TAG: "Pharmacy"

UCSF appoints new dean of nation’s top pharmacy school

Pharmacist Joe Guglielmo to lead school.

B. Joseph Guglielmo, UC San Francisco

UC San Francisco has named a highly accomplished pharmacist and clinical scientist, B. Joseph Guglielmo, Pharm.D., to lead the nation’s premier School of Pharmacy, continuing the school’s focus on shaping the course of the therapeutic sciences, pharmacy education, patient care, and health policy.

UCSF Chancellor Susan Desmond-Hellmann, M.D., M.P.H., announced the appointment today, noting the numerous contributions that Guglielmo already has made to UCSF, as well as his breadth of leadership across the academic pharmacy landscape.

“In its decades as the pre-eminent School of Pharmacy in the nation, the school has never been stronger, and there is no better dean to guide it into the future,” Desmond-Hellmann said. “Joe is both an able leader and an international expert in his field, and will provide a clear course for the school as it helps guide the changing world of health care.”

As the nation’s leading pharmacy school in terms of both research funding from the National Institutes of Health and the ranking of its Doctor of Pharmacy degree program in U.S. News & World Report, the UCSF School of Pharmacy serves as a bellwether for pharmacy schools worldwide.

“It is a tremendous honor to be named the next steward of this accomplished school,” said Guglielmo. “The caliber of people and the culture of respect and inclusion here are second to none: the faculty is brilliant and collegial; the students are leaders by instinct and experience; and the staff is extremely talented. Excellence is their common ground.”

Guglielmo has served as the school’s interim dean since July 2012. He previously led the school’s Department of Clinical Pharmacy as the Thomas A. Oliver Chair in Clinical Pharmacy.

“We see a time when new, precise therapeutics – drugs, medical devices, and diagnostic tests – are used safely and effectively to improve the health of people everywhere,” he said. “This view will drive my work as dean.”

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UC Health ranks among best in nation

U.S. News gives high marks to UC medical schools.

University of California Health ranked among the nation’s best graduate schools in a survey released today (March 12) by U.S. News & World Report.

Five UC medical schools placed in the top 50 nationally for research rankings and four placed in the top 40 nationally for primary care rankings.

In research, UC San Francisco was the top-ranked public school and tied for fourth among all U.S. schools, with UCLA 13th overall, UC San Diego 15th, and UC Davis and UC Irvine tied for 42nd. In primary care, UCSF ranked fourth, UCLA ranked 11th, UC Davis tied for 19th and UC San Diego tied for 39th, with UC Irvine tied for 66th. UCSF has the only medical school ranked in the top five of both categories.

UC medical schools also received high marks in a number of specialty programs. UCSF ranked first for its medical program in AIDS, second in both internal medicine and women’s health, tied for second in drug/alcohol abuse education, fourth in family medicine, sixth in geriatrics, and seventh in pediatrics. UCLA ranked third in geriatrics, seventh in drug/alcohol abuse education, tied for ninth in AIDS and 10th in women’s health. UC San Diego ranked ninth in drug/alcohol abuse education and 11th in AIDS.

U.S. News’ 2014 America’s Best Graduate Schools rankings were released online today (March 12) and can be viewed at www.usnews.com/grad.

The new rankings include previous assessments of a number of other health fields, which U.S. News also surveys but not each year. UCLA ranked first in clinical psychology, UCSF ranked first in pharmacy, UC Davis ranked second in veterinary medicine, UCSF ranked fourth for both its master’s of nursing program (tied) and its nursing-midwifery program, while in public health UC Berkeley tied for eighth and UCLA was 10th. The surveys do not rank dental or optometry schools.

UC Health runs five academic health centers and the nation’s largest health sciences education system with more than 14,000 students and 18 health professional schools and programs in medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine. UC’s sixth medical school, UC Riverside, will enroll its first class this fall.

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UCSF-Safeway pharmacy alliance aims to help customers quit smoking

Safeway’s pharmacists will be trained in proven smoking-cessation counseling techniques.

B. Joseph Guglielmo Jr., UC San Francisco

The UC San Francisco School of Pharmacy has partnered with Safeway Inc. to help Safeway customers quit smoking, by connecting them with specially trained pharmacists to learn about smoking-cessation programs and other resources.

