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Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.

The patient's voice, which we define as the words the patient uses found in notes and messages and other sources, and their preferences for care and its outcomes, is too small a part of the electronic health record (EHR). To address this shortcoming will require innovation, research, funding, perhaps architectural changes to commercial EHRs, and that we address barriers that have resulted in this state, including clinician burden and financial drivers for care. Advantages to greater patient voice may accrue to many groups of EHR users and to patients themselves. For clinicians, the patient's voice, including symptoms, is invaluable in identifying new serious illness that cannot be detected by screening tests, and as an aid to accurate diagnosis. Informaticians benefit from greater patient voice in the EHR because it provides clues not found elsewhere that aid diagnostic decision support, predictive analytics, and machine learning. Patients benefit when their treatment priorities and care outcomes considered in treatment decisions. What patient voice there is in the EHR today can be found in locations not usually used by researchers. Increasing the patient voice needs be accomplished in equitable ways available to people with less access to technology and whose primary language is not well supported by EHR tools and portals. Use of direct quotations, while carrying potential for harm, permits the voice to be recorded unfiltered. If you are a researcher or innovator, collaborate with patient groups and clinicians to create new ways to capture the patient voice, and to leverage it for good.

Peroxy acyl nitrates (PANs) are photochemical pollutants with implications for health and atmospheric oxidation capacity. PANs are formed via the oxidation of non-methane volatile organic compounds (NMVOCs) in the presence of nitrogen oxide radicals (NOx = NO + NO2). While urban environments are large sources of PANs, in situ observations in urban areas are limited. Here we use satellite measurements of PANs from the Tropospheric Emission Spectrometer (TES) and the Suomi National Polar-orbiting Partnership (S-NPP) Cross-track Infrared Sounder (CrIS) to evaluate the spatiotemporal variability of PANs over and around Mexico City. Monthly mean maxima in PANs over the Mexico City Metropolitan Area (MCMA) occur during spring months (March–May). This time of year coincides with a peak in local photochemistry and more frequent air stagnation. Local fire activity also typically peaks between February and May, which leads to strong interannual variability of PANs over the MCMA. We use S-NPP CrIS data to probe the spatial outflow pattern of PANs produced within urban Mexico City during the month with the largest mixing ratios of PANs (April). Peak outflow in April occurs to the northeast of the city and over the mountains south of the city. Outflow to the northwest appears infrequently. Using observations during 2018 versus 2019, we also show that PANs were not significantly reduced during a year, with a significant decrease in NOx over Mexico City. Our analysis demonstrates that the space-based observations provided by CrIS and TES can increase understanding of the spatiotemporal variability of PANs over and surrounding Mexico City.

The new single-pixel TROPESS (TRopospheric Ozone and its Precursors from Earth System Sounding) profile retrievals of carbon monoxide (CO) from the Cross-track Infrared Sounder (CrIS) are evaluated using vertical profiles of in situ observations from the National Oceanic and Atmospheric Administration (NOAA) Global Monitoring Laboratory (GML) aircraft program and from the Atmospheric Tomography Mission (ATom) campaigns. The TROPESS optimal estimation retrievals are produced using the MUSES (MUlti-SpEctra, MUlti-SpEcies, MUlti-Sensors) algorithm, which has heritage from retrieval algorithms developed for the EOS/Aura Tropospheric Emission Spectrometer (TES). TROPESS products provide retrieval diagnostics and error covariance matrices that propagate instrument noise as well as the uncertainties from sequential retrievals of parameters such as temperature and water vapor that are required to estimate the carbon monoxide profiles. The validation approach used here evaluates biases in column and profile values as well as the validity of the retrieval error estimates using the mean and variance of the compared satellite and aircraft observations. CrIS–NOAA GML comparisons had biases of 0.6 % for partial column average volume mixing ratios (VMRs) and (2.3, 0.9, −4.5) % for VMRs at (750, 511, 287) hPa vertical levels, respectively, with standard deviations from 9 % to 14 %. CrIS–ATom comparisons had biases of −0.04 % for partial column and (2.2, 0.5, −3.0) % for (750, 511, 287) hPa vertical levels, respectively, with standard deviations from 6 % to 10 %. The reported observational errors for TROPESS/CrIS CO profiles have the expected behavior with respect to the vertical pattern in standard deviation of the comparisons. These comparison results give us confidence in the use of TROPESS/CrIS CO profiles and error characterization for continuing the multi-decadal record of satellite CO observations.

Dry eye disease (DED) affects up to half of the world's population and causes blur, eye pain, decreased quality of life. Unfortunately, many people do not receive proper treatment due to current challenges associated with DED diagnoses. To address this issue, point-of-care (PoC) clinical tear film diagnostics are beginning to be used for rapid in-office testing. However, these diagnostics also have significant obstacles, including challenges associated with tear sampling. We previously demonstrated how soft contact lenses (SCLs) can be used to capture and concentrate tear proteins on the eye. Given the low tear volume associated with DED subjects, SCL sampling holds great potential to improve DED PoC diagnostics and facilitate prompt treatment for patients. Here we show the detection of new and established DED protein biomarkers using our SCL sampling method. Our analysis revealed associations between DED tear proteins and the immune system, ferroptosis, salivary secretion, and calcium binding proteins. We also identified correlations between clinical DED testing and proteomics, emphasizing the power and importance of translational medicine research. These experiments lay the foundation for both SCL sampled tear protein biomarker discovery as well as improved diagnostic testing to improve DED patient care.

Soft contact lenses (SCLs) have recently been introduced as an alternative method for human tear protein sampling. However, SCLs are available in a variety of chemical compositions which affect protein binding specificity. Here we analyzed 8 different SCL materials to identify an optimal lens for tear protein sampling. Polymer contamination, mass spectrometry (MS) sample preparation method, total protein capture, individual protein specificity, and SCL cost were all assessed. Using a filter-aided sample prep (FASP) method with 4M guanidine for protein removal, only etafilcon A and verofilcon A did not have significant polymer contamination. Polymer was successfully removed using phosphate buffered saline (PBS) with S-Trap columns for all SCL materials, though yielding a slightly lower number of protein identifications per sample. Minor quantitative differences were observed between SCL materials. However, we also saw significant intersubject variation in protein abundance. Of all the assessed SCL materials, verofilcon A lenses yielded the most total protein while comfilcon A and senofilcon A had the least protein variability. As a newly released daily disposable modality (Precision 1, Alcon), verofilcon A has one of the longest predictable production schedules and one of the lowest costs per lens, making it beneficial for large-scale experiments and diagnostics. Furthermore, we demonstrate how protein binding bias with SCL tear sampling is useful for intra-experiment normalization. Overall, these experiments have led us to optimize our previous protocol for SCL tear protein sampling, highlighting important differences between SCL materials and identifying etafilcon A and verofilcon A as optimal materials for tear protein sampling.Abstract Figure