PURPOSE: To evaluate intraobserver reproducibility of measurements in images obtained by the ultrasound biomicroscopy (UBM plus, model P45, Paradigm(R), Inc., Utah, USA) and estimate the agreement of measurements by ultrasound biomicroscopy and A-scan ultrasound (model P37, Paradigm(R), Inc., Utah, USA). METHODS: The anterior segment images of fifteen normal patients were obtained twice by single examiner. Six different parameters were measured in each image. Among the parameters, anterior chamber depth was compared with that measured by A-scan ultrasound. RESULTS: The intraobserver reproducibility was high for all six parameters that includes central corneal thickness (coefficient of variation (%) 2.80), anterior chamber depth (coefficient of variation (%) 1.20), anterior chamber angle (coefficient of variation (%) 4.01), scleral thickness (coefficient of variation (%) 4.28), trabecular meshwork-iris distance (coefficient of variation (%) 6.09) and angle opening distance (AOD500, coefficient of variation (%) 6.09). The correlation between ultrasound biomicroscopy and A-scan ultrasound in measuring the anterior chamber depth was statistically significant (correlation coefficient = 0.79, p=0.002). CONCLUSIONS: The measurements of anterior segment parameters by ultrasound biomicroscopy have high reproducibility and will be useful in evaluating the anterior segment structure.
Anterior Chamber ; Humans ; Microscopy, Acoustic* ; Ultrasonography* ; Utah

PURPOSE: To estimate the horizontal and vertical white-to-white diameters (WTW) and anterior chamber depths (ACD) with a dual Scheimpflug camera (GALILEI(TM), Ziemer, Switzerland) and to compare the estimates measured by a measuring caliper and ultrasound biomicroscopy (UBM PlusTM, Paradigm Inc., Utah, USA) in normal subjects. METHODS: Forty-four eyes of 23 subjects were evaluated. Corneal diameter as measured by GALILEI was directly compared with the white-to-white diameter (WTW) measured by a caliper and the correlation with ciliary sulcus diameter (STS) by UBM was evaluated. The anterior chamber depth (ACD) as measured by GALILEI(TM) was compared with the estimates measured by UBM. RESULTS: The horizontal and vertical diameters of WTW by GALILEI were not significantly different from the measurements taken by calipers (p>0.05, p>0.05, respectively), and there were no correlations between the measurements (r=-0.074, p>0.05 at 180degrees r=0.297, p>0.05 at 90degrees, respectively). The estimates by GALILEI did not correlate with those measured with UBM (r=-0.006, p>0.05 at 180degrees r=-0.222, p>0.05 at 90degrees, respectively). However, the mean ACD by GALILEI was deeper than thatby UBM (p<0.01), and the measurements correlated strongly with each other (r=0.760; p<0.01). CONCLUSIONS: The mean WTW measured by GALILEI was not significantly different from the measurements taken by calipers and the measurements did not correlate with each other. There was also no correlation with the measurementsby GALILEI and UBM. ACD by GALILEI was measured to be deeper those that by UBM.
Anterior Chamber ; Eye ; Microscopy, Acoustic ; Utah

BACKGROUND: Onset of rocuronium is rapid but relatively large doses are needed to achieve a suitable intubating condition. So we compared the single bolus injection with divided injection of rocuronium about tlie onset time, intubation time and intubating condition. METHOD: Thirty patients were divided into three groups of 10 each randomly. Patients in group I were given a single dose of 0.6mg/kg rocuronium. Those in group 2I or 3 received 0.06 mg/kg or 0.09 mg/kg as priming dose followed by 0.54 mg/kg and 0.81 mg/kg as intubating dose 3 min. later. The train of four responses of adductor pollicis muscle was recorded using Paragraph(Utah Medical Product Inc. Midvale Utah, U.S.A.) every 10 seconds. The trachea was intubated by one clinician who was blinded to the muscle relaxant administered when he thought the patients were suitable for intubation, and he recorded the intubating conditions. The endotracheal intubation time and twitch height at the moment was recorded by other clinician. The onset time was recorded when the post tetanic count is marked as '0'. RESULT: The onset time of group 1, 2, and 3 were 90.0+/-22.lsec, 109.0+/-35.0 sec and 85.0+/-35.0 sec. respectively. Endotracheal intubation times were 77.0+/-10.6sec, 60.0+/-10.0sec and 44.0+/-5.2sec respectively. CONCLUSION: There was no differences about onset time between single and devided injection with same total dose or incremental dose of 0.9mg/kg. But the intubation time was faster in priming group with dose dependent manner, and the intubating conditions were excellent to good in all patients.
Humans ; Intubation* ; Intubation, Intratracheal ; Trachea ; Utah