Under the partnership, Safeway’s pharmacists will be trained in proven smoking-cessation counseling techniques using a program developed by the UCSF pharmacy faculty. The stores also will locate non-prescription, nicotine-replacement therapies near store pharmacy areas, giving customers convenient access to a pharmacist to answer questions. The partnership is designed to give Safeway customers access, in a community setting, to the patient-care expertise of the UCSF School of Pharmacy.

The school, which has the nation’s top-ranked pharmacy degree program, pioneered the field of clinical pharmacy in the 1960s to provide direct interactions between hospital patients and pharmacists.

“Pharmacists are often the most accessible health care provider for patients within their own communities, but we haven’t maximized their expertise in that setting,” said B. Joseph Guglielmo Jr., Pharm.D., interim dean of the UCSF School of Pharmacy. “This project offers Safeway customers the full patient-care skill set of pharmacists with a goal of helping customers prevent and manage their chronic medical conditions.”

The project initially will focus on 20 pharmacy stores in Northern and Southern California and will expand throughout 2013 to include hundreds of Safeway pharmacies across the country.

“We are proud to partner with the UCSF School of Pharmacy on this effort to help our customers quit smoking and live healthier lives,” said Darren Singer, Safeway senior vice president for pharmacy, health & wellness. “Our pharmacists are, at all times, ready to help customers reach their health and wellness goals.”

This will be the first time a smoking cessation intervention has been applied systematically across a network of pharmacies, Singer said. Safeway sees this important new service as complementary to the ever-evolving range of patient-centered care offerings that Safeway pharmacies provide.

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Industry funding changes study results, research shows

Who pays for clinical trial has direct impact on reported outcome.

Lisa Bero, UC San Francisco

Drugs and medical devices tend to appear more beneficial in scientific papers if they were manufactured by the company that sponsored the study, showing that who pays for the clinical trial has a direct impact on the reported outcome, according to a new analysis by researchers at UC San Francisco and the Cochrane Collaboration.

Lisa Bero, Ph.D., a UCSF professor of clinical pharmacy and health policy who heads the San Francisco branch of the U.S. Cochrane Centre, at UCSF; and Joel Lexchin, M.D., a professor of health policy at York University, in Toronto. A definitive analysis in 2003 by Bero and Lexchin found discrepancies across drug studies sponsored by pharmaceutical companies.

Clinical studies on drugs and medical devices are routinely used by physicians worldwide to assess which medications are most effective and appropriate for their patients. However, that research is increasingly sponsored by the pharmaceutical or device companies that make these products, either because the companies directly perform the studies or fund them. The team set out to assess whether that sponsorship continues to have an impact on results.

“We found that papers reporting the results of industry-sponsored studies present a more favorable picture of the effects of drugs and medical devices than those reporting on studies that were not sponsored by industry,” said Andreas Lundh, of the Nordic Cochrane Centre at the Rigshospitalet in Copenhagen, Denmark, who led the new research and is first author on the paper.

“Of a particular interest was our finding that when two drugs were compared head-to-head in an industry-sponsored study, the drug that came out most favorable in a specific study was most often the drug manufactured by the sponsor of that study,” Lundh said.

The current analysis more than doubled the number of studies from the 2003 review, to a total of 48, and included papers on both drugs and medical devices for conditions ranging from heart disease to psychiatric illnesses. The number of favorable results was 24 percent higher in industry-sponsored studies, compared to non-industry sponsored ones, and included reports of both greater benefits from the drug or medical device and fewer harmful side effects. The team also found that industry-funded papers were more likely to report conclusions that were inconsistent with the papers’ results sections.

“This is really important because it means that people must take sponsorship into account when evaluating whether they should believe the results of a study. This is still rarely done,” said Bero, who is in the UCSF School of Pharmacy. “A fundamental question now is that when a systematic review is entirely based on industry-sponsored studies and finds a favorable result for the sponsor’s product, can we really trust it?”

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International scholars make intellectual, cultural impact at UCSF

UCSF has the most international scholars of any U.S. health sciences university.

