family

Family Life Educator credential endorsements expand career opportunities

The Certified Family Life Educator credential, available through the Human Development and Family Studies degree program, was recently endorsed by the U.S. Department of Veterans Affairs and the Office of Head Start.




family

News24 Business | Tencent, Guillemot family said to consider buyout of Ubisoft

Tencent Holdings and Ubisoft Entertainment SA's founding Guillemot family are considering options, including a potential buyout of the French video game developer, after it lost more than half its market value this year, according to people familiar with the matter.




family

Military service is family tradition for Penn State Harrisburg father, daughter

Retired Master Sgt. Gary Barb, campus technology officer at Penn State Harrisburg, is a veteran of both the U.S. Navy, which he served from 1989 to 1993, and the Pennsylvania Air National Guard, which he served from 1994 to 2012. His daughter, Jessica Barb, is a communications major at Penn State Harrisburg, where she participates in the Army ROTC program, and serves in the Pennsylvania Army National Guard.




family

The Pullo Family Performing Arts Center Announces its fall lineup

The Pullo Family Performing Arts Center kicks off its Fall 2024 season with magic and haunted tales, before weaving into nostalgic cinema, familiar songs, and holiday spirit. Tickets are available for purchase on Ticketmaster.




family

Penn State Brandywine to host annual Homecoming & Family Day on Oct. 26

Penn State Brandywine will host its annual Homecoming & Family Day from 11 a.m. to 5 p.m. on Saturday, Oct. 26.




family

David Rosenberg and Moyer family named 2024 Fundraising Volunteers of the Year

Penn State has named David Rosenberg, a 1974 graduate of the College of Health and Human Development and longtime supporter of Penn State Brandywine, and the Moyer family, whose transgenerational giving has benefited multiple units across the University, as the 2024 Fundraising Volunteers of the Year.




family

Penn State Brandywine celebrates Homecoming & Family Day

Penn State Brandywine celebrated its annual Homecoming & Family Day on Oct. 26. With more 500 guests in attendance, and in collaboration with Penn State Day, Homecoming & Family Day was packed with alumni, prospective and current students, families, and friends participating in various activities.




family

Woskob Family Gallery to host immersive rope-braiding workshop

The Woskob Family Gallery will host “Hands-on History: The Experience of Braiding a Lost Inca Rope” from Nov. 15-17, where participants will learn ancient braiding techniques and contribute to the reconstruction of a centuries-old Incan rope. The workshop will be open to the public each day from 9 a.m. to 8 p.m. and participants are encouraged to dedicate at least one hour to the workshop.




family

My Family of Four's Monthly Water Usage (Gallons) Compared to the Town of Cary's Average

Have you ever been curious about your monthly water consumption and how it compares to others in your community? Recently, I had this question and decided to get ahold of my family's water usage data for analysis. Harnessing the power of data visualization, I compared my family of four's monthly [...]

The post My Family of Four's Monthly Water Usage (Gallons) Compared to the Town of Cary's Average appeared first on Graphically Speaking.




family

K-5 Family Crisis Therapists Engage Families, Children This Summer

WILMINGTON – Despite COVID-19, Family Crisis Therapists with the Delaware Children’s Department have continued to engage families with targeted early intervention programming to further social and development skills this summer. The K-5 Family Crisis Therapists (FCTs), through the Division of Prevention and Behavioral Health Services, work in elementary schools across our state helping children and […]



  • Department of Services for Children
  • Youth and their Families
  • News

family

The miracle of a family meal

Jessie Stein tells the story of God's faithfulness in the midst of learning a foreign language and the struggles of a broken family.




family

Pompeii DNA Study Reveals Surprising Ancestry and Uncovers New Insights on Family and Gender Assumptions

Recent DNA findings from Pompeii reveal complex ancestry and social diversity, challenging earlier assumptions about family structures and cultural roles in the ancient city. Analysing skeletal remains has shown that some groups presumed to be family members were not biologically related, while traditional gender roles were also re-evaluated. This research highlights the cosmopolitan nature of Pompeii’s society and opens a new chapter in understanding life before the eruption of Mount Vesuvius.




