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Catherine Wang,1 Katherine A Joltikov,1,2 Sasha Kravets,2,3 Deepak P Edward2,4 1University of Illinois at Chicago College of Medicine, Chicago, IL, USA; 2Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; 3Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA; 4Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Deepak P Edward, Illinois Eye and Ear Infirmary, 1009 S Wood St, Chicago, IL, 60612, USA, Tel +1 312 996 6590, Fax +1 312 996 4255, Email deepedwa@uic.eduPurpose: The purpose of this study was to evaluate Computer Vision Syndrome (CVS) in undergraduate and medical students since transitioning to online learning during the COVID-19 pandemic.Patients and Methods: This was a cross-sectional single center survey-based study using a validated CVS questionnaire (CVS-Q). The survey was distributed to 20,080 undergraduate students and 680 medical students at the University of Illinois at Chicago. The primary outcome measures were prevalence of CVS (based on CVS severity score of 6 or more), frequency of CVS and intensity of CVS symptoms.Results: The survey was completed by 2300 undergraduate students (11.4% response rate) and 154 medical students (22.6% response rate). The prevalence of CVS was 77.1% in undergraduate students and 69.1% in medical students. CVS-Q severity scores were highest for headaches and eye dryness, with over half of students reporting worsening of symptoms since March 2020. Increased time spent on online learning (undergraduate: P < 0.001, medical: P = 0.018), blue light glasses usage (undergraduate: P < 0.001, medical: P = 0.0015), and increased number of device usage were associated with higher CVS severity scores (undergraduate: P < 0.001, medical: P = 0.0032).Conclusion: CVS among undergraduate and medical students has increased since the start of the COVID-19 pandemic. More focus should be placed on the management of CVS for students in higher education. Physicians should be cognizant of the consequences of online learning and be proactive about providing advice regarding preventative measures.Keywords: digital eye strain, screen time

The presented results of scientific research are aimed at increasing the efficiency of trenching for laying the utility lines using new less energy-consuming technologies of excavating the soil with the working equipment of multi-scraper excavators. The proposed method of determining the efficient operating modes for excavators when digging a trench is based on the idea of cutting the soil with the blades at a critical depth level, which guarantees consumption of minimum specific energy and maximum efficiency of the machine. This becomes possible if the operation of such blades is provided with the absolute values and the ratio of the speeds of cutting and submitting the working body into the face. To determine the efficient modes of multi-scraper excavators and the size of their edge side blades, the conditions of their effective unloading were identified and the patterns of changing the soil movement over the surface of unloading scrapers depending on the time of unloading were determined. For the same purpose, the dependences of the blocked cutting speed on the trench width were determined and the technical performance of the excavator was specified on the basis of determining the soil bearing capacity for one group of blades. It is found that the time of unloading the soil from the scrapers very slightly depends on their angular velocity within its change in the unloading zone. On this basis, the maximum angular speed of the scrapers is determined. The identified indicators are related to the width of the edge side blades performing asymmetric locked cutting, whose dimensions were determined by calculations. The obtained efficient operating modes of scraper trench excavators and the size of their edge side blades allow developing practical recommendations for improving the working equipment of excavators of this type [ABSTRACT FROM AUTHOR]

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The work deals with the results of theoretical research of the process of interaction of the couplant equipment with the plants. The equations for calculating the cutting height and the drum position respective to the cut plants were developed within the present work. [ABSTRACT FROM AUTHOR]

The relevance of this article lies in the need to improve the process of developing competences future professionals need to develop self-employment skills under the conditions of the socio-economic crisis and the instability of the Ukrainian labour market. The article aims to prove the need for systematic implementation of self-education and self-management technologies in Ukrainian professional education schools to develop entrepreneurship competence in future professionals. Research methods include a survey and an analysis of documentary information. Ukraine strives to increase the importance of young people's readiness for lifelong learning. However, the article finds that most students do not have sufficient psychological knowledge and selfmanagement skills for successful self-development and self-employment. The development of entrepreneurship competence is, for the first time, justified through the systemic implementation of self-education and selfmanagement technologies in the educational process of professional education schools. The article presents a pedagogical technology for developing entrepreneurship competence in future professionals through selfmanagement. Besides, it offers the most effective forms of its introduction (psychology workshops, video lectures, electronic portfolios) and singles out the optimal conditions of their use. The level of the technology's readiness is IRL5 (the efficiency was proven at the level of experimental educational institutions). Success in its implementation depends on the regulatory recognition of the role of the social and humanities-related component in professional education; the incorporation of a self-management course in all programmes for training, retraining and advanced training of psychology and teaching staff; the encouragement of teaching staff to effectively use the described technologies in the educational process; systematic training of students to implement self-education and self-management as the technologies of success.

The article presents the clarified concepts’ system in the context of the stated research theme, the current state of skilled workers’ and junior specialists’ distance learning in the Ukrainian vocational education and training institutions. The received data shows: education institutions’ regional affiliation and profiles; education institutions’ teaching staff experience in using distance learning technologies in teaching; their assessment of prospects of distance learning implementation in the Ukrainian VET system; teaching staff willingness to improve their distance learning technology mastering. The empirical data were obtained, analysed and systemized by conducting the e-survey using Google Forms web-service with restricted access to the form. The results of the SWOT analysis are presented; distance vocational learning implementation strengths, problems, opportunities and threats are summarized. The levels of teachers’ readiness to implement distance vocational learning are revealed by diagnosis results. The proposals concerning the constructive solution of distance learning implementation in the skilled workers’ and junior specialists’ vocational education and training system are formulated and presented.

