Neural étendue expander for ultra-wide-angle high-fidelity holographic display.

Holographic displays can generate light fields by dynamically modulating the wavefront of a coherent beam of light using a spatial light modulator, promising rich virtual and augmented reality applications. However, the limited spatial resolution of existing dynamic spatial light modulators imposes a tight bound on the diffraction angle. As a result, modern holographic displays possess low étendue, which is the product of the display area and the maximum solid angle of diffracted light. The low étendue forces a sacrifice of either the field-of-view (FOV) or the display size. In this work, we lift this limitation by presenting neural étendue expanders. This new breed of optical elements, which is learned from a natural image dataset, enables higher diffraction angles for ultra-wide FOV while maintaining both a compact form factor and the fidelity of displayed contents to human viewers. With neural étendue expanders, we experimentally achieve 64 × étendue expansion of natural images in full color, expanding the FOV by an order of magnitude horizontally and vertically, with high-fidelity reconstruction quality (measured in PSNR) over 29 dB on retinal-resolution images.

Lymphocyte-Activation Gene 3 Facilitates Pathological Tau Neuron-to-Neuron Transmission.

The spread of prion-like protein aggregates is a common driver of pathogenesis in various neurodegenerative diseases, including Alzheimer's disease (AD) and related Tauopathies. Tau pathologies exhibit a clear progressive spreading pattern that correlates with disease severity. Clinical observation combined with complementary experimental studies has shown that Tau preformed fibrils (PFF) are prion-like seeds that propagate pathology by entering cells and templating misfolding and aggregation of endogenous Tau. While several cell surface receptors of Tau are known, they are not specific to the fibrillar form of Tau. Moreover, the underlying cellular mechanisms of Tau PFF spreading remain poorly understood. Here, it is shown that the lymphocyte-activation gene 3 (Lag3) is a cell surface receptor that binds to PFF but not the monomer of Tau. Deletion of Lag3 or inhibition of Lag3 in primary cortical neurons significantly reduces the internalization of Tau PFF and subsequent Tau propagation and neuron-to-neuron transmission. Propagation of Tau pathology and behavioral deficits induced by injection of Tau PFF in the hippocampus and overlying cortex are attenuated in mice lacking Lag3 selectively in neurons. These results identify neuronal Lag3 as a receptor of pathologic Tau in the brain，and for AD and related Tauopathies, a therapeutic target.

Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment.

Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.

Immunonutrition with Omega-3 Fatty Acid Supplementation in Severe TBI: Retrospective Analysis of Patient Characteristics and Outcomes.

Background: Early evidence-based medical interventions to improve patient outcomes after traumatic brain injury (TBI) are lacking. In patients admitted to the ICU after TBI, optimization of nutrition is an emerging field of interest. Specialized enteral nutrition (EN) formulas that include immunonutrition containing omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been developed and are used for their proposed anti-inflammatory and pro-immune properties; however, their use has not been rigorously studied in human TBI populations. Methods: A single-center, retrospective, descriptive observational study was conducted at LAC + USC Medical Center. Patients with severe TBI (sTBI, Glasgow Coma Scale score ≤ 8) who remained in the ICU for ≥ 2 weeks and received EN were identified between 2017 and 2022 using the institutional trauma registry. Those who received immunonutrition formulas containing n-3 PUFAs were compared to those who received standard, polymeric EN in regard to baseline characteristics, clinical markers of inflammation and immune function, and short-term clinical outcomes. Results: A total of 151 patients with sTBI were analyzed. Those who received immunonutrition with n-3 PUFA supplementation were more likely to be male, younger, Hispanic/Latinx, and have polytrauma needing non-central nervous system surgery. No differences in clinical markers of inflammation or infection rate were found. In multivariate regression analysis, immunonutrition was associated with reduced hospital length of stay (LOS). ICU LOS was also reduced in the subgroup of patients with polytrauma and TBI. Conclusion: This study identifies important differences in patient characteristics and outcomes associated with the EN formula prescribed. Study results can directly inform a prospective pragmatic study of immunonutrition with n-3 PUFA supplementation aimed to confirm the biomechanistic and clinical benefits of the intervention.

Organizational values: Essential substrate for professional identity formation.