family

Prateik Babbar Reveals He Started Taking Drugs At Age 13: "Had A Different Upbringing, Family Situation Was Complicated"

Prateik clarified that it was not money and recognition that pushed him into taking drugs, as people often think




family

The Delaware Public Archives unveils the Abraham Shadd Family Historical Marker

The Delaware Public Archives was proud to unveil its newest State of Delaware Historical Marker on Wednesday, February 3, 2022, in Wilmington, Delaware honoring the Abraham Shadd Family.   A cobbler by day and an abolitionist by night, Abraham Shadd lived in Wilmington, Delaware in the early 19th Century with his family.  Shadd owned several […]



  • Delaware Public Archives
  • News
  • african american history
  • African American History Month
  • historical marker

family

Twenty-one State Employees and their Family Members Awarded Art Honors

The Awards Show and Closing Reception will be held at Delaware State University’s Arts Center/Gallery on March 14, 2015, 1-3 p.m. Secretary of State Jeffrey W. Bullock and Division of the Arts Deputy Director Kristin Pleasanton will preside at the Awards Ceremony.



  • Delaware Division of the Arts
  • Delaware Health and Social Services
  • Department of Correction
  • Department of Education
  • Department of Labor
  • Department of Natural Resources and Environmental Control
  • Division of Public Health
  • Kent County
  • New Castle County
  • News
  • Sussex County
  • "Delaware Division of the Arts"
  • art
  • arts
  • Delaware
  • Delaware State University
  • employees
  • events
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  • family
  • gallery
  • National Arts Program

family

Governor Carney Reestablishes the Family Services Cabinet Council

Council will help coordinate crucial public and private services for Delaware families WILMINGTON, Del. – Governor John Carney signed Executive Order Five on Tuesday, reestablishing the Family Services Cabinet Council to help coordinate public and private services for Delaware families. Delaware families continue to face significant challenges – including the high cost of child care; […]




family

Governor Carney Announces Family Services Cabinet Council Summer Initiative

The Summer Initiative will coordinate delivery of state services for families in Wilmington WILMINGTON, Del. – Governor John Carney on Thursday announced the Family Services Cabinet Council’s Summer Initiative, an interagency effort to improve the coordination of state services to better meet the needs of families in the city of Wilmington. The FSCC Summer Initiative […]



  • Delaware Health and Social Services
  • Department of Labor
  • Department of Safety and Homeland Security
  • Department of Services for Children
  • Youth and their Families
  • Governor John Carney
  • Office of the Governor
  • Cabinet
  • City of Wilmington
  • Delaware
  • Family Services Cabinet Council
  • Governor Carney
  • Governor'sCabinet
  • Wilmington

family

ADVISORY: Discussion on Wilmington with the Family Services Cabinet Council

Governor Carney and Council members will hold meeting to discuss state service delivery in Wilmington WILMINGTON, Del. – At 6:00 p.m. on Monday, November 13, Governor Carney will host a public discussion on Wilmington with the Family Services Cabinet Council. Governor Carney signed Executive Order #5 in February, re-establishing the Family Services Cabinet Council to […]



  • Delaware Health and Social Services
  • Department of Education
  • Department of Labor
  • Department of Services for Children
  • Youth and their Families
  • Department of Technology and Information
  • Governor John Carney
  • Office of the Governor
  • Cabinet
  • Delaware
  • Family Services
  • Family Services Cabinet Council
  • governor
  • Governor Carney
  • Wilmington

family

Sussex County Farm Family Receives Delaware Secretary’s Award for Agriculture

Recently, Delaware Secretary of Agriculture Michael T. Scuse took a road trip down to Sussex County to make a surprise presentation to a family farm in Laurel. Scuse recognized the Vincent Family for their commitment to Delaware through agricultural production and equipment sales, for providing gainful employment to community members, and for continuing to alleviate hunger through their participation in the USDA Farmers to Families Food Box Program.



