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Abstract Background Practice-based research networks (PBRNs) have been implemented to support clinical research in German general practice since 2020. General practitioners (GPs) are often critical concerning the feasibility of clinical trials. Among others, high workload, lack of resources in GP teams and little acceptance of the trial requirements by the patients are assumed barriers. Therefore, the aim of this study was to evaluate the perspectives of the GP teams and their patients on the set up of BayFoNet during the implementation of the two pilot cluster-randomized trials to improve this collaboration on a sustainable basis. Methods GPs and medical assistants (MAs) were interviewed using semi-structured interviews based on the Consolidated Framework for Implementation Research. Implementation research and verbatim transcripts were analyzed using qualitative content analysis. Patient attitudes were evaluated quantitatively with questionnaires based on the theoretical domains framework using descriptive statistics. Results A total of 15 GPs and 15 MAs were interviewed, and 109 complete patient questionnaires were returned. Main facilitators for GPs’ active participation in clinical research were networking as well as active participation of GP teams at different levels of the research process. Increased awareness concerning PBRNs might promote a lively network. From the GPs’ perspective, lack of motivation among MAs and patients was a perceived barrier to support clinical research in general practice. MAs emphasized their own increase in knowledge and competence as well as the importance of clinical research for improved patient care. In contrast to the GPs, most MAs were not aware of BayFoNet as a network structure. The surveyed patients rated their own capabilities and opportunities to actively participate in the pilot studies as very good. Prior to the implementations of the interventions, some patients experienced some difficulty in defining clear goals for their own participation. Discussion Increased awareness concerning PBRNs might promote a lively network. Target-group specific dissemination strategies as well as opportunities for GP teams and their patients to participate in clinical research should be elaborated. This might increase the feasibility of clinical trials and the motivation of all participants to conduct clinical trials in general practice. Trial registration Pilot cluster-randomized trial 1 (MicUTI) was prospectively registered on December 19, 2022 at www.clinicaltrials.gov (NCT05667207); Pilot cluster-randomized trial 2 (IMONEDA) was prospectively registered on April 22, 2022 at www.bfarm.de (DRKS00028805).

Abstract Background Long-lasting symptoms with a possible relation to psychosomatic comorbidity have been described following COVID-19. However, data is sparse in general practice. The trial’s objective was to investigate the time-dependent frequency of disease symptoms and relation to psychosomatic comorbidity and daily life impairment (DLI). Methods Comparative cohort study of patients reporting a previous SARS-CoV-2 infection and uninfected controls in general practice. Participants were recruited in 14 general practices in the greater Munich area. Data collection was questionnaire based with a 12 months follow-up. Descriptive statistics, multivariable regression and bivariate correlations were used for analysis. Results A total of n = 204 cases infected up to 42 months ago (n = 141 Omicron, n = 63 earlier variants), and n = 119 controls were included. Disease symptoms were substantially more prevalent in cases (55–79% vs. 43% within one year of infection). This difference also appeared in the multivariable analysis adjusting for socio-demographics and psychosomatic comorbidity with odds ratios (OR) of 4.15 (p

Abstract Background Despite general practitioners' (GPs') key role in Germany`s primary health care, clinical research in general practice is scarce. Clinical research is mainly conducted at inpatient facilities, although their results are rarely transferable. German GPs have no extra time or funding for research, as well as limited research training. To support clinical research in German primary health care, practice-based research networks (PBRNs) are developed. As they will be based on an active involvement of GPs, we need more information on GPs` participation-readiness. The aim of this study was to explore facilitators and barriers to participation in the Bavarian Research Practice Network (BayFoNet) from the GPs`perspective before clinical trials will be performed. Methods We have performed semi-structured qualitative interviews with a purposive sample of 20 Bavarian GPs in 2022 under the application of the consolidated framework for implementation research (CFIR). Transcriptions were analysed according to Kuckartz` qualitative content analysis. The five domains of the CFIR framework served as initial deductive codes. Results N = 14 interviewees already agreed to participate in BayFoNet, whereas n = 6 interviewees opted not to participate in BayFoNet at the time of data collection. Main facilitators to conduct clinical research within BayFoNet were the motivation to contribute to evidence strength and quality in general practice, professional development and training of practice staff, as well as networking. Barriers for an active participation were bad experiences with previous clinical studies and lack of resources. Conclusions PBRNS in Germany have to be promoted and the entire practice team has to be involved at an early stage of development. Professional training of general practice staff and a living network might enhance engagement. Participatory approaches could help to develop acceptable and feasible study designs. Furthermore, PBRNs should support patient recruitment and data collection in general practices and disseminate the results of their research projects regularly to maintain GPs` engagement. Trial registration DRKS00028805, NCT05667207.

