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Introduction: Despite the lack of high-quality evidence regarding its long-term effectiveness, intravenous corticosteroid therapy is recommended as the standard treatment of acute multiple sclerosis relapses in Germany. High financial expenses and the equivalent effectiveness of oral corticosteroid therapy contrast with this trend. There is an urgent need to provide patients with evidence-based and comprehensible information on relapse management and to actively involve patients in relapse treatment decisions. Web-based decision support on relapse management could be an effective measure to empower people with multiple sclerosis making informed treatment decisions., Objectives: To develop a web-based programme on relapse management for people with multiple sclerosis and evaluate the feasibility and acceptability of the intervention., Methods: The study followed the first two phases of the UK Medical Research Council Framework for complex interventions. The first phase involved the development of an interactive web-based programme on relapse management. The second phase focused on the feasibility and pilot testing of the programme with people with multiple sclerosis and experts with a professional background in multiple sclerosis. Data was obtained using questionnaires with closed- and open-ended questions as well as qualitative semi-structured telephone interviews. Quantitative data was analyzed descriptively, whereas qualitative data was clustered by topic., Results: Feasibility of the intervention programme was tested with 10 people with multiple sclerosis and 10 experts. Feasibility testing indicated good practicability and acceptance of the content. After revision, the programme was piloted with seven people with multiple sclerosis and three experts. The results showed good acceptance in both groups. Based on the feedback, a final revision was performed., Conclusion: Feasibility and pilot testing indicated good user-friendliness, acceptance, and practicability of the programme. The programme is currently evaluated in a randomized controlled trial (Registration Number on ClinicalTrials.gov: NCT04233970). It is expected that the programme will have a positive impact on patients' relapse management and strengthen their autonomy and participation., Competing Interests: Author CH has received research grants, speaker honoraria, and travel grants from Biogen, Celgene, Genzyme, Roche, and Merck. Authors FT and BM are employed at GAIA AG, the company that developed and operates the intervention described in this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wenzel, Heesen, Peper, Grentzenberg, Faßhauer, Scheiderbauer, Thale, Meyer, Köpke and Rahn.)

Background: Multiple sclerosis treatment options are increasing. Evidence-based patient information (EBPI) are therefore crucial to enable patient involvement in decision making. Based on earlier work on decision support, patient information handbooks on 8 MS immunotherapies were developed, piloted and evaluated with support from the German Clinical Competence Network MS and the German MS Society., Methods: Handbooks were structured according to EBPI concepts. Drafts were commented by patient representatives and neurologists with an MS expertise. Executive boards of the German MS Society and the Competence Network as well as pharmaceutical companies' feedback was included. Handbooks were distributed among MS neurologists by the German MS Society. Evaluation followed applying a mixed methods approach with interviews, focus groups and surveys. One survey addressed persons with MS (pwMS) based on a questionnaire included in each handbook. Neurologists who received printed patient handbooks were invited to give feedback in a second survey., Results: Eight handbooks were developed providing absolute and relative risk information in numbers and figures as well as monitoring needs and drug fact boxes. Despite the high amount of information and the display of low absolute risk reduction rates of treatments, handbooks were overall appreciated by pwMS (n=107) and mostly also by physicians (n=24). For more than 70% of the pwMS the information was new, understandable and supportive for decision making. But patients felt uncomfortable with relative risk information. However, response rates in the evaluation were low, exposing the challenges when implementing EBPI into clinical care. Therefore, conclusions must be considered preliminary., Conclusion: EBPI on immunotherapies for MS seem feasible and are appreciated by patients and treating neurologists but more implementation research is needed., (Copyright © 2022. Published by Elsevier B.V.)