  • Department of Agriculture
  • Delaware Secretary of Agriculture Michael T. Scuse
  • farm family
  • Secretary's Award for Distinguished Service to Delaware Agriculture
  • USDA Farmers to Families Food Box Program
  • Vincent Farms

family

Focus Group Insights Help Guide Future Enhancements to Family Caregiver Services at DHSS

NEWARK (Nov. 14, 2022) – The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) is using the findings from a report based on caregiver focus groups held late last year across the state to enhance its current supports and develop a new approach to caregiver services. This includes the formation of the […]




family

Family SHADE Mini-Grant Program Awards $25,000 to Three Community Organizations

WILMINGTON – The Parent Information Center of Delaware (PIC), in partnership with the Delaware Division of Public Health (DPH), announced the recipients of the Statewide Family SHADE Mini-Grant Program for 2023-2024. The Family SHADE (Support Healthcare Alliance Delaware) mini-grant program aims to build state and local capacity and test small-scale innovative strategies to improve the […]



  • Delaware Health and Social Services
  • Division of Public Health
  • News
  • DE Division of Public Health
  • Delaware Department of Health and Social Services
  • DPH
  • Family Shade
  • Mini-grant
  • Parent Information Center of Delaware
  • PIC

family

DPH Hosts Family Assistance Center Emergency Response Full-Scale Exercise

The Delaware Division of Public Health (DPH) hosted a Family Assistance Center (FAC) Full-Scale Exercise on Thursday, April 18, in Frankford. The exercise simulated a traffic collision with multiple coach buses and numerous injuries and fatalities. It was held to test the readiness and response capabilities of state agencies and the community. DPH collaborated with […]



  • Delaware Health and Social Services
  • Division of Public Health
  • News
  • Delaware Division of Forensic Sciences
  • Delaware Division of Public Health
  • Delaware Emergency Management Agency
  • delaware state police
  • Division of Social Services
  • Family Assistance Center
  • Josette Manning
  • Steven Blessing
  • Victim Services

family

Statewide Family Reentry Pilot Program Launched

DOVER – Delaware’s five public housing authorities (PHAs), the Delaware Department of Correction (DOC) and the Delaware Center for Justice (DCJ) today launched the Delaware Family Reentry Pilot (FRP) Program, a statewide initiative to give individuals recently released from incarceration the opportunity to access safe and stable housing by reuniting with their families who live […]



  • Delaware State Housing Authority
  • Department of Correction
  • affordable housing
  • Delaware Department of Correction

family

Family Emergency Preparedness Day Returns on September 17

The 16th annual Family Emergency Preparedness Day returns on Saturday, September 17, 10 a.m. to 2 p.m. at Brecknock County Park, 80 Old Camden Road, Camden, DE 19934. The rain date is Sunday, September 18. September is “National Preparedness Month,” and attendees can get a wealth of resources and information to enhance their emergency preparedness – all in a fun, family environment. The event is co-sponsored by the Delaware Citizen Corps, Kent County Parks and Recreation, Kent County Department of Public Safety, Delaware Emergency Management Agency (DEMA), and the Delaware Division of Public Health Office of Preparedness.



  • Delaware Emergency Management Agency
  • Delaware Health and Social Services
  • Department of Safety and Homeland Security
  • Division of Public Health
  • Kent County
  • News

family

Family Emergency Preparedness Day is September 23

The 17th annual Family Emergency Preparedness Day is on Saturday, September 23, from 10 a.m. to 2 p.m. at Brecknock County Park, 80 Old Camden Road, Camden, DE 19934. The event is rain or shine. September is “National Preparedness Month,” and attendees can get a wealth of resources and information to enhance their emergency preparedness – all in a fun, family environment. Exhibitors will offer interactive activities, games, promo items, and safety-themed giveaways. Event highlights include appearances by Smokey Bear, Sparky the Fire Dog, and a vehicle extrication demo by the Camden -Wyoming Fire Company. The first 500 people who complete an activity challenge will get a free water ice from Kona Ice! For more information, contact DEMAPIO@delaware.gov