Digital interventions with artificial intelligence (AI) can potentially support people with asthma to reduce the risk of exacerbation. Engaging patients throughout the development process is essential to ensure usability of the intervention for the end-users. Using our Connected for Asthma (C4A) intervention as an exemplar, we explore how patient involvement can shape a digital intervention. Seven Patient and Public Involvement (PPI) colleagues from the Asthma UK Centre for Applied Research participated in four advisory workshops to discuss how they would prefer to use/interact with AI to support living with their asthma, the benefit and caveats to use the AI that incorporated asthma monitoring and indoor/outdoor environmental data. Discussion focussed on the three most wanted use cases identified in our previous studies. PPI colleagues wanted AI to support data collection, remind them about self-management tasks, teach them about asthma environmental triggers, identify risk, and empower them to confidently look after their asthma whilst emphasising that AI does not replace clinicians. The discussion informed the key components in the next C4A interventions, including the approach to interacting with AI, the technology features and the research topics. Attendees highlighted the importance of considering health inequities, the presentation of data, and concerns about data accuracy, data privacy, security and ownership. We have demonstrated how patient roles can shift from that of 'user' (the traditional 'tester' of a digital intervention), to a co-design partner who shapes the next iteration of the intervention. Technology innovators should seek practical and feasible strategies to involve PPI colleagues throughout the development cycle of a digital intervention; supporting researchers to explore the barriers, concerns, enablers and advantages of implementing digital healthcare.

Introduction Uncomplicated urinary tract infections (uUTIs) in women are common infections encountered in primary care. Evidence suggests that rapid point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to identify women with uUTIs in whom antibiotics can be withheld without influencing clinical outcomes. This pilot study aims to provide preliminary evidence on whether a POCT informed management of uUTI in women can safely reduce antibiotic use.Methods and analysis This is an open-label two-arm parallel cluster-randomised controlled pilot trial. 20 general practices affiliated with the Bavarian Practice-Based Research Network (BayFoNet) in Germany were randomly assigned to deliver patient management based on POCTs or to provide usual care. POCTs consist of phase-contrast microscopy to detect bacteria and urinary dipsticks to detect erythrocytes in urine samples. In both arms, urine samples will be obtained at presentation for POCTs (intervention arm only) and microbiological analysis. Women will be followed-up for 28 days from enrolment using self-reported symptom diaries, telephone follow-up and a review of the electronic medical record. Primary outcomes are feasibility of patient enrolment and retention rates per site, which will be summarised by means and SDs, with corresponding confidence and prediction intervals. Secondary outcomes include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, number of recurrent and upper UTIs and re-consultations and diagnostic accuracy of POCTs versus urine culture as the reference standard. These outcomes will be explored at cluster-levels and individual-levels using descriptive statistics, two-sample hypothesis tests and mixed effects models or generalised estimation equations.Ethics and dissemination The University of Würzburg institutional review board approved MicUTI on 16 December 2022 (protocol n. 109/22-sc). Study findings will be disseminated through peer-reviewed publications, conferences, reports addressed to clinicians and the local citizen’s forums.Trial registration number ClinicalTrials.gov NCT05667207.

