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The German energy transition is not only characterized by wide technological changes but also by spatial restructuring. The decentralization of energy supply potentially increases the importance of the regional or local scale. The Anglo-American debate on the Politics of Scale addresses the production and transformation of scale while energy issues have not yet been systematically addressed. This paper combines the theoretical paradigms of scale, rescaling and scalar strategies with empirical examples from the German energy transition. Using the cases of energy regions, remunicipalizations and social movements, the implications of the German energy transition are analyzed regarding the role of scale. The paper argues that the perspective of the Politics of Scale can contribute not only to a better understanding of the different dimensions of energy transitions but also to critical energy geographies in general.

This editorial introduces different theoretical strands in political ecology both in English and German speaking contexts. Comparing Marxist with more relational and "new materialist" approaches, it is argued that the various theoretical approaches chosen induce different ways of how the relationship between society and nature, between material and culture is conceptualized. The dialectical perspective derived from Marxism is thereby contrasted with the more emergent, and relativist understandings of actor network theory and assemblage thinking. Besides, the six single contributions in this Special Issue are introduced and five areas for further research are laid out: (1) the multiplicity of materiality, (2) the opposition between dialectic and relativist thinking, (3) the tension between elements and entire socio-material configurations, (4) materiality in the production of space and (5) issues of materiality and power.

Background: The electrocardiogram (ECG) represents an essential diagnostic tool in cardiology and beyond. Classical ECG devices enable the registration of up to 12 leads, whereas modern ECG systems enable additional leads even with a reduced number of electrodes. Additionally, "smart" devices even enable patients to record an ECG at home., Objective: Evaluation of a potential additional benefit of using various modern ECG systems for the detection of ECG alterations typical for myocardial ischemia., Material and Methods: Presentation of various signs of ischemia in the ECG according to the latest guidelines. Demonstration of modern ECG systems and their potential advantage in the detection of signs of ischemia in the ECG based on current study results., Results: Modern ECG systems with vector-based electrocardiography can facilitate and optimize the detection of ischemic ECG alterations. Smart nonvector-based devices for patients are primarily useful for detection of arrhythmias and do not replace the 12-lead ECG for detection of ischemia, even though they can be useful for documentation of temporary ECG alterations also within the ST-segment., Conclusion: The ECG systems based on vector electrocardiography can improve the detection of ECG alterations typical for ischemia compared to the conventional 12-lead ECG.

Introduction: Monitoring of Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in pig farms is performed usually by testing for antibodies against PRRSV in serum samples. A new method is the detection of PRRSV antibodies in porcine saliva. In this study serum samples and saliva were collected in nine farms suspicious for PRRSV and tested for the presence of PRRSV antibodies. In total 220 serum and 41 saliva samples were taken from pigs at the age of 8 weeks (± 1 week). One saliva and one pooled serum sample (1:5) were tested from each pen. In total 11 (Cut-off 0.4/0.3) or 14 (Cut-off 0.2) serum samples and 23 saliva out of 41 pens were positive for PRRSV antibodies. Cohen`s Kappa testing showed a moderate agreement (κ = 0.446). Saliva samples compared to pooled serum samples were very sensitive, the specificity was 60 and 67, respectively.

In the course of digitalization the smartphone is penetrating more and more areas of life giving the user mobile and almost ubiquitous access to the internet and other web applications. The advantages of mHealth are an integral part in some areas of patient care but in contrast to other disciplines, routine integration of mobile devices into orthopedics and trauma surgery is still in its infancy. A survey among German orthopedists and trauma surgeons revealed which kind of apps have become established in everyday clinical practice to date. Apps published by representative institutions such as the AO Foundation demonstrated the highest usage rates. In summary, the number of regularly used apps is low; however, the causes of this lack of acceptance have not yet been conclusively clarified. The authors of this study proclaim a significant increase in the use of mHealth and mobile devices in daily clinical practice in the future.