  • Delaware Emergency Management Agency
  • Department of Safety and Homeland Security
  • Kent County
  • News

family

Family Emergency Preparedness Day Canceled

The Family Emergency Preparedness Day event scheduled for Saturday, September 23 at Brecknock County Park in Camden, Delaware has been canceled due to expected inclement weather from a pending coastal storm. Out of an abundance of caution, officials from participating agencies determined that the threat of high winds and precipitation would make the event unsafe to both participants and attendees.



  • Delaware Emergency Management Agency
  • Department of Safety and Homeland Security
  • Kent County
  • News

family

Gov. Carney, First Spouse, Sen. Coons, Sec. Holodick, Pritchett Family Open Doors at New Maurice Pritchett Sr. Academy

WILMINGTON, Del. – Governor Carney and First Spouse Tracey Quillen Carney joined Senator Coons, members of the General Assembly, Mayor Mike Purzycki, the Christina School District, the Delaware Department of Education, the Wilmington Learning Collaborative, educators, students, families, and community members to celebrate the grand opening of the Maurice Pritchett Sr. Academy. “The brand-new Maurice Pritchett Sr. Academy […]



  • Department of Education
  • Governor John Carney
  • News
  • Office of the Governor
  • City of Wilmington
  • Gov. John Carney
  • Governor Carney
  • Wilmington Learning Collaborative

family

Family Emergency Preparedness Day on September 14 for National Preparedness Month

To celebrate September as National Preparedness Month, more than 45 public safety agencies, nonprofits, and utilities will join together for the 18th Annual Family Emergency Preparedness Day on Saturday, September 14, from 10 a.m. to 2 p.m. at Brecknock County Park, 80 Old Camden Road, Camden, Delaware. There is no cost to attend and free parking is available onsite at the park. There is no rain date. The event offers attendees a chance to meet first responders and public safety experts in a fun, friendly environment where families can find a wealth of information and resources to promote emergency preparedness and help them “make a plan, build a kit, and stay informed” by visiting PrepareDE.org. Family Emergency Preparedness Day is sponsored by the Delaware Emergency Management Agency (DEMA), Kent County Parks and Recreation, Kent County Department of Public Safety, Delaware State Fire School, and the Delaware Division of Public Health’s Office of Preparedness.




family

Delaware Brings Private Paid Family Medical Leave Policies to Market

Insurers approved to offer plans with benefits equal to or greater than the forthcoming state plan Insurance Commissioner Trinidad Navarro announced today that the Department of Insurance has approved Delaware’s first private Paid Family Medical Leave plans. These filings, reviewed by independent actuaries and against state requirements, provide options for businesses who wish to purchase […]




family

Student Found Hanging In Telangana Hostel, Family Alleges Foul Play

A 17-year-old girl student of Rajiv Gandhi University of Knowledge Technologies (RGUKT) in Nirmal district of Telangana allegedly died by suicide on Monday, police said.




family

Family Members Of Foreign Workers In Canada Now Allowed To Work: Spouses, Working-Age Children Will Get Work Permits!

After its decision to strengthen visa infrastructure in Delhi and Chandigarh, Canada has now announced that family members of temporary international workers will also be allowed to work in the country. Sean Fraser, Canada’s Minister of Immigration, Refugees, and Citizenship, recently informed the media that his agency will be granting work permits to relatives of […]




family

Arduino adds two boards to its MKR family of products for new use cases

Arduino’s MKR family of products got two new wireless connectivity boards added to its range of products. These include MKR WiFi 1010 and MKR NB 1500, both aimed at streamlining IoT product/service development.