Abstract Background Asthma education programs (AEPs) have been shown to increase quality of life and reduce emergency treatments and hospital admissions. Despite the proven benefits, only a minority of asthma patients attend such programs. To increase the number of educated patients, an online education program (electronic AEP, eAEP) for asthma patients has been developed. The present study aims to investigate the effectiveness of the eAEP in terms of asthma knowledge, asthma control and emergency treatments in general practice settings. Methods This is a cluster randomized controlled trial including 100 patients with bronchial asthma from 20 general practices in Bavaria, Germany. General practices will be randomly assigned to either the intervention or control group. Patients in the intervention group will receive access to the eAEP and instructions to complete this program within two weeks. Patients in the control group will receive usual care including a referral to face-to-face AEP (fAEP) by a certified primary care physician or a pulmonologist according to guideline recommendations. Furthermore, patients of both the intervention and control groups will be invited to a follow-up consultation in their general practice after completion of the eAEP and fAEP (three weeks and twelve weeks after study inclusion, respectively) to discuss any open issues. Outcomes for both groups will be assessed at baseline (t0), after two weeks (t1), three months (t2) and six months (t3). The primary outcome is the comparison of asthma knowledge gain between intervention and control groups after completion of the eAEP (two weeks after study inclusion) and fAEP (twelve weeks after study inclusion), respectively. Secondary outcomes include asthma control, frequency of emergency treatments, patient autonomy as well as attitudes towards asthma medication. Discussion The results of the present trial will provide knowledge about the effectiveness of an online education program for asthma patients compared to usual care in primary care. Trial registration German Clinical Trials Register (DRKS), DRKS00028805 . Registered 22 April 2022.

Introduction General practitioners often criticise clinical trials for their poor applicability in primary care, which may at least partially explain why their engagement in primary care research remains limited. In order to enhance primary care research, the German government has funded six regional practice based research networks (PBRNs). Within the Bavarian PBRN (BayFoNet), two cluster-randomised pilot trials will be conducted. This paper presents the protocol of the process evaluation accompanying both trials, which aims to explore relevance, feasibility, acceptability and credibility of clinical research in primary care from the perspectives of BayFoNet researchers, general practitioners, and patients.Methods and analysis The BayFoNet will be established by recruiting general practices (GPs) as prospective research collaborators in two cluster randomised pilot trials. Research teams will provide training in good clinical practice, and support practices in patient recruitment, data collection and documentation. Our process evaluation explores barriers and facilitators in the set up of the BayFoNet PBRN and both cluster randomised pilot trials, under the application of the consolidated framework for implementation research and the theoretical domains framework. In a mixed-methods concept, we will use qualitative and quantitative approaches to evaluate both pilot cluster-randomised trials as well as the BayFoNet itself: focus groups with researchers, semi-structured interviews with general practitioners and questionnaires for patients participating in the pilot cluster-randomised trials at three different time points.Ethics and dissemination Research ethical approval for this study was granted by the Ethics Committee of the Medical Department, Ludwig-Maximilians-University Munich (AZ 21-1135). Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as other PBRNs, GP teams and patients.Trial registration numbers DRKS00028805, NCT05667207.

ABSTRACT Objectives The aim of this in vitro study was to investigate whether and to what extent different scenarios of rotational freedom in different IAC designs affect the vertical dimension of a three‐part fixed partial denture (FPD). At the same time, the experimental setup should simulate all clinical and laboratory steps of the implementation of such an FPD as accurately as possible. Material and Methods Twenty identical pairs of jaw models were fabricated from aluminum, each lower‐jaw model holding two implants with conical or flat IACs. Three impressions of each model were taken to fabricate stone casts and three‐unit FPDs. Three assembly scenarios were compared for the vertical position stability they offered for these FPDs, differing by how the sequential implant components (impression posts > laboratory analogs > abutments 1 > abutments 2) were aligned with the positional index of the IAC. In this way, a total of 60 stone casts and FPDs were fabricated and statistically analyzed for changes in vertical dimension (p 0.05), significantly greater mean changes in vertical dimension were consistently (all comparisons p

Contrary to other semiconductor alloys, incorporation of Ag into CuGaSe2 increases the bandgap, even though the lattice expands, and the Ga–Se bond length is theoretically predicted to decrease rather than increase. Herein, we experimentally confirm this peculiar bond length dependence of (Ag,Cu)GaSe2 using x-ray absorption spectroscopy. We further model the different anion displacements and estimate that their combined contribution to the bandgap bowing is close to zero. These findings differ from those for Cu(In,Ga)Se2 and demonstrate the diversity of chalcopyrite alloys and their properties.

