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eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow-the sequence and personnel needed to undertake a series of tasks for clinical care. Our central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation. This paper aims to provide an introductory tutorial on when and how to use a clinical workflow analysis to guide the implementation of eHealth interventions. The tutorial includes a step-by-step guide to conducting a clinical workflow analysis in planning for eHealth implementation. We began with a description of why a clinical workflow analysis is best completed before the implementation of eHealth interventions. Next, we described 4 steps needed to perform the clinical workflow analysis: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation. Finally, we presented a case study of a clinical workflow analysis, which was conducted during patient visits of patients aged 11 or 12 years from 4 diverse pediatric or family medicine clinics to plan the implementation of a tablet-based app for adolescent vaccination. Investigators planning the implementation of new eHealth interventions in health care settings can use the presented steps to assess clinical workflow, thereby maximizing the match of their intervention with the clinical workflow. Conducting a prospective workflow study allows for evidence-based planning, identifying potential pitfalls, and increasing stakeholder buy-in and engagement. This tutorial should aid investigators in increasing the successful implementation of eHealth interventions.

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BACKGROUND: Bacteria in the Pantoea genus are plant and soil associated Gram-negative rods described as nosocomial pathogens and as rare causes of community-acquired infections. The latter have been classically associated with gardening and plant thorn injuries and immunocompromised states are additional risk factors. We report a patient with pica and geophagia, Pantoea sepsis, and sickle cell crisis, associations not previously described. CASE REPORT: A 23-year-old pregnant female presented to the emergency department with sickle cell pain crisis. On the third day of hospitalization the patient developed fever subsequently determined to be caused by Pantoea bacteremia and sepsis. She was successfully treated with a two-week course of ceftriaxone. The patient admitted to a habit of frequently eating large amounts of soil and this geophagia had increased since she became pregnant. She had marked clinical improvement with treatment and she was counseled to stop eating soil. CONCLUSIONS: This is the first reported case of Pantoea infection possibly associated with geophagia and the first reported case of Pantoea bacteremia and sepsis related to an episode of sickle cell crisis.

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Electron microscopy is still the most frequently used method for visualization of subcellular structures in spite of limitations due to the preparation required to visualize the specimen, High resolution X-ray microscopy is a relatively new technique, still under development and restricted to a few large synchrotron X-ray sources. We utilized a single-shot laser (nanosecond) plasma to generate X-rays similar to synchrotron facilities to image live cells of Candida albicans. The emission spectrum was tuned for optimal absorption by carbon-rich material. The photoresist was then scanned by an atomic force microscope to give a differential X-ray absorption pattern. Using this technique, with a sample image time of 90 min, we have visualized a distinct 152.24 nm thick consistent ring structure around cells of C albicans representing the cell wall, and distinct 'craters' inside, one of 570-90 nm diameter and three smaller ones, each 400 nm in diameter. This technique deserves further exploration concerning its application in the ultrastructural study of live, hydrated microbiological samples and of macromolecules.

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