Arduino MKR WiFi 1010

Arduino’s blog notes that “the Arduino MKR WiFi 1010 is the new version of the MKR1000 with ESP32 module on board made by U-BLOX.”

MKR WiFi 1010: For prototyping of WI-FI based IoT applications

The core difference of MKR WiFi 1010 compared to MKR WiFi 1000 is that the former can be put to use in production-grade IoT apps and it has ESP32-based module manufactured by u-blox. The former enables to add 2.4GHz WiFi and Bluetooth capability to the application. Additionally, it comes with a programmable dual-processor system (an ARM processor and a dual-core Espressif IC).

MKR NB 1500: For on-field monitoring systems and remote-controlled LTE-enabled modules

The Arduino MKR NB 1500 is based on new low-power NB-IoT (narrowband IoT) standard. This makes it appropriate for IoT apps running over cellular/LTE networks.

Arduino MKR NB 1500

Key use cases of this board are remote monitoring systems and remote-controlled LTE-enabled modules. It supports AT&T, T-Mobile USA, Telstra, Verizon over the Cat M1/NB1 deployed bands 2, 3, 4, 5, 8, 12, 13, 20 and 28.

Arduino also pitches this board to be used in IoT apps which used to rely on alternative IoT networks such as LoRa and Sigfox. It promises to save power compared to GSM or 3G cellular-based connections.

“The new boards bring new communication options to satisfy the needs of the most demanding use cases, giving users one of the widest range of options on the market of certified products.” Arduino co-founder and CTO Massimo Banzi






family

Fish Family Foundation Awards EWC $50,000 to Support Women’s Entrepreneurship

Fish Family Foundation Awards EWC $50,000 to Support Women’s Entrepreneurship Fish Family Foundation Awards EWC $50,000 to Support Women’s Entrepreneurship
ferrard

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family

Divine Wisdom for the Family (Selected Scriptures)

Check here each week to keep up with the latest from John MacArthur's pulpit at Grace Community Church.




family

Divine Design for Family (Ephesians 6:1-4)

Check here each week to keep up with the latest from John MacArthur's pulpit at Grace Community Church.




family

Family bond runs deep in Petersen’s debut memoir




family

Anti-Bullying Week: toxic family dynamics among indicators of bullying in children





family

Family Doctor Can Safely Assist Many Births

Title: Family Doctor Can Safely Assist Many Births
Category: Health News
Created: 8/24/2015 12:00:00 AM
Last Editorial Review: 8/25/2015 12:00:00 AM




family

Family Trumps Friends in Extending Seniors' Lives

Title: Family Trumps Friends in Extending Seniors' Lives
Category: Health News
Created: 8/21/2016 12:00:00 AM
Last Editorial Review: 8/22/2016 12:00:00 AM




family

Serious Heart Problem a Family Matter

Title: Serious Heart Problem a Family Matter
Category: Health News
Created: 8/25/2016 12:00:00 AM
Last Editorial Review: 8/25/2016 12:00:00 AM




family

Family History of Mental Illness Ups Odds for Postpartum Depression

Title: Family History of Mental Illness Ups Odds for Postpartum Depression
Category: Health News
Created: 8/22/2022 12:00:00 AM
Last Editorial Review: 8/23/2022 12:00:00 AM




family

Wonca Europe 2023 Definition of General Practice/Family Medicine: New Needs New Content




family

Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform

Two decades into the era of Electronic Health Records (EHRs), the promise of streamlining clinical care, reducing burden, and improving patient outcomes has yet to be realized. A cross-sectional family physician census conducted by the American Board of Family Medicine in 2022 and 2023 included self-reported physician EHR satisfaction. Of the nearly 10,000 responding family physicians, only one-in-four (26.2%) report being very satisfied and one-in-three (33.8%) were not satisfied. These low levels of satisfaction point to the need for greater transparency in the marketplace and pressure to increase user-centric EHR design.




family

Sexual Misconduct by Board Certified Family Physicians

Purpose:

Sexual misconduct by physicians is a consequential violation of patient trust. The purpose of this study was to determine the frequency and patterns of sexual misconduct by physicians certified by the American Board of Family Medicine (ABFM).

