'Other indoor settings' (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence. CONCLUSIONS We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people. TRIAL REGISTRATION NUMBER NCT02928536. © Author(s) (or their employer(s)) 2020. No commercial re-use.  https://www.selleckchem.com/products/ve-822.html  See rights and permissions. Published by BMJ.BACKGROUND The aim of this study was to characterise all 2018 Food and Drug Administration (FDA) warning letters specific to e-cigarette products and to evaluate whether online retailers complied with FDA requested actions. METHODS All 2018 FDA e-cigarette warning letters issued by the Center for Tobacco Products to online retailers were reviewed and characterised. Date of issuance, name, type, and location of the retailer, and violation type were recorded. Retailer websites were rechecked a minimum of 30 days after the issuance of the warning letter to assess compliance with enforcement actions. RESULTS One hundred and thirteen of 124 letters met the inclusion criteria; one duplicate letter and 10 letters unrelated to e-cigarettes were excluded. One manufacturer was cited for associating their e-liquid with prescription drugs, and when analysed, the e-liquid was found to contain phosphodiesterase inhibitors. A majority of violations, 98.2% (111/113), pertained to the sales of an e-cigarette product to a minor and/or use of marketing that appeals to children. The majority of websites (63.7%, 72/113) resolved all violations. However, 19.5% (22/113) inactivated their website, and 16.8% (19/113) did not fully correct all violations. CONCLUSIONS Sales of e-cigarette products to minors and the purposeful marketing of e-liquids in a manner that appeals to children and adolescents continues to be problematic. While the warning letters were successful in getting a majority of online retailers to correct the stated violation, many sold other products that would be considered a violation of marketing to minors. The appearance of e-liquids that contain prescription medications is also alarming. Comprehensive and continued enforcement of online e-cigarette retailers is urgently needed. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND Burnout results from chronic exposure to stress comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian residents, and no multispecialty studies using the Maslach Burnout Inventory-Health Sciences Survey (MBI-HSS) exist. The purpose of our study is to identify burnout prevalence, contributory factors and solutions. METHODS A prospective 62-item survey, including the 22-item MBI-HSS, was sent to all Alberta residents, with a resident population of 1745. The association between burnout, EE, DP and PA with items in the survey was performed. Continuous data were evaluated using Student's t-test or analysis of variance. Ordinal data were evaluated using Spearman's correlation coefficient and Mann-Whitney U test. Nominal data were evaluated using χ2 test. RESULTS Response rate was 41.1% (n=718), with burnout prevalence of 69.4%. 61.6% of residents demonstrated high EE, 47.8% high DP and 29.0% low PA. More hours worked, poor work-life balance, poor service-education balance, poor mental health support, experiencing intimidation/harassment and being unhappy with programme and with career choice were associated with higher burnout (p less then 0.001). 53.5% of residents experienced intimidation/harassment. Solutions to burnout included improved teaching, improved call/working hours, more wellness days and a change in medicine culture. CONCLUSION High prevalence of burnout in Canadian residents with contributory factors and solutions identified. We hope programmes across the world can use this information to improve the burden of burnout among residents. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.Congenital heart disease is a major public health concern in the United States. Outcomes of surgery for children with congenital heart disease have dramatically improved over the last several decades with current aggregate operative mortality rates approximating 3%, inclusive of all ages and defects. However, there remains significant variability among institutions, especially for higher-risk and more complex patients. As health care moves toward the quadruple aim of improving patient experience, improving the health of populations, lowering costs, and increasing satisfaction among providers, congenital heart surgery programs must evolve to meet the growing scrutiny, demands, and expectations of numerous stakeholders. Improved outcomes and reduced interinstitutional variability are achieved through prioritization of quality assurance and improvement. Copyright © 2020 by the American Academy of Pediatrics.Failure of the normal transition from in utero to ex utero physiology leads to "persistent" pulmonary hypertension of the newborn (PPHN). PPHN is frequently associated with low systemic blood pressure and low cardiac output because of increased right ventricular afterload and myocardial dysfunction. The general management of newborns with PPHN is geared toward maintenance of normothermia, normal serum electrolytes, normal intravascular volume, correction of acidosis, adequate sedation/analgesia, adequate ventilation and oxygenation with optimal lung recruitment, and avoidance of hyperoxia. Inotropic and vasoactive agents are commonly initiated early to increase cardiac output, maintain adequate systemic blood pressure, and enhance oxygen delivery to the tissue. Unfortunately, there is not much evidence on the choice, timing of initiation, dosing, monitoring, and titrating of vasoactive agents in this patient population. In this review, we will discuss the pathophysiology of PPHN and review the use of inotropic, lusitropic, and vasoactive agents in the management of PPHN, with particular attention to milrinone.