Background: In May 2021, a new guideline on the diagnosis and treatment of multiple sclerosis and related disorders was released in Germany. Since the success of a guideline depends on how it integrates into everyday clinical practice, the German Society for Neurology (DGN) has launched a multimethod implementation project. Here we report on the results based on the consultation version of the guideline., Methods: We used qualitative and quantitative data analyses to capture the nature and extent of barriers and facilitating factors to the implementation. We centered on the guideline's chapter A on diagnosis, relapse therapy, and immunotherapy of multiple sclerosis. We performed nine online focus group discussions and a web-based survey and analyzed emails and letters with comments from stakeholders and independent parties that were sent spontaneously or by invitation., Results: 94 neurologists answered the survey, and ≥70% agreed with the recommendations of the guideline on each major content topic. Barriers to implementation were detected in group discussions and written input. The most controversial issues of the guideline were "early treatment", "criteria for starting or switching therapy", "stepwise escalation versus early aggressive treatment", "classification of drugs into three categories of efficacy" and the scenarios on "treatment cessation". Some appreciated the highly structured recommendations, but others felt that the guideline restricts the free choice of therapy, or they were afraid of recourse claims. Some considered the guideline as too cautious regarding treatment initiation, possibly delaying necessary therapies. Others appreciated that conflicts of interests of the guideline's authoring group were minimized and thought that the new guideline is clearer, more extensive and practical., Conclusion: In contrast to the survey, feedback in the focus group discussions and from individuals was diverse and sometimes more critical. Based on the overall feedback rate of about 250 people in relation to the number of 6500 board-certified neurologists in Germany, the overall appreciation of the guideline can only be considered as an indicator and not proof of acceptance. Results of this analysis were incorporated into several adjustments to the final guideline of 2021. Since the guideline is to be updated regularly under the auspices of a "living guideline", active interaction with users will continue to matter and help to improve it., (Copyright © 2021. Published by Elsevier B.V.)

Auger-Meitner processes are electronic decay processes of energetically low-lying vacancies. In these processes, the vacancy is filled by an electron of an energetically higher lying orbital, while another electron is simultaneously emitted to the continuum. In low-lying orbitals, relativistic effects can not, even for light elements, be neglected. At the same time, lifetime calculations are computationally expensive. In this context, we investigate which effect spin-orbit coupling has on Auger-Meitner decay widths and aim for a rule of thumb for the relative decay widths of initial states split by spin-orbit coupling. We base this rule of thumb on Auger-Meitner decay widths of Sr4p -1 and Ra6p -1 obtained by relativistic FanoADC-Stieltjes calculations and validate it against Auger-Meitner decay widths from the literature.

DIRAC is a freely distributed general-purpose program system for one-, two-, and four-component relativistic molecular calculations at the level of Hartree-Fock, Kohn-Sham (including range-separated theory), multiconfigurational self-consistent-field, multireference configuration interaction, electron propagator, and various flavors of coupled cluster theory. At the self-consistent-field level, a highly original scheme, based on quaternion algebra, is implemented for the treatment of both spatial and time reversal symmetry. DIRAC features a very general module for the calculation of molecular properties that to a large extent may be defined by the user and further analyzed through a powerful visualization module. It allows for the inclusion of environmental effects through three different classes of increasingly sophisticated embedding approaches: the implicit solvation polarizable continuum model, the explicit polarizable embedding model, and the frozen density embedding model.

A theoretical framework for understanding molecular structures is crucial for the development of new technologies such as catalysts or solar cells. Apart from electronic excitation energies, however, only spectroscopic properties of molecules consisting of lighter elements can be computationally described at a high level of theory today since heavy elements require a relativistic framework, and thus far, most methods have only been derived in a non-relativistic framework. Important new technologies such as those mentioned above require molecules that contain heavier elements, and hence, there is a great need for the development of relativistic computational methods at a higher level of accuracy. Here, the Second-Order-Polarization-Propagator-Approximation (SOPPA), which has proven to be very successful in the non-relativistic case, is adapted to a relativistic framework. The equations for SOPPA are presented in their most general form, i.e., in a non-canonical spin-orbital basis, which can be reduced to the canonical case, and the expressions needed for a relativistic four-component SOPPA are obtained. The equations are one-index transformed, giving more compact expressions that correspond to those already available for the four-component RPA. The equations are ready for implementation in a four-component quantum chemistry program, which will allow both linear response properties and excitation energies to be calculated relativistically at the SOPPA level.