The chalcopyrite alloy (Ag,Cu)(In,Ga)Se _2 is a highly efficient thin film solar cell absorber, reaching record efficiencies above 23%. Recently, a peculiar behavior in the bond length dependence of (Ag,Cu)GaSe _2 was experimentally proven. The common cation bond length, namely Ga–Se, decreases with increasing Ag/(Ag + Cu) ratio even though the crystal lattice expands. This is opposite to the behavior observed for Cu(In,Ga)Se _2 , where all bond lengths increase with increasing lattice size. To better understand this peculiar bond length behavior, element-specific bond lengths of (Ag,Cu)InSe _2 and Ag(In,Ga)Se _2 alloys are determined using extended x-ray absorption fine structure spectroscopy. They show that the peculiar bond length dependence occurs only for (Ag,Cu) alloys, independent of the species of common cation (In or Ga). The bond lengths are used to determine the anion displacements and to estimate their contribution to the bandgap bowing. Again, both behaviors differ significantly depending on the type of alloyed cation. A valence force field approach, relaxing bond lengths and bond angles, is used to describe the structural distortion energy for a comprehensive set of I–III–VI _2 and II–IV–V _2 chalcopyrites. The model reveals bond angle distortions as main driving factor for the tetragonal distortion and reproduces the literature values with less than 10% deviation. In contrast, the peculiar bond length dependence is not reproduced, demonstrating that it originates from electronic effects beyond the scope of this structural model. Thus, a fundamental understanding of bond length behavior and tetragonal distortion is achieved for chalcopyrite materials, benefiting their technological applications such as high efficiency thin film photovoltaics.

Vanadium doped indium sulphide, In _2 S _3 :V, is studied as a potential absorber material for intermediate band (IB) solar cells. Based on electronic considerations, it is usually assumed that V occupies octahedrally coordinated In sites, although geometrical considerations would favour tetrahedral In sites. In this study, we therefore combined experimental x-ray diffraction and x-ray absorption spectroscopy with ab initio theoretical calculations of both $\mathrm{\alpha}$ and $\mathrm{\beta}$ phase to elucidate the incorporation of V in In _2 S _3 :V thin films grown with different V content and different growth temperatures. Comparing shape and position of the measured and calculated x-ray absorption edge of V, comparing experimentally determined and calculated V–S bond lengths, and evaluating the calculated heat of solution of V on different lattice sites all indicate that V is incorporated on octahedral rather than tetrahedral sites in the In _2 S _3 matrix. For this material system, the electronic benefit of octahedral coordination thus outweighs the mechanical stress of the associated lattice relaxation. Finally, we studied the electronic structure of V-substituted $\mathrm{\alpha}$ - $\mathrm{In_2S_3}$ using hybrid density functional calculations and find that for a concentration of 1.9 at %, V on octahedrally coordinated In sites forms an empty IB isolated from valence band and conduction band (CB). By increasing the V content to 3.8 at %, however, the gap between IB and CB closes, which results in a reduction of the band gap. This differs from the electronic structure calculated for $\mathrm{\beta}$ - $\mathrm{In_2S_3}$ :V and clearly demonstrates that both crystal structure and V incorporation site affect the resulting electronic material properties.