Methods:

We described a cohort of current or formerly ABFM certified physicians ("Diplomates") disciplined for sexual misconduct in 2016 to 2022.

Results:

Ninety-four physicians, representing only 0.1% of ABFM Diplomates, were identified as having received disciplinary action(s) for reported sexual misconduct. These constituted 8.9% of the 1122 cases that resulted in a physician losing board certification or eligibility for any cause in 2016 to 2022. Ninety-three of the 94 physicians identified as male, with an average age of 56 (range 22 to 88 years). Eighty-nine percent of victims were female, and 90% were patients of the physician. Unwanted sexual behavior/assault occurred in more than half of the cases, whereas one third described an ongoing sexual relationship between patient and physician. Nearly 1 in 5 cases also included controlled substance prescribing. Seven cases involved minors. Noncontact ("grooming") behaviors were described in 34 cases, 28 of which included subsequent physical sexual behavior. A clinical setting was the site of misconduct in 84% of cases.

Conclusions:

Reports of sexual misconduct among board-certified family physicians are infrequent. However, any sexual misconduct by physicians is harmful to patients and the profession. The specialty should work to enhance education and change professional culture to mitigate this important problem.




family

How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency

Background:

Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women’s experiences negotiating for their first job out of residency to ascertain women’s engagement with and approach to the negotiation process.

Methods:

We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women’s experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach.

Results:

Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants’ inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households.

Conclusion:

To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency.




family

Performance Evaluation of the Generative Pre-trained Transformer (GPT-4) on the Family Medicine In-Training Examination

Objective:

In this study, we sought to comprehensively evaluate GPT-4 (Generative Pre-trained Transformer)’s performance on the 2022 American Board of Family Medicine’s (ABFM) In-Training Examination (ITE), compared with its predecessor, GPT-3.5, and the national family residents’ performance on the same examination.

Methods:

We utilized both quantitative and qualitative analyses. First, a quantitative analysis was employed to evaluate the model's performance metrics using zero-shot prompt (where only examination questions were provided without any additional information). After this, qualitative analysis was executed to understand the nature of the model's responses, the depth of its medical knowledge, and its ability to comprehend contextual or new information through chain-of-thoughts prompts (interactive conversation) with the model.

Results:

This study demonstrated that GPT-4 made significant improvement in accuracy compared with GPT-3.5 over a 4-month interval between their respective release dates. The correct percentage with zero-shot prompt increased from 56% to 84%, which translates to a scaled score growth from 280 to 690, a 410-point increase. Most notably, further chain-of-thought investigation revealed GPT-4’s ability to integrate new information and make self-correction when needed.

Conclusions:

In this study, GPT-4 has demonstrated notably high accuracy, as well as rapid reading and learning capabilities. These results are consistent with previous research indicating GPT-4's significant potential to assist in clinical decision making. Furthermore, the study highlights the essential role of physicians' critical thinking and lifelong learning skills, particularly evident through the analysis of GPT-4's incorrect responses. This emphasizes the indispensable human element in effectively implementing and using AI technologies in medical settings.




family

Family Medicine Must Prepare for Artificial Intelligence

Artificial Intelligence (AI) is poised to revolutionize family medicine, offering a transformative approach to achieving the Quintuple Aim. This article examines the imperative for family medicine to adapt to the rapidly evolving field of AI, with an emphasis on its integration in clinical practice. AI's recent advancements have the potential to significantly transform health care. We argue for the proactive engagement of family medicine in directing AI technologies toward enhancing the "Quintuple Aim."

