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BACKGROUND: Primary care providers manage most patients with chronic pain. Pain is a complex problem, particularly in underserved populations. A technology-enabled, point-of-care decision support tool may improve pain management outcomes. METHODS: We created an electronic health record (EHR)-based decision support tool, the Pain Management Support System-Primary Care (PMSS-PC), and studied the tool-plus-education in 6 Federally Qualified Health Center practices using a randomized, wait-list controlled design. The PMSS-PC generated "best practice alerts," gave clinicians access to a pain assessment template, psychological distress and substance use measures, guidelines for drug and non-drug therapies, and facilitated referrals. Practices were randomly assigned to early vs delayed (after 6 months) implementation of the intervention, including technical support and 6 webinars. The primary outcome was change in worst pain intensity scores after 6 months, assessed on the Brief Pain Inventory-Short Form. Changes in outcomes were compared between the practices using linear multilevel modeling. The EHR provided clinician data on PMSS-PC utilization. RESULTS: The 256 patients in the early implementation practices had significantly improved worst pain (standardized effect size [ES] = -.32) compared with the 272 patients in the delayed implementation practices (ES = -.11). There was very low clinician uptake of the intervention in both conditions. CONCLUSIONS: Early implementation of the PMSS-PC improved worst pain, but this effect cannot be attributed to clinician use of the tool. Further PMSS-PC development is not indicated, but practice-level interventions can improve pain, and studies are needed to identify the determinants of change.

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Objective: Previous research suggests that race/ethnicity predicts health-related quality of life (HRQL) in chronic pain populations but has not examined this in community settings. This study evaluated this association in 522 community-dwelling patients with chronic pain treated at a Federally Qualified Health Center (FQHC). Design: Cross-sectional secondary analysis. Setting: Six practice sites of an FQHC in New York. Subjects: One hundred forty-two non-Hispanic blacks, 121 non-Hispanic whites, 219 Hispanics, and 40 classified as "other" with severe chronic pain. Methods: Patients with chronic severe pain (three or more months with worst pain ≥ 4/10 or T-score > 60.5 on the Patient-Reported Outcomes Measurement Information System pain interference tool) were interviewed as part of a clinical trial. Race/ethnicity and other potential predictors of HRQL were assessed. Results: Mean age was 53.0 years, and 70.1% were women; 62.8% earned less than $10,000 per year, and 22.8% were Spanish-speaking with low acculturation. Mean worst pain during the past week was 8.6/10, and 39.6% used opioids. In multivariate analyses, race/ethnicity was not significantly associated with mental HRQL. Hispanics had significantly lower physical HRQL than non-Hispanic whites or blacks, but this difference was not clinically meaningful (mean T-scores = 33.9 [Hispanics], 35.8 [non-Hispanic whites], and 35.6 [non-Hispanic blacks]). Mental HRQL was predicted by depression, anxiety, pain disability, income, and physical HRQL; physical HRQL was predicted by race/ethnicity, anxiety, pain disability, age, care satisfaction, and mental HRQL. Conclusions: Race/ethnicity does not explain important variation in HRQL reported by diverse patients with chronic pain. Psychological distress, pain disability, age, and socioeconomic status predicted this health outcome. Future studies may clarify modifiers of these associations to guide treatment in FQHC populations.

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Earlier the geminate recombination of ions and solvated electrons, produced by ionizing radiation or laser light, was theoretically treated by a model which consisted of a Rydberg atom interacting with the thermodynamic fluctuations of the medium [R. Schiller, J. Chem. Phys. 92, 5527 (1990)]. The theory was applied to liquid-to-supercritical water [R. Schiller and Á. Horváth, J. Chem. Phys. 135, 084510 (2011)]. Now it is compared with recent experiments performed on liquid-to-supercritical ammonia [J. Urbanek, A. Dahmen, J. Torres-Alacan, P. Königshoven, J. Lindner, and P. Vöhringer, J. Phys. Chem. B 116, 2223 (2012)]. The agreement between theory and experiment seems to be reasonable. The treatment is critically assessed.