Core organizational values are essential for any organization, including academic institutions. Formal and informal leaders can have a positive, or negative, impact on shaping their culture through the core values. Members of an organization, including students, can be shaped by the organizational values in ways that strengthen, or impede, their professional identity formation. Here, we discuss the use of organizational values as vital substrates needed to shape the desired behaviors and attitudes that will help describe the organizational culture and identity. We define and discuss various types of core values, identify the benefits and challenges of core values alignment, and offer strategies for leaders at all levels to reflect on their own organization's core values and their current approach to their contribution to an effective and sustainable workplace that supports the professional identity formation of all members.

Research and Scholarly Methods: Implementation Science Studies.

Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.

The interface between U.S. primary care clinics and pharmacies for HPV vaccination delivery: A scoping literature review.

Completion of the Human Papilloma Virus (HPV) vaccine series remains low. Partnerships between primary care (PC) clinics and local pharmacies could boost vaccination rates. We conducted a scoping literature review to address what is known and what gaps exist on the interface between U.S. primary care clinics and pharmacies for HPV vaccination. We searched Ovid MEDLINE ALL file and Cumulative Index to Allied Health Literature for articles published between 1/1/2010 and 12/31/2020. Search subjects included: 1) Pharmacy HPV Vaccination, 2) Pharmacy/PC Collaboration, and 3) Pharmacy/PC Collaboration vaccination. We developed an abstraction form to collect information on research methods, settings, strengths, weaknesses and findings. We screened 407 articles for inclusion; 17 met inclusion criteria: 13 (76.5%) reported on observational/descriptive studies; 4 articles (23.5%) reported on intervention studies, none of which were conducted in rural areas. Observational studies focused on willingness to be vaccinated for HPV and facilitators and barriers for vaccination, especially at pharmacies. Many studies concluded that knowledge about and comfort with HPV vaccine administration were needed for all vaccination stakeholders (clinicians, pharmacists, parents, and patients). Intervention studies were small with weak study designs, many of which revealed that pharmacists were not successful in integrating services into broader primary care systems. Challenges included getting physicians to sign standing order protocols, poor service delivery due to engagement barriers, and low parental demand for pharmacists to administer the vaccine. In conclusion, larger more discerning studies are needed to fully understand the potential of primary care and pharmacy interactions for HPV vaccination.

Untrained networks for compressive lensless photography.

Compressive lensless imagers enable novel applications in an extremely compact device, requiring only a phase or amplitude mask placed close to the sensor. They have been demonstrated for 2D and 3D microscopy, single-shot video, and single-shot hyperspectral imaging; in each case, a compressive-sensing-based inverse problem is solved in order to recover a 3D data-cube from a 2D measurement. Typically, this is accomplished using convex optimization and hand-picked priors. Alternatively, deep learning-based reconstruction methods offer the promise of better priors, but require many thousands of ground truth training pairs, which can be difficult or impossible to acquire. In this work, we propose an unsupervised approach based on untrained networks for compressive image recovery. Our approach does not require any labeled training data, but instead uses the measurement itself to update the network weights. We demonstrate our untrained approach on lensless compressive 2D imaging, single-shot high-speed video recovery using the camera's rolling shutter, and single-shot hyperspectral imaging. We provide simulation and experimental verification, showing that our method results in improved image quality over existing methods.

Fourier DiffuserScope: single-shot 3D Fourier light field microscopy with a diffuser.

Light field microscopy (LFM) uses a microlens array (MLA) near the sensor plane of a microscope to achieve single-shot 3D imaging of a sample without any moving parts. Unfortunately, the 3D capability of LFM comes with a significant loss of lateral resolution at the focal plane. Placing the MLA near the pupil plane of the microscope, instead of the image plane, can mitigate the artifacts and provide an efficient forward model, at the expense of field-of-view (FOV). Here, we demonstrate improved resolution across a large volume with Fourier DiffuserScope, which uses a diffuser in the pupil plane to encode 3D information, then computationally reconstructs the volume by solving a sparsity-constrained inverse problem. Our diffuser consists of randomly placed microlenses with varying focal lengths; the random positions provide a larger FOV compared to a conventional MLA, and the diverse focal lengths improve the axial depth range. To predict system performance based on diffuser parameters, we, for the first time, establish a theoretical framework and design guidelines, which are verified by numerical simulations, and then build an experimental system that achieves < 3 µm lateral and 4 µm axial resolution over a 1000 × 1000 × 280 µm3 volume. Our diffuser design outperforms the MLA used in LFM, providing more uniform resolution over a larger volume, both laterally and axially.

