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Background: Several interventions including reading drug doses from a table are known to reduce drug dosing errors in paediatric emergencies. The role of education and experience of the operator on the occurrence of these errors with or without supporting aids is unknown. Methods: Within an interventional questionnaire trial, medical professionals were first asked to indicate their training (nurse (N), medical student (MS), trainee (T) or consultant physician (CP)). They were then requested to calculate the dose of four emergency drugs within 2 minutes time for a child weighing 7 kg, first unaided and then with a tabular aid. Deviations from the recommended dose of 120% (DRD120), 300% (DRD300) and 1000% (DRD1000) with or without the tabular aid were measured. Results: A total of 186 questionnaires and 1,326 drug prescriptions were available. CP made less unaided emergency drug dosing errors e.g. with epinephrine when compared to T, N and MS (DRD120: CP 18%, T 23%, N 50% and MS 78%, respectively). With the tabular aid, fewer errors were made (DRD120: CP 7% (p=0.031), T 9% (p=0.375), N 11% (p=0.016), MS 0% (p<0.001)). The tabular aid greatly reduced errors in N and MS, eliminating DRD1000 in N and all DRDs in MS. Despite the tabular aid, CP and T continued to make potentially life-threatening errors when prescribing epinephrine. Conclusions: Although CP and T made fewer unaided emergency drug dosing errors, they failed to gain comparable benefits from a tabular aid. Strict adherence to safety structures and implementation of a safety culture is required to further reduce paediatric emergency drug prescription errors.

BackgroundThermal injuries are among the most common accidental injuries in childhood and can cause significant permanent functional and esthetic impairments.AimIn this review article the current recommendations for the treatment of thermal injuries in children are summarized. The special requirements and challenges in preclinical and inpatient treatment of children with thermal injuries are highlighted.Material and methodIn the context of the current literature clinical experiences are outlined to introduce treatment recommendations for children with thermal injuries. Contemporary treatment principles and special aspects are presented and discussed.ResultsThe treatment of thermal injuries in children poses special challenges as it requires adifferentiated approach adapted to the anatomy and physiology of the child. Acute preclinical treatment of thermal injuries is demanding, as ahigh standard has to be met even though the experience in pediatric emergencies is often limited. In the specialized clinic or center for children with severe burns, the treatment has to be adjusted to the severity of the burn or scald. In particular, special aspects of pediatric intensive care and surgical treatment have to be in focus to achieve satisfactory long-term functional and cosmetic results and decrease restrictions to aminimum.ConclusionThe treatment of (severely) burnt children requires close interdisciplinary cooperation, starting from preclinical care through inpatient treatment and follow-up to long-term care.

Diffusion-weighted magnetic resonance imaging (dMRI) enables the microstructural characterization and reconstruction of white matter pathways in vivo non-invasively. However, dMRI only provides information on the orientation of potential fibers but not on their anatomical plausibility. To that end, recent methodological advances facilitate the effective use of anatomical priors in the process of fiber reconstruction, thus improving the accuracy of the results. Here, we investigated the potential of anatomically constrained tracking (ACT), a modular addition to the tractography software package MRtrix3, to accurately reconstruct the optic radiation, a commonly affected pathway in multiple sclerosis (MS). Diffusion MRI data were acquired from 28 MS patients and 22 age- and sex-matched healthy controls. For each participant, the optic radiation was segmented based on the fiber reconstruction obtained using ACT. When implementing ACT in MS, it proved essential to incorporate lesion maps to avoid incorrect reconstructions due to tissue-type misclassifications in lesional areas. The ACT-based results were compared with those obtained using two commonly used probabilistic fiber tracking procedures, based on FSL (FMRIB Software Library) and MRtrix3 without ACT. All three procedures enabled a reliable localization of the optic radiation in both MS patients and controls. However, for FSL and MRtrix3 without ACT it was necessary to place an additional waypoint halfway between the lateral geniculate nucleus and the primary visual cortex to filter out anatomically implausible tracks. In the case of ACT, the results with and without an additional waypoint were virtually identical, presumably because the employed anatomical constraints already prevented the occurrence of the most implausible tracks. Irrespective of the employed tractography procedure, increased diffusivity and decreased anisotropy were found in the optic radiation of the MS patients compared to the controls.

[EN] Whether and how differences in environmental predictability affect life-history traits is controversial and may depend on mean environmental conditions. Solid evidence for effects of environmental predictability are lacking and thus, the consequences of the currently observed and forecasted climatechange induced reduction of precipitation predictability are largely unknown. Here we experimentally tested whether and how changes in the predictability of precipitation affect growth, reproduction, and survival of common lizard Zootoca vivipara. Precipitation predictability affected all three age classes. While adults were able to compensate the treatment effects, yearlings and juvenile females were not able to compensate negative effects of less predictable precipitation on growth and body condition, respectively. Differences among the age-classes¿ response reflect differences (among age-classes) in the sensitivity to environmental predictability. Moreover, effects of environmental predictability depended on mean environmental conditions. This indicates that integrating differences in environmental sensitivity, and changes in averages and the predictability of climatic variables will be key to understand whether species are able to cope with the current climatic change