Kesterite based materials are being researched and developed as affordable, efficient, and mechanically flexible absorber materials for thin film photovoltaics. Both (Ag,Cu)2ZnSnSe4 and Cu2Zn(Sn,Ge)Se4 based devices have shown great potential in overcoming some of the remaining challenges for further increasing the conversion efficiency of kesterite based solar cells. This study therefore investigates the long range crystallographic structure and the local atomic scale structure of technologically relevant thin films by means of grazing incidence X-ray diffraction and low temperature X-ray absorption spectroscopy. As expected, the unit cell dimensions change about an order of magnitude more than the element specific average bond lengths. In case of Cu2Zn(Sn,Ge)Se4, the thin film absorbers show a very similar behavior as Cu2Zn(Sn,Ge)Se4 powder samples previously studied. Small amounts of residual S in the thin films were taken into account in the analysis and the results imply a preferential formation of Sn-S bonds instead of Ge-S bonds. In (Ag,Cu)2ZnSnSe4, the dependence of the Ag-Se and Cu-Se bond lengths on Ag/(Ag+Cu) might indicate an energetic advantage in the formation of certain local configurations.

The controlled release of antibiotics prevents the spread of pathogens and thereby improves healing processes in regenerative medicine. However, high concentrations may interfere with healing processes. It is therefore advantageous to use biodegradable materials for a controlled release. In particular, multilayer materials enable differential release at different surfaces. For this purpose, collagen sheets of different properties can be bonded by photochemical crosslinking. Here, we present the development and application of an easily accessible, additively manufactured sample holder to study the controlled release of vancomycin from modularly assembled collagen laminates in two directions. As proof-of-concept, we show that laminates of collagen sheets covalently linked by rose bengal and green light crosslinking (RGX) can be tightly inserted into the device without leakage from the upper to lower cavity. We used this sample holder to detect the release of vancomycin from symmetrically and asymmetrically loaded two-layer and three-layer collagen laminates into the upper and lower cavity of the sample holder. We show that these collagen laminates are characterized by a collagen type-dependent vancomycin release, enabling the control of antibiotic release profiles as well as the direction of antibiotic release.

To prevent infections local delivery of antibiotics is a useful tool. Especially in bone fractures, vancomycin impregnated bone cements are often used allowing high concentrations of antibiotics at the infection side without high serum concentrations. However, besides potential pathogens, cells involved in tissue regeneration may also be affected by the drug. We investigated the effect of vancomycin on the viability and functionality on osteoblasts, endothelial cells, fibroblasts and skeletal muscle cells. Our results show that the viability of all cells analyzed was reduced by vancomycin and that the observed effects were time and concentration dependent. The most pronounced toxic effect was detected on day three when even the lowest concentration of 0.01 mg/ml led to a significant decrease in proliferation compared to control. Functionality assays of osteoblasts and skeletal muscle cells revealed a sensitive reaction of the cells to the drug, indicating that vancomycin is toxic to these cells during the process of differentiation. These data suggest that the vancomycin administration is critical for cell survival and function. Therefore, the concentration of administered antibiotics needs to be carefully evaluated to find a balance between defense against pathogens and functionality of host cells and tissues.

Children’s posture has been of growing concern due to observations that it seems to be impaired compared to previous generations. So far there is no reference data for spinal posture and pelvic position in healthy children available. Purpose of this pilot study was to determine rasterstereographic posture values in children during their second growth phase. Three hundred and forty-five pupils were measured with a rasterstereographic device in a neutral standing position with hanging arms. To further analyse for changes in spinal posture during growth, the children were divided into 12-month age clusters. A mean kyphotic angle of 47.1°±7.5 and a mean lordotic angle of 42.1°±9.9 were measured. Trunk imbalance in girls (5.85 mm±0.74) and boys (7.48 mm± 0.83) varied only little between the age groups, with boys showing slightly higher values than girls. The trunk inclination did not show any significant differences between the age groups in boys or girls. Girls’ inclination was 2.53°±1.96 with a tendency to decreasing angles by age, therefore slightly smaller compared to boys (2.98°±2.18). Lateral deviation (4.8 mm) and pelvic position (tilt: 2.75 mm; torsion: 1.53°; inclination: 19.8°±19.8) were comparable for all age groups and genders. This study provides the first systematic rasterstereographic analysis of spinal posture in children between 6 and 11 years. With the method of rasterstereography a reliable three-dimensional analysis of spinal posture and pelvic position is possible. Spinal posture and pelvic position does not change significantly with increasing age in this collective of children during the second growth phase.