Development of an innovative adult attention-deficit hyperactivity disorder clinic.

Pharmacist-psychiatrist collaborative clinic models in specialty mental health clinics are limited, and there has been only 1 report of a clinic focused on adult attention-deficit hyperactivity disorder (ADHD). In this article, we describe the successful implementation of a pharmacist-psychiatrist collaborative practice agreement in an adult ADHD clinic at an academic medical center. Adult patients diagnosed with ADHD after a comprehensive assessment, including a full neuropsychological evaluation, were enrolled in the collaborative treatment clinic. The collaboration was a partnership between a psychiatry department and a school of pharmacy at a public university. We report the details of 58 patients and 774 patient encounters at the collaborative pharmacist-psychiatrist practice from March 2015 through June 2018. The visits were billed using traditional medical billing codes for follow-up visits. Pharmacist practice opportunities included psychiatric evaluation, medication management, counseling, and referral to auxiliary services. Challenges to the clinic's success included limited pharmacist time, prescriptive authority, and reimbursement for services from payors. A collaborative practice model targeted at adult ADHD patients may be a unique clinic setting for psychiatric pharmacists.

On-chip fluorescence microscopy with a random microlens diffuser.

We present an on-chip, widefield fluorescence microscope, which consists of a diffuser placed a few millimeters away from a traditional image sensor. The diffuser replaces the optics of a microscope, resulting in a compact and easy-to-assemble system with a practical working distance of over 1.5 mm. Furthermore, the diffuser encodes volumetric information, enabling refocusability in post-processing and three-dimensional (3D) imaging of sparse samples from a single acquisition. Reconstruction of images from the raw data requires a precise model of the system, so we introduce a practical calibration scheme and a physics-based forward model to efficiently account for the spatially-varying point spread function (PSF). To improve performance in low-light, we propose a random microlens diffuser, which consists of many small lenslets randomly placed on the mask surface and yields PSFs that are robust to noise. We build an experimental prototype and demonstrate our system on both planar and 3D samples.

Learned reconstructions for practical mask-based lensless imaging.

Mask-based lensless imagers are smaller and lighter than traditional lensed cameras. In these imagers, the sensor does not directly record an image of the scene; rather, a computational algorithm reconstructs it. Typically, mask-based lensless imagers use a model-based reconstruction approach that suffers from long compute times and a heavy reliance on both system calibration and heuristically chosen denoisers. In this work, we address these limitations using a bounded-compute, trainable neural network to reconstruct the image. We leverage our knowledge of the physical system by unrolling a traditional model-based optimization algorithm, whose parameters we optimize using experimentally gathered ground-truth data. Optionally, images produced by the unrolled network are then fed into a jointly-trained denoiser. As compared to traditional methods, our architecture achieves better perceptual image quality and runs 20× faster, enabling interactive previewing of the scene. We explore a spectrum between model-based and deep learning methods, showing the benefits of using an intermediate approach. Finally, we test our network on images taken in the wild with a prototype mask-based camera, demonstrating that our network generalizes to natural images.

Development of a community-academic collaborative pharmacy residency program.

PURPOSE: To describe the development of a collaborative community-academic postgraduate year 1 pharmacy residency program in San Diego that provides a hybrid experience of opportunities in community practice, ambulatory care, and teaching. SUMMARY: Residency training programs are being developed to better match the evolving role of the community pharmacist. In 2016, the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences partnered with Ralphs Pharmacy, a division of the Kroger Co., to launch a 1-year community residency to develop community-based pharmacists with diverse patient care, leadership, and education skills. Learning experiences include pharmacy operations, clinical services focusing on chronic disease management and education, teaching, and practice-based research. Training settings include community pharmacy, corporate pharmacy, ambulatory care, and academia. Graduates are prepared to work in these settings as well as capitalize on advanced training opportunities, including postgraduate year 2 residencies and professional certifications. The program has been successfully accredited, and graduates have completed the program: one completed a postgraduate year 2 residency, and both have obtained a management or clinical pharmacist position. CONCLUSION: An innovative community-academic residency program preparing postgraduate year 1 learners for careers in community-based pharmacy, corporate, ambulatory care, and academic settings was developed, with positive preliminary outcomes.