The article highlights potential benefits of AI, such as improved patient outcomes through enhanced diagnostic tools, clinician well-being through reduced administrative burdens, and the promotion of health equity by analyzing diverse data sets. However, we also acknowledge the risks associated with AI, including the potential for automation to diverge from patient-centered care and exacerbate health care disparities. Our recommendations stress the need for family medicine education to incorporate AI literacy, the development of a collaborative for AI integration, and the establishment of guidelines and standards through interdisciplinary cooperation. We conclude that although AI poses challenges, its responsible and ethical implementation can revolutionize family medicine, optimizing patient care and enhancing the role of clinicians in a technology-driven future.




family

Artificial Intelligence and Family Medicine

Artificial intelligence (AI) is certainly going to have a large, potentially huge, impact on the practice of family medicine. The specialty is fortunate to have leading experts in the field to guide us along the way. One such team of forward thinkers provides insights into where AI can take the specialty. Another article reports on how well AI performed on the American Board of Family Medicine In-Training Examination. In addition to AI, we have 3 articles that investigate the intersection of social needs and the practice of medicine. Four clinical review articles cover nonalcoholic fatty liver disease, headache treatments, single maintenance and reliever therapy for asthma, and the use of cannabis in the setting of chronic pain. The clinical research articles cover point-of-care hemoglobin A1c testing, continuous glucose monitoring, and screening for HIV. Another group of articles examines the profession of family medicine, covering topics ranging from how women family physicians negotiate their first jobs to the words we use to define primary care.




family

The Simultaneous Inhibition of Solute Carrier Family 6 Member 19 and Breast Cancer Resistance Protein Transporters Leads to an Increase of Indoxyl Sulfate (a Uremic Toxin) in Plasma and Kidney [Articles]

Solute carrier family 6 member 19 (SLC6A19) inhibitors are being studied as therapeutic agents for phenylketonuria. In this work, a potent SLC6A19 inhibitor (RA836) elevated rat kidney uremic toxin indoxyl sulfate (IDS) levels by intensity (arbitrary unit) of 13.7 ± 7.7 compared with vehicle 0.3 ± 0.1 (P = 0.01) as determined by tissue mass spectrometry imaging analysis. We hypothesized that increased plasma and kidney levels of IDS could be caused by the simultaneous inhibition of both Slc6a19 and a kidney IDS transporter responsible for excretion of IDS into urine. To test this, we first confirmed the formation of IDS through tryptophan metabolism by feeding rats a Trp-free diet. Inhibiting Slc6a19 with RA836 led to increased IDS in these rats. Next, RA836 and its key metabolites were evaluated in vitro for inhibiting kidney transporters such as organic anion transporter (OAT)1, OAT3, and breast cancer resistance protein (BCRP). RA836 inhibits BCRP with an IC50 of 0.045 μM but shows no significant inhibition of OAT1 or OAT3. Finally, RA836 analogs with either potent or no inhibition of SLC6A19 and/or BCRP were synthesized and administered to rats fed a normal diet. Plasma and kidney samples were collected to quantify IDS using liquid chromatography–mass spectrometry. Neither a SLC6A19 inactive but potent BCRP inhibitor nor a SLC6A19 active but weak BCRP inhibitor raised IDS levels, whereas compounds inhibiting both transporters caused IDS accumulation in rat plasma and kidney, supporting the hypothesis that rat Bcrp contributes to the excretion of IDS. In summary, we identified that inhibiting Slc6a19 increases IDS formation, while simultaneously inhibiting Bcrp results in IDS accumulation in the kidney and plasma.

SIGNIFICANCE STATEMENT

This is the first publication to decipher the mechanism for accumulation of indoxyl sulfate (IDS) (a uremic toxin) in rats via inhibition of both Slc6a19 and Bcrp. Specifically, inhibition of Slc6a19 in the gastrointestinal track increases IDS formation, and inhibition of Bcrp in the kidney blocks IDS excretion. Therefore, we should avoid inhibiting both solute carrier family 6 member 19 and breast cancer resistance protein simultaneously in humans to prevent accumulation of IDS, a known risk factor for cardiovascular disease, psychic anxiety, and mortality in chronic kidney disease patients.