High-Power Growth-Robust InGaAs/InAlAs Terahertz Quantum Cascade Lasers.

We report on high-power terahertz quantum cascade lasers based on low effective electron mass InGaAs/InAlAs semiconductor heterostructures with excellent reproducibility. Growth-related asymmetries in the form of interface roughness and dopant migration play a crucial role in this material system. These bias polarity dependent phenomena are studied using a nominally symmetric active region resulting in a preferential electron transport in the growth direction.

Spectrally resolved far-fields of terahertz quantum cascade lasers.

We demonstrate a convenient and fast method to measure the spectrally resolved far-fields of multimode terahertz quantum cascade lasers by combining a microbolometer focal plane array with an FTIR spectrometer. Far-fields of fundamental TM0 and higher lateral order TM1 modes of multimode Fabry-Pérot type lasers have been distinguished, which very well fit to the results obtained by a 3D finite-element simulation. Furthermore, multimode random laser cavities have been investigated, analyzing the contribution of each single laser mode to the total far-field.

Controlled Generation of a p-n Junction in a Waveguide Integrated Graphene Photodetector.

With its electrically tunable light absorption and ultrafast photoresponse, graphene is a promising candidate for high-speed chip-integrated photonics. The generation mechanisms of photosignals in graphene photodetectors have been studied extensively in the past years. However, the knowledge about efficient light conversion at graphene p-n junctions has not yet been translated into high-performance devices.

Variation in high-priority drug-drug interaction alerts across institutions and electronic health records.

Objective: The United States Office of the National Coordinator for Health Information Technology sponsored the development of a "high-priority" list of drug-drug interactions (DDIs) to be used for clinical decision support. We assessed current adoption of this list and current alerting practice for these DDIs with regard to alert implementation (presence or absence of an alert) and display (alert appearance as interruptive or passive).

Materials And Methods: We conducted evaluations of electronic health records (EHRs) at a convenience sample of health care organizations across the United States using a standardized testing protocol with simulated orders.

A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems.

Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.

Problem list completeness in electronic health records: A multi-site study and assessment of success factors.

Objective: To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness.

Methods: We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United Kingdom, and Argentina who use a variety of electronic health record systems: four self-developed and six commercial. At each site, we assessed the proportion of patients who have diabetes recorded on their problem list out of all patients with a hemoglobin A1c elevation>=7.

A Metrics Taxonomy and Reporting Strategy for Rule-Based Alerts.

An action-oriented alerts taxonomy according to structure, actions, and implicit intended process outcomes using a set of 333 rule-based alerts at Kaiser Permanente Northwest (KPNW) was developed. The authors identified 9 major and 17 overall classes of alerts and developed a specific metric approach for 5 of these classes, including the 3 most numerous ones in KPNW, accounting for 224 (67%) of the alerts.

Coupled cavity terahertz quantum cascade lasers with integrated emission monitoring.

We demonstrate the on-chip generation and detection of terahertz radiation in coupled cavity systems using a single semiconductor heterostructure. Multiple sections of a terahertz quantum cascade laser structure in a double-metal waveguide are optically coupled and operate either as a laser or an integrated emission monitor. A detailed analysis of the photon-assisted carrier transport in the active region below threshold reveals the detection mechanism for photons emitted by the very same structure above threshold.

Subwavelength micropillar array terahertz lasers.

We report on micropillar-based terahertz lasers with active pillars that are much smaller than the emission wavelength. These micropillar array lasers correspond to scaled-down band-edge photonic crystal lasers forming an active photonic metamaterial. In contrast to photonic crystal lasers which use significantly larger pillar structures, lasing emission is not observed close to high-symmetry points in the photonic band diagram, but in the effective medium regime.

Use of order sets in inpatient computerized provider order entry systems: a comparative analysis of usage patterns at seven sites.

Background: Many computerized provider order entry (CPOE) systems include the ability to create electronic order sets: collections of clinically related orders grouped by purpose. Order sets promise to make CPOE systems more efficient, improve care quality and increase adherence to evidence-based guidelines. However, the development and implementation of order sets can be expensive and time-consuming and limited literature exists about their utilization.

Order sets in computerized physician order entry systems: an analysis of seven sites.

Most computerized physician order entry (CPOE) systems have built-in support for order sets (collections of orders grouped by a clinical purpose). Evidence and experience suggest that order sets are important tools for ordering efficiency and decision support and may influence ordering. Developing and maintaining order sets is costly, so hospitals often must prioritize which order sets can be created.

Reducing warfarin medication interactions: an interrupted time series evaluation.

Background: Computerized decision support reduces medication errors in inpatients, but limited evidence supports its effectiveness in reducing the coprescribing of interacting medications, especially in the outpatient setting. The usefulness of academic detailing to enhance the effectiveness of medication interaction alerts also is uncertain.

Methods: This study used an interrupted time series design.

A survey of factors affecting clinician acceptance of clinical decision support.

Background: Real-time clinical decision support (CDS) integrated into clinicians' workflow has the potential to profoundly affect the cost, quality, and safety of health care delivery. Recent reports have identified a surprisingly low acceptance rate for different types of CDS. We hypothesized that factors affecting CDS system acceptance could be categorized as relating to differences in patients, physicians, CDS-type, or environmental characteristics.

Emotional aspects of computer-based provider order entry: a qualitative study.

Objectives: Computer-based provider order entry (CPOE) systems are implemented to increase both efficiency and accuracy in health care, but these systems often cause a myriad of emotions to arise. This qualitative research investigates the emotions surrounding CPOE implementation and use.

Methods: We performed a secondary analysis of several previously collected qualitative data sets from interviews and observations of over 50 individuals.

How to design computerized alerts to safe prescribing practices.

Background: Medication errors and preventable adverse drug events are common, and about half of medication errors occur during medication ordering. This study was designed to develop and evaluate medication safety alerts and processes for educating prescribers about the alerts.

Methods: At Kaiser Permanente Northwest, a group-model health maintenance organization where prescribers have used computerized order entry since 1996, qualitative interviews were conducted with 20 primary care prescribers.

Effectiveness of an electronic medical record clinical quality alert prepared by off-line data analysis.

We tested whether off-line data analysis, instead of event monitoring, was a viable method for initiating a clinical quality alert. A cohort of patients eligible for an alert was identified by off-line data analysis and a flag was set in their ambulatory Electronic Medical Records. One hundred clinicians were randomly assigned either to a control group or to a group that received the alert when viewing the electronic medical record of eligible patients.

Clinician's assessments of outpatient electronic medical record alert and reminder usability and usefulness requirements.

Electronic medical record alerts and reminders are increasingly employed as a means of decreasing medical errors and increasing the quality and cost-effectiveness of care. However, clinicians indicate that alerts and reminders can be either help or hindrance. Discerning the elements that determine which they will be, and the requirements of a helpful alert or reminder, was the focus of this study.