Janina Patsch, a visiting scholar from Austria, works on bone micro-structure analysis at her China Basin lab.

As she entered her boss’ office at the Vienna General Hospital in 2010, Janina Patsch, M.D., Ph.D., didn’t know what to expect. A bone specialist by training, pursuing a residency program in diagnostic radiology, Patsch was hoping for an opportunity to pursue her other passion: research.

So the first question Patsch’s boss asked caught her by surprise: Would she like to do research in the United States?

Patsch joined the Musculoskeletal Imaging Center in the UC San Francisco Department of Radiology and Biomedical Imaging in January 2011. Her work over the past two years under Thomas M. Link, M.D., Ph.D., chief of the department, has focused on developing a better understanding of the micro-architecture and metabolism of the skeletal system, particularly for patients suffering from diabetes. During this time, Patsch has written papers in high-impact journals and presented her research at international meetings.

As an international faculty member himself, Link says he is well aware of his role as an international ambassador and notes that some of the brightest UCSF leaders and faculty – including 2012 Nobel laureate Shinya Yamanaka, M.D., Ph.D., of Japan and 2009 Nobel laureate Elizabeth Blackburn, Ph.D., of Australia – hail from other countries.

“UCSF continues to attract the brightest and most promising scholars chosen by their country,” said Link. “They will go back as leaders in their field and consolidate the role of UCSF as a global leader in medical research.”

Providing a collaborative and inviting environment for international scholars, as well as all faculty, staff and students, is a priority for UCSF.

In 2010, UCSF had the most international scholars of any U.S. health sciences university, and ranked 25th among all U.S. universities with a total of 1,267, according to the Institute of International Education. Of those, 132 were international students enrolled in the schools of dentistry, nursing and pharmacy, as well as the Graduate Division.

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Nanoparticles detect biochemistry of inflammation

UC San Diego develops polymer designed to detect hydrogen peroxide.

Adah Almutairi, UC San Diego

Inflammation is the hallmark of many human diseases, from infection to neurodegeneration.  The chemical balance within a tissue is disturbed, resulting in the accumulation of reactive oxygen species (ROS) such as hydrogen peroxide, which can cause oxidative stress and associated toxic effects.

Although some ROS are important in cell signaling and the body’s defense mechanisms, these chemicals also contribute to and are indicators of many diseases, including cardiovascular dysfunction.  A non-invasive way of detecting measurable, low levels of hydrogen peroxide and other ROS would provide a viable way to detect inflammation. Such a method would also provide a way to selectively deliver drugs to their targets.

Adah Almutairi, PhD, associate professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences, the Department of NanoEngineering, and the Materials Science and Engineering Program at the University of California, San Diego, and colleagues have developed the first degradable polymer that is extremely sensitive to low but biologically relevant concentrations of hydrogen peroxide.

Their work is currently published in the online issue of the Journal of the American Chemical Society.

These polymeric capsules, or nanoparticles, are taken up by macrophages and neutrophils – immune system cells that rush to the site of inflammation. The nanoparticles then release their contents when they degrade in the presence of hydrogen peroxide produced by these cells.

“This is the first example of a biocompatible way to respond to oxidative stress and inflammation,” said Almutairi, director of the UC San Diego Laboratory of Bioresponsive Materials. “Because the capsules are tailored to biodegrade and release their cargo when encountering hydrogen peroxide, they may allow for targeted drug delivery to diseased tissue.”

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FDA, UCSF partnership helps industry identify drug interactions

Goal is to find risks before drugs reach patients.

Kathleen Giacomini, UC San Francisco

Drug interactions and drug side effects occur all-too-often in patients’ lives. Now there’s a new online resource to help guide pharmaceutical developers as they endeavor to improve testing for potentially harmful drug interactions before new medicines reach consumers.

The UCSF-FDA TransPortal is the result of partnership spearheaded by UC San Francisco and the U.S. Food and Drug Administration (FDA). Its focus is on how drugs interact with gatekeeper proteins called membrane transporters.

Transporters play specific roles as hosts or bouncers to either boot out specific drugs or to escort them inside. They control whether drugs can gain access to cells and organs throughout the body, including the liver and kidneys — big players in drug metabolism and elimination.

