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IntroductionParents of babies who required neonatal care are responsible for managing their medicines after they are discharged home. There is wide variation in the information and amount of preparation given to parents prior to assuming this challenging task. The aim of the Parent co-Designed Drug Information for parents and Guardians Taking Neonates home (PADDINGToN) study was to explore parents' experiences of managing their babies' medicines post discharge from a neonatal unit and to use this information to develop suitable resources for future families.MethodsA qualitative participatory interpretative approach using a mixture of remote and face-to-face small group interviews or one-to-one interviews was used. Parents were recruited using social media advertisements and convenience sampling from five study sites (four neonatal units in England and one in Ireland). Parents from other neonatal units were invited to take part through social media advertisement. The interviews were audio-recorded and inductive reflexive thematic analysis was used to analyze the data.Results17 parents (14 mothers, 3 fathers) participated. One over-arching theme, 'A hard won capability', and four major interpretive themes were generated from the analysis of the data: Being in NICU and the prospect of going home: emotional and practical challenges; Living the reality of being at home: the uncertainty associated with giving medicines; Being at home: battling the system and a lack of support/knowledge; and Suggesting ways forward: parents' lived insights into improving information and resources.ConclusionDespite the challenges they faced, parents developed strategies for safely and reliably managing medicines administration and they assimilated knowledge, built their confidence and achieved a capability in medicines administration. Their experiences have been used to build a suite of medicines administration resources to support future parents.

BackgroundOxygen (O2) is a mainstay of treatment in acute severe asthma but how it is administered varies widely. The objectives were to examine whether a trial comparing humidified O2 to standard O2 in children is feasible, and specifically to obtain data on recruitment, tolerability and outcome measure stability.MethodsHeated humidified, cold humidified and standard O2 treatments were compared for children (2-16 years) with acute severe asthma in a multi-centre, open, parallel, pilot randomised controlled trial (RCT). Multiple outcomes were assessed.ResultsOf 258 children screened, 66 were randomised (heated humidified O2 n = 25; cold humidified O2 n = 21; standard O2 n = 20). Median (IQR) length of stay (hours) in hospital was 37.9 (29.1), 52 (35.4) and 49.1 (29.7) for standard, heated humidified and cold humidified respectively and time (hours) on O2 was 15.9 (9.4), 13.6 (14.9) and 13.1 (14.9) for the three groups respectively. The mean (standard deviation) time (hours) taken to step down nebulised to inhaled treatment was 5.6 (14.3), 35.1 (28.2) and 32.7 (20.1). Asthma Severity Score decreased in all three groups similarly, although missing data prevented complete analysis. Humidified O2 was least well tolerated with eight participants discontinuing their randomised treatment early. An important barrier to recruitment was research nurse availability.ConclusionAlthough, the results of this pilot study should not be extrapolated beyond the study sample and inferential conclusions should not be drawn from the results, this is the first RCT to compare humidified and standard O2 therapy in acute severe asthmatics of any age. These findings and accompanying screening data show that a large RCT of O2 therapy is feasible. However, challenges associated with randomisation and data collection should be addressed in any future trial design.

Objectives The study sought to explore the knowledge, attitudes and perceptions of healthcare providers and health programme managers regarding the benefits, challenges and impact of international medical volunteers’ clinical placements. Views on how to better improve the work of international medical volunteers and the volunteer organisation Voluntary Service Overseas (VSO) for the benefit of local communities were also explored.Settings Public healthcare facilities, VSO offices in Gulu and VSO offices in Kampala, Uganda.Participants Ugandan healthcare providers (n=11) and health programme managers (n=6) who had worked with or managed international medical volunteers.Interventions Data collection was conducted using key informant interviews. Transcribed interviews were coded by topic and grouped into categories. Thematic framework analysis using NVivo identified emerging themes.Results Both healthcare providers and managers reported a beneficial impact of volunteers and working with the volunteer organisation (clinical service provision, multidisciplinary teamwork, patient-centred care, implementation of audits, improved quality of care, clinical teaching and mentoring for local healthcare providers); identified challenges of working with volunteers (language barriers and unrealistic expectations) and the organisation (lack of clear communication and feedback processes); and provided recommendations to improve volunteer placements and working partnership with the organisation (more local stakeholder input and longer placements). Most healthcare providers were positive and recommended that volunteers are enabled to continue to work in such settings if resources are available to do so.Conclusions Healthcare providers based in a low-resource setting report positive experiences and impacts of working with international medical volunteers. Currently, there is lack of local feedback processes, and the establishment of such processes that consider local stakeholder reflections requires further strengthening. These would help gain a better understanding of what is needed to ensure optimal effectiveness and sustainable impact of international medical volunteer placements.