Objective: In some cases, classical diagnostic procedures of bovine mastitis, including adspectation, palpation, and examination of milk samples, are of limited reliability, such that histological examination of udder tissue would be a useful addition. The study aimed to identify localizations for tissue sampling and to validate the biopsy technique., Animals and Methods: In the present study, sonographic examinations on bovine udders (n = 16) were performed, to identify ideal localizations for tissue sampling, which were tested in slaughterhouse organs (n = 10) and verified in udders of lactating cows (n = 16)., Results: Ideal localizations for tissue sampling, avoiding puncturing of blood vessels, were sonographically identified in the area of the udder cistern. Tissue sampling in lactating cows proved to be free of complications in 73 % of cases and all tissue specimens obtained were suitable for histology., Conclusion and Clinical Relevance: Tissue sampling by biopsy for microbiological and histopathological examinations supplements common procedures in the diagnostics of mastitis in the dairy cow and, if performed in the area of the udder cistern, can be conducted without sonographical control under field conditions., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Current Situation: The discharge letter currently represents the gold standard of the information and transfer document in the field of inpatient orthopedic and trauma patient care. In the age of digitization, the smartphone is penetrating more and more areas of life as an omnipresent internet access medium and is thus fundamentally influencing the awareness of our society. Whereas the use of applications on smartphones is already well established today, the range of medical apps is rudimentary. The potential of apps on smartphones as an innovative digital communication medium is undeniable, but the currently available medical apps in orthopedics and trauma surgery are available to a small patient clientele only., Forecast: Currently, the use of medical apps is not an adequate alternative to the discharge letter. However, it is only a matter of time before the innovative potential of applications is used as a communication tool in outpatient and inpatient care. It is, therefore, essential to start creating the legal, ethical and medical framework and to establish a relevant regulatory body.

Antibiotic agents are crucial pillars in intensive care medicine and must be used rationally and sensibly. In the case of critically ill patients optimal dosing with respect to pharmacokinetic and pharmacodynamic principles (PK/PD) can be vital. Preclinical results demonstrated important differences between antibiotic classes and gave rise to differing clinical dosing strategies, e.g. high dose once daily regimens for aminoglycosides or extended/continuous infusion of betalactams. Critically ill patients with altered pharmacokinetic parameters and infections by pathogens with low susceptibility are most likely to benefit from PK/PD-guided therapy.

Background: Older patients more often suffer perioperative complications than younger people. Especially geriatric patients who require emergency treatment represent a high-risk group. Therefore, perioperative risk assessment supports the treatment team in identifying patients at risk and in defining the treatment plan accordingly., Materials and Methods: A thorough medical history and clinical examination are pivotal elements of any risk stratification. The organ-specific risk assessment is primarily used to plan the surgical and anesthesiological procedures., Results: For a comprehensive risk assessment in geriatric patients, the organ-specific risk stratification is insufficient. Assessment instruments that reflect the idiosyncrasies of multidimensional disease in geriatric patients can complement risk stratification. These should include the assessment of multimorbidity, frailty, nutrition, activities of daily living, and cognition. In addition to risk prediction, geriatric assessment has the major advantage of providing both a diagnostic and a planning perspective. This allows the implementation of supporting measures for optimal perioperative care, which is the goal of any risk stratification. Risk scores provide a global assessment, but they have their limitations in predicting individual patient risk.

Ticks can transmit different pathogens to humans and animals. Dogs are frequently exposed to tick infestation, which underscores the importance of tick control measures. The objective of this study was to examine the awareness of dog owners regarding tick infestation and tick prophylaxis by a questionnaire survey. During the period from March to December 2010 a total of 616 owners of 670 dogs completed the questionnaire. According to the questionnaire results, 92% of the dogs were previously infested by ticks; 31% of these showed a moderate tick infestation (1-2 ticks a month), almost one in ten dogs was infested by eight or more ticks a month. 17% of the dogs were examined for ticks by the respective owner not at all or only at irregular intervals, 61% of the dogs were examined at least once a day. A tick prophylaxis was performed in 469 dogs (71%). In 353 dogs (53%), registered pharmaceutical products with appropriate label claims were employed. Spot-on products were used most frequently (93%), followed by collars (5%) and sprays (1%).These products were not used as recommended in 56% of the dogs. For further 33% of the dogs, it was not possible to decide if the products were used correctly or not. According to the dog owner statements, tick borne diseases were diagnosed in approximately 2% of the dogs. Dog specific characters, such as coat length, size, age, and walking habits were significant factors influencing the frequency of tick infestation. In summary it can be concluded that nearly every dog in the area of Berlin/Brandenburg is infested by ticks. In the majority of cases the prophylactic and/or therapeutic measures to prevent infestation are not performed correctly.