Anticipating drug side effects

In recent years specific transporters have been found to play a role in drug side effects, such as the muscle pain and weakness sometimes caused by statins. Transporters influence the effectiveness of certain anti-cancer treatments.

An unanticipated drug interaction with a transporter associated with the blood-brain barrier determines how much of the anti-flu drug Tamiflu gets into the brain, and might help explain rare cases of suicide documented among young Tamiflu users.

Kathleen Giacomini, Ph.D., chair of the Department of Bioengineering and Therapeutic Sciences at UCSF, a joint program of the UCSF schools of pharmacy and medicine, is an international expert on transporters and leads the partnership. She is a leader in the study of pharmacogenomics – how an individual’s genetics determine his or her response to medicines. Giacomini’s lab focuses on the roles of membrane transporters in drug absorption, disposition, targeting and in clinical drug response.

Giacomini also is a leader within the International Transporter Consortium, a collaborative group of scientists from academia, industry and the FDA that explores the role of transporters in therapeutic and adverse drug responses. She has identified several genetic variants among these transporter proteins that can cause metabolism of certain drugs to vary among individuals.

Drugs rely on the smooth operation of specific membrane transporters, of which there are dozens, but some drugs can affect the functioning of a transporter that another drug relies upon.

In addition, researchers are discovering genetic variations among individuals in transporter genes that can affect drug effectiveness and safety.

The FDA already has issued guidelines strongly recommending that drug interactions with seven membrane transporters be tested, but there is information on the new site available on many more.

To better understand how drug concentrations rise and fall within the body after a particular dosage, one ought to know which transporters act on the drug, Giacomini said — but that is not all one needs to know.

Drugs taken at the same time might rely on the same transporters to get where they’re going. More dramatically, sometimes a co-administered drug can inhibit the workings of a transporter the other drug relies on.

“Transporter-mediated drug–drug interactions often affect clinical outcomes,” Giacomini said.

While much remains to be discovered about how drugs interact with transporters, drug developers can use the UCSF-FDA TransPortal to make better use of what is already known, she said.

Speeding development of improved treatments

The project is one of many that the FDA has supported through its Critical Path Initiative, through which it aims to speed the development of improved treatments for patients by facilitating better use of scientific discoveries, technical tools and information technology in the evaluation of the safety, effectiveness and manufacturability of new medical products.

Through the initiative, the FDA strives to bring together federal agencies, patient groups, academic researchers, industry, health care practitioners and others to collaborate on practical solutions to problems that slow the advancement of new treatments through the drug development pipeline.

During a May 2012 lecture on UCSF’s Mission Bay campus, Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research (CDER), said that evaluating the effectiveness of drugs remains a “huge challenge.” There is a need for better tools, techniques and strategies to identify winners, minimize costs and reduce failures during drug development, according to Woodcock.

The UCSF-FDA TransPortal helps further these aims, Giacomini said, not only by providing a compendium about what has been learned to date about drug-drug interactions at transporters, but also because it offers guidance about how to select and conduct pre-clinical studies to identify potential interactions with new drug candidates.

Other major contributors to the UCSF-FDA TransPortal include Shiew Mei Huang, Ph.D., deputy director, and Lei Zhang, Ph.D., special assistant, both at the FDA’s Office of Clinical Pharmacology, and UCSF graduate students Kari Morrissey and Chris Wen.

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Master of Translational Medicine program gets final UC approval

UCSF, UC Berkeley joint effort trains students to bring innovative treatments into clinical use.

Tejal Desai, UC San Francisco

Two years after launching as a pilot effort, an innovative graduate curriculum in translational medicine jointly offered by UC San Francisco and UC Berkeley has received final approval from University of California President Mark Yudof as a master’s degree program.

Until now, the joint effort had been granting Master of Science degrees in bioengineering “with coursework and project emphasis on translational medicine.” The program is run by the UC Berkeley Department of Bioengineering and the UCSF Department of Bioengineering and Therapeutic Sciences (BTS), itself a joint department of the UCSF Schools of Pharmacy and Medicine.

