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Abstract Background Patients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients. Methods We conducted 27 focus groups with general practitioners (n = 65) and patients (n = 145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories. Results General practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners’ budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs. Conclusions While many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions. This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.

The paper presents a new method of more precise estimation of the depth map in 3D videos. The novelty of the proposed approach lies in sophisticated combination of partial results obtained by selected existing passive and active 3D scanning methods. The aim of the combination is to overcome drawbacks of individual methods and this way to improve the accessible precision of the final depth map. The active method used is incoherent profilometry scanning which fails on surface discontinuities. As a passive method, a stereo pair matching is used. This method is currently the most widely applied method of depth map estimation in the field of 3D capturing and is available in various implementations. Unfortunately, it fails if there is a lack of identifiable corresponding points in the scanned scene. The paper provides a specific way of combining these methods to improve the accuracy and usability. The proposed innovative technique exploits the advantages of both approaches. Specifically, the more accurate depth profiles of individual discontinuous objects obtained from the active method, and information about mean depths of the objects from the stereo pair are combined. Two implementations of the passive method have been tested for combination with active scanning: matching from stereo pair, and SIFT. The paper includes a brief description of the active and passive methods used and a thorough explanation of their combination. As an example, the proposed method is tested on a simple scene whose nature enables straight assessment of the achieved accuracy. The choice of a suitable implementation of the passive component is also shown and discussed. The obtained results of individual existing methods used and of the proposed combined method are given and compared. To demonstrate the contribution of the proposed combined method, also a comparison with the results obtained with a commercial solution is presented with significantly good results.

Methodologies and procedures in processing gained data vary based on possibilities and needs of scientific projects. This paper should help to get a general overview in the choice of small unmanned aircraft systems (sUAS – commonly known as drones) for scientific purposes, namely remote sensing of geomorphologic processes such as soil degradation in high mountainous areas that are hard to access and have unfavourable weather conditions. All high mountain areas in European countries are legislatively protected, and so various permissions and observation of strict procedures are needed in order to not have a negative influence on the environment. Nowadays, several types of UAS exist that could effectively help us in such protection, as well as in full-fledged utilization when answering scientific questions about the alpine lake genesis. We demonstrate it here with selected examples of our photo documentation.

The article deals with the influence of inaccurate rotation of cameras in camera system alignment on 3D reconstruction accuracy. The accuracy of the all three spatial coordinates is analyzed for two alignments (setups) of 3D cameras. In the first setup, a 3D system with parallel optical axes of the cameras is analyzed. In this stereoscopic setup, the deterministic relations are derived by the trigonometry and basic stereoscopic formulas. The second alignment is a generalized setup with cameras in arbitrary positions. The analysis of the situation in the general setup is closely related with the influence of errors of the points' correspondences. Therefore the relation between errors of points' correspondences and reconstruction of the spatial position of the point was investigated. This issue is very complex. The worst case analysis was executed with the use of Monte Carlo method. The aim is to estimate a critical situation and the possible extent of these errors. Analysis of the generalized system and derived relations for normal system represent a significant improvement of the spatial coordinates accuracy analysis. A practical experiment was executed which confirmed the proposed relations.

This paper deals with the reconstruction of spatial coordinates of an arbitrary point in a scene using two images scanned by a 3D camera or two displaced cameras. Calculations are based on the perspective geom-etry. Accurate determination of corresponding points is a fundamental step in this process. The usually used methods can have a problem with points, which lie in areas without sufficient contrast. This paper describes our proposed method based on the use of the relationship between the selected points and area feature points. The proposed method finds correspondence using a set of feature points found by SURF. An algorithm is proposed and described for quick removal of false correspondences, which could ruin the correct reconstruction. The new method, which makes use of pseudo color image representation (pseudo coloring) has been proposed subsequently. By means of this method it is possible to significantly increase the color contrast of the surveyed image, and therefore add more information to find the correct correspondence. Reliability of the found correspondence can be verified by reconstruction of 3D position of selected points. Executed experiments confirm our assumptions

