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Issue addressed: Health professionals have described barriers to providing carer smoking cessation support in children's wards. This article reports the findings of a research translation process that explored opportunities and developed pathways for change. Methods: A facilitated discussion workshop and scheduled stakeholder meetings were used to evaluate research evidence and translate it to an evidence‐informed organisational change process, with actions for implementation. Workshop and meeting participants were senior health staff with either a pharmacist, personnel with expertise in alcohol and other drugs, medical or nursing backgrounds, and who held senior managerial roles who worked in a hospital in the Northern Territory. A qualitative approach was used. The data from the workshop were transcribed and analysed using thematic analysis. The first author took notes for meetings that were not recorded and analysed these alongside the transcripts. Results: The process was able to initiate change to overcome barriers to providing carer smoking cessation support. All participants agreed to prioritise and make carer smoking cessation everybody's responsibility and supported a systematic approach, including provision of nicotine replacement therapy, new record‐keeping systems, and training to address staff knowledge deficits and skills gaps. This movement to solution‐focused change continued after the workshop. Conclusions: With some preparation, a research translation workshop and meetings with selected leaders can initiate organisational change in similar settings and is consistent with theories of planned change. So what?: This article describes the use of a process to support health promotion through new policies and practices following research which identified barriers in a hospital ward. [ABSTRACT FROM AUTHOR]

Objective: Develop and evaluate an interactive information visualization embedded within the electronic health record (EHR) by following human-centered design (HCD) processes and leveraging modern health information exchange standards.Materials and Methods: We applied an HCD process to develop a Fast Healthcare Interoperability Resources (FHIR) application that displays a patient's asthma history to clinicians in a pediatric emergency department. We performed a preimplementation comparative system evaluation to measure time on task, number of screens, information retrieval accuracy, cognitive load, user satisfaction, and perceived utility and usefulness. Application usage and system functionality were assessed using application logs and a postimplementation survey of end users.Results: Usability testing of the Asthma Timeline Application demonstrated a statistically significant reduction in time on task (P < .001), number of screens (P < .001), and cognitive load (P < .001) for clinicians when compared to base EHR functionality. Postimplementation evaluation demonstrated reliable functionality and high user satisfaction.Discussion: Following HCD processes to develop an application in the context of clinical operations/quality improvement is feasible. Our work also highlights the potential benefits and challenges associated with using internationally recognized data exchange standards as currently implemented.Conclusion: Compared to standard EHR functionality, our visualization increased clinician efficiency when reviewing the charts of pediatric asthma patients. Application development efforts in an operational context should leverage existing health information exchange standards, such as FHIR, and evidence-based mixed methods approaches. [ABSTRACT FROM AUTHOR]

Objective: To develop a process for translating semi-structured clinical decision support (CDS) into shareable, computer-readable CDS.Materials and Methods: We developed a systematic and transparent process using publicly available tools (eGLIA, GEM Cutter, VSAC, and the CDS Authoring Tool) to translate an evidence-based clinical pathway (CP) into a Clinical Quality Language (CQL)-encoded CDS artifact.Results: We produced a 4-phase process for translating a CP into a CQL-based CDS artifact. CP content was extracted using GEM into discrete clinical concepts, encoded using standard terminologies into value sets on VSAC, evaluated against workflows using a wireframe, and finally structured as a computer readable CDS artifact using CQL. This process included a quality control step and intermediate products to support transparency and reuse by other CDS developers.Discussion: Translating a CP into a shareable, computer-readable CDS artifact was accomplished through a systematic process. Our process identified areas of ambiguity and gaps in the CP, which generated improvements in the CP. Collaboration with clinical subject experts and the CP development team was essential for translation. Publicly available tools were sufficient to support most translation steps, but expression of certain complex concepts required manual encoding.Conclusion: Standardized development of CDS from a CP is feasible using a systematic 4-phase process. CPs represent a potential reservoir for developers of evidence-based CDS. Aspects of CP development simplified portions of the CDS translation process. Publicly available tools can facilitate CDS development; however, enhanced tool features are needed to model complex CDS statements. [ABSTRACT FROM AUTHOR]

Over the past few decades, our knowledge of jets produced by active galactic nuclei (AGN) has greatly progressed thanks to the development of very-long-baseline interferometry (VLBI). Nevertheless, the crucial mechanisms involved in the formation of the plasma flow, as well as those driving its exceptional radiative output up to TeV energies, remain to be clarified. Most likely, these physical processes take place at short separations from the supermassive black hole, on scales which are inaccessible to VLBI observations at centimeter wavelengths. Due to their high synchrotron opacity, the dense and highly magnetized regions in the vicinity of the central engine can only be penetrated when observing at shorter wavelengths, in the millimeter and sub-millimeter regimes. While this was recognized already in the early days of VLBI, it was not until the very recent years that sensitive VLBI imaging at high frequencies has become possible. Ongoing technical development and wide band observing now provide adequate imaging fidelity to carry out more detailed analyses. In this article, we overview some open questions concerning the physics of AGN jets, and we discuss the impact of mm-VLBI studies. Among the rich set of results produced so far in this frequency regime, we particularly focus on studies performed at 43 GHz (7 mm) and at 86 GHz (3 mm). Some of the first findings at 230 GHz (1 mm) obtained with the Event Horizon Telescope are also presented. [ABSTRACT FROM AUTHOR]

One century ago Viktor Hess carried out several balloon flights that led him to conclude that the penetrating radiation responsible for the discharge of electroscopes was of extraterrestrial origin. One century from the discovery of this phenomenon seems to be a good time to stop and think about what we have understood about Cosmic Rays. The aim of this review is to illustrate the ideas that have been and are being explored in order to account for the observable quantities related to cosmic rays and to summarize the numerous new pieces of observation that are becoming available. In fact, despite the possible impression that development in this field is somewhat slow, the rate of new discoveries in the last decade or so has been impressive, and mainly driven by beautiful pieces of observation. At the same time scientists in this field have been able to propose new, fascinating ways to investigate particle acceleration inside the sources, making use of multifrequency observations that range from the radio, to the optical, to X-rays and gamma rays. These ideas can now be confronted with data. I will mostly focus on supernova remnants as the most plausible sources of Galactic cosmic rays, and I will review the main aspects of the modern theory of diffusive particle acceleration at supernova remnant shocks, with special attention for the dynamical reaction of accelerated particles on the shock and the phenomenon of magnetic field amplification at the shock. Cosmic-ray escape from the sources is discussed as a necessary step to determine the spectrum of cosmic rays at the Earth. The discussion of these theoretical ideas will always proceed parallel to an account of the data being collected especially in X-ray and gamma-ray astronomy. In the end of this review I will also discuss the phenomenon of cosmic-ray acceleration at shocks propagating in partially ionized media and the implications of this phenomenon in terms of width of the Balmer line emission. This field of research has recently experienced a remarkable growth, in that Hα lines have been found to bear information on the cosmic-ray acceleration efficiency of supernova shocks. [ABSTRACT FROM AUTHOR]