The multidimensional geriatric assessment is an interdisciplinary diagnostic process, taking into account several health dimensions. The resulting know-ledge is used to establish a treatment plan. The multidimensional geriatric assessment has shown its efficacy in the acute care treatment of multidimensionally ill and polymorbid patients in acute geriatric structures. The multidimensional geriatric assessment plays a central role in questions regarding the allocation of resources and is becoming more important because of the demographic development and the rapidly changing framework in our health system. It ensures that older patients don't slip through the net in a more fragmented clinical medicine. Growing evidence allows using this assessment approach in polymorbid patients being treated in specialised fields as traumatology, cardiology, oncology and nephrology.

In the paper, a new adaptive hand prosthesis developed in the Institute of Applied Computer Sciences of the Forschungszentrum Karlsruhe is described. Starting from the state-of-the-art, the requirements of the hand prosthesis are derived and the realisation of the new prosthesis is shown. Finally the results obtained are discussed.

Background: SmartLens (ODC Ophthalmic Development Company AG, Zürich) is a contact lens tonometer, which allows continuous registration of intraocular pressure (IOP) and ocular pulse amplitude (OPA) and simultaneous ophthalmoscopy. The purpose of this study was to evaluate the intra- and interobserver variability and reliability of intraocular pressure and ocular pulse amplitude measurements using SmartLens., Methods: To evaluate the intraobserver variability, intraocular pressure (IOP) and ocular pulse amplitude (OPA) were both measured 5 times in 10 healthy eyes by one observer. To evaluate the interobserver variability, intraocular pressure and ocular pulse amplitude were measured by 3 different observers in 10 healthy eyes. Data description is based on coefficients of variation (SD/mean in %), statistical inference on ANOVA-based reliability estimation., Results: The coefficient of the intraobserver variation was 9.57% for the IOP and 14.5% for the OPA (SD IOP: +/- 1.64 mmHg, SD OPA: +/- 0.39 mmHg). The coefficient of the interobserver variation with 5 replicate measurements was 10.16% for the IOP and 14% for the OPA (SD IOP: +/- 1.83 mmHg, SD OPA: +/- 0.4 mmHg). The interobserver reliability was 87% for the IOP and 86% for the OPA. One of the three observers obtained significantly higher IOP and OPA values., Conclusions: SmartLens is a reasonably precise and reliable device for IOP as well as OPA measurements but the results were not found to be observer independent.

Objective: To investigate the influence of cordocentesis with or without blood transfusion on umbilical and fetal blood flow characteristics., Methods: Of 42 pregnant women suffering from Rh. incompatibility 15 had a puncture of the umbilical cord for diagnostic reasons only. In 27 cases a total of 86 punctures was done for blood transfusion. Fetal heart rate, umbilical artery A/B Ratio and Pulsatility Index (PI) in the fetal aorta were measured before and after cordocentesis in all cases having or having not a transfusion., Results: Diagnostic and therapeutic cordocentesis resulted in a slight decrease of peripheral resistance. Significant differences were only observed in cases with a haematocrit < 20% compared to cases with values > 40% or if the final haematocrit after transfusion resulted in a value of < 30%., Conclusion: The decrease peripheral resistance in cases of therapeutic cordocentesis can be attributed to the increase in blood volume and sufficient oxygenation of blood improving fetal perfusion. Doppler sonography is not helpful in the clinical management of red blood cell immunisation.

Human rotavirus infection which heals spontaneously causes gastroenteritis in newborns and infants. 150 pediatric patients infected with rotavirus as diagnosed by ELISA suffered from diarrhoea for an average of 3 days, from vomiting for 1 day, and/or fever for 1-2 days. Nowadays this disease is known as "human rotavirus syndrome". Human rotaviruses can be divided into at least 4 serotype antigens and some 3 further subgroup antigens. The serotype antigens are only detectable biologically (e.g. by neutralization test), whereas the subgroup antigens can be demonstrated as specific proteins by a solid-phase test (ELISA). This study investigated whether an infection with human rotavirus of subgroup 1 (21%) or 2 (77%), which occur most frequently causes different degrees of severity of the rotavirus syndrome. The clinical comparison of 27 (subgroup 1) and 98 (subgroup 2) infected patients shows that the disease is not significantly different. This means that the detection of subgroup antigens 1 and 2 does not result in a different prognosis for the disease. The diagnosis of subgroup antigens after human rotavirus infection is therefore clinically important only for the detection of nosocomial infections, especially due to the rarely occurring subgroups 1 and 3.