The three dimensional (3D) display technology has started flooding the consumer television market. There is a number of different systems available with different marketing strategies and different advertised advantages. The main goal of the experiment described in this paper is to compare the systems in terms of achievable Quality of Experience (QoE) in different situations. The display systems considered are the liquid crystal display using polarized light and passive lightweight glasses for the separation of the left- and right-eye images, a plasma display with time multiplexed images and active shutter glasses and a projection system with time multiplexed images and active shutter glasses. As no standardized test methodology has been defined for testing of stereoscopic systems, we develop our own approach to testing different aspects of QoE on different systems without reference using semantic differential scales. We present an analysis of scores with respect to different phenomena under study and define which of the tested aspects can really express a difference in the performance of the considered display technologies.

A spinal cord injury (SCI) disrupts the neuronal projections from the brain to the region of the spinal cord that produces walking, leading to various degrees of paralysis. Here, we aimed to identify brain regions that steer the recovery of walking after incomplete SCI and that could be targeted to augment this recovery. To uncover these regions, we constructed a space-time brain-wide atlas of transcriptionally active and spinal cord-projecting neurons underlying the recovery of walking after incomplete SCI. Unexpectedly, interrogation of this atlas nominated the lateral hypothalamus (LH). We demonstrate that glutamatergic neurons located in the LH (LH Vglut2 ) contribute to the recovery of walking after incomplete SCI and that augmenting their activity improves walking. We translated this discovery into a deep brain stimulation therapy of the LH (DBS LH ) that immediately augmented walking in mice and rats with SCI and durably increased recovery through the reorganization of residual lumbar-terminating projections from brainstem neurons. A pilot clinical study showed that DBS LH immediately improved walking in two participants with incomplete SCI and, in conjunction with rehabilitation, mediated functional recovery that persisted when DBS LH was turned off. There were no serious adverse events related to DBS LH . These results highlight the potential of targeting specific brain regions to maximize the engagement of spinal cord-projecting neurons in the recovery of neurological functions after SCI. Further trials must establish the safety and efficacy profile of DBS LH , including potential changes in body weight, psychological status, hormonal profiles and autonomic functions., Competing Interests: Competing interests: G.C., J.B., N.C., J.W.S., R.D., L.A. and L.B.-F. hold various patents in relation to the present work. G.C. is a consultant of ONWARD Medical. G.C. and J.B. are minority shareholders of ONWARD Medical, a company with partial relationships with the presented work. The other authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Patients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients., Methods: We conducted 27 focus groups with general practitioners (n = 65) and patients (n = 145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories., Results: General practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners' budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs., Conclusions: While many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions. This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.

Introduction: Inappropriate supply and an increasing demand on the healthcare system have been of concern for health policy in Germany for at least 15 years. In the primary care setting, this especially relates to an undersupply of general practitioners (GPs) in the countryside. In addition, there seem to be other regional differences, for example, a difference in accessing primary and secondary care between rural and urban areas. Despite these findings, regional differences in health services have not been studied extensively in Germany. Therefore, this study aims to explore regional variations of patient populations and reasons for accessing primary medical care., Methods and Analysis: We will conduct a cross-sectional observational study based on standardised interviews with 240 GPs and ∼1200 patients. Data collection started on 10 June 2015 and will probably be completed by 31 October 2016. We will include all districts and cities within 100 km from Hamburg and assign them according to the type of regions: rural, urban and environs. All eligible GPs will be invited to participate. Each practice will recruit up to 15 patients, aged 18 years or older. Questionnaires are based on a preliminary qualitative study and were pretested. Data will be analysed with descriptive statistics and regression modelling strategies adjusted for confounders and the GP-induced cluster structure., Ethics and Dissemination: Our study was approved by the Ethics Committee of the Medical Association of Hamburg and is conducted in accordance with the Declaration of Helsinki. Study participants give written informed consent before data collection and data is pseudonymised. Survey data and person identifiers are stored separately in locked cabinets and have restricted availability. The results of our study will be presented at conferences and published in peer-reviewed journals., Trial Registration Number: NCT02558322; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)