Antimicrobial mouthwashes are considered to reduce dental plaque biofilm and thus the potential to prevent plaque-induced oral diseases, particularly periodontal diseases. The effectiveness of mouthwashes relates to this antiplaque role, as well as, their tooth-whitening potential and ability to mask/mange malodour (halitosis). There is also a growing interest in the use of mouthwashes as an adjunctive measure in post surgical and post-dental care, while the COVID-19 pandemic has given a new lease of life to mouthwashes as an oral antispetic that may be useful in reducing the oral viral load. The mode of action of mouthwashes varies, depending on their active ingredients, concentrations, and mode and frequency of use, as does their potential effectiveness. This article aims to provide a narrative overview of the evidence of the effectiveness of the most widely used mouthwashes in managing oral diseases, oral conditions, and adjunctive care roles.

We delineated and scored Biologically Important Areas (BIAs) for cetaceans in the Aleutian Islands and Bering Sea region. BIAs represent areas and times in which cetaceans are known to concentrate for activities related to reproduction, feeding, and migration, and also the known ranges of small and resident populations. This effort, the second led by the National Oceanic and Atmospheric Administration (NOAA), uses structured elicitation principles to build upon the first version of NOAA’s BIAs (BIA I) for cetaceans. Supporting evidence for BIA II came from aerial-, land-, and vessel-based surveys; satellite-tagging data; passive acoustic monitoring; Indigenous knowledge; photo-identification data; whaling data, including stomach and fecal contents; prey studies; and genetics. In addition to narratives, maps, and metadata tables, the BIA II products incorporate a scoring and labeling system, which will improve their utility and interpretability. BIAs are compilations of the best available science and have no inherent regulatory authority. They have been used by NOAA, other federal agencies, and the public to support planning and marine mammal impact assessments, and to inform the development of conservation measures for cetaceans. In the Aleutian Islands and Bering Sea region, a total of 19 BIAs were identified, delineated, and scored for seven species, including bowhead, North Pacific right, gray, humpback, fin, and sperm whales, and belugas. These include one hierarchical BIA for belugas that consists of one localized “child” BIA within an overarching “parent” BIA. There were 15 feeding, 3 migratory, and 1 small and resident population BIAs; no reproductive BIAs were identified. In some instances, information existed about a species’ use of a particular area and time, but the information was insufficient to confidently delineate the candidate BIA; in those cases, the candidate BIA was added to a watch list. A total of 22 watch list areas were identified and delineated for 10 species, including all species mentioned above and minke whales, harbor porpoises, and Dall’s porpoises. There were 15 feeding, 4 migratory, 2 reproductive, and 1 small and resident population watch list areas. Some BIAs and watch list areas were transboundary between the Aleutian Islands and Bering Sea region and the Arctic region.

The southern Chukchi Sea is one of the most productive areas in the world ocean. Over the past decade, there have been dramatic changes in this region in sea ice cover and in Bering Strait inflow, and it is now in the path of transpolar shipping and destinational ship traffic, including vessels supporting Arctic offshore oil and gas development and tourism, all of which are anticipated to increase with decreasing seasonal sea ice cover. Little research on cetaceans has been conducted in the southern Chukchi Sea, and most information on the occurrence of subarctic species (humpback whale Megaptera novaeangliae, fin whale Balaenoptera physalus, minke whale B. acutorostrata, and killer whale Orcinus orca) comes from the ships' logs of commercial whalers in the mid to late twentieth century and from observers stationed along the Chukotka Peninsula. Information on cetacean seasonal occurrence east of the International Date Line (IDL) in US waters is particularly scarce. To address this information gap, we compiled visual sightings and acoustic detections of subarctic cetaceans in the southern Chukchi Sea during summer and early autumn from 2009 to 2012. Humpback whales were common on both sides of the IDL in August and September. Fin and minke whales were widely distributed east of the IDL from July to September, and killer whales were seen sporadically but were the most widely dispersed of the four species. Comparisons of our results with historical records indicate that the incidence of subarctic cetaceans may be increasing in the southern Chukchi Sea. An increase in occurrence may simply be a post-commercial whaling recovery of whale numbers and seasonal range by each species, or it may reflect responses to ongoing climate change. Understanding current stock identity, spatial and temporal distribution, habitat preference, relative abundance, and potential impacts of climate change on these species will require cetacean-focused research in this region of the Arctic.