Comparisons of immunization records between a community pharmacy, a regional registry, and a health system.

OBJECTIVES: To compare the completeness of immunization records for 6 vaccines between a community pharmacy database, a regional immunization information system (IIS), and a health system's electronic health record (EHR). METHODS: In a community pharmacy immunization program, 2 pharmacists and a community pharmacy resident performed a needs assessment for 6 vaccines (tetanus-diphtheria-acellular pertussis vaccine for adults or diphtheria-tetanus-acellular pertussis vaccine for children and adolescents, zoster vaccine live, 13-valent pneumococcal conjugate vaccine, 23-valent pneumococcal polysaccharide vaccine, hepatitis B vaccine series, and human papillomavirus vaccine) for more than 2400 patients from August 2016 to March 2017. This was a retrospective study to review immunization records for 243 patients. Inclusion criteria included patients from the community pharmacy immunization program who also had at least 1 medication prescribed by an academic health system provider. Immunization records for 6 vaccines were collected from the community pharmacy database, the regional IIS, and the EHR. RESULTS: A total of 186 of 243 patients (77%) had additional immunization records in the regional IIS or EHR that were not found in the community pharmacy database. Among those 186 patients, 108 (58%) had additional immunization records for 2 or more unique vaccines. In total, 378 additional immunization records were identified for the 6 vaccines. For all 6 vaccines, the regional IIS and EHR possessed more complete immunization records than the community pharmacy database (P < 0.05 for HPV and P < 0.001 for the remaining 5 vaccines). CONCLUSION: Our study showed that immunization records were more complete in a regional IIS and health system EHR compared with a community pharmacy database. If all 3 sources were used by the pharmacist during the needs assessment, the community pharmacy team would have made fewer vaccine recommendations, which would have reduced the potential for duplicate or inappropriate vaccines.

Genomics and electronic health record systems.

Several reviews and case reports have described how information derived from the analysis of genomes are currently included in electronic health records (EHRs) for the purposes of supporting clinical decisions. Since the introduction of this new type of information in EHRs is relatively new (for instance, the widespread adoption of EHRs in the United States is just about a decade old), it is not surprising that a myriad of approaches has been attempted, with various degrees of success. EHR systems undergo much customization to fit the needs of health systems; these approaches have been varied and not always generalizable. The intent of this article is to present a high-level view of these approaches, emphasizing the functionality that they are trying to achieve, and not to advocate for specific solutions, which may become obsolete soon after this review is published. We start by broadly defining the end goal of including genomics in EHRs for healthcare and then explaining the various sources of information that need to be linked to arrive at a clinically actionable genomics analysis using a pharmacogenomics example. In addition, we include discussions on open issues and a vision for the next generation systems that integrate whole genome sequencing and EHRs in a seamless fashion.

Longitudinal trajectories of antidepressant use in pregnancy and the postnatal period.

Studies of antidepressant safety in pregnancy typically do not address complex patterns of use throughout pregnancy. We performed longitudinal trajectory modeling to describe patterns of antidepressant use in the first 32 weeks of pregnancy, and test whether these trajectories are associated with a reduction in birth weight or gestational age at delivery. Our study included 166 pregnant women with deliveries between 2011 and 2015 who were prescribed an antidepressant between 91 days prior to last menstrual period and 32 weeks of gestation. From electronic medical records, we estimated average daily dose and cumulative dose per week for the first 32 weeks of gestation and for the first 13 weeks postnatal. We clustered women with similar utilization patterns using k-means longitudinal modeling and assessed the associations between trajectory group and birth weight and gestational age at delivery. We identified four cumulative dose trajectory groups and three average daily dose trajectory groups in each period. Relative to the lowest trajectory group, the highest trajectory group during pregnancy was associated with reduced birth weight in multivariable analysis (average daily highest trajectory vs. lowest trajectory ß - 314.1 g, 95% CI - 613.7, - 15.5) adjusted for depression severity score, maternal age, race, and pregnancy smoking. Trajectory groups were not associated with gestational age at delivery. The highest trajectory group of antidepressant use in pregnancy was associated with a modest reduction in birth weight but not with gestational age at delivery. Longitudinal trajectories allow for a dynamic visualization and quantification of medication use among pregnant women.

