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Background: Patient-reported outcome (PRO) measures have become an essential component of quality measurement, quality improvement, and capturing the voice of the patient in clinical care. In 2004, the National Institutes of Health endorsed the importance of PROs by initiating the Patient-Reported Outcomes Measurement Information System (PROMIS), which leverages computer-adaptive tests (CATs) to reduce patient burden while maintaining measurement precision. Historically, PROMIS CATs have been used in a large number of research studies outside the electronic health record (EHR), but growing demand for clinical use of PROs requires creative information technology solutions for integration into the EHR., Objectives: This paper describes the introduction of PROMIS CATs into the Epic Systems EHR at a large academic medical center using a tight integration; we describe the process of creating a secure, automatic connection between the application programming interface (API) which scores and selects CAT items and Epic., Methods: The overarching strategy was to make CATs appear indistinguishable from conventional measures to clinical users, patients, and the EHR software itself. We implemented CATs in Epic without compromising patient data security by creating custom middleware software within the organization's existing middleware framework. This software communicated between the Assessment Center API for item selection and scoring and Epic for item presentation and results. The middleware software seamlessly administered CATs alongside fixed-length, conventional PROs while maintaining the display characteristics and functions of other Epic measures, including automatic display of PROMIS scores in the patient's chart. Pilot implementation revealed differing workflows for clinicians using the software., Results: The middleware software was adopted in 27 clinics across the hospital system. In the first 2 years of hospital-wide implementation, 793 providers collected 70,446 PROs from patients using this system., Conclusion: This project demonstrated the importance of regular communication across interdisciplinary teams in the design and development of clinical software. It also demonstrated that implementation relies on buy-in from clinical partners as they integrate new tools into their existing clinical workflow., Competing Interests: The authors do not have any direct financial or personal relationships that conflict with the objectivity of this article's content. However, we wish to mention several indirect relationships. The HealthMeasures/PROMIS team which has supported K.N., N.E.R., M.B., and M.L is funded in part by Assessment Center API licensing fees. D.C. served as President of the PROMIS Health Organization in a noncompensated role. Z.B. is an employee of Phreesia, Inc. and receives equity in the company., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The analytic and numerical method for determining the desired gradient of dopant density in edge-pumped slabs, which also applies equally to end-pumped slabs, is presented. Both analytic and numerical calculations show that the method could be used to design composite slab and ceramic slab lasers that are both efficiently and uniformly pumped with either monochromatic or broad-band diode arrays.

Diode lasers used to pump high average power solid-state lasers typically have broad spectral width so that most of the pump light is not at the peak of the gain medium's absorption feature. The long absorption length in these lasers enables even weakly absorbed light to pump efficiently.

The conceptual and numerical difficulties in applying methods for calculating thermal-gradient-induced stress birefringence to crystalline laser media are discussed. The calculations of the stress-induced birefringence and depolarization loss in Yb:YAG slab lasers for both straight-through and zigzag propagation is presented.

Analytical expressions are described that generate expected trends and relative changes in laser performance over a broad range of temperatures.

A computational procedure that relies on commercially available optical ray tracing software is shown to accurately represent the performance of the crossed Porro prism laser resonator. Simulation techniques, developed to determine laser oscillation angles and output energies caused by intracavity misalignments, can be applied to more complex resonator configurations.

A study on Cr4+-doped yttrium aluminum garnet as an absorber medium for Nd lasers was conducted to derive more realistic values of ground state absorption and excited state absorption cross sections to serve as input parameters to the theory. The Z-scan technique was used to gauge both cross sections in several Cr4+-doped yttrium aluminum garnet samples at temperatures ranging from -60 degrees C to 98 degrees C. Results are discussed.

A rate-equation-based model that represents the behavior of a passively Q-switched solid-state laser containing an intracavity optical parametric oscillator (OPO) was developed. In such as a laser, there is not output at the fundamental or pump wavelength. When the OPO signal field begins to build up, it acts as a loss for the pump and, therefore, cavity dumps the pump resonator. The application of the model for a compact, lightweight, eye-safe, laser range finder operating at 1.54 microns is also presented.

A generalized design technique for passively Q-switched lasers optimizes the performance even when the saturable absorber shows ground as well as excited state absorption (ESA). The design approach is not only useful for determining resonator and Q-switch parameters, but also accurately accounts for the lasing material properties. The inclusion of ESA is important for predicting the dynamics of the absorber material as it gives rise to high-intensity absorptivity in the Q-switch during lasing. Application of the technique to an Nd:glass laser demonstrates its efficiency.