A Brain-Machine interface (BMI) allows for direct communication between the brain and machines. Neural probes for recording neural signals are among the essential components of a BMI system. In this report, we review research regarding implantable neural probes and their applications to BMIs. We first discuss conventional neural probes such as the tetrode, Utah array, Michigan probe, and electroencephalography (ECoG), following which we cover advancements in next-generation neural probes. These next-generation probes are associated with improvements in electrical properties, mechanical durability, biocompatibility, and offer a high degree of freedom in practical settings. Specifically, we focus on three key topics: (1) novel implantable neural probes that decrease the level of invasiveness without sacrificing performance, (2) multi-modal neural probes that measure both electrical and optical signals, (3) and neural probes developed using advanced materials. Because safety and precision are critical for practical applications of BMI systems, future studies should aim to enhance these properties when developing next-generation neural probes.
Brain ; Brain-Computer Interfaces* ; Electroencephalography ; Freedom ; Michigan ; Utah

Student feedback is a critical component of the teacher-learner cycle. However, there is not a gold standard course or clerkship evaluation form and limited research on the impact of changing the evaluation process. Results from a focus group and pre-implementation feedback survey coupled with best practices in survey design were used to improve all course/clerkship evaluation for academic year 2013-2014. In spring 2014 we asked all subjected students in University of Utah School of Medicine, United States of America to complete the same feedback survey (post-implementation survey). We assessed the evaluation climate with 3 measures on the feedback survey: overall satisfaction with the evaluation process; time students gave effort to the process; and time students used shortcuts. Scores from these measures were compared between 2013 and 2014 with Mann-Whitney U-tests. Response rates were 79% (254) for 2013 and 52% (179) for 2014. Students' overall satisfaction score were significantly higher (more positive) post-implementation compared to pre-implementation (P<0.001). There was no change in the amount of time students gave effort to completing evaluations (P=0.981) and no change for the amount of time they used shortcuts to complete evaluations (P=0.956). We were able to change overall satisfaction with the medical school evaluation culture, but there was no change in the amount of time students gave effort to completing evaluations and times they used shortcuts to complete evaluations. To ensure accurate evaluation results we will need to focus our efforts on time needed to complete course evaluations across all four years.
Americas ; Climate ; Focus Groups ; Humans ; Personal Satisfaction ; Practice Guidelines as Topic ; Schools, Medical ; United States ; Utah

Since the implementation of workers' compensation, accurately and consistently rating impairment has been a concern for the employee and employer, as well as rating physicians. In an attempt to standardize and classify impairments, the American Medical Association (AMA) publishes the AMA Guides ("Guides"), and recently published its 6th edition of the AMA Guides. Common critiques of the AMA Guides 6th edition are that they are too complex, lacking in evidence-based methods, and rarely yield consistent ratings. Many states mandate use of some edition of the AMA Guides, but few states are adopting the current edition due to the increasing difficulty and frustration with their implementation. A clearer, simpler approach is needed. Some states have begun to develop their own supplemental guides to combat problems in complexity and validity. Likewise studies in Korea show that past methods for rating impairment are outdated and inconsistent, and call for measures to adapt current methods to Korea's specific needs. The Utah Supplemental Guides to the AMA Guides have been effective in increasing consistency in rating impairment. It is estimated that litigation of permanent impairment has fallen below 1% and Utah is now one of the least costly states for obtaining workers' compensation insurance, while maintaining a medical fee schedule above the national average. Utah's guides serve as a model for national or international impairment guides.
American Medical Association ; *Disability Evaluation ; Guidelines as Topic ; Humans ; United States ; Utah ; *Workers' Compensation

PURPOSE: The situational judgment test (SJT) shows promise for assessing the non-cognitive skills of medical school applicants, but has only been used in Europe. Since the admissions processes and education levels of applicants to medical school are different in the United States and in Europe, it is necessary to obtain validity evidence of the SJT based on a sample of United States applicants. METHODS: Ninety SJT items were developed and Kane's validity framework was used to create a test blueprint. A total of 489 applicants selected for assessment/interview day at the University of Utah School of Medicine during the 2014-2015 admissions cycle completed one of five SJTs, which assessed professionalism, coping with pressure, communication, patient focus, and teamwork. Item difficulty, each item's discrimination index, internal consistency, and the categorization of items by two experts were used to create the test blueprint. RESULTS: The majority of item scores were within an acceptable range of difficulty, as measured by the difficulty index (0.50-0.85) and had fair to good discrimination. However, internal consistency was low for each domain, and 63% of items appeared to assess multiple domains. The concordance of categorization between the two educational experts ranged from 24% to 76% across the five domains. CONCLUSION: The results of this study will help medical school admissions departments determine how to begin constructing a SJT. Further testing with a more representative sample is needed to determine if the SJT is a useful assessment tool for measuring the non-cognitive skills of medical school applicants.
Cognition ; Discrimination (Psychology) ; Education ; Europe ; Humans ; Judgment* ; School Admission Criteria ; Schools, Medical ; United States* ; Utah*