Pharmacist training in suicide prevention.

OBJECTIVE: Suicide in the United States is a major preventable public health problem. Pharmacists need to be educated on suicide prevention strategies so that they can increase their own awareness and identify patients at-risk. A training program for pharmacists was used to provide skills necessary to recognize a crisis and the warning signs of suicide. The program's effect on the participant's general perception, self-efficacy, and attitude towards suicide prevention was examined. SETTING: Various academic, health care, and professional meetings throughout San Diego County. PRACTICE INNOVATION: First Question, Persuade, and Refer training program targeting pharmacists. EVALUATION: A self-administered presurvey, postsurvey and, Program Outcome Evaluation were given to participants of the suicide training program. Items included demographics, general perception, self-efficacy, and attitude toward suicide prevention. Descriptive statistics were used to describe participants' demographics. t tests were used to compare general perception, attitudes, and self-efficacy scores between pretest and post-program evaluation survey responses. Nonparametric Wilcoxon signed rank analyses for matched pairs were used to compare survey responses that asked about attitudes before and after trainings. Regression analyses were conducted to assess factors associated with general perception, self-efficacy, and attitudes. RESULTS: Participants were more likely to update knowledge after training and reported more confidence to make an intervention for a patient at risk for suicide. CONCLUSION: Our findings suggest that a suicide prevention training program helped pharmacist respondents build confidence in several self-efficacy areas relating to detection of suicide signs, response to patients with suicidal thoughts, reassurance for patients, and provision of resources and referrals.

Agreement Between Maternal Report and Medical Records During Pregnancy: Medications for Rheumatoid Arthritis and Asthma.

BACKGROUND: There are limited data regarding the comparability of medication exposure information during pregnancy from maternal report and medical records, including for rheumatoid arthritis and asthma-related medications. METHODS: This study included pregnant women with rheumatoid arthritis (n = 216) and asthma (n = 172) enrolled in the MothertoBaby Pregnancy Studies (2009-2014). Women reported types and dates of medications used through semi-structured telephone interviews up to three times during pregnancy and once after delivery, and medical records were obtained. We calculated Cohen's kappa coefficients and 95% confidence intervals (CIs) and per cent agreement for agreement between report and records. RESULTS: For rheumatoid arthritis, prednisone was reported most frequently (53%). During pregnancy, kappa coefficients for rheumatoid arthritis medications ranged from 0.32 (95% CI 0.15, 0.50) for ibuprofen, with 84.3% agreement, to 0.90 (95% CI 0.84, 0.96) for etanercept with 95.4% agreement, and was 0.44 (95% CI 0.33, 0.55) for prednisone, with 71.3% agreement. For asthma, albuterol was reported most frequently (77.9%). During pregnancy, kappa coefficients for asthma medications ranged from 0.21 (95% CI 0.08, 0.35), with 64.5% agreement for albuterol to 0.84 (95% CI 0.71, 0.96) for budesonide/formoterol, with 96.5% agreement. Where kappas for any use during pregnancy were less than excellent (i.e. ≤0.80), medication use was more frequently captured by report than record. CONCLUSIONS: Agreement was higher for medications typically used continuously than sporadically. Information on medication use from medical records alone may not be adequate when studying the impact of intermittently used medications during pregnancy on perinatal outcomes.

Pharmacogenomics competencies in pharmacy practice: A blueprint for change.

The emerging use of genomic data to inform medication therapy populates the medical literature and provides evidence for guidelines in the prescribing information for many medications. Despite the availability of pharmacogenomic studies, few pharmacists feel competent to use these new data in patient care. The first pharmacogenomics competency statement for pharmacists was published in 2002. In 2011, the Pharmacogenomics Special Interest Group of the American Association of Colleges of Pharmacy led a process to update this competency statement with the use of a consensus-based method that incorporated input from multiple key professional pharmacy organizations to reflect growth in genomic science as well as the need for pharmacist application of genomic data. Given the rapidly evolving science, educational needs, and practice models in this area, a standardized competency-based approach to pharmacist education and training in pharmacogenomics is needed to equip pharmacists for leadership roles as essential members of health care teams that implement clinical utilization strategies for genomic data.