“It was a way to test out the curriculum and get the program in place so we could actually do it when it was approved,” says Tejal Desai, Ph.D., a UCSF BTS faculty member and vice chair for education, who co-directs the program along with Song Li, Ph.D., a UC Berkeley bioengineering faculty member.

The translational medicine program trains students from varied backgrounds — basic scientists, clinicians, and engineers — to bring innovative treatments, ranging from drug delivery or imaging technologies to new medical devices or pharmaceuticals, into clinical use.

The approved Master of Translational Medicine (M.T.M.) program will become a professional degree program akin to the well-known Master of Business Administration (M.B.A.), with somewhat more emphasis on professional development, business and leadership than the Master of Science program.

Read the full story on the UCSF School of Pharmacy website.

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Leaders gather to develop competencies for pain management education

UC Davis Health System hosts two-day summit.

Heather Young, UC Davis

A team of 30 pain and education experts from throughout North America gathered for an intensive two-day summit at UC Davis Health System last week to develop competencies in pain management education for new clinicians across the health professions.

“It is a remarkable outcome to have this group of leaders with diverse expertise, opinions and perspectives reach consensus on core competencies for pain throughout curricula for nurses, physicians, physical therapists and other health professionals,” said Heather M. Young, associate vice chancellor for nursing at UC Davis and founding dean for the Betty Irene Moore School of Nursing.

The Expert Summit for Interprofessional Consensus on Pain Management Competencies included  leaders from several health-related disciplines — such as dentistry, medicine, nursing, pharmacy, physical therapy, psychology, social work and veterinary medicine — as well as educational experts and researchers.

“Although the management of acute and chronic pain remains a challenge, pain education is lacking in many health science curricula, particularly for beginning students,” said summit participant Judy Watt-Watson, president of the Canadian Pain Society and professor emerita for The Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. “The work of this interprofessional group was remarkable in that they produced such an important document so quickly that will have major benefit for educators and ultimately patients.”

The summit was part of the Interprofessional Pain Management Competency Program, a project to develop pain management core competencies and drive curriculum reform related to pain management. The program is led by Scott M. Fishman, professor and chief of pain medicine and vice chair of the Department of Anesthesiology and Pain Medicine and Young.

The Interprofessional Pain Management Competency Program’s initial phases, including the summit, are supported by The Mayday Fund, an organization dedicated to alleviating the incidence, degree and consequence of human physical pain.

“The current state of pain management competencies and content in schools of medicine and nursing, as well as other health professions, is inadequate,” Fishman said. “The creation and distribution of core competencies in pain management that apply across professions and can serve as a foundational step in improving the culture and content of care for adults and children with acute, chronic or end-of-life pain.”

A 2011 Institute of Medicine report revealed the need for improved pain education for health professionals due to increasing numbers of Americans coping with chronic pain as well as skyrocketing costs. According to the Institute of Medicine, an estimated 100 million American adults–more than the total affected by heart diseases, cancer and diabetes combined–suffer from chronic pain. Pain costs the nation up to $600 billion annually in medical treatment and lost productivity.

Prior to the summit, Fishman and Young worked with a five-member executive committee to examine the current state of pain education for early-stage health-professional students through literature and curricula review and expert interviews. The result of that work was presented to the summit participants who worked over the two days to reach consensus on a framework for pain management competencies. They agreed the core competencies would cover four key areas:

  • Multidimensional nature of pain
  • Assessment and measurement
  • Management of pain
  • Clinical conditions: interprofessional, patient-centered care in context

The group plans to summarize the summit results in a journal article and full report within the next six months. Other means of dissemination, such as additional peer-reviewed publications, presentations at professional conferences and distribution to academic and professional organizations is also planned to encourage endorsement and application of the competencies in various health education programs throughout the world.

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country’s best medical schools, a 619-bed acute care teaching hospital, a 1,000-member physician’s practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children’s hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

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Web-enabled bathroom scale could monitor heart failure from home

UCSF student wins award to build device that lets doctors check the heart via cloud.

Can a retrofitted bathroom scale costing less than $100 save lives and improve the health of millions of Americans living with heart failure while cutting billions of dollars in annual health care spending?

