During the last years, digital writing devices are increasingly replacing handwriting with pencil and paper. As reading and writing skills are central for education, it is important to know, which writing tool is optimal for initial literacy education. The present training study was therefore set up to test the influence of the writing tool on the acquisition of literacy skills at the letter and word level with various tests in a large sample of kindergarten children (n = 147). Using closely matched letter learning games, children were trained with 16 letters by handwriting with a pencil on a sheet of paper, by writing with a stylus on a tablet computer, or by typing letters using a virtual keyboard on a tablet across 7 weeks. Training using a stylus on a touchscreen is an interesting comparison condition for traditional handwriting, because the slippery surface of a touchscreen has lower friction than paper and thus increases difficulty of motor control. Before training, immediately after training and four to five weeks after training, we assessed reading and writing performance using standardized tests. We also assessed visuo-spatial skills before and after training, in order to test, whether the different training regimens affected cognitive domains other than written language. Children of the pencil group showed superior performance in letter recognition and improved visuo-spatial skills compared with keyboard training. The performance of the stylus group did not differ significantly neither from the keyboard nor from the pencil group. Keyboard training, however, resulted in superior performance in word writing and reading compared with handwriting training with a stylus on the tablet, but not compared with the pencil group. Our results suggest that handwriting with pencil fosters acquisition of letter knowledge and improves visuo-spatial skills compared with keyboarding. At least given the current technological state, writing with a stylus on a touchscreen seems to be the least

Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.

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