Atoms and molecules attached to rare-gas clusters are ionized by an interatomic autoionization process traditionally termed "Penning ionization" when the host cluster is resonantly excited. Here we analyze this process in the light of the interatomic Coulombic decay (ICD) mechanism, which usually contains a contribution from charge exchange at a short interatomic distance and one from virtual photon transfer at a large interatomic distance. For helium (He) nanodroplets doped with alkali metal atoms (Li, Rb), we show that long-range and short-range contributions to the interatomic autoionization can be clearly distinguished by detecting electrons and ions in coincidence. Surprisingly, ab initio calculations show that even for alkali metal atoms floating in dimples at a large distance from the nanodroplet surface, autoionization is largely dominated by charge-exchange ICD. Furthermore, the measured electron spectra manifest the ultrafast internal relaxation of the droplet mainly into the 1s2s 1 S state and partially into the metastable 1s2s 3 S state.

Electronic decay processes of ionized systems are, for example, the Auger decay or the Interatomic/ Intermolecular Coulombic Decay. In both processes, an energetically low lying vacancy is filled by an electron of an energetically higher lying orbital and a secondary electron is instantaneously emitted to the continuum. Whether or not such a process occurs depends both on the energetic accessibility and the corresponding lifetime compared to the lifetime of competing decay mechanisms. We present a realization of the non-relativistically established FanoADC-Stieltjes method for the description of autoionization decay widths including relativistic effects. This procedure, being based on the Algebraic Diagrammatic Construction (ADC), was adapted to the relativistic framework and implemented into the relativistic quantum chemistry program package Dirac. It is, in contrast to other existing relativistic atomic codes, not limited to the description of autoionization lifetimes in spherically symmetric systems, but is instead also applicable to molecules and clusters. We employ this method to the Auger processes following the Kr3d(-1), Xe4d(-1), and Rn5d(-1) ionization. Based on the results, we show a pronounced influence of mainly scalar-relativistic effects on the decay widths of autoionization processes.

In this work we investigate interatomic electronic decay processes taking place in mixed argon-xenon clusters upon the inner-valence ionization of an argon center. We demonstrate that both interatomic Coulombic decay and electron-transfer mediated decay (ETMD) are important in larger rare gas clusters as opposed to dimers. Calculated secondary electron spectra are shown to depend strongly on the spin-orbit coupling in the final states of the decay as well as the presence of polarizable environment. It follows from our calculations that ETMD is a pure interface process taking place between the argon-xenon layers. The interplay of all these effects is investigated in order to arrive at a suitable physical model for the decay of inner-valence vacancies taking place in mixed ArXe clusters.

Electronic decay of the inner-valence Ar 3s(-1) vacancy is energetically forbidden in an isolated argon atom and in all rare gas dimers where argon is present. However, if an argon atom has at least two suitable rare gas atoms in its neighborhood, the Ar 3s(-1) vacancy may decay electronically via an electron transfer mediated decay (ETMD) mechanism. An ArXe(2) cluster is considered in the present paper as an example of such systems. The single and double ionization spectra of different ArXe(2) isomers as well as of homonuclear Ar(2) and Xe(2) and heteronuclear ArXe clusters have been calculated by means of propagator methods to reveal possible electronic decay channels. A four-component version of the one-particle propagator utilizing the Dirac-Coulomb Hamiltonian was employed to obtain the single ionization potentials of the clusters studied. Hereby electron correlation, scalar relativistic effects, and spin-orbit couplings are described in a consistent manner. A two-particle propagator in its one-component form, in conjunction with effective core potentials to account consistently for correlation and scalar relativistic effects, was used to calculate the double ionization potentials. ETMD is shown to be the only possible electronic decay process of the Ar 3s(-1) vacancy in the ArXe(2) cluster. In clusters with more Xe atoms, alternative electronic decay mechanisms may appear.