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After a diminishing of its ranks following the post-World War II explosion of growth in medical discoveries, advanced medical technology, and the concomitant specialization of the physician workforce, family medicine is re-establishing itself as a leading medical specialty that has garnered growing interest among recent medical-school graduates. Family physicians provide care for patients of all ages, from newborns to the elderly. In addition to its wide scope of practice, family medicine is characterized by its emphasis on understanding of the whole person, its partnership approach with patients over many years, and its command of medical complexity. Family physicians are trained both to use community resources to assist individual patients in meeting medical or social needs and to identify and address community-wide needs. The specialty of family medicine is uniquely positioned to provide a leadership role in health-reform efforts that are accelerating across the country. Health care models that are gaining traction, such as the patient-centered medical home model, health homes, and accountable care organizations, share the characteristics of providing comprehensive, coordinated patient care with an emphasis on disease prevention and health promotion. This model of care, provided in the context of family and community, has been the hallmark of family medicine since its creation as a distinct medical specialty more than 40 years ago. In addition, family physicians' ability to care for patients of all ages make them particularly cost-effective as the new models of care move to improve access to care through expanded hours and locations.

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The photochemical yield of hydrated electrons as a function of temperature in liquid and supercritical water is treated in terms of energy fluctuations of the medium. The geminate pair, consisting of a positive ion and a hydrated electron, is regarded as a H-like atom embedded in a completely relaxed dielectric continuum. If the local medium energy is larger than the ionization energy of this atom, the electron escapes its geminate partner. By making use of the classical theory of energy fluctuations, escape probability is described by a simple explicit function, the variable of which is a combination of temperature, relative permittivity, and specific heat. First our earlier calculations on the recombination of solvated electrons, produced by ionizing radiation in a number of polar liquids, are improved and then the theory is compared with the experimental results on temperature dependent electron survival by Kratz et al. [S. Kratz, J. Torres-Alcan, J. Urbanek, J. Lindner, and P. Vöhringer, Phys. Chem. Chem. Phys. 12, 12169 (2010)]. Two adjustable parameters are needed to achieve reasonable quantitative agreement.

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White noise is expected to show up in both pressure and temperature at the nanoscale if linear transport equations prevail. This prediction is based on the thermodynamic fluctuation theory in analogy to a new derivation of the Johnson-Nyquist voltage noise. The pressure noise in liquid filled nanotubes, and temperature noise in nanoslabs are estimated and experiments are proposed. Measurements might prove useful in the determination of nanoscopic transport coefficients.

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Glucosamine is one of the most popular dietary supplements sold in the United States. Most clinical trials have focused on its use in osteoarthritis of the knee. The reported adverse effects have been relatively well studied and are generally uncommon and minor. No significant supplement-drug interactions involving glucosamine have been reported. The National Institutes of Health-sponsored Glucosamine/chondroitin Arthritis Intervention Trial, the largest randomized, double-blind, placebo-controlled study involving the supplement, still has not confirmed whether glucosamine is effective in the treatment of osteoarthritis. Despite conflicting results in studies, there is no clear evidence to recommend against its use. If physicians have patients who wish to try glucosamine, it would be reasonable to support a 60-day trial of glucosamine sulfate, especially in those at high risk of secondary effects from other accepted treatments. The decision to continue therapy can then be left to patients on an individual basis, while the physician monitors for possible adverse effects. Glucosamine should be used with caution in patients who have shellfish allergies or asthma, and in those taking diabetes medications or warfarin.

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A microscopic theory is developed for the interplay of diffusion and chemical reaction and the results are compared with electrode impedance measurements on an oxide electrode. The theory is based on the ideas of continuous-time random walk and accounts for the interference of diffusion and recombination of the charge carriers in the oxide. The treatment results in a dispersive diffusivity with two time constants, one of them corresponding to the random walk, the other to the reaction. Combining this diffusivity with the Warburg electrode admittance expression, which refers to cases where the rate-limiting step is diffusion in a semi-infinite medium bounded by a plane, an admittance function is obtained. The phase angle is found to be higher than 45 degrees distinguishing it from the Gerischer impedance which was developed for a related problem. The oxides were produced by hydrothermal oxidation of Zr-l%Nb alloy, a metal used as cladding material for nuclear fuel elements. The electrode impedance spectra of Zr/Zr-oxide electrodes in aqueous SO(3) (2-) solutions were taken at various anodic voltages between 1 Hz and 100 kHz and temperatures between 278 and 333 K. The theoretical admittance functions could be successfully compared with the observed spectra. Both the functional forms and the fitted parameter values support our theory which is also in keeping with Macdonald's point-defect model.

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