Mozziyar Etemadi, UC San Francisco

A team led by Mozziyar Etemadi, M.S., has been awarded $110,000 to find out. Etemadi is an M.D./Ph.D. student in the UC San Francisco Medical Scientist Training Program through which he is pursuing a Ph.D. in the UCSF/UC Berkeley Joint Graduate Group in Bioengineering and working in the lab of School of Pharmacy faculty member Shuvo Roy, Ph.D.

The project is one of three national winners, taking second place in the 2012 Prize for Primary Healthcare awarded by the Boston-based Center for Integration of Medicine and Innovative Technology (CIMIT) and funded by the Gelfand Family Charitable Trust.

Etemadi’s project — “Cloud-Enabled Technology for Monitoring Heart Failure at Home” — seeks to inexpensively tackle a rapidly growing medical problem: Six million Americans living with heart failure and suffering unpredictable health crises.

That solution starts with an everyday phenomenon, says Etemadi. If you stand on an older-style bathroom scale, the kind with a needle that indicates your weight, you will see the needle wiggle slightly with each of your heartbeats.

Read full story on the UCSF School of Pharmacy website.

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Child’s illness fuels lab team’s search for early-life epilepsy diagnostics

Disease hits home for UCSF postdoctoral fellow.

UCSF postdoctoral fellow Ramon Birnbaum and his daughter Ruth

When Ramon Birnbaum, Ph.D., came to UC San Francisco three years ago to do his postdoctoral work on the role of genetic regulation in human disease in the lab of School of Pharmacy faculty member Nadav Ahituv, Ph.D., epilepsy was barely on his radar.

Once, while serving in the Israeli military, he saw a fellow soldier suffer a seizure. Upon arriving on campus, just out of curiosity, he attended a presentation by Daniel Lowenstein, M.D., director of the UCSF Epilepsy Center. That was the sum total of Birnbaum’s experience with this spectrum of seizure disorders, which affect an estimated 50 million people worldwide.

Then, in 2010, his daughter Ruth was born, and everything changed.

The parents of three healthy boys, Birnbaum and his wife, Adva, immediately noticed when 3-week-old Ruth exhibited “subtle but unusual repetitive movements.” Following her intuition, Adva took their newborn to the pediatrician, who suspected Ruth was having seizures.

According to Birnbaum, the first neurologist they consulted thought it was probable that Ruth had Ohtahara syndrome, a severe disorder with a grim prognosis. Indeed, despite prescribed medications, Ruth’s seizure rate worsened, he recalls. She suffered several clusters per day, with some involving hundreds of convulsions over the course of an hour.

“It’s hard to imagine and even harder when, as a parent, you can’t do anything to help her,” Birnbaum says. “Her brain was on fire 24/7 with no chance to develop normally.”

But a second opinion by Joseph Sullivan, M.D., director of the UCSF Pediatric Epilepsy Center, was more optimistic.

While abnormal electrical activity in Ruth’s brain was similar to that seen in Ohtahara, after viewing a homemade video of her seizures, Sullivan diagnosed her as having infantile spasms, a different type of early onset epilepsy.

For Birnbaum and his adviser, Ahituv, a geneticist in the UCSF Department of Bioengineering and Therapeutic Sciences, the experience fueled a drive to discover a genetic diagnosis for infantile spasms, and potentially for other epilepsies and complex diseases. Then, if an infant like Ruth Birnbaum develops a seizure disorder, physicians would know what it is sooner in order to treat it faster.

Read the full story on the UCSF School of Pharmacy website.

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UC celebrates commencement

Coverage of the class of 2012 graduations.

Congratulations to the class of 2012.

More than 61,000 students on University of California campuses graduated this spring, joining the ranks of more than 1.6 million UC alumni. They include graduates from UC Health’s 16 professional schools in seven fields: dentistry, medicine, nursing, optometry, pharmacy, public health and veterinary medicine.

We’ve collected photos, tweets, Facebook posts and videos from commencement ceremonies at UC campuses on Storify to commemorate this year’s graduates. Find links to additional UC Health commencement coverage below.

UC Berkeley

UC Davis

UC Irvine

UCLA (view photos)

UC San Diego (view slideshow)

UC San Francisco

Graduate profiles

More UC commencement coverage

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Match Day at UC San Diego School of Medicine

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