PURPOSE: Smartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. METHODS: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women's Hospital about their smartphone use and prior training experiences. Scores (0%-100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. RESULTS: A total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3-4 residents, 15.0/20 (75.1%) than year 1-2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P=0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3-4 residents, 16.1/44 (36.5%) than for year 1-2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use. CONCLUSION: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.
Smartphone ; Surveys and Questionnaires ; Delivery of Health Care ; Emergencies* ; Emergency Medicine* ; Internal Medicine* ; United States* ; Utah

PURPOSE: To identify the essential morphologic characteristics concerned with angle closure in chronic primary angle-closure glaucoma (PACG) and to assess the changes in quantified values for angle relationships after laser iridotomy (LI) in them using ultrasound biomicroscopy (UBM). METHODS: Anterior segment imaging and quantitative assessment of angle relationships were obtained in 25 eyes of 25 patients with chronic PACG using UBM (UBM plus2000 system, Paradigm(R) Inc., Utah, USA) before and 2 weeks after LI. RESULTS: The mean anterior chamber depth (ACD), anterior chamber angle (ACA), angle-opening distance (AOD500), and trabecular-iris distance (TID) were 2.16 mm, 12.73 degrees, 0.128 mm, and 0.101 mm, respectively. All our results were significantly smaller than previously reported quantified values in normal adult. In comparison between before and after LI, ACD and iris thickness (IT) did not change significantly, whereas ACA, AOD500, AOD250, and TID all significantly increased after LI. CONCLUSIONS: Using UBM, we identified the essential morphologic characteristics concerned with angle closure in chronic PACG and quantitatively demonstrated the result of treatment based on the changes of angle relationships after LI.
Adult ; Anterior Chamber ; Glaucoma, Angle-Closure* ; Humans ; Iris ; Microscopy, Acoustic ; Ultrasonography* ; Utah

OBJECTIVE: Patients with bipolar disorder have attention deficit during even euthymic status. Bipolar disorder patients showed more childhood attention deficit and other ADHD like feature. Alpha 7 nicotinic receptor (CHRNA7) gene has been known to play roles in attention and sensory gating, and association between CHRNA7 gene and bipolar disorder has been reported. Therefore, we investigated a possible association between childhood attention deficit of bipolar disorder and CHRNA7 gene polymorphisms. METHODS: We included 122 patients with bipolar disorder (89 subjects of bipolar disorder type I, 33 subjects of bipolar disorder type II). Childhood attention deficit was measured by Wender Utah Rating Scale (WURS). Factor analysis was done for WURS to extract inattention factor from childhood ADHD like feature. Three factors were extracted: Impulsivity, Inattention, and Mood instability. All subjects were ethnically Korean. Genotyping was done for three intronic Single Nucleotide Polymorphism (SNPs) of CHRNA7 gene: rs2337506 (A/G), rs6494223 (C/T), and rs12916879 (A/G). Analysis of association was done by UNPHASED version 3.1.4, a free software for genetic statistics. RESULTS: Genetic association tests found no association between factor score of inattention and any SNP or combination of SNPs of CHRNA7. Positive association between WURS total score and SNP rs6494223 (p=0.043), factor score of impulsivity and SNP rs2337506 (p=0.038) as well as SNP rs6494223 (p=0.043) was revealed. These positive associations were survived after 1,000 permutation tests. Combination of SNPs association tests performed for total WURS and factor scores could not find any significant association. CONCLUSION: We could not find association between CHRNA7 gene and childhood attention deficit in bipolar disorder. However, we found CHRNA7 gene involved in childhood impulsivity of bipolar disorder, another ADHD like feature. Further studies with larger sample and denser polymorphisms are necessary to clarify genetic role of CHRNA7 in attention and impulsivity of bipolar disorder.
Bipolar Disorder ; Humans ; Introns ; Polymorphism, Single Nucleotide ; Receptors, Nicotinic ; Sensory Gating ; Utah