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Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress. Synovial membrane-derived factors are implicated in arthritis-related bone changes. The route that synovial factors use to access subchondral bone and the mechanisms responsible for these bone changes remain unclear. A safe