The article is dedicated to the questions of intercultural competence relevance of a secondary educational institution leader. The notion of intercultural competence is analyzed; the definition of intercultural competence of secondary educational institution leader is given; the main behavioral characteristics and abilities needed for effective activity in intercultural situation are investigated; the main components of intercultural competence are studied. Conceptualizing model for intercultural competence level assessment which is aimed at internal and external results of this competence which is based on development of special views, knowledge and skills immanent to it is given and analyzed

The purpose of the study is to create a new design of the working tip for the perforation of the soil when laying two or more buildings trenchless way and determine its rational parameters. Method. It is known that for static perforation in the formation of cavities in the soil for communication is traditionally used cone-shaped working elements, which is the most common, cheap and reliable. However, the study revealed inefficiency. The design of the working elements of the soil perforation for trenchless laying of two or more buildings simultaneously in the form of a tip, which consists of a wedge-shaped part and a control part in the form of a rectangle with half-cylinders. The basic principles and mathematical dependences of determining the size of the working body are described. Scientific novelty. Regularities of changes in soil pressure on the lateral, conical and wedge surface, flat and cylindrical part of the tip, allowed to obtain an analytical dependence for the calculation of the resistance force depending on the physical and mechanical properties of the soil, the diameter and the number of cases established simultaneously. Also, when comparing the cone-cylindrical and flat tips, it can be argued that the breakdown force of the flat tip decreases from 1.2 to 1.7 times.

Sequential, multiple assignment, randomized trial (SMART) designs are appropriate for comparing adaptive treatment interventions, in which intermediate outcomes (called tailoring variables) guide subsequent treatment decisions for individual patients. Within a SMART design, patients may be re-randomized to subsequent treatments following the outcomes of their intermediate assessments. In this paper, we provide an overview of statistical considerations necessary to design and implement a two-stage SMART design with a binary tailoring variable and a survival final endpoint. A chronic lymphocytic leukemia trial with a final endpoint of progression-free survival is used as an example for the simulations to assess how design parameters, including, choice of randomization ratios for each stage of randomization, and response rates of the tailoring variable affect the statistical power. We assess the choice of weights from restricted re-randomization on data analyses and appropriate hazard rate assumptions. Specifically, for a given first-stage therapy and prior to the tailoring variable assessment, we assume equal hazard rates for all patients randomized to a treatment arm. After the tailoring variable assessment, individual hazard rates are assumed for each intervention path. Simulation studies demonstrate that the response rate of the binary tailoring variable impacts power as it directly impacts the distribution of patients. We also confirm that when the first stage randomization is 1:1, it is not necessary to consider the first stage randomization ratio when applying the weights. We provide an R-shiny application for obtaining power for a given sample size for SMART designs.

Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value =  < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages., (© 2024. The Author(s).)

Purpose: To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments., Methods: In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient's residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments., Results: Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73])., Conclusion: Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.

Title: Patient Adherence to Immunosuppressive Therapy for Chronic Inflammatory Eye Disease., Purpose: To investigate adherence rates to immunosuppressive therapy (IMT) for treatment of noninfectious inflammatory eye disease (IED), adherence and disease control, and factors associated with nonadherence., Method: Retrospective review of medical charts from 2015 to 2020 was conducted on patients with IED at 6 months, 1 and 2 years after initiation of IMT., Results: Of 183 patients, adherence rates at 6 months and 1 year were 70% and 58% by 2 years. Eighty-two percent, 78%, and 65% of patients with disease quiescence were adherent at 6 months, 1 and 2 years, respectively. Adherent patients have 1.86 (95% CI 1.09, 3.20) times greater likelihood for disease control compared to nonadherent. Primary reason for nonadherence was patient self-discontinuation. No specific factors were associated with nonadherence., Conclusion: Patients on IMT for IED had steady adherence rates up to 1 year, with decreased adherence at 2 years. Adherence to IMT significantly correlates with disease quiescence.

Introduction: This study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services., Methods: This prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores., Results: Postoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: -0.58, 0.10; non-inferiority margin=-1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15) vs 8.17 morphine milliequivalents (MMEs) (IQR=40.33); p<0.01) and had fewer discharge prescription opioids (median=0 (IQR=60) vs 86.4 MMEs (IQR=140.4); p<0.01)., Discussion: The SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the predictability of phenylephrine testing for congenital ptosis and review outcomes of Müller's Muscle-conjunctival resection (MMCR) for congenital ptosis across ten years of follow-up., Methods: In this retrospective case series, all patients who underwent MMCR for congenital ptosis at a single institution between 2010 and 2020 were identified. Exclusion criteria included patients who had not undergone preoperative testing with 2.5% phenylephrine in the superior fornix; patients who underwent revision surgery; and patients who had a broken suture in the early postoperative period. Demographics, margin-reflex distance 1 (MRD1) values pre- and postphenylephrine, millimeters of tissue resected intraoperatively, and final postoperative MRD1 were recorded., Results: A total of 28 patients were included; 19 patients received MMCR and 9 patients received a combined MMCR plus tarsectomy. The amount of tissue resected ranged from 5 to 11 mm. There was no significant difference between median postphenylephrine MRD1 and median final postoperative MRD1 in either surgical group. Neither patient age nor levator function was significantly associated with a change in MRD1 in either group. The addition of a tarsectomy had no bearing on the final MRD1 value., Conclusions: MMCR is a viable option for patients with congenital ptosis and moderate levator function with a response to phenylephrine. In these patients, MRD1 after 2.5% phenylephrine testing correlates to the final postoperative MRD1 outcome within 0.5 mm., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2023 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)