based project was developed to support quit attempts and denormalise smoking in Aboriginal communities. This qualitative study evaluates the effectiveness of project strategies, messages and the partnership process, and explores impacts observed by Aboriginal community members, complementing findings from a quantitative evaluation., Methods: The study comprised five focus groups (40 participants) and 14 in-depth interviews (with 15 community members). Data were analysed thematically by manual and NVivo software methods., Results: Results demonstrate that the project attracted community attention, was well recalled and messages were considered convincing and persuasive. Participants reported being more likely to quit and to discuss smoking with family and friends, and noticed that many people were quitting. Participants observed an increase in asking people not to smoke in the home and fewer people smoking at events, but noted that many smokers struggled to stay quit. The partnership and participation of Aboriginal Health Workers were viewed as crucial., Conclusion: The qualitative findings reinforce quantitative evaluation findings suggesting that the project contributed to denormalising smoking and motivating quit attempts., So What: The evaluation provided insight into how the project changed attitudes and motivated community members to make quit attempts and provided ideas to meet the ongoing challenge., (© 2020 Australian Health Promotion Association.)

We document that declining hours worked are the primary driver of widening inequality in the bottom half of the male labor earnings distribution in the United States over the past 52 years. This decline in hours is heavily concentrated in recessions: hours and earnings at the bottom fall sharply in recessions and do not fully recover in subsequent expansions. Motivated by this evidence, we build a structural model to explore the possibility that recessions cause persistent increases in inequality; that is, that the cycle drives the trend. The model features skill-biased technical change, which implies a trend decline in low-skill wages relative to the value of non-market activities. With this adverse trend in the background, recessions imply a potential double-whammy for low skilled men. This group is disproportionately likely to experience unemployment, which further reduces skills and potential earnings via a scarring effect. As unemployed low skilled men give up job search, recessions generate surges in non-participation. Because non-participation is highly persistent, earnings inequality remains elevated long after the recession ends., (© 2020 Elsevier Inc. All rights reserved.)

Introduction: A partnership between three Aboriginal Community Controlled Organisations and a mainstream health service was formed to develop, implement and evaluate a comprehensive and culturally appropriate social marketing project which aimed to encourage smokers to quit smoking. The project also supported quit attempts and promoted denormalisation of smoking., Methods: The project was evaluated through baseline (n = 427) and follow-up (n = 611) surveys carried out face-to-face with Aboriginal and/or Torres Strait Islander participants 18 years and older recruited through convenience sampling at community events and venues during 2010-2011 and 2015., Results: The proportion of participants who had made one or more quit attempts increased significantly between baseline and follow-up surveys (54%, 101 out of 187; vs 64%, 189 out of 297; P < 0.05). Participants who had intended to quit within 6 months (AOR, 3.29; 95% CI 1.90-5.68; P < 0.01); and participants disagreeing with the statement "I don't mind if people smoke inside my home" (AOR, 1.74; 95% CI 1.06-2.84; P < 0.05) were significantly more likely to have made one or more quit attempts compared to the respective reference groups., Conclusion: Study findings demonstrate that the project was associated with increased quit attempts. Intention to quit and attitude were found to be the predictors of making a quit attempt. SO WHAT?: Many studies suggest the need to denormalise smoking; this study demonstrated both change in attitudes and an increase in quit attempts. It is recognised that many quit attempts may be needed for long-term smoking cessation., (© 2019 Australian Health Promotion Association.)

Women and men globally are delaying the birth of their first child. In the UK, the average age of first conception in women is 29 years. Women experience age-related fertility decline so it is important that men and women are well-informed about this, and other aspects of fertility. A group of UK stakeholders have established the Fertility Education Initiative to develop tools and information for children, adults, teachers, parents and healthcare professionals dedicated to improving knowledge of fertility and reproductive health.

Issue addressed Tobacco consumption contributes to health disparities among Aboriginal Australians who experience a greater burden of smoking-related death and diseases. This paper reports findings from a baseline survey on factors associated with smoking, cessation behaviours and attitudes towards smoke-free homes among the Aboriginal population in inner and south-western Sydney. Methods A baseline survey was conducted in inner and south-western Sydney from October 2010 to July 2011. The survey applied both interviewer-administered and self-administered data collection methods. Multiple logistic regression was performed to determine the factors associated with smoking. Results Six hundred and sixty-three participants completed the survey. The majority were female (67.5%), below the age of 50 (66.6%) and more than half were employed (54.7%). Almost half were current smokers (48.4%) with the majority intending to quit in the next 6 months (79.0%) and living in a smoke-free home (70.4%). Those aged 30-39 years (AOR 3.28; 95% CI: 2.06-5.23) and the unemployed (AOR 1.67; 95% CI: 1.11-2.51) had higher odds for current smoking. Participants who had a more positive attitude towards smoke-free homes were less likely to smoke (AOR 0.79; 95% CI: 0.74-.85). Conclusions A high proportion of participants were current smokers among whom intention to quit was high. Age, work status and attitudes towards smoke-free home were factors associated with smoking. So what? The findings address the scarcity of local evidence crucial for promoting cessation among Aboriginal tobacco smokers. Targeted promotions for socio-demographic subgroups and of attitudes towards smoke-free homes could be meaningful strategies for future smoking-cessation initiatives.

Fire is an integral part of savanna ecology and changes in fire patterns are linked to biodiversity loss in savannas worldwide. In Australia, changed fire regimes are implicated in the contemporary declines of small mammals, riparian species, obligate-seeding plants and grass seed-eating birds. Translating this knowledge into management to recover threatened species has proved elusive. We report here on a landscape-scale experiment carried out by the Australian Wildlife Conservancy (AWC) on Mornington Wildlife Sanctuary in northwest Australia. The experiment was designed to understand the response of a key savanna bird guild to fire, and to use that information to manage fire with the aim of recovering a threatened species population. We compared condition indices among three seed-eating bird species--one endangered (Gouldian finch) and two non-threatened (long-tailed finch and double-barred finch)--from two large areas (> 2,830 km2) with initial contrasting fire regimes ('extreme': frequent, extensive, intense fire; versus 'benign': less frequent, smaller, lower intensity fires). Populations of all three species living with the extreme fire regime had condition indices that differed from their counterparts living with the benign fire regime, including higher haematocrit levels in some seasons (suggesting higher levels of activity required to find food), different seasonal haematocrit profiles, higher fat scores in the early wet season (suggesting greater food uncertainty), and then lower muscle scores later in the wet season (suggesting prolonged food deprivation). Gouldian finches also showed seasonally increasing stress hormone concentrations with the extreme fire regime. Cumulatively, these patterns indicated greater nutritional stress over many months for seed-eating birds exposed to extreme fire regimes. We tested these relationships by monitoring finch condition over the following years, as AWC implemented fire management to produce the 'benign' fire regime throughout the property. The condition indices of finch populations originally living with the extreme fire regime shifted to resemble those of their counterparts living with the benign fire regime. This research supports the hypothesis that fire regimes affect food resources for savanna seed-eating birds, with this impact mediated through a range of grass species utilised by the birds over different seasons, and that fire management can effectively moderate that impact. This work provides a rare example of applied research supporting the recovery of a population of a threatened species.