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Gay and bisexual men who have sex with men (MSM) in the rural United States are less likely to test for HIV and sexually transmitted infections (STIs) and use pre-exposure prophylaxis (PrEP) compared to urban MSM. Given the challenges in building brick-and-mortar facilities serving the sexual health needs of MSM in rural communities, there is a need to evaluate digital engagement strategies. Combine is a smartphone app designed to provide HIV prevention information and resources to MSM that may be particularly well suited to support rural MSM. HealthMindr, an app from which Combine is adapted, has previously been shown to increase HIV testing and PrEP uptake among urban MSM. Because rural MSM face additional barriers to accessing HIV prevention services, a motivational interview (MI) focused on HIV prevention strategies might enhance the effectiveness of Combine to increase uptake of HIV testing, STI testing, and PrEP. This study aims to determine the effectiveness of the Combine app to increase HIV testing, STI testing, and PrEP initiation among rural cisgender MSM. We will also assess the effectiveness of 2 adjunctive interventions: the availability of free HIV and STI self-test kits and the offering of an MI. In this type 2 hybrid effectiveness-implementation randomized controlled trial, we will assess the effectiveness of Combine to increase HIV testing, STI testing, and PrEP initiation among rural MSM across the Southern United States. A total of 464 men will be recruited and randomized to 1 of the 4 arms. Participants in all 4 arms will have access to most app features (eg, health resources, quizzes, health care provider locators, and ordering free condoms and lubricants). Using a 2×2 factorial design, half (232/464, 50%) of the participants will be randomized to receive access to free at-home HIV and STI self-test kits and half (232/464, 50%) will be randomized to receive an MI. Participants will complete surveys every 6 months to allow for assessment of self-reported outcomes: app use, HIV testing, STI testing, and PrEP initiation over the 24-month follow-up period. Self-reported PrEP uptake will be verified by dried blood spot testing or uploading a photograph of a PrEP prescription. Participant recruitment began in March 2024. As of July 2025, 395 participants have been enrolled and randomized. Recruitment is expected to be completed by December 2025. This trial will determine whether the Combine app increases HIV testing, STI testing, and PrEP uptake among rural MSM in the Southern United States. It will also provide critical information about the most effective strategies for implementing digital health interventions for rural MSM. ClinicalTrials.gov NCT06205368; https://clinicaltrials.gov/study/NCT06205368. DERR1-10.2196/69540.

An oxygen-rich atmosphere obligated living organisms to cope with reactive oxygen species (O2-, H2O2, OH*) that were the unavoidable by-products of cellular metabolism. As a redox cofactor Cu was selected as a co-catalyst for numerous biological processes, many involving the utilization of oxygen. Inadequate or excessive intake of Cu can be pathogenic and life-threatening. Mutations to genes that code for Cu-transporting ATPase enzymes are the molecular basis of Wilson and Menkes diseases and more recently Cu has been identified as a preemptory factor in amyloid and prion diseases. This review is dedicated to bringing historical and timely information on Cu transport, metabolism and homeostasis to the attention of those not familiar with this important mineral. Other comprehensive reviews are available to the interested readers.

The transport and cellular metabolism of Cu depends on a series of membrane proteins and smaller soluble peptides that comprise a functionally integrated system for maintaining cellular Cu homeostasis. Inward transport across the plasma membrane appears to be a function of integral membrane proteins that form the channels that select Cu ions for passage. Two membrane-bound Cu-transporting ATPase enzymes, ATP7A and ATP7B, the products of the Menkes and Wilson disease genes, respectively, catalyze an ATP-dependent transfer of Cu to intracellular compartments or expel Cu from the cell. ATP7A and ATP7B work in concert with a series of smaller peptides, the copper chaperones, that exchange Cu at the ATPase sites or incorporate the Cu directly into the structure of Cu-dependent enzymes such as cytochrome c oxidase and Cu, Zn superoxide dismutase. These mechanisms come into play in response to a high influx of Cu or during the course of normal Cu metabolism.

Copper transport at the cellular level is achieved by a coordinate series of interactions between passive and active membrane transport proteins, vesicles, and soluble peptides. Knowing the function of each component of this complex network has made the task of delineating the mechanism of intracellular copper homeostasis achievable.

Current high-stakes accountability mandates emphasize data use for school improvement. However, teachers often lack training for effective data use, and data is often too far removed from students to actually influence instructional practice. This qualitative case study was designed to gain a better understanding of a district-wide, teacher-centered approach to data use. Findings suggest that when data is used to “inform” instruction rather than “evaluate” instruction, teachers begin to practice reflective teaching. A common language emerged across grade levels facilitating a collaborative approach to data use. Using the theoretical framework of Self-Determination Theory, we propose a data informed instructional theoretical model that stakeholders in K-12 education systems can use to enhance instruction and learning at the classroom level. This teacher-centered model is of particular importance as a framework to build collective capacity by meeting psychological needs of teachers of autonomy, competence, and relatedness.

A former Arizona sheriff's wife is killed while riding on their ranch property. It would appear a Mexican man illegally crossing into the US is at fault. As the former and the current sheriff search for answers, lives are changed forever.

Purpose: Little is known about parental attitudes toward return of individual research results (IRRs) in pediatric genomic research. The aim of this study was to understand the views of the parents who enrolled their children in a genomic repository in which IRRs will be returned. Methods: We conducted focus groups with parents of children with developmental disorders enrolled in the Gene Partnership (GP), a genomic research repository that offers to return IRRs, to learn about their understanding of the GP, motivations for enrolling their children, and expectations regarding the return of IRRs. Results: Parents hoped to receive IRRs that would help them better understand their children’s condition(s). They understood that this outcome was unlikely, but hoped that their children’s participation in the GP would contribute to scientific knowledge. Most parents wanted to receive all IRRs about their child, even for diseases that were severe and untreatable, citing reasons of personal utility. Parents preferred electronic delivery of the results and wanted to designate their preferences regarding what information they would receive. Conclusion: It is important for researchers to understand participant expectations in enrolling in a research repository that offers to disclose children’s IRRs in order to effectively communicate the implications to parents during the consenting process. Genet Med 2012:14(3):330–337

Opioids and other controlled substances prescribed for chronic pain are associated with abuse, addiction, and death, prompting national initiatives to identify safe and effective pain management strategies including topical analgesics. This prospective, observational study evaluated changes from baseline in overall mean severity and interference scores on the Brief Pain Inventory scale and the use of concurrent pain medications at 3- and 6-month follow-up assessments in chronic pain patients treated with topical analgesics. Changes in pain severity and interference and medication usage were compared between treated patients and unmatched and matched controls. The unmatched intervention group (unmatched-IG) included 631 patients who completed baseline and 3-month follow-up surveys (3-month unmatched-IG) and 158 who completed baseline and 6-month follow-up assessments (6-month unmatched-IG). Baseline and 3-month follow-up data were provided by 76 unmatched controls and 76 matched controls (3-month unmatched-CG and matched-CG), and 51 unmatched and 36 matched patients completed baseline and 6-month follow-up surveys (6-month unmatched-CG and matched-CG). Baseline demographic characteristics and mean pain severity and interference scores were similar between groups. There were statistically significant decreases from baseline in mean pain severity and interference scores within the 3- and 6-month unmatched-IG (all <0.001). Significantly greater decreases in the mean change from baseline in pain severity and interference scores were evident for the 3- and 6-month unmatched-IG versus unmatched-CG (all <0.001), with similar results when the 3- and 6-month matched-IG and matched-CG were compared. A higher percentage of the 3- and 6-month unmatched-IG and matched-IG de-escalated use of concurrent pain medications (all <0.001), while significantly higher percentages of the unmatched-CG and matched-CG escalated medication use. Side effects were reported by <1% of the unmatched-IG. Topical analgesics appear to be effective and safe for the treatment of chronic pain, with randomized controlled trials needed to confirm these findings.

Today’s opioid addiction epidemic is the worst man-made public health epidemic in American history. Every year, we lose more people to opioid addiction deaths than were killed in the entire Vietnam War. Working closely with Dr. Andrew Kolodny and PROP (Physicians for Responsible Opioid Prescribing), the new feature documentary Do No Harm: The Opioid Epidemic exposes how this catastrophic man-made public health crisis began. Filmed in the opioid epidemic ground zeros of Seattle, Kentucky and New Hampshire, the film features poignant stories from recovering addicts and families with losses; reveals the insights of leading doctors and law enforcement officers; reports the failure of drug companies to take appropriate responsibility for the crisis; traces what monies legislators have received; and focuses on those who fight back with effective, long-lasting treatment programs. Narrated by Golden Globe®-winning actor Ed Harris, the 90-minute feature unravels the unintentional web of co-conspirators and sheds light on the suspicious